PCOS and Dietary Supplements: The Best Supplements to Choose

Dietary Supplements of Interest for PCOS

When dealing with PCOS, diet, sleep, stress management, and physical activities are all key to improving your health. However, there are times when you may feel that you need an additional boost. That's when dietary supplements come in handy!

Ideally, the supplement you choose should be specifically formulated for YOUR issue. In any case, never hesitate to consult a healthcare professional specialized in hormonal balance for tailored advice.

Let's take a look at some of the best dietary supplements for PCOS !

Micronutrients

Micronutrients are essential nutrients for a healthy body. This group includes vitamins (A, B, C, D, E, K), minerals (calcium, magnesium...), and trace elements (iron, zinc, chromium, iodine).

These are called "micronutrients" in contrast to "macronutrients," which are the nutrients in our diet providing us with daily energy: carbohydrates, fats, and proteins.

In this article, we’ll take you through the best and most useful micronutrients when dealing with PCOS.

Inositol

If you’re looking for THE star among PCOS-specific dietary supplements, look no further since it’s also the most studied. Initially mistaken for a vitamin, inositol was named as vitamin B7 upon its discovery. Today, we know that inositol belongs to the carbohydrate (sugar) family.

It is found throughout our diet, and the human body can normally synthesize it. However, when affected by Polycystic Ovary Syndrome (PCOS), this synthesis doesn't go according to plan. Studies have shown that women with PCOS have lower ovarian concentrations of inositol.

Inositol plays a crucial role in insulin secretion, which affects sugar regulation, and signal transmission between cells. Poor synthesis and utilization of inositol lead to improper insulin regulation, resulting in symptoms of hormonal imbalance. Additionally, it has been demonstrated that hyperinsulinemia leads to a deficiency of myo-inositol inside ovarian follicles.

Myo-inositol acts as a messenger for FSH (= hormone that stimulates follicle growth), and a lack of myo-inositol alters FSH secretion, affecting the proper maturation of ovarian follicles.

Source: https://link.springer.com/article/10.1177/1933719113518985

This mechanism can both delay ovulation (resulting in long and irregular cycles) and hinder egg quality (one reason why women with PCOS often experience poor egg quality).

Different Forms of Inositol and the Ideal Ratio

The two most used forms of inositol in dietary supplements dedicated to PCOS are myo-inositol and D-chiro inositol. Science suggests favoring a ratio of 40:1 between myo-inositol and D-chiro inositol (source). This means a myo-inositol quantity 40 times greater than the amount of D-chiro inositol. This recommendation is based on the fact that women with PCOS often have an inverted ratio with an excess of D-chiro inositol due to excessive insulin secretion.

Ovastart was designed specifically to follow PCOS science: 1 stick provides 2000 mg of myo-inositol and 50 mg of D-chiro inositol.

Magnesium

Magnesium is crucial for our body. It plays a part in over 300 enzymatic reactions! In France, the majority of women are magnesium-deficient , and this is even more pronounced in women with PCOS as they are 19 times more likely to be deficient than others (source: Journal of Gynecology and Endocrinology)!

We can assume that almost all women with PCOS are probably deficient in this essential mineral.

Benefits of Magnesium for Women with PCOS

Magnesium offers numerous benefits to improve the quality of life for women with PCOS. A study conducted in 2022 evaluated various parameters such as emotional management, energy levels, and overall quality of life in 64 women with PCOS. The group of women who received magnesium supplementation showed significant improvements compared to the placebo group (source).

Magnesium also plays a crucial role in regulating blood sugar and insulin secretion. It directly influences glucose metabolism by acting as a cofactor for many enzymes involved in energy metabolism. Several studies have shown that a lower concentration of magnesium is associated with worsened insulin resistance and higher testosterone levels (source).

As a reminder, 70% of women with PCOS are affected by insulin resistance, so magnesium supplementation should be one of the first things you take after changing your diet (for more information on diet with PCOS, go here).

Forms and Dosage

Most studies have been conducted with doses ranging from 200 to 400 mg of magnesium. In the UK, the NHS considers that taking 400mg or less of magnesium per day is safe, as of the writing of this article.

Make sure to choose a readily absorbable form that won't cause digestive discomfort! Below is a small table to guide you:

Well-Absorbed Forms ✅:

- Bisglycinate

- Malate

- Glycerophosphate

- Liposomal (provided you read the composition carefully)

Less Well-Absorbed Forms 💩:

- Magnesium oxide

- Marine magnesium

- Magnesium citrate

- Magnesium chloride

- Magnesium sulfate

Vitamin D

Much more than just a vitamin, vitamin D behaves like a true hormone. It is so vital to the body that it is one of the very few vitamins the body can synthesize itself. It does it mainly under the action of sunlight (UVB rays) or through direct absorption (fatty fish, etc). Unfortunately, as of today, 1 in 6 adultsin the UK have Vitamine D deficiency (*)

Vitamin D is essential for hormonal and immune system balance. It also contributes to the production of sex hormones, promoting a good level of progesterone in the postovulatory phase and early pregnancy.

Women with PCOS are particularly affected by vitamin D deficiencies: according to a study, 67 to 85% of women with PCOS have vitamin D levels below 20 ng/ml, placing them in a state of pronounced deficiency (source).

Furthermore,clear links between vitamin D levels and the issues faced by women with PCOS have also been established through various studies. For example, did you know that low levels of vitamin D are significantly correlated with insulin resistance? (source).

As a rule of thumb, low levels of vitamin D may exacerbate PCOS symptoms, including insulin resistance, ovulatory and menstrual irregularities, infertility, hyperandrogenism, obesity, and increase the risk of cardiovascular diseases (source).

Form and Dosage

Prioritize low-dose daily supplementation (around 2000 IU/day) rather than a loading dose every few weeks. Indeed, while high-dose ampoules quickly increase vitamin D concentration in the blood, they do not ensure sustained levels over the weeks. High-dose ampoules also have the negative effect of causing magnesium loss. Their use should be restricted to an initial loading dose if your levels are really very low. Your doctor will help you assess this!

Furthermore, try to choose vitamin D3 over D2 since our body does not use the latter effectively. Most of the time, vitamin D is derived from lanolin (i.e., sheep's wool). If you prefer a vegan form, look for products made from boreal lichen; it is currently the only recognized source of vegan vitamin D3.

In the UK the NHS recommends staying below the relatively safe level of 4 000 UI/day. They also advise people at risk of vitamin D deficiency such as us, women with PCOS, to take it throughout the year, rather than just through autumn and winter.

B-Vitamins

Vitamin B9

Vitamin B9, often called folic acid is crucial to produce our genetic material. It must be provided to our body as a dietary supplement during pregnancy since vitamin B9 deficiencies can lead to serious embryonic malformations,including "spina bifida".

Vitamin B9 is also an important supplement for women with PCOS who are often deficient. It helps lower our often too high homocysteine levels (an amino acid which may damage the lining of your arteries and create blood clots if present in excessive amounts).

You should preferably choose an active folate such as methylated vitamin B9 Quatrefolic® (used in Ovastart) to ensure adequate use from your body. Basic folic acid should be avoided!

Two other vitamins also play a crucial role with homocysteine: vitamins B6 and B12.

Vitamin B6

For example, vitamin B6 synergistically works with vitamins B9 and B12 to produce red blood cells. It also contributes to reducing fatigue and effective immune system function.

Vitamin B12

Supplementing with vitamin B12 is key if you consume few animal products as it is mostly found in meat and offal, fish, cheese, etc. A vitamin B12 deficiency can be harmful all the way up to nerve damage and motor difficulties in the most severe cases.

B-vitamin supplementation is even more critical if you are being treated with antidiabetic medications. For example, this study (SOURCE) demonstrated that while the most prescribed antidiabetic medication could contribute to elevated homocysteine levels, vitamin B1/B6/B12 and folic acid supplementation helped maintain lower homocysteine levels than when the antidiabetic was taken alone.

Similarly, if you are on oral contraceptives, it may be wise to seek advice from your medical practitioner to assess a potential deficiency and take adequate dietary supplements if necessary (source).

