Inositol is from the vitamin B family and has the molecular form of sugar, although the body does not metabolize it as sugar. Although Inositol is classified as a B vitamin, it is not considered an essential nutrient. Inositol exists as 9 possible stereoisomers (forms) in the body, and is synthesized in greatest amounts in the kidneys. For women with PCOS, it is important to be educated specifically about D-Chiro Inositol (DCI) and Myo Inositol (MYO).
In the body, Inositol helps the liver to metabolize fat, reduces high blood sugar, reduces serum cholesterol and can enhance calming brain hormones and neurotransmitters.
Many women with PCOS are also vitamin B deficient.
Exactly what do blood sugar levels have to do with fertility and our menstrual cycles?
Insulin interacts with the ovary at the follicle level. Too much circulating insulin can encourage cyst formation. Depending on the degree of circulating insulin, the cysts can either present as few or many. Insulin encourages receptors on the follicle to be overly sensitive to LH, thus increasing the production of testosterone and fluid in the follicle and forming a cyst.
D-Chiro Inositol
D-Chirol Inositol is actually created from a base of Myo Inositol. For women with PCOS, DCI has been proven to lower free testosterone, increase insulin sensitivity (lower blood sugar levels), and lower triglyceride levels.
In our bodies, the presence of DCI signals the creation of a DCI mediator, which allows the cell to process glucose after insulin binds to the cell's surface. It's been theorized that a vitamin B deficiency, specifically a DCI deficiency, can enhance insulin resistance in PCOS patients because the lack of the DCI mediator will not allow insulin to bind to the cell's surface.
Because DCI is not naturally occurring in the body, continued supplementation is needed to continue receiving any benefits that it may contribute to.
Myo Inositol
Myo Inositol is another form of Inositol. In fact, it is the most common form of Inositol found in the body. MYO is synthesized in the body from glucose, and plays an important role as the structural basis for a number of cell messengers. It's main function is to ensure the health of cell membranes.
Recent research studies have found that supplementing with MYO may be more beneficial for PCOS patients than supplementing with DCI. Adding MYO to Metformin increases these benefits.
Specific Benefits of MYO:
* Decreased fasting insulin levels
* Weight loss
* Normalized LH/FSH ratio
* Regularity of menstrual cycle
* Ovulation restoration
* Improved egg quality and quantity
* Prevention of Ovarian Hyper-Stimulation Syndrome (OHSS)
* Reduced incidences of gestational diabetes
* Reduced androgen production (which leads to acne and
hirsutism)
* Reduced oxidative stress and inflammation
* Automatically restores DCI levels because DCI is synthesized by
MYO
What's the bottom line?
While DCI has been the "supplement of choice" for women with PCOS for many years, current research has proven that supplementation with MYO not only has its own benefits, but will also give women all of the benefits of DCI.
Both MYO and DCI are involved in insulin function. In fact, a normal metabolic process is the conversion of MYO into DCI. In most tissues, supplementing with DCI helps to maintain levels of this compound; which is why insulin resistance improves when supplementing with this particular compound.
However, ovaries do not develop insulin resistance. In a nutshell, that means that supplementing with DCI does not help them. The only way they can maintain healthy DCI levels is to improve conversion of MYO to DCI. Eventually, that enhanced conversion process depletes MYO levels, and there is not enough available to maintain normal ovarian function. Ironically, the only way to achieve healthy DCI levels seems to be to supplement with MYO. DCI supplementation does not appear to have the same effect. While some studies have shown an enhanced DCI concentration in the urinary output of patients with insulin resistance, many companies and authors have skewed the interpretation of these findings. An enhanced DCI output does not put the body in a state of DCI deficiency - it actually means that the body needs more MYO. Increased DCI levels mean that more MYO is being converted to DCI, leaving the body in a state of MYO deficiency (remember - DCI is created from MYO). Supplementing with DCI does not fix the MYO problem. In fact, it may make it worse. When you keep adding DCI to your body, your body thinks that there was already enough MYO present to make the DCI, so it stops making MYO.
As previously discussed, in the past researchers thought that a DCI deficiency was responsible for causing or exacerbating many PCOS symptoms. However, in light of current research, researchers are now leaning towards the belief that an MYO deficiency may be the culprit.
Where can I buy MYO?
In countries other than the U.S., a combination MYO/folic acid known as Inofolic has been available for purchase for years.
Earlier this month, Everett Laboratories announced that they would begin distribution of their own MYO/folic acid complex in the U.S.. Pregnitude is now available for purchase through the product website for $34.99, and will be available for over-the-counter purchase in pharmacies nationwide.
If you happen to be sensitive to folic acid, MYO is available online and in health and vitamin shops in powder and pill form. Because MYO is the most common form of Inositol found in the body, many times it is simply sold as "Inositol". The dose recommended is 2g (2000mg), twice a day.
