PCOS is often a result of micronutrient deficiencies

- that you can correct with diet changes and supplements

PCOS is often a result of micronutrient deficienciesPCOS – or polycystic ovary syndrome – is a problem that occurs in 5-10 percent of women of childbearing age. It is the most common cause of involuntary infertility. Related symptoms include tiredness, hirsutism (male hair growth), acne, and irregular menstrual periods. PCOS is often linked to instable blood sugar, increased risk of insulin resistance, overweight, cardiovascular disease, type 2 diabetes, and autoimmune diseases like Hashimoto’s thyroiditis that causes slow metabolism. Diet and exercise mean a lot in terms of prevention and treatment. The same is the case with different vitamins and minerals. We will be looking closer at B vitamins, vitamin D, vitamin E, and coenzyme Q10, plus magnesium, zinc, selenium, chromium, iodine, and fish oil. We will also be looking at how relevant supplements, according to science, can help control blood sugar levels and the hormone balance.

Up to 20 percent of all women have cysts in one or both ovaries without that being a problem. PCOS (polycystic ovary syndrome) occurs when the cysts are linked to hormone changes and various genes. PCOS ruins the quality of life for many women because it drains their energy levels, affects their appearance, and messes with their fertility. As it in many cases is only one ovary that has abnormalities, the main cause is believed to be rooted in that particular ovary. PCOS is characterized by too much androgen (male sex hormone like e.g. testosterone) and too little progesterone, especially if the woman is not ovulating.
The hormone imbalances are often caused by elevated insulin levels. Normally, the pancreas produces insulin to help glucose enter the cells. However, in the case of insulin resistance, the cells’ ability to take up glucose from the bloodstream is impaired. As compensation, the pancreas starts overproducing insulin but to no avail because the insulin is weak so the body fails to respond to it. This condition with insulin resistance and permanently elevated insulin levels is very harmful and can lead to several of the symptoms that are seen with PCOS, for instance:

  • Imperfect glucose metabolism
  • Glucose is stored as fat instead of being converted into energy
  • Overweight with too much abdominal fat (apple-shaped body)
  • Increased production of androgens that result in male hair growth (hirsutism), acne, and impaired fertility
  • The liver produces less sex hormone-binding globulin (SHBG) that binds and inactivates testosterone
  • The liver produces too much triglyceride and LDL cholesterol
  • A tendency to inflammation and increased risk of oxidative stress
  • Increased risk of atherosclerosis and cardiovascular disease
  • Increased risk of metabolic syndrome and type 2 diabetes
  • Increased risk of autoimmune diseases like Hashimoto’s thyroiditis that causes the metabolism to slow down

The aim with therapy is to stabilize blood sugar levels and normalize body weight and waist circumference by means of diet changes and the use of relevant supplements. This should reduce androgen production and stimulate ovulation. However, let us begin by looking at the sensitive hormone balance.

The structure of steroid hormones

Our hormones function like chemical messengers that promote or inhibit different processes, and it is vital that the balance between the different hormones is just right. Cholesterol is the basic component of steroid hormones, mainly in progesterone (a precursor of the stress hormone cortisol) and sex hormones like testosterone and estradiol. The steroid hormones vary slightly and are converted into other steroid hormones in the so-called steroid chain. The enzyme aromatase makes sure that male sex hormone like testosterone is converted into estrogen. The conversion and the regulation of hormones in the steroid chain require certain vitamins and minerals that help carry out numerous enzyme processes. In the following, you can read more about the extensive science in this field. You can also click on the different nutrients and various other subjects.

B vitamins

Vitamin D

Vitamin E and Q10

Magnesium

Chromium

Zinc

Selenium

Iodine

Hormone-disrupting substances also upset the mineral balance

Omega-3 and fish oils

General dietary advice for insulin resistance and PCOS

B vitamins

Patients with PCOS have elevated homocysteine levels in their blood. Homocysteine is an amino acid that contributes to cardiovascular disease if there is too much in the blood. Many women with PCOS already have increased risk of cardiovascular disease, which means that elevated homocysteine increases the risk additionally. Normally, homocysteine must be broken down into the two amino acids, cysteine and methionine. This process requires adequate amounts of folic acid (vitamin B9), vitamin B6, and vitamin B12. It is therefore vital for women with PCOS to get enough of these B vitamins from their diet or from supplements.
Many women who suffer from PCOS take metformin or other types of diabetes medication to increase their insulin sensitivity, but metformin inhibits the absorption and utilization of folic acid and vitamin B12. That way, metformin may indirectly increase blood levels of homocysteine and the risk of cardiovascular disease.
Lack of vitamin B12 may also cause anemia, increased risk of osteoporosis, and symptoms of the nervous system that are normally associated with ageing. A blood sample can reveal a deficiency of folic acid and/or vitamin B12.

