PCOS Supplements Guide (Part I)
Before reading this guide, please check out my 10 tips to choose supplements for PCOS. If you’re not going to head over there - note: this is NOT a shopping list. Self-medicating with a concoction of supplements can lead to more harm than good, and consulting a qualified professional, like your doctor, a naturopathic or integrative medicine doctor, a registered dietitian, etc., should be part of your journey. 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. Inositol for PCOS (Combination of Myo and D-Chiro Inositol at a 40:1 Ratio)
Why it’s a common PCOS supplement recommendation
I raise this one first because it is estimated that anywhere from 70-80% of those with PCOS struggle with insulin resistance, meaning our body doesn’t quite respond to insulin the way it should, eventually leading to excess glucose levels, and can lead to diabetes. The prescription doctors will often recommend is Metformin. While it’s really a diabetic medication and not a PCOS-specific drug, it has been used off-label to treat PCOS insulin resistance for many years. While this is a viable option for addressing insulin resistance, some people will have some unpleasant gastrointestinal side effects. In response, inositol, or vitamin B8, rose up in the marketplace as an alternative to Metformin.
What does the research say?
A systematic review of 26 randomized controlled trials on the effects of inositol on PCOS patients revealed non-inferiority in cycle regulation compared to Metformin. This means that inositol treatments were just as effective as Metformin in increasing likelihood of regulating the menstrual cycle. Secondary outcomes the reviewers looked at were body mass index, carbohydrate metabolism and hyperandrogenism. Inositols were deemed a safe and effective way to help decrease body mass index, free testosterone, total testosterone, androstenedione, glucose levels, and area under the curve insulin levels. A 2016 study showed a direct beneficial effect of supplementing myo- and d-chiro-inositol on glycemic parameters in type II diabetes. There was a significant reduction in blood glucose levels and hemoglobin A1c levels, so research is very promising.
Dosing
A meta-analysis on the effects of inositol for PCOS mostly show the effectiveness at a ratio of 40:1 between Myo and D-chiro Inositol, with at least 2,000mg of myo-inositol. Look for these ratios when choosing an inositol supplement! And, always check ingredients. We want third party tested with a certificate of analysis, USP verification, NSF certification, etc. Avoid heavy fillers, additives, preservatives. The fewer ingredients, the better.
How to Know if Inositol Can Help You:
This post I researched and organized can help you identify whether insulin resistance may be at play for you. As always, use this as a tool to discuss with your care team before deciding you want to try out Inositol.
2. Vitamin D for PCOS
Why it’s a common PCOS supplement recommendation
A 2012 study suggested that 67-85% of those with PCOS are also Vitamin D deficient. This is a problem because Vitamin D serves as an absolute powerhouse for the body, especially for those of us with PCOS. Not only is it an essential vitamin, but it is also a hormone produced by the kidneys. Vitamin D controls blood calcium concentration, impacts the endocrine, reproductive, cardiovascular and immune systems, and helps our cells to generate energy through use of oxygen. Proper levels of Vitamin D have also been shown to reduce inflammation and help with infections.
What does the research say?
In 2020, scientists performed a meta-analysis of 11 studies on 483 participants to see the effect of Vitamin D supplementation in those with PCOS. What they found was pretty phenomenal. There was an improvement in total testosterone, insulin resistance, beta cell function, total cholesterol, and low-density lipo-protein-cholesterol. A meta-analysis is so powerful because it’s a review of the findings across various randomized controlled trials, so we can learn a lot from these. By improving testosterone levels and insulin resistance, we can get even closer to hormonal balance, which means correcting a Vitamin D deficiency can improve energy levels, fertility, anxiety and depression, immunity, and even bone health.
Ways to get Vitamin D
One great way to achieve optimal levels of Vitamin D is sun exposure, 10 minutes per day, which is estimated to provide the majority of the body’s vitamin D. Milk, eggs and fatty fishes like salmon, tuna, and swordfish, are great sources of Vitamin D as well. Note: some people actually have a genetic predisposition to underproduce Vitamin D. In these cases, supplementation will be necessary.
Dosing
As for dosage, you will want to test your Vitamin D levels. Supplementing Vitamin D without a deficiency can lead to Vitamin D toxicity. Here are some things to keep in mind:
The “normal” range is going to be lower than the optimal range in a traditional lab test
While working with my good friend, The Happy Hormones Dietitian, Ellison told me the “normal range” is 30-100 ng/mL, but the optimal range of Vitamin D levels is 50-100 ng/mL. She considers anything below 30 ng/mL to be critically low.
Choosing High Quality Vitamin D
Your doctor may prescribe Vitamin D to you depending on your level of deficiency. If you need more than 5,000 IU per day, it will require a prescription
Opt for USDA certified organic if possible
Vitamin D is fat soluble - have it with fats like avocado at breakfast or lunch for optimal absorption
Vitamin D3 is the form already stored in the body so it may be easier to absorb (but if you’re vegan, you may want to choose Vitamin D2)
3rd Party Tested with a COA, USP verification, etc.
Signs of Vitamin D Deficiency
If testing your Vitamin D levels is really out of the question right now, here are some potential symptoms of Vitamin D deficiency:
Fatigue
Muscle or bone pain
Muscle weakness, aches, spasms or cramps
Mood struggles or depression
Tingling pins and needles in hands or feet
Muscle weakness in upper arms or thighs
3. Magnesium for PCOS
Why it’s a common PCOS supplement recommendation
According to the National Institute of Health, magnesium deficiency is a risk if you have insulin resistance and/or Type II diabetes, which we know is very common in people with PCOS. It is thought that magnesium loss is due to more frequent urination spurred by higher glucose levels in the kidneys. Magnesium deficiency is also a risk if you have chronic diarrhea or fat malabsorption, gluten sensitivity, or regional enteritis, as a few examples. Spironolactone, which is a common medication used for PCOS, is a diuretic. Long-term use of diuretics can contribute to the magnesium deficiency in our bodies.
What does the research say?
A 2019 review of 4 epidemiological analytic studies and 3 experimental trials of magnesium and PCOS revealed there is an association between adequate magnesium in the body and improved insulin resistance. However, we need some additional research to know if a magnesium supplementation or nutritional intervention is needed for all those with PCOS. Regardless, if you are deficient in magnesium, it’s important to get those levels back up! Magnesium is a cofactor in over 300 enzyme systems. We need it for energy as it functions as an electrolyte, muscle function, blood glucose control, blood pressure regulation, and for mood and anxiety regulation. Magnesium also serves as an antioxidant. There’s evidence to suggest it helps us better regulate stress hormones like cortisol, and that when it is in proper supply, magnesium has a calming effect. If you are suboptimal in Magnesium, once levels improve, you may notice better sleep, mood, insulin resistance and inflammation.
Signs of Magnesium Deficiency
Numbness, tingling
Muscle Cramps
Mood changes
Abnormal heart rhythm
Nausea
Vomiting
Fatigue
Muscle weakness
Ways to get Magnesium
Pumpkin seeds
Chia seeds
Dark chocolate
Almonds
Spinach
Cashews
Fish
Dosing
Recommended daily intake of magnesium varies by age and whether pregnant or breastfeeding, and can be found on the NIH website. If you can’t get Magnesium through diet and have identified a deficiency, consider the following:
If you have impaired glucose control, or insulin resistance, research suggests your Magnesium levels should be between 2.07 mg/dL and 3.65 mg/dL
Form: Make sure it’s a highly absorbable form! Generally you will hear a recommendation for Magnesium Glycinate because this form binds to the amino acid glycine, which can help with absorption, and reduces the risk of gastrointestinal side effects. This Healthline article does a great job of walking you through the different types of magnesium you can choose from. Dosing may range from 300-450 mg.
Was it third party tested? The U.S. Pharmacopeia (USP), NSF International, etc. can provide certificates of analysis. It’s also good practice to opt for brands that manufacture in facilities with Current Good Manufacturing Practices or CGMPs as set out by the FDA.
Check those ingredients! Are there fillers, additives, preservatives, sugars or artificial ingredients? If so, stay away!
4. Vitamin B12, B6, Folate (B-Complex Vitamins) for PCOS
Why it’s a common PCOS supplement recommendation
Metformin, often used to treat insulin resistance with PCOS, blocks the absorption of vitamin B12. Oral contraceptives, often used to treat symptoms of PCOS like acne, irregular menstruation cycles and more, are also associated with depletion of vitamins B6, B12 and folate. When we are deficient in Vitamin B12, we lack what we need to help our body’s methylation processes, nerve cells, oxygenate our blood and optimize cardiovascular health, make DNA, optimize cognitive function, and more. We do not make Vitamin B12 on our own so we have to get it from our diet. This can be particularly difficult if you are vegetarian unless you choose B12 fortified foods.
Vitamin B6 is important for mood, immune system, metabolism and general hormonal balance. It helps us produce serotonin and dopamine, the neurotransmitters that help us regulate mood and focus.
Folate is necessary for what is mentioned above, with an added level of importance during pregnancy to help your baby grow happily and healthily in the womb.
Signs of B-Complex Deficiency
Anemia
Fatigue
Weakness
Pale yellow skin color
Canker sores
Constipation
Blurred vision
Balance issues
Tingling
Memory loss or confusion
Depression
Getting B-Complex Vitamins From Diet
Oranges
Leafy Greens
Broccoli
Lentils
Eggs
Red Meat, including liver from beef, pork, lamb or chicken
Poultry like chicken and turkey
Shellfish like oysters, clams and mussels
Salmon
If you get a blood test and discuss B-Complex supplementation with your care team:
Vitamin B12 values of less than 160 pg/mL indicate deficiency
Choosing B-Complex Vitamins if you are deciding to supplement
Vitamin B12: If you can find it, a sublingual supplement may be better if your deficiency is due to poor absorption because of a medication you are taking (Metformin and hormonal birth control tend to be culprits of this), and some clinics will even offer B12 injections so you can bypass the digestion process.
If you have multiple B-vitamin deficiencies, a B complex vitamin with methylated B12 is probably your better bet
Check those ingredients! Are there fillers, additives, preservatives, sugars or artificial ingredients? If so, stay away!
Was it third party tested? The U.S. Pharmacopeia (USP), NSF International, etc. can provide certificates of analysis. It’s also good practice to opt for brands that manufacture in facilities with Current Good Manufacturing Practices or CGMPs as set out by the FDA
5. Zinc for PCOS
Why it’s a common PCOS supplement recommendation
A 2019 meta-analysis of individuals with PCOS revealed that circulating levels of Zinc were, on average, significantly lower in those with PCOS versus those without PCOS. Zinc is a trace mineral, so even though we only need it in small amounts, it packs a major punch to help with our bodily functions. Zinc serves as an important antioxidant, and is important for insulin synthesis, release, action and storage. This is due to its regulatory action in phosphorylation signaling of insulin. Zinc deficiency is a risk in if you have persistent digestive issues because of general malabsorption of nutrients. Liver and kidney diseases can also make us susceptible to zinc deficiency.
What does the research say?
A 2020 meta-analysis of 36 randomized controlled studies on reproductive, pre and post menopausal women was conducted to showcase the effect of zinc supplementation on the female reproductive system. Studies primarily provided zinc in the form of zinc sulfate, and did consistently reveal a positive effect. Specifically, various markers of insulin resistance improved, including insulin concentration, lipid concentrations, total cholesterol and triglycerides. The meta-analysis could not confirm that the decrease in testosterone and DHEAs was due solely to zinc supplementation, since some studies paired zinc with magnesium, or calcium and Vitamin D.
You may hear that Zinc can help to decrease testosterone, through reduction of the enzyme 5-alpha-reductase that converts testosterone into the androgen DHT, which basically strengthens the effects of testosterone. High testosterone symptoms include hirsutism, acne, oily skin, belly weight gain, head hair loss, mood issues, etc. It well may be the case, as some individual studies do reveal Zinc reduces testosterone levels, but for the time being, this meta-analysis was not able to make that determination. It may also be an indirect relationship at play, that when we start to balance and control insulin resistance, testosterone levels also balance out. The two do have a tendency to move in tandem with each other.
