Effects of myo-inositol, gymnemic acid, and L-methylfolate in polycystic ovary syndrome patients

Abstract

Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine and metabolic disorder, characterized by chronic anovulation/oligomenorrhea, hyperandrogenism, and insulin-resistance. Moreover, some studies propose a possible association between insulin resistance and hyperhomocysteinemia, which is a significant long-term risk for factor for atherogenesis and chronic vascular damage, especially in situations where insulin levels are increased. Insulin-sensitizing agents are used in the treatment of PCOS: in fact, inositols were shown to have insulin-mimetic properties. Synergic action to myo-inositol is that of gymnemic acids that have antidiabetic, anti-sweetener, and anti-inflammatory activities. Gymnemic acid formulations have also been found useful against obesity due to their ability to delay the glucose absorption in the blood. L-methyl-folate increases peripheral sensitivity to insulin, maintaining folatemia stable, and thus restoring normal homocysteine levels. Unlike folic acid, L-methyl folate has a higher bioavailability, no drug/food interferences, high absorption, and it is stable to UV-A exposure. The aim of our study is to compare the clinical, endocrine, and metabolic parameters in 100 PCOS women treated with myo-inositol, gymnemic acid, and l-methylfolate (Group A) or myo inositol and folic acid only (Group B), continuously for 6 months. From a clinical point of view, it was noticed a more significant improvement of the menstrual cycle regularity and a more significant reduction of BMI in Group A. Moreover, a more significant decrease of total testosterone and increase of SHBG serum levels were noticed in Group A. The metabolic assessment found a more significant decrease of total cholesterol and homocysteine levels; OGTT glycemia and insulinemia values were significantly more improved after treatment with myo-inositol + gymnemic acid. In conclusion, we can state that a good option for the treatment of PCOS is the combined administration of myo-inositol + gymnemic acid + l-methyl-folate, especially for overweight/obese patients with marked insulin resistance and with associated hyperhomocysteinemia.

Chinese abstract

多囊卵巢综合征（PCOS）是一种内分泌和代谢紊乱的异质性疾病, 其特征为慢性无排卵/月经稀少, 雄激素过多和胰岛素抵抗。此外, 一些研究提出胰岛素抵抗和高同型半胱氨酸血症之间可能存在关联, 高同型半胱氨酸血症是动脉粥样硬化和慢性血管损伤重要的长期风险因素, 特别是在胰岛素水平升高的情况下。胰岛素敏化剂被用于治疗PCOS：实际上, 肌醇具有模拟胰岛素的性质。匙羹藤酸对肌醇具有协同作用, 具有抗糖尿病, 抗甜味剂和抗炎活性。由于能够延迟血液中葡萄糖的吸收, 匙羹藤酸制剂也被发现对抗肥胖有效。 L-甲基叶酸可增加胰岛素的外周敏感性, 维持了糖尿病的稳定, 从而使高半胱氨酸水平恢复正常。与叶酸不同, L-甲基叶酸具有更高的生物利用度, 无药物/食物的干扰, 具有高吸收率, 并且对UV-A暴露稳定。我们的研究目的是比较100名接受6个月肌醇, 匙羹藤酸和L-甲基叶酸（A组）或肌醇和叶酸（B组）治疗的PCOS女性的临床, 内分泌和代谢参数。从临床结果来看, A组的月经周期规律性更明显, BMI下降更显著。此外, A组总体睾酮水平明显降低, SHBG血清水平升高更明显, 代谢评估发现总胆固醇和同型半胱氨酸水平降低更为显著; OGTT血糖和胰岛素血症值在肌醇+匙羹藤酸治疗后得到明显改善。总之, 结果表明, 肌醇+匙羹藤酸+L-甲基叶酸的联合用药是PCOS治疗的良好选择, 特别是对于有明显胰岛素抵抗和伴有高同型半胱氨酸血症的超重/肥胖患者。

Keywords:

• PCOS
• insulin resistance
• inositol
• gymnemic acid
• methylfolate

Disclosure statement

The authors declare that there is no conflict of interest regarding the publication of this article.