Nutrient Deficiencies May be at the Root Cause of PCOS
Polycystic Ovary Syndrome (PCOS) is a disorder that still remains an enigma to many healthcare professionals. It is the leading cause of infertility in young women, yet there is not one single cause, which is partly the reason why there is no highly effective singular treatment. Like other ‘syndromes’, it is marked by a cluster of symptoms, of which infertility is only one.
Two other major symptoms of PCOS is hyperandrogenism (or simply, too many androgens which are male sex hormones notably testosterone) and insulin resistance. The reason why it is so named is due to the formation of ovarian “cysts”, which are actually immature egg follicles that never descend into the uterus, remaining in the ovary and thus appearing as a cysts. Ovulation does not occur in women with PCOS, so these follicles that normally turn into a corpus luteum (egg ready for fertilization) remain undeveloped and consequently, infertility results.
TOO MUCH TESTOSTERONE
Hyperandrogenism (too much testosterone) in women has many complex, and cascading effects. Testosterone is the most potent circulating sex steroid and in women, although we have much less amounts than men, it is produced in the ovaries. Levels in healthy women are 5-10% of the levels found in healthy men. It is most often clinically associated with increased muscle mass, enhanced libido, bone health and a general sense of well being, when at optimal levels (in men or women). Another hormone that directly affects testosterone’s biological activity is SHBG (sex hormone binding globulin). Testosterone that is bound to SHBG is biologically inactive so any nutrient that affects either SHBG or testosterone can affect physiologic activity. Symptoms of excess testosterone in women are increased facial hair (hirsutism), acne and PCOS.
TOO MUCH INSULIN
Hyperinsulinemia (too much insulin) also has many downstream physiological effects. Excess insulin is typically an indication that the body is not sensitive to insulin so it has to pump out more and more in order to metabolize blood glucose. Insulin is a hormone that allows blood sugar to be utilized by muscle, liver and fat cells throughout the body. It is produced by specialized cells called β-cells in the in the pancreas and secreted in response to elevated blood sugar levels. Its main function is to regulate plasma glucose levels within a narrow range. Insulin binds to cellular insulin receptors, which signals glucose to be taken up into various types of cells (such as skeletal muscle or liver tissue) thus removing it the bloodstream.
TOO MUCH INFLAMMATION
The end result of this dysfunctional hormone balance (insulin and testosterone are both hormones) is excess inflammation. However, according to many experts, excess inflammation is also a cause of PCOS. A recent review confirms this conclusion and outlines the various trials that show improvement in various biomarkers from nutrient supplementation. The role of nutrients in quelling inflammatory processes is well-established. Primary markers of oxidative stress in PCOS patients include the following:
- Homocysteine – B vitamins are necessary for detoxifying homocysteine into benign metabolites.
- SOD (superoxide dismutase) – this powerful antioxidant is dependent on zinc, manganese, and copper in order to function properly.
- Glutathione – another powerful antioxidant in cells that is highly protective against inflammation
NUTRIENTS THAT HAVE SHOWN BENEFIT FOR PCOS PATIENTS IN TRIALS
- Vitamin D – Trials suggest that the inflammatory process that occurs in PCOS patients can be prevented by vitamin D. Several studies confirm this. Since vitamin D deficiency is linked to obesity, insulin resistance, inflammation and infertility, its role in PCOS is no surprise.
- Folate – lowers homocysteine, which is often elevated in PCOS women and trials show that it also lowered CRP (c-reactive protein), which is a marker for overall systemic stress and typically elevated in PCOS women
- Inositol – overall, this nutrient has a favorable effect on hirsutism (excess body hair caused by hormone imbalance), which is one of the major consequences of PCOS.
- Carnitine – at least one trial showed that supplementation with carnitine resulted in a decrease in total testosterone and hirsutism, as well as lower levels of oxidative stress biomarkers such as MDA (malondialdehyde) which is a marker for lipid peroxidation
- Chromium – part of glucose tolerance factor, which is the molecule that enhances the ability of insulin to do its job. Chromium deficiency is a well know risk factor for insulin resistance. Supplementation may benefit PCOS women who have this nutrient deficiency.
- Vitamin E – improves features of the endometrial lining in infertile women due to its antioxidant effects. It also regulates gene expression for lipid physiology that can ultimately impact inflammation in the vascular system of PCOS women, who often have dyslipidemia.
- Selenium – Also a powerful antioxidant, selenium plays a key role in reproductive tissue formation. Low selenium is associated with high androgen hormones in women with PCOS. However, indiscriminate use of selenium is not recommended, as too much consumption of selenium may actually worsen insulin resistance in PCOS patients. Research has confirmed that selenium has a U-shaped relationship with markers of oxidative stress. In other words, too much selenium can be just as harmful as too little selenium, suggesting that targeted supplementation is the best approach.
NUTRIENTS PLAY A MAJOR ROLE IN REPRODUCTIVE HEALTH
Overwhelming evidence suggests that infertility issues stem from low antioxidant status. Deficiencies in vitamins C and E, zinc, copper, magnesium, folate as well as the powerful antioxidant cysteine have been linked to infertility. In many cases, targeted repletion is very beneficial with fertility and related issues like polycystic ovary syndrome, which are also strongly linked to oxidative stress.
For more information on the physiologic role of micronutrients and PCOS related conditions, click the following links:
Micronutrients and WEIGHT MANAGEMENT
Micronutrients and FEMALE FERTILITY
Micronutrients and INFLAMMATION
Micronutrients and TESTOSTERONE
Micronutrients and ADRENAL HEALTH
REFERENCE
Dubey et al. Effect of Nutritional Supplementation on Oxidative Stress and Hormonal and Lipid Profiles in PCOS-Affected Females. Nutrients 2021;13:2938.
