PCOS Supplements Guide (Part II)
Before reading this guide, please check out my 10 tips to choose supplements for PCOS. Note: this is NOT a shopping list, nor is Part I of this guide. Self-medicating with a concoction of supplements can lead to more harm than good and a hole in your wallet. Many supplements serve similar purposes to each other, and you may be duplicating efforts or counteracting effectiveness of certain vitamins or minerals. Consulting a qualified professional, like your doctor, a naturopathic or integrative medicine doctor, a registered dietitian, etc., should be part of your journey to choosing supplements.
Also, be mindful of who is selling you supplements. What’s in it for them to sell it to you? Can they try it themselves and speak to effectiveness? Be weary of influencers selling you specific supplements - there is profit in it for them! You are a stranger on the internet to them, and while some have your best interests at heart, others may not. Look for authenticity, proper therapeutic doses and forms of ingredients, and certified third party purity standards. Lastly, remember that supplements are just that, supplements. They will never be a cure-all and need to supplement your lifestyle.
1. Omega-3 Fish Oil for PCOS
What are Omega-3 fatty acids?
Omega-3 fatty acids include alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). DHA and EPA are found in fish and other seafood, and are the active form found in our bodies. ALA is mainly in plant oils, like flaxseed oil, and needs to be converted into DHA and EPA. It is essential that we get all 3 omega-3 fatty acids either from diet or supplements since these are key parts of all cell membranes. DHA levels are especially important for our eyes, brains and reproductive cells. Omega-3s are crucial for those of us with PCOS because of the role they play in the endocrine (hormone) system, cardiovascular function, respiratory and immune functions. For this reason, getting plenty of omega-3 fatty acids can help with fertility, inflammation, heart health, mood, concentration, and liver detoxification.
What does the research say?
In 2018, a meta-analysis was conducted on nine randomized controlled trials across 591 PCOS patients to evaluate the effectiveness of omega-3 fatty acids on insulin resistance, triglycerides and total cholesterol. The results suggest that omega-3 fats improve insulin resistance, decrease total cholesterol and decrease triglyceride levels. Eight of the randomized controlled trials discussed the impact of omega-3 fatty acids on body mass index, but there was not strong enough evidence to conclude a relationship in this case. There was not a statistical difference between those who received omega-3 fatty acids and those who received a placebo on fasting glucose, or on fasting insulin levels. The researchers were also not able to establish a strong enough direct relationship between omega-3 fatty acids and follicle stimulating hormone, luteinizing hormone, SHGB, and total testosterone. Now, this doesn’t necessarily mean there is no relationship. In time more evidence may reveal there is a direct relationship.
Why Omega-3 fatty acids are important for PCOS
Regardless, Omega-3 fatty acids are an important part of our diet. Note, these studies and meta analyses are not taking into account things that many of us with PCOS suffer from that Omega-3 fatty acids play a key role in. Think, cognitive function, working memory, ability to focus, ability to find the words you are looking for, etc. Omega-3s also have wonderful anti-inflammatory properties, and we do know that inflammation can drive a great deal of our PCOS symptoms. If you’re a jackpot winner with PCOS, ADHD, Hashimoto’s, asthma and anxiety co-occurring all at once (hi, it’s me), omega-3s are also crucial for thyroid function, brain health and concentration, anxiety and depression.
According to the National Institute of Health, here are some key sources of Omega-3 fatty acids
DHA and EPA. The American Heart Association recommends at least 2 servings of cold-water / fatty fish per week to maintain proper levels of omega-3s, and for PCOS, we likely benefit from having this even more often weekly.
Salmon
Mackerel
Tuna
Herring
Sardines
Anchovies
Egg yolks
Natural fish oil
If you are concerned about mercury, prioritizing smaller fish like anchovies or sardines can help!
Note: DHA and EPA are essential fatty acids the body cannot produce. It’s also the active form of Omega-3s in our body. Prioritizing these makes it easier for your body to absorb Omega-3s.
ALA
Chia seeds
Walnuts
Flaxseed
Avocado
Avocado oil
Olive oil
Note: ALAs are not the active form of Omega-3s, EPA and DHA
If you choose to supplement, here are some tips:
Opt for supplements with high relative concentrations of DHA and EPA to the total dose. Aim for 1,000 to 4,000 mg of EPA and DHA. These are the active forms of Omega-3s that our body doesn’t need to convert
Opt for supplements that adhere to purity standards, are third party tested, and have a certificate to prove third party testing
Opt for Omega-3s supplements in the form of free fatty acids, triglycerides or phospholipids instead of ethyl esters
Taking these supplements with a meal that has fat is important to increase absorption
If you are vegan or vegetarian, try algal oil
2. Curcumin for PCOS
Why is it commonly recommended as a supplement for PCOS?
