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Based on this observation, lots of research has tried to identify genetic risk factors for PCOS by looking at genes related to insulin metabolism. To date, the results have been hazy, with no clear genetic causes for PCOS. Studies have largely focused on genes that are known risk factors for type II diabetes.
However, a large body of evidence points to errors in inositol metabolism as a possible cause for PCOS. Identifying genetic factors in inositol metabolism is a focus of active research. The conversion of myo-inositol to D-chiro-inositol is particularly interesting because errors here have been strongly implicated in PCOS.
The conversion is also interesting because Myo-inositol is abundant in a variety of foods and D-chiro-inositol isn't. In fact, urinary excretion of D-chiro-inositol has been shown to be greater than dietary intake in healthy adults. This means that the body must make D-chiro-inositol. Strong circumstantial evidence supports the theory 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. An inability to make this conversion would lead to an imbalance in the ratio of D-chiro-inositol to myo-inositol. And, since both are necessary for separate but complementary roles in insulin signaling, changes in either direction could have negative effects.
This in turn leads to overproduction of testosterone and all of the other symptoms of PCOS. Some people take this model and see it as black and white: either you make the conversion or you don't. This leads to a lot of bad hypotheses and incorrect conclusions. With a little imagination, we can see this impaired conversion of myo-inositol to D-chiro-inositol as a spectrum. Some women make the conversion efficiently, and they have no symptoms of PCOS.
Their symptoms may be mild. At the other end of the spectrum, some people would be completely unable to make this conversion, and they would consequently present with the most severe symptoms. And, as part of the human tapestry, there would be everything in between as well.
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, folks in between, might see the best results from a blend of the two.
Interestingly, clinical trials have shown that large doses of myo-inositol mg daily benefit women with PCOS and smaller doses of D-chiro-inositol mg daily benefit women with PCOS also. It might be tempting to think that there is a conflict here, that one set of studies must be false. But, keep in mind the following; clinical data are always averages.
If you take a group of women with PCOS all along the spectrum, some might see phenomenal results with myo-inositol and others might see phenomenal results with D-chiro-inositol. But, on average, both treatments will appear to be effective.
This phenomenon, better known as the ovarian paradox , arises from an intuition, subsequently demonstrated through experimental data: since the ovary is never insulin resistant and that the activity of epimerase mediated by insulin was more understood in women PCOS, causing a myo-inositol deficiency and therefore a reduced oocyte quality [3].
However, the role of d-chiro in reducing insulin levels remains irrefutable. But the question is: which is the optimal dosage to take advantage of the d-chiro-inositol efficacy without compromising the ovarian functionality? To answer this question, we try to summarize some fundamental assumptions, reaffirmed in a review published recently in one of the most authoritative endocrinology journals in the world, Cell Press [4].
Therefore, Myo-inositol plays a crucial role in FSH signaling, oocyte maturation and embryonic development [4]. Conclusions Finally, considering the specific Myo and D-chiro-inositol ratio remember the ratio in the ovary and the different physiological roles of the two inositols, the combined oral therapy of Myo and D-chiro inositol in the ratio the physiological plasma ratio has been proposed as an alternative and effective treatment for PCOS women [4].
Sources [1] Inositoli: storia e personaggi di una terapia efficace, V. Unfer, Minerva Medica, Int J. Endocrinol Vittorio Unfer, John E. Nestler, Zdravko A. Myo-inositol rather than D-chiro-inositol is able to improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial.
Eur Rev Med Pharmacol Sci ; 15 4 : FF [6] Can high levels of D-chiro-inositol in follicular fluid exert detrimental effects on blastocyst quality? Ravanos, G. Monastra, T. Pavlidou, M. Goudakou, N. Prapas, Search Search for:. The Guide to Inositols.
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