It should be noted that supplementing with any form of Inositol (including both DCI and MYO) is discouraged if you are taking anti-depressants, as Inositol has been found to exacerbate the effects of drugs classified as SSRIs and SNRIs (commonly used to treat conditions such as depression, panic disorder and OCD).
As always, we encourage you to share these findings with your physician and discuss any supplement with him or her before adding it to your treatment regimen.
Sources:
Fertility and Sterility Vol 91 Pages 1750-1754 (May 2009) Myo-inositol may improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial. Enrico Papaleo, M.D., et al (Article)
Unfer V et al, 2011. Effect of a supplementation with myo-inositol plus melatonin on oocyte quality in women who failed to conceive in previous in vitro fertilization cycles for poor oocyte quality: a prospective, longitudinal, cohort study. Gynecol Endocrinol, Vol 27(11):857-61) (Article)
Additional Research:
Since 1in10 first published the post on MYO back in June, there have been multiple studies released that continue to suggest that MYO is far more effective for PCOS patients. The following is a breakdown of those studies.
Does ovary need D-chiro-inositol?
Summary: Proponents of DCI have long believed that supplementing with DCI would restore proper ovarian function in women with PCOS. This study aimed to further explore the role of DCI at the ovarian level. Because this study was aimed solely at defining the role of DCI on the ovaries independent of its role on insulin, 54 women with PCOS without insulin resistance were randomly divided into 5 groups - groups were given DCI supplements of 300-600-1200-2400mg daily for 8 weeks before FSH administration. The fifth group received a placebo.
Results: Total r-FSH units increased significantly in the two groups that received the higher doses of DCI. The number of immature oocytes was significantly increased in the three groups that received the higher doses of DCI. Concurrently, the number of MII oocytes was significantly lower in the D group compared to placebo group. Noteworthy, the number of grade I embryos was significantly reduced by DCI supplementation.
CONCLUSIONS:
Indeed, increasing DCI dosage progressively worsens oocyte quality and ovarian response.
*Note: Oocytes are the cells in the ovaries that develop into follicles. When speaking about "embryo grading", it's important to note that physicians use "grading" during assisted fertility procedures (particularly IVF) to determine which embryos are suitable for transferring/freezing. Embryos are graded using 2 criteria: the number of cells in the embryo and their appearance under a high-power microscope. The score for appearance is given a range of 1-4, 1 being the highest and 4 being the lowest. The phrase "MII oocytes" refers to oocytes that have completed "metaphase II", a stage of cell division. Embryos that have completed MII before transfer have a much higher rate of fertilization.
Myo-inositol rather than D-chiro-inositol is able to improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial.
Summary: MYO and DCI were tested side-by-side in patients with normal glucose levels to assess their effects on ovarian function in a double-blind trial. 84 PCOS patients undergoing ovulation induction were divided randomly into two groups. 43 patients received MYO at 2g twice daily. 41 patients received DCI at 0.6g twice daily.
Results: The results of our study showed that the total number of oocytes retrieved did not differ in the two treatments groups. However, the number of mature oocytes was significantly increased in the myo-inositol group compared to D-chiro-inositol. Concurrently, the number of immature oocytes decreased in myo-inositol treated patients. Furthermore, the myo-inositol-treated group showed an increase in the mean number of top quality embryos and in the total number of pregnancies compared to the D-chiro-inositol-treated group.
CONCLUSIONS:
Our data shows that, in PCOS patients having a normal insulin response, myo-inositol treatment rather than D-chiro-inositol is able to improve oocyte and embryo quality during ovarian stimulation protocols.
*Note: ICSI stands for Intra Cytoplasmic Sperm Injection. It is a process by which a single sperm is injected into an egg.
Inositol safety: clinical evidences
Abstract: The aim of the present review was to summarize and discuss available data on the myo-inositol safety both in non-clinical and clinical settings. The main outcome was that only the highest dose of myo-inositol (12 g/day) induced mild gastrointestinal side effects such as nausea, flatus and diarrhea. The severity of side effects did not increase with the dosage.
Bye-bye chiro-inositol - myo-inositol: true progress in the treatment of polycystic ovary syndrome and ovulation induction.
Abstract: Polycystic ovary syndrome (PCOS) is a multifactorial syndrome affecting 10% of women in reproductive age. Insulin sensitizer agents are the best therapeutic option for PCOS patients; among which there is Inositol. Inositol is a polyalcohol existing as nine different stereoisomers, two of which have been shown to be insulin mediators: myo-inositol (MI) and D-chiro-inositol (DCI). So far only MI have been show to be present in the follicular fluid and in a direct comparison between MI and DCI only MI was able to improve oocyte and embryo quality.