Zinc

Zinc is a trace element (i.e., a mineral present in small quantities in our bodies). Like magnesium, it is a key nutrient involved in hundreds of enzymatic reactions and is necessary for the proper functioning of our immune system. It helps us metabolize carbohydrates, lipids, and proteins and also plays a role in insulin synthesis (source: Vidal).

Zinc is useful to improve our metabolic profile (sugar management, insulin secretion, etc.), particularly when faced with insulin resistance. A study on 52 women with PCOS conducted in 2015 demonstrated this (source).

Zinc may also be beneficial when dealing with various pesky symptoms associated with PCOS. A 2016 study showed that zinc supplementation in women with PCOS had positive effects on both hirsutism (excessive body hair) and hair loss (source).

Dermatologists often use zinc for its positive effects on inflammatory acne. It is also a crucial mineral for fertility, preventing cell oxidation and playing a significant role in cell division and DNA synthesis. If you have PCOS and are planning a pregnancy, do think about supplementing with zinc!

Forms and Dosages

The safe dose recommended by the NHS is 25mg/day.

As was the case with magnesium, some formulations are better than others. A good and safe bet is zinc bisglycinate! Be cautious, though, if you are supplementing with iron. Indeed, zinc and iron are not compatible. Try to space them by at least 2 hours.

Ovastart contains 10mg/day of Zinc Bisglycinate.

N-Acetylcysteine (NAC)

N-acetylcysteine (often abbreviated as NAC) is a powerful antioxidant very useful for PCOS. NAC has mucolytic properties, i.e., it thins out bodily secretions. Ffor example, it is used in cases of bronchitis to thin mucus out and promote expectoration. (source). As such, it would have an effect on follicular fluid, both helping to absorb the accumulation of follicles in the ovaries and facilitating ovulation.

NAC has shown very good results when combined with Clomid for women with PCOS trying to conceive. It also helps improve endometrial thickness (source). On the same principle, it can help boost the fertility of cervical mucus by making it more fluid and abundant. Finally, its antioxidant properties help improve the quality of oocytes by reducing inflammation markers that are often elevated in women with PCOS.

The beneficial effects of NAC are not limited to fertility, though. A study comparing the effectiveness of NAC vs. antidiabetic medication showed similar results (source). Also, NAC significantly improved insulin sensitivity. (which is why it was included in our product "Balance tes sucres.")

Studies have also detailed the benefits of NAC on hyperandrogenism: NAC supplementation can help reduce testosterone levels in women with PCOS. Elevated testosterone levels can cause symptoms such as acne, hirsutism, hair loss, etc. (source).

Dosage

Most studies have been conducted with 600mg of N-acetylcysteine, 1 to 3 times a day (max. 1800mg/day). NAC is generally well-tolerated,the only downside being the odor…In its purest form, expect a smell reminiscent of sulfur!

Chrome (Chromium)

Chromium is a trace element mostly used for its metabolism-regulating function as it increases insulin sensitivity and thus contributes to blood sugar regulation. It is often advised with type II diabetes (source: Vidal).

A 2017 meta-analysis compiled several studies conducted on women with PCOS. Overall, most studies demonstrated chromium’s positive effect on fasting insulin, free testosterone levels, and Body Mass Index (BMI) (source).

Dosage

A safe dosage from the NHS is 10mg/day. Be cautious if you are pregnant or planning a pregnancy as the safe dose is lower in such cases. Chromium supplementation is not recommended if you are already on antidiabetic medication.

In conclusion

Of course, this list is non-exhaustive and there are numerous beneficial micronutrients when dealing with PCOS. Remember that a proper diet is the cornerstone of effective PCOS management. Dietary supplements are here to support and enhance the effects of the diet you have already implemented.

Supplementing with vitamins and minerals becomes even more crucial if you are taking an oral contraceptive as they can lead to vitamins C, B9, B6, B12, and E losses (source), as well as zinc, magnesium, and selenium deficiencies.

If in any doubt, seek medical advice first. You can also seek guidance from a good naturopath or healthcare professional trained in micronutrition and hormonal disorders.

In an upcoming article, we will delve into the realm of plants that can help women with PCOS: berberine, gymnema, alfalfa, evening primrose... These plants will no longer hold any secret from you!