Vitamin D

The sun during the summer period is our main source of vitamin D, which we synthesize in our skin in a process that involves a cholesterol precursor and UV light. Vitamin D is considered a steroid hormone and all cells in the body have vitamin D receptors (VDR), including cells in the ovaries and adrenal glands.
The daily reference intake (RI) level for adults is five micrograms (in Denmark), but many scientists claim that we need a lot more vitamin D to cover the body’s needs for the nutrient, among other reasons because of the sensitive hormone balance.
PCOS sufferers have significantly lower blood levels of vitamin D compared to women without the condition, according to a study that is published in PLoS One. Women with PCOS and lack of vitamin D also have lower levels of HDL cholesterol, a type of cholesterol that is normally considered to be beneficial. Other studies have revealed that being vitamin D-deficient can increase your risk of insulin resistance and that overweight individuals have difficulty with utilizing the nutrient. One smaller study of 11 PCOS patients showed that vitamin D supplementation has a positive effect on insulin sensitivity. Vitamin D can also inhibit inflammation, which is a key problem in PCOS.
The need for vitamin D varies from one person to another, and it appears that overweight people and women with PCOS have an increased need for the nutrient. It is easy to produce between 20-100 micrograms of vitamin D on a hot summer’s day. This amount is similar to what some supplements on the market contain (20-80 micrograms).
Vitamin D is lipid-soluble, so preparations where the nutrient is contained in oil in gelatin capsules generally have better absorption. We also need magnesium to convert into its active form the type of vitamin D that we get from sun exposure and supplements. This activation takes place in the liver and kidneys.

Hormone changes are like ripples on water

Because hormone glands work in close collaboration, disturbances and imbalances one place can easily cause problems in another place.

Vitamin E and Q10

Vitamin E is a lipid-soluble vitamin that is important for cell growth and for the cardiovascular system. It is also a powerful antioxidant that protects cells against oxidative stress. Good vitamin E sources include unspoiled plant oils, nuts, kernels, avocado, egg yolk and cod roe. According to a study that is published in Journal of Assisted Reproduction Control, vitamin E is able to strengthen the uterine mucosa.
An eight-week placebo-controlled study of women with PCOS has demonstrated that daily supplementation with 100 mg of Q10 combined with vitamin E has a positive effect on fasting blood glucose levels, insulin levels, sex hormone-binding globulin (SHBG), and testosterone levels. Q10 is a co-enzyme that is involved in cellular energy turnover and also functions as an antioxidant. We humans are able to synthesize Q10 in the body, the endogenous synthesis of the substance peaks in our mid-twenties and gradually decreases from that point onward. In addition, the use of cholesterol-lowering statins depletes Q10 levels because it interferes with the body’s synthesis of the compound.
The scientists believe that the combination of vitamin E and Q10 has a synergistic effect. The study is published in Journal of Clinical Endocrinology & Metabolism. Always make sure to choose a Q10 preparation with documented bioavailability.

Magnesium

Magnesium is mainly found in kernels, almonds, nuts, whole grains, cabbage, and other compact vegetables. The nutrient is important for energy turnover, the nervous system, and hundreds of different enzyme activities that involve the blood sugar balance and hormone balance. Magnesium is needed to ensure that most of the calcium we ingest is stored in bone cells, while making sure that cells in soft tissues and organs remain practically devoid of calcium. If calcium ions flood cells in soft tissues, it may stress the cells and cause inflammation and cell death. In Denmark, the reference intake (RI) level for magnesium is 375 mg (adults), but it has been demonstrated that many people lack magnesium. Moreover, women with PCOS are far more likely to have low magnesium concentrations in their blood. According to a review article that is published in Nutrients, there is a link between low magnesium levels and insulin resistance in women with PCOS.
In the Framingham Offspring Cohort Study, researchers followed a group of people for an extended period of time and found that higher magnesium intake improved insulin sensitivity and lowered the risk of type 2 diabetes. Several other studies have shown a similar result. Daily supplementation doses of 200-600 mg have been used in these studies. Larger doses are normally not recommended, as they may cause diarrhea. If this happens, however, it is just a matter of reducing ones daily dose.
The scientists explain that magnesium activates vitamin D and it is involved in two genes that control glucose and insulin levels. Make sure to study the label when buying magnesium supplements. Magnesium carbonate, magnesium acetate, and magnesium citrate are all organic compounds, but they are only absorbed as free magnesium ions in the small intestine if their quality is alright. Magnesium oxide, which is found in a variety of supplements and in Magnesia
(a laxative), has poor absorption and works locally in the intestine. It is a good idea to take magnesium in combination with chromium.

Chromium

There is chromium in almonds, beans, nuts, fish, and shellfish. Chromium assists insulin in helping glucose into the cells by attaching to the insulin molecule. This effective teamwork by chromium and insulin helps ensure an effective cellular glucose uptake, which is necessary for energy turnover and long-term satiety. The problem is that most people’s diets are not sufficiently balanced and their intake of refined carbohydrates and stimulants depletes the body’s chromium stores.
Studies suggest that women with PCOS have low chromium levels in their blood and that increases their risk of insulin resistance.
Many studies have shown that chromium supplementation has a positive effect on insulin sensitivity and blood sugar levels. According to a placebo-controlled study from China, giving a combination of chromium and magnesium to people with insulin resistance has a better effect than if they take the nutrients separately. There seems to be a synergy effect because both nutrients are important for insulin sensitivity. In the Chinese study, the participