These findings strongly suggest a
contribution of abnormal metabolism of
inositol to the insulin resistance in PCOS patient which leads to a reduction in circulating inositol and its availability to the
tissues . Finally in conclusion a
defect in tissue availability of
inositol in PCOS contributes to the insulin resistance leading to decreased cellular
availability of the PI 3 kinase
mediated insulin action.
Theory
3: Altered insulin signaling and its
relationship with IR and PCOS.
PI 3 kinase is a mediator for
glucose metabolism and its utilization
by the cell.
Deficiency of inositol alters
activity of PI3 kinase.
Reduced activity of PI 3 kinase
reduces translocation of GLUT 4
thereby causing hyperglycemia
This brings about altered insulin
signaling causing
hyperinsulinemia and thus IR . Insulin resistance thus is
responsible for PCOS.
Pathway of inositol deficiency and
PCOS
Metformin fails to manage Insulin Resistance in PCOS women
Metformin is the most commonly prescribed insulin sensitizing drug in the treatment of PCOS. It
enhances insulin sensitivity by
activating PI 3 kinase but it has been postulated that Metformin has a very restrictive mechanism of action due to
which it is not a right
treatment option for PCOS. How
useful is metformin??Authentic
journal statements on the use of metformin in PCOS
In the absence of large adequately
powered placebo controlled trials it
is difficult to provide useful answers about the longer term
benefits of metformin in PCOS
women. However there are more side effects
with metformin like lactic
acidosis and malabsorption
including poor adsorption of
vitamin B12
Thus there arises a therapy which
cares for each and every symptom
of PCOS along with documented
safety.
Now coming back to efficacy of MI:-How
important is MI?? Myo- inositol – The
Ultimate Insulin Sensitizer
Myo- inositol a six carbon sugar
alcohol present abundantly in the body. The chemical name of myo inositol is
1,2, 3,,5/4,6- Hexahydroxycyclohexane .
It is a precursor of various cell membrane phospholipids.
Generally myo inositol is
present in the cells. Serum concentrations are high during fetal life and later on falls
However during certain conditions
like polycystic ovary
syndrome physiological
requirements of myo inositol increased.
Myo inositol is an insulin
sensitizing agent produced by the human body from glucose and is one of 9 distinct isomers of
the nutrient inositol naturally produced by the human body. It is
a vitamin B complex derived product that has been
evaluated in a number of controlled studies
looking at ovulation frequency , time
to ovulation follicular
maturation and the quality of
oocyte production cell morphogenesis and
cytogenesis lipid synthesis the
structure of cell membranes and cell growth . Myo
inositol plays an important role as the structural basis for a number of
secondary messengers like to
synthesise phosphatidylinositol 3 kinase
a key messenger to improve insulin sensitivity and glucose
utilization along with reduction of insulin resistance.
PCO & Myoinositol:--Growing
evidences of Myo inositol in PCOS
Studies have found that deficiency of inositol which is precursor for phosphatidylinositol 3 kinase contributes to the insulin resistance in pcos
women. The women with PCOS are characterized by abnormal metabolism of inositol and have diminished insulin stimulates releases of the putative phsophatidylinositol
mediator.
Myo inositol significantly improves
insulin activity and reduces glucose level in PCOS
patient. It also reduces total
testosterone as a result it
improves hormonal balance and ovulation. Elevated concentration of myo inositol in human
follicular fluid
appears to play important role in follicular maturity
and provides good quality oocytes.
Myo inositol besides improving hormonal profile and restoring ovulation
is also able to induce
regular menses in PCOS patients . Finally
in conclusion myo inositol
increases implantation and pregnancy rate in PCOS patients.
Clinical effects of myo inositol supplementation can be summarized as follows :
Reduces insulin
resistance and increases insulin sensitivity
Increases glucose uptake
Lowers insulin levels
Lower total and free testosterone
Improves menstrual cycle
frequency
Improves pregnancy rate
and live birth rate
Lowers triglycerides and improves
lipid profile .
As per ped Health 2010; Adolescent girls
with PCOS require a long term
committed treatment . Therefore alternative treatments may be
possible option for a subset of
PCOS adolescent females. Myo inositol a component of the vitamin B complex has been shown to improve
insulin signaling thereby restoring
normal ovulatory function
in PCOS women.
Thus as Myo inositol takes care of
the major symptoms associated with PCOS Care in established PCOS cases and in adolescent PCOS
cases .
Clinical studies of Myo inositol in PCOS
Myo inositol shows 56% reduction
in HOMA Index
P.G, Artini et al evaluated the
effects the administration of
myo inositol on hormonal
paratemeters in a group of
polycystic ovary syndrome patients
in a controlled clinical study
50 overweight PCOS patients
were enrolled after informed consent. All patients underwent
hormonal evaluations and an oral glucose tolerance test before and after 12 weeks of therapy MYO 2 g plus folic acid 200 mg every day Group B
folic acid 200 mg Ultrasound
examination and Ferriman – Gallway
score were also performed
Main outcome measures were plasma
LH, FSH, PRL , E2 17 OHP , A, T ,
glucose insulin , c peptide
concentrations , BMI, HOMA index and
glucose to insulin ratio.
First of all in the MYO treated
group the duration of stimulation was lower
than in control group and also
r-FSH units used were fewer in the MYO
treated group. The HOMA index
got significantly reduced from 2.5 + 0.6
to 1.1 + 0.3 in the MYO group
.However in the control group the HOMA
index remained unchanged from 2.5
+ 0.4 to 2.4 + 0.7
The insulin levels got significantly reduced from
11.4 + 2.2 to 5.5 + 1.1 in the MYO
group However in the control group
the insulin levels
decreased from 11.4 + 1.3
to 10+ 1.1
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