Polycystic ovary syndrome (PCOS) is an endocrine disorder associated with irregular menstrual periods infertility obesity diabetes excess hair growth acne and other hormonal difficulties. The condition occurs when a woman's body produces slightly higher than normal amounts of testosterone and other sex hormones.

Pharmaceutical interventions provide some improvements but they do not correct many of the underlying factors and have side effects that may not be tolerated by patients. In addition many PCOS patients are overweight and have dietary habits that exacerbate the condition.

Recent research has demonstrated that there is an increased risk of mental health disorders such as anxiety and depression in women with PCOS. Many of us are familiar with carnitines role in lipid and carbohydrate metabolism; however there is evidence of carnitine improving depressive symptoms in those with major depressive disorder. Other studies have also shown reduced oxidative stress with carnitine supplementation.

According to a study published this month in Gynecological Endocrinology researchers demonstrated that carnitine supplementation improved both mental health parameters and oxidative stress biomarkers in women with PCOS.

In this study 60 patient with PCOS ages 18-40 were divided in two groups to take either a carnitine supplement (250 mg) or placebo for 12 weeks. These individuals did not change their physical activity or take any additional nutritional supplements.

After 12 weeks of carnitine supplementation there was a significant reduction in weight and BMI change as well as an improvement in Beck Disability Inventory (BDI) total score and Depression Anxiety and Stress Scale (DASS) scores. In addition there were changes in plasma total antioxidant capacity demonstrating positive effects on oxidative stress. As a result there were significant improvements in mental health parameters and biomarkers of oxidative stress compared to the placebo.

Additional nutrients to consider to support PCOS

Studies have shown that an inositol deficiency is common in women with PCOS resulting from what appears to be a reduced ability to process metabolize and effectively use inositol from foods. As a result the nutritional requirements of PCOS patients may not be met by a simple change in the diet and that inositol should be viewed as a conditionally essential nutrient in these women.

Myo-inositol and D-chiro-inositol are both essential for patients with PCOS. The conversion of myo-inositol to D-chiro-inositol is of interest because errors here have been strongly involved in PCOS patients. Strong evidence supports that the body makes D-chiro-inositol from myo-inositol and more evidence suggests that some people are less able to make this conversion than others.  Along this spectrum people who are completely unable to convert myo-inositol to D-chiro-inositol are only going to benefit from supplementation with D-chiro-inositol. Other people who make the conversion but with less than optimal efficiency may benefit from large doses of myo-inositol. And other individuals in between these two groups might see the best results from a blend of the two. Since this conversion is impaired in individuals with PCOS it is important to always include D-chiro-inositol with myo-inositol supplementation. D-chiro-inositol is the more potent form of inositol for supporting insulin resistance; however myo-inositol is need for oocyte quality and maturation. Therefore supplementing with D-chiro-inositol alone cannot not fulfill myo-inositols roles that are specific and different from D-chiro-inositol since it does not convert to myo-inositol.

Essential fatty acids (EFAs) should also be considered. EFAs contribute to overall health but most individuals with insulin resistance are deficient. Fish oils are significant in that they help to improve insulin sensitivity and reduce inflammation.

By Michael Jurgelewicz DC DACBN DCBCN CNS

Source: Jamilian H et al. Oral carnitine supplementation influences mental health parameters and biomarkers of oxidative stress in women with polycystic ovary syndrome: a randomized double-blind placebo-controlled trial. Gynecological Endocrinology 2017; 33(6):442-447.