Signs of Zinc Deficiency
Recurrent infections
Diarrhea
Delayed wound healing
Low bone mineral density
Lip inflammation with red, dry, scaling and itchy lips
Dermatitis
Difficulty staying alert
Loss or weakening of smell and/or taste
Ways to Get Zinc
The Recommended Dietary Allowance for female adults 19+ is 8 mg per day, and 11 mg during pregnancy, and 12 mg if lactating. Do not exceed 40 mg per day. You can get your RDA through:
Oysters
Crab
Sardines
Shrimp
Pumpkin seeds
Greek yogurt
Beef
Poultry
Pork
Lentils
Chickpeas
Brown rice
If you discuss supplementation with your doctor:
Choose a highly absorbable form of Zinc. These may include Zinc Picolinate, Zinc Glycinate, Zinc Sulfate, and Zinc Citrate, for example
Check those ingredients! Are there fillers, additives, preservatives, sugars or artificial ingredients? If so, stay away!
Was it third party tested? The U.S. Pharmacopeia (USP), NSF International, etc. can provide certificates of analysis. It’s also good practice to opt for brands that manufacture in facilities with Current Good Manufacturing Practices or CGMPs as set out by the FDA.
6. Chromium for PCOS
Why it’s commonly recommended for PCOS
Chromium is another trace mineral that is crucial to how insulin functions in the body to regulate blood sugar levels. It does not occur naturally in the body, so we need to get it either from our diet or from supplements. Given we’re often concerned with insulin resistance when it comes to PCOS, you’ll see it recommended from time to time. According to the National Institute of Health, chromium deficiency is rather rare. At the same time it is difficult to assess because blood levels are typically not reflective of true amounts since chromium is stored in the liver, spleen, soft tissue and bones.
What does the research say?
A 2017 meta-analysis of 7 randomized controlled trials showed supplementing with chromium helped to decrease body mass index, free testosterone, and fasting insulin. Supplementing with chromium was not found to benefit total testosterone levels, DHEA, FSH, or LH according to this particular meta-analysis. Again, it does not necessarily mean there is no effect or relationship. It just means the researchers did not have strong enough evidence to draw this conclusion.
Potential Interactions with Other Drugs
According to the National Institute of Health, combining chromium with Metformin could potentially increase the risk of hypoglycemia.
Additionally, if you have hypothyroidism, one study suggested that chromium supplementation inhibits the absorption of levothyroxine. On a personal note, I have been on medication for hypothyroidism since I was about 13. My endocrinologist has always told me as a general rule of thumb to wait at least four hours after taking my thyroid medication before I take anything else so my body can fully absorb that first.
Naturally rich sources of chromium
Ham
Brewer’s yeast
Beef
Lettuce
Turkey breast
Tomato juice
Bananas
Chicken breast
Haddock
Dosing
For adult females, the recommended daily intake for chromium is 25 mcg, with increased recommendations during pregnancy and breastfeeding. The RDI dips to 20 mcg after age 50.
Form
If you discussed a chromium supplement with your doctor, recommended forms include Chromium Chelavite; Chromium Chloride Hexahydrate; Chromium Nicotinate Glycinate; Chromium Picolinate is thought to be very absorbable but may increase oxidative stress
7. NAC for PCOS
Why it’s commonly recommended for PCOS
N-acetylcystine (NAC) increases cellular levels of antioxidants and reduces glutathione at higher doses. A 2015 meta-analysis of eight studies across 910 women with PCOS was conducted. Across the studies, the PCOS subjects were randomized to either NAC, other treatments, or no treatment. On average, the findings revealed that those with NAC had higher odds of having a live birth, getting pregnant, or ovulating when compared to those with PCOS who had no treatment.
However, it is worth noting that with NAC, pregnancy and ovulation were less likely to occur than in those who were given Metformin. The meta-analysis did not show significant difference in the rates of miscarriage, period regulation, acne, hirsutism, and there was not a significant difference in the change in body mass index, testosterone or insulin levels when NAC was present versus when the patients received no treatment. It’s likely that more research is needed.
How to get NAC through your meals:
Meat
Seafood
Chicken
Turkey
I put so much research into this article because I fell victim to the influencer community telling me why I needed 600 different supplements for my PCOS. I felt like my head was spinning, I didn’t know where to turn or what to believe. I spent money on supplements that would promise to fix my acne, get my period back, grow back my hair, and more. Truthfully, I had completely lost faith in my providers to give me my whole range of options. I took matters into my own hands and tried to self-medicate. Please don’t repeat my mistakes, I promise you it did NOT work. It only took my money, made me more frustrated and it made me feel more hopeless. Guard your trust, friends! I’ll be back next week with more info on commonly recommended supplements for PCOS.