The role of D-pinitol N-acetyl cysteine (NAC) tackling Homocysteine in PCO women to minimize adverse metabolic effects in PCO women??

D-Pinitol is 3-O-methyl-D-chiro-inositol that occurs naturally in several different foods, including legumes and citrus fruits (Kang 2006). D-Pinitol is converted into d-chiro-inositol in the body. Like d-chiro-inositol, pinitol appears to favorably influence the action of insulin (Bates 2000). In a double-blind study of patients with type 2 diabetes, administration of 600 mg of pinitol twice a day for three months reduced blood glucose concentration by 19.3%, decreased hemoglobin A1c (HbA1c) concentration by 12.4% and significantly improved insulin resistance (Kim 2007). In a shorter-term double-blind study, administration of pinitol at a dose of 20 mg per kg of body weight per day for four weeks decreased mean fasting plasma glucose concentration by 5.3% (Kim 2005).

N-acetyl cysteine (NAC)

N-acetyl-cysteine (NAC) is a stable derivative of the sulfur-containing amino acid cysteine and an antioxidant that is needed for the production of glutathione, one of the body's most important natural antioxidants and detoxifiers. While cysteine is found in high protein foods, n-acetyl cysteine is not. A large body of evidence supports the use of NAC in women with PCOS.

• Improving Insulin Sensitivity
  Women with PCOS frequently have an abnormally high insulin response to sugars and refined starches. A 2002 study evaluated the effect of NAC on insulin secretion and peripheral insulin resistance in women with PCOS (Fulghesu 2002). The study subjects who had an exaggerated insulin response to a glucose challenge and were treated with NAC showed an improvement in insulin function in their peripheral tissues. The NAC treatment also produced a significant decline in testosterone levels and in free androgen index values. The researchers concluded, "NAC may be a new treatment for the improvement of circulating insulin levels and insulin sensitivity in hyperinsulinemic patients with polycystic ovary syndrome." (Abu 2010)

• Restoring Fertility
  NAC may also be useful for improving fertility in women with PCOS. In one study, NAC appeared to improve the effects of Clomid®, the widely used fertility drug. Clomid® plus NAC significantly improved ovulation rates in a study of 573 women with PCOS. According to the researchers, 52% of the study participants who took Clomid® plus NAC ovulated, whereas only 18% ovulated in the Clomid® alone group. The authors concluded: "N-Acetyl cysteine is proved effective in inducing or augmenting ovulation in polycystic ovary patients." (Badawy 2007).

Similarly, a study of Clomid®-resistant women has shown that NAC appears to make Clomid® more effective. In the study, 150 Clomid®-resistant women with PCOS were divided into two groups: one group took Clomid® and NAC. The other 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 (Rizk 2005).

Worth noting, the same researchers compared the effects of a NAC- Clomid® combination with the metformin- Clomid® combination on ovulation induction in anovulatory Clomid®-resistant women with PCOS. The efficacy of the metformin- Clomid® combination therapy is significantly higher than that of NAC-Clomid^® for inducing ovulation and achieving pregnancy among Clomid®-resistant PCOS patients (Abu 2010).

Homocysteine is bad for eggs & heart

• Tackling Homocysteine
  Women with PCOS are often given metformin to deal with their insulin problems. But metformin may increase homocysteine levels and many women with PCOS have high homocysteine levels to begin with (Badaway 2007). Elevated homocysteine is associated with coronary artery disease, heart attack, chronic fatigue, fibromyalgia, cognitive impairment, and cervical cancer. A 2009 study showed that people taking NAC for two months had a significant decrease in homocysteine levels (Rymarz 2009).