Turmeric is a major source of the polyphenol, curcumin. Its PCOS benefits are thought to be linked to its properties as an antioxidant and anti-inflammatory agent. We need antioxidants to help prevent oxidative stress. Oxidative stress occurs when there is an imbalance of oxygen reactive species in cells and tissues, or more free radicals than the body can clear. It becomes more difficult for the body to detoxify free radicals when excessive stressors are present like UV rays, ionizing radiations, pollutants, and heavy metals. Our body can also be driven into free radical production if we have an immune response to something, overexercise, experience inflammation, or have excessive mental stress. This can damage our cell membranes, protein cells, and even our DNA. When out of control, oxidative stress can trigger premature aging and chronic conditions (hello, PCOS!).
And, as we know, inflammation can be one of the main drivers of our PCOS symptoms (if you’ve seen the Mediterranean diet recommended for PCOS, this is why). It’s important to note that no single antioxidant can solve all our issues. Like we’ve mentioned many times before, supplements will never take the place of lifestyle.
What does the research say?
A review published by the National Institute of Health evaluated curcumin’s mechanism of action, revealing that it improves markers of oxidative stress. This is why having plenty of antioxidants in our diet is key! We are exposed to a host of environmental issues that can trigger free radical production and throw off that balance. Curcumin in particular can detoxify different forms of free radicals, modulate enzymes that neutralize free radicals, and inhibit certain enzymes reactive oxygen species can produce. Curcumin helps to effectively locate peroxyl radicals, which helps to disrupt harmful activity of free radicals, similar to the way Vitamin E functions as an antioxidant. From the anti-inflammatory perspective, curcumin has been shown to block the activation of a transcription factor that regulates tumor necrosis factor, which is a mediator of inflammation in most diseases.
Keep in mind, you can get antioxidants into your diet through many avenues:
Vitamin C: Broccoli, brussels sprouts, cantaloupe, cauliflower, grapefruit, leafy greens, kiwi, lemon, strawberries, sweet potatoes
Vitamin E: Almonds, avocados, swiss chard, leafy greens, peanuts, boiled spinach, sunflower seeds
Carotenoids: Apricots, asparagus, beets, broccoli, cantaloupe, carrots, bell peppers, kale, mangos, pumpkin, spinach, sweet potato
Selenium: Brazil nuts, fish, shellfish, beef, poultry
Zinc: Oysters, shrimp, sesame seeds, pumpkin seeds, chickpeas, lentils, cashews, beef, poultry
Getting Curcurmin into Your Diet
Add ½ tsp to 1 tsp of turmeric powder or grated turmeric root into your food daily
Try to add black pepper in as well to optimize absorbability
Consume with a source of fat to increase absorption
Add to eggs, poultry, fish
Make turmeric tea
Flavor your nuts with turmeric
Absorbable Form of Curcumin
It’s important to note that bioavailability of curcumin can be quite low, but when combined with piperine from black pepper, bioavailability can be enhanced.
Dosing
The Joint United Nations and World Health Organization Expert Committee on Food Additives and European Food Safety Authority report the allowable daily intake of curcumin is 0-3 mg/kg of body weight. However, like anything in excess, too much curcumin can cause unwanted side effects like nausea and diarrhea, headache, rash and yellow stool.
If you’ve discussed with your doctor and have decided to supplement:
Make sure you choose a tablet, capsule or powder that combines turmeric with black pepper
Opt for third party tested
Opt for trustworthy brands that adhere to the FDA’s CGMPs (current good manufacturing practices)
3. Berberine for PCOS
Why is it berberine recommended as a supplement for PCOS?
Berberine is a compound often used in traditional Chinese medicine, and is found in plants such as goldthread, Oregon grape and barberry. It has antimicrobial and anti-inflammatory properties, and can assist with bile secretion which helps us to digest our food. The main reason it has gotten a lot of attention for PCOS is for, you guessed it, insulin resistance.
What does the research say?
