Natural Solutions for PCOS: The Best Supplements
There is little doubt in anyone’s mind any more that we need the best nutritional supplements to be optimally healthy. While many of us are over-fed, meaning we eat too many calories for the amount of energy we use every day, most of us are also under-nourished. That is, the food we eat does not give us enough of the kind and quality of vitamins, minerals fatty acids and amino acids we need to meet all the demands on our bodies. The ways we grow, harvest, store, transport, cook and eat our food all plays a role in how much nutrition it actually offers us.
In the last decade or so, even the most conservative medical journals have reviewed the available research and concluded we need help, in the form of nutritional supplements, to be optimally healthy. The New England Journal of Medicine and the Journal of the American Medical Association have stated:
- “Most people do not consume an optimal amount of all vitamins by diet alone.”
- “Inadequate intake of several vitamins has been linked to chronic disease, including coronary artery disease, cancer and osteoporosis.”
- “Suboptimal folic acid levels, along with suboptimal levels of vitamins B6 and B12, are a risk factor for cardiovascular disease, neural tube defects, and colon and breast cancer; low levels of vitamin D contribute to osteoporosis and bone fracture and low levels of the antioxidant vitamins (vitamins A, E and C) may increase risk for several chronic diseases.”
- “It appears prudent for all adults to take vitamin supplements.”
Since these two journals published these conclusions, there have been literally thousands of studies relating the usefulness of specific nutrients and the sorts of biochemistry that lead to the development of PCOS and all its associated risks. As a naturopathic physician I have accumulated expertise in the use of botanical medicines as well. The traditional uses of plant medicines are being examined and research is available that fully supports the use of an array of herbs for the treatment of human disease, including PCOS.
In fact, there is a wide range of supplements and plant medicines that can help you with PCOS, fertility, and chronic disease prevention. Of course, not all of these are appropriate or necessary for every woman with PCOS. You will notice I do not make specific dosing recommendations here. Instead I encourage you to take the very best care of yourself by becoming the patient of a licensed naturopathic physician in your community, in order to receive the best care for your individual circumstances. To find a licensed or licensable ND, see the Find a ND feature at www.naturopathic.org to find an excellent natural medicine doctor near you.
If there are no professional naturopathic physicians near you, consider introducing your local medical provider to this information, and requesting a professional collaboration with me, to determine the best blend of conventional and natural medicine approaches for you. You deserve attention to the correct prescription for your unique health history, current status and body size. The quality of the supplements you use is also an essential feature of your success.
You need calcium and Vitamin D for your muscles, bones, thyroid, nervous system, heart function, hormones, colon, and breast tissue and more. A couple small studies show women with PCOS may be especially deficient in both these nutrients. Functions of vitamin D include improved insulin sensitivity, stable and positive moods, better bone health, reduction of inflammation and pain, and longer lifespan. Calcium and vitamin D are required for the normal development of your ovarian follicle. Low vitamin D has been linked to insulin resistance, obesity and fatty liver degeneration.
One study determined that 5 of 13 women with PCOS were significantly deficient in vitamin D according to current standards. (NOTE: recent research is causing the standard for what is considered a normal amount to vitamin D to be reconsidered. It is likely that under new standards, many more women with PCOS will be understood to be vitamin D deficient.). In another study seven of nine women with no or irregular menses, had a return to a normal menstrual cycle within two months of being given 50,000 IU once or twice per week of vitamin D and 1,500 mg per day of calcium. Supplementing with vitamin D and calcium will improve acne, blood sugar metabolism and weight loss efforts as well.
N-acetylcysteine (NAC) is a compound that is useful for insulin resistance, a factor that is key in the development of PCOS. A study looked at the effect of NAC on insulin secretion and insulin resistance in 6 lean and 31 obese women with PCOS. Most took 1.8 grams of NAC daily for 5-6 weeks. (3.0 grams per day were given to the massively obese women) Six of the 31 obese patients were treated with placebo. Those treated with NAC showed significant improvements of their insulin metabolism and a significant fall in testosterone levels.
Another study showed that taking NAC for two months can effectively decrease elevated homocysteine levels. Higher doses were more effective than lower doses. Women with PCOS, especially those who take metformin tend to have elevated homocysteine levels, which is a risk factor related to heart disease.
NAC can improve your chances of a successful pregnancy. A study of 150 women with PCOS has shown that NAC appears to make Clomid more effective. One group took Clomid and NAC while another group took Clomid and a placebo. In the NAC group, 49.3% ovulated and 1.3% became pregnant. In contrast, in the placebo group, only 21% ovulated and there were no pregnancies.
Inositol is a relative in the B vitamin family. Exciting studies out of Italy show that it safely and effectively reduces testosterone effects. When taken over 6 months inositol will improve insulin function and show significant reductions of acne and undesirable hair growth patterns. The women taking inositol in these studies saw their testosterone levels drop by 70%. Study subjects taking inositol also achieved better ovulation: 16 of 23 women in inositol group ovulated vs. only 4 of 19 in other group. In another study, 136 PCOS women took inositol (100 mg., twice daily) for 14 weeks. The control group of PCOS women took placebo pills. The ovulation frequency was significantly higher in the treated group (23%) compared with the placebo (13%).
In addition, the women taking inositol reduced their triglycerides and blood pressure. Inositol also facilitates fat metabolism in the liver. This is important because, according to research, the majority of women with PCOS have some degree of fatty liver degeneration.
Chromium is a trace mineral that enhances the action of insulin. Supplementing with chromium has been shown in some studies to improve the blood sugar control in those with Type 2 Diabetes. Giving 1,000 mcg per day of chromium to women with PCOS for as little as two months improved insulin sensitivity by 30% in lean subjects and by 38% in obese women with PCOS. Their baseline insulin levels fell by 22%.
Biotin is a water-soluble B-vitamin that is an essential co-factor in many metabolic processes. In higher doses, it promotes healthy glucose metabolism, cholesterol metabolism and nervous system health. At higher doses, biotin help supports hair and nail growth by reinforcing the structure of keratin. Women with thinning scalp hair see benefit from high doses of biotin.
Plant medicine for PCOS is a huge category; which you take, when, how much and for how long requires the guidance of a knowledgeable physician who can follow your progress with appropriate physical exams and diagnostic testing. Excess androgen hormone effect is a consistent feature of women with PCOS. You can reduce the effect of testosterone in your body with a number of different plant medicines. Caffeine containing herbal beverages like coffee and green and black tea, are associated with lower estrogen levels. Women with PCOS-related infertility often have an excess of estrogen, due to a corresponding lack of ovulation-produced progesterone. Excess estrogen can cause a number of unwanted health effects including mood swings, weight gain and increased risk of certain cancers. Some herbs can optimize the progesterone effect in your system and others can protect you from the energy exhaustion many women with PCOS experience.
The quality of the herbs you use- the freshness, or strength and potency of plant medicines varies wildly in the over-the-counter retail market place. A naturopathic physician is your best bet for combining the knowledge and skill you need to make best use of plant medicines.
In general, the most prominent biochemical feature of PCOS is the effects of too much androgen (testosterone) hormone activity. Some plant medicines that work to decrease testosterone effect in your body are:
- Urtica dioca (stinging nettles root)
- Glycyrrhiza glabra (licorice root)
- Flax seed, freshly ground
- Green tea (camellia sinensis)
- Spearmint (mentha spicata)
- Saw palmetto (serenoa repens)
- Vitex Agnus castus (chaste berry)
The root of the nettles plant contains compounds that increase sex hormone binding globulin (SHBG) in humans. SHBG works to ‘disarm’ strong testosterone. Nettles root can also work by a second chemical route, which will interfere with the conversion of the weaker testosterone to DHT.
In a small study of young women dosed daily with 0.25 grams total glycyrrhizic acid from licorice root, the mean total serum testosterone significantly decreased after one and two months of treatment. Earlier studies of licorice root extracts found that licorice may reduce testosterone secretion in women with polycystic ovary syndrome as well as women with excess androgen hormone effecting their menstrual cycles.
Flax seeds contain compounds similar to those in the nettles root, that will increase SHBG and thus lower blood testosterone levels. The fiber in flax also helps clear ‘bad’ cholesterol through your bowels. I recommend working up to 2 TBS, ground fresh daily (a coffee bean grinder works great) with 8 to 10 oz water.
Green tea is very effective in supporting cardiovascular health and helps to maintain cholesterol levels that are already within the normal range. The catechins in green tea have been shown to support and enhance the immune system as well. Studies show it has reliable anti-tumor effect, especially for bowel and breast tissue. While relatively low in caffiene, green tea has other properties that increase thermogenisis, or the biologic processes that help you burn fat as fuel for your muscles.
Spearmint tea, just 2 cups daily, has a positive effect on the hormones involved In PCOS. A 2009 study by the Department of Diabetes and Endocrinology, Eastbourne District General Hospital, U.K. followed up a previous Turkish study that suggested drinking spearmint tea reduced excess hair growth (an aspect of hirsuitism, which also includes scalp hair loss) in women with PCOS. Unfortunately, both of these studies tested the tea therapy for a month or less, so there was no objectively measurable reduction in hair growth. To see that change a therapy must be used a minimum of 6 months, based on the nature of hair growth patterns. However, it was demonstrated and confirmed that spearmint did significantly reduce blood levels of testosterone as well as create a more favorable ration between follicle stimulating hormone and lutenizing hormone, both very positive indications this good tasting herb is an important ally for you.
Saw palmetto works by suppressing an enzyme needed to convert testosterone to its strongest form, called dihydrotestosterone or DHT. Saw palmetto has been extensively studied and is seen to lessen hair loss and improve hair density in women with hair loss related to testosterone levels. Saw palmetto can be helpful for women with PCOS especially if they have elevated DHT. Saw palmetto helps to block 5-alpha-reductase activity – thereby reducing the amount of testosterone converted to DHT. It does not change hair that is already altered by excess testosterone back to fine, soft light colored hair; it can prevent new hair growth, or dark coarse hair re-growth in women who have had laser therapy or electrolysis.
Vitex agnus castus helps maintain healthy prolactin, required for optimal breastfeeding of a newborn and hormonal balance during the monthly menstrual cycle. Vitex helps support breast comfort and a normal healthy attitude and mood during the menstrual cycle. Vitex also helps maintain normal ovarian function. The impact of vitex on prolactin is also thought to assist men with low libido and premature ejaculation.
It is important to understand that saw palmetto (and potentially any herb that lowers blood levels of testosterone) will cause your androgens to be converted to estrogens. This increase in estrogens can further complicate your PCOS, and risk your long term health. When you slow down the conversion of testosterone to DHT, you leave more testosterone to be converted to estrone. In other words, you may be trading one problem in this picture for another. The risks of elevated estrogens are increased if you are also not ovulating, meaning you are not producing enough progesterone to balance the estrogen effect. This increases your risk of female cancers as well as worsening premenstrual experiences like breast tenderness, belly bloating and weight gain.
I do not recommend testosterone-altering herbs to a woman with PCOS without also supporting estrone metabolism and ensuring estrogen clearance, via your liver and bowels. How an individual woman does this is beyond the scope this article, however a high fiber diet (abundant fresh vegetables and fruit, nuts and seeds like flax) is an essential aspect of estrogen clearance. To assess your risk and receive a set of clinical recommendations specific to your individual circumstances, please consider a consultation with a naturopathic physician. NDs are expert in the safe and effective use of natural medicines.
1. Willett, WC et al, Clinical Practice. What vitamins should I be taking, Doctor? N Engl J Med. 2001 Dec 20;345(25):1819-4
2. Fairfield KM et al, Vitamins for chronic disease prevention in adults:scientific review. JAMA. 2002 Jun19;287(23):3116-26
3. Fletcher RH, et al, Vitamins for chronic disease preventim in adults: clincal applications. JAMA.2002 Jun 19;287(23):3127-29
4. Costantino D et al, Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial, Eur Rev Med Pharmacol Sci. 2009 Mar-Apr;13(2):105-10
5. Zacche MM et al, Efficacy of myo-inositol in the treatment of cutaneous disorders in young women with polycystic ovary syndrome, Gynecol Endocrinol. 2009 Jun 23:1-6
6. Schottner M, Gansser D, Spiteller G. Lignans from the roots of Urtica dioica and their metabolites bind to human sex hormone binding globulin. Planta Med 1997; 63(6): 529-532
7. Gansser D, Spiteller G. Plant constituents interfering with human sex hormone-binding globulin. Evaluation of a test method and its application to Urtica dioica root extracts. Z Naturforsch 1995;50(1-2):98-104.
8. Schottner M, GanBer D, Spiteller G. Lignans from the roots of Urtica dioica and their metabolites bind to human sex hormone binding globulin (SHBG). Planta Med 1997; 63:529-532
9. Gansser D, Spiteller G. Aromatase inhibitors from Urtica dioica roots. Planta Med. 1995;61(2): 138-140
10. Nagata C, Kabuto M, Shimizu H. Association of coffee, green tea, and caffeine intakes with serum concentrations of estradiol and sex hormone-binding globulin in premenopausal Japanese Women. Nutrition and Cancer 1998; 30(1): 21-24.
11. Prager N, Bicket K, French N, Marovici G. A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia. JAH and Comple Med 2002;8(2): 143-152
12. Acta Obst Gynecol Jpn 1982;34:939-44
13. Thys-Jacobs S, Donovan D, Papadopoulos A, et al. Vitamin D and calcium dysregulation in the polycystic ovarian syndrome. Steroids 1999;64:430-435.
14. Raghuramulu N, Raghunath M, Chandra S, et al. Vitamin D improves oral glucose tolerance and insulin secretion in human diabetes. J Clin Biochem Butr 1992;13:45-51.
15. Borissova A, Tankova T, Kirilov G, et al. The effect of vitamin D3 on insulin secretion and peripheral insulin sensitivity in type 2 diabetic patients, Int J Clin Pract 2003;57:258-261.
16. Gaby A. Chromium. Integrative Med 2006;5(4):22-26
17. Lydic L, McNurlan M, Komaroff E, et al. Effects of chromium supplementation on insulin sensitivity and reproductive function in polycystic ovarian syndrome: a pilot study. Fertil Steril 2003;80 (Suppl 3): S45-S46
18. Lydic M, McNurlan M, Bembo S, Mitchell L, Komaroff E, Gelato M. Chromium picolinate improves insulin sensitivity in obese subjects with polycystic ovary syndrome. Fertil Steril 2006;86:243-246.
19. Davis A, Christiansen M, Horowitz J, et al. Effect of pinitol treatment on insulin action in subjects with insulin resistance. Diabetes Care 2000;23:1000-1005.
20. Kim J, Kim J, Kang M, et al. Effects of pinitol isolated from soybeans on glycaemic control and cardiovascular risk factors in Korean patients with type II diabetes mellitus: a randomized controlled study. Eur J Clin Nutr 2005;59:456-458.
© 2010 by Nancy Dunne, N.D. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written consent of the author.