A 2018 meta-analysis on the effect of berberine for PCOS patients with insulin resistance reviewed 9 randomized controlled trials evaluating the performance of berberine against and with prescriptions like Metformin. The results were promising, revealing that there was no significant difference in lowering insulin resistance, improving glycolipid metabolism or improving reproductive function, between berberine and Metformin. Combining berberine with Metformin did not reveal superiority to using Metformin alone. Overall, the researchers found that it is a promising compound as a potential use for treating insulin resistance with PCOS.
A study published in 2022 assigned three groups of PCOS patients either 500 mg of berberine hydrochloride twice daily, metformin hydrochloride 500 mg twice daily, or myoinositol 1000 mg twice daily to compare results. (Keep in mind, generally a combination of myo and d-chiro inositol is recommended) This study found that all groups showed significant improvement across parameters across the three month treatment, including a significant change in the free androgen index. Berberine appeared to edge out the other treatments in its effects on weight, BMI, waist circumference, waist-to-hip ratio, sex hormone-binding globulin, triglyceride and low-density lipoprotein (LDL) levels than did Metformin and Myoinositol. However, myoinositol showed greater improvement in carbohydrate metabolic parameters, meaning fasting blood glucose and serum fasting insulin. Keep in mind this is not a meta-analysis, it is an individual study, with only 43 PCOS patients in each group.
Be careful with Berberine if..
According to RX List, it’s best not to take berberine if pregnant or breastfeeding, as it may harm fetal or infant brain development. It’s also important to note that if you are already taking measures to lower your blood sugar, or taking medications to lower your blood sugar, taking berberine can lower those levels further and increase your risk of hypoglycemia. Similarly, it may lower blood pressure, so if you are taking a blood pressure medication or have low blood pressure, it could cause issues of dangerously low blood pressure.
If you discussed supplementing with your doctor:
Dosing should be 900 to 1,500 mg per day
Opt for third party tested
Opt for trustworthy brands that adhere to the FDA’s CGMPs (current good manufacturing practices)
4. CoQ10 for PCOS
What is Coenzyme Q10?
CoQ10 is an antioxidant our bodies produce naturally. We extract it from the foods we eat. If you remember what we discussed about curcumin above, antioxidants help protect our bodies from oxidative stress. This can damage our cell membranes, protein cells, and even our DNA. When out of control, oxidative stress can trigger premature aging and chronic conditions, or exacerbate symptoms. CoQ10 helps to protect cell membranes from associated free radical damage, and is very important in energy production. It can also regenerate antioxidants Vitamin C and Vitamin E. Overall it contributes to metabolic and cardiovascular health.
Why is CoQ10 commonly recommended for PCOS?
A meta-analysis published in 2022 reviewed 9 randomized controlled trials across a total of 1,021 patients. The evidence revealed that CoQ10 appears to be a safe therapy to assist PCOS patients with improving insulin resistance, increasing follicle stimulating hormone, reducing testosterone, and reducing triglycerides, total cholesterol and low density lipoprotein.
PCOS is thought to manifest from a combination of both environmental and genetic factors. Recall, environmental factors can contribute to mitochondrial dysfunction, inflammation and oxidative stress, which is why it’s thought CoQ10 might be helpful for PCOS. One study showed that supplementing with CoQ10 for 8 weeks decreased inflammatory markers in the study participants. However, it is worth noting that the study only included 43 PCOS patients, so we have a small sample size to base this on. Additionally, all of these patients were overweight or obese, so there may be some selection bias.
There is also some research to suggest females struggling with poor or low ovarian reserve may benefit from CoQ10 supplementation prior to IVF-ICSI cycle. CoQ10 supplementation, in a study of 169 participants, was associated with increased fertilization rate, more high-quality embryos, and more oocytes retrieved. Lastly, if you have diabetes, there has been an association of diabetes with lower CoQ10 levels in the blood. Discussing supplementation with your doctor may be helpful.
Get CoQ10 in your diet:
Organ meats
Pork
Beef
Chicken
Trout
Herring
Sardines
Sesame Seeds
Pistachios
If you have discussed CoQ10 supplementation with your doctor:
Form: Ubiquinone
Dose: 100-200 mg/day
Note: do not take if you are taking blood thinning medications
Note: if you are taking a statin medication, supplementing with CoQ10 may help with muscle pain
In conclusion, be careful.
Be weary of the supplements industry with a keen eye, and collaborate with your care team to know what supplements would truly benefit you to cut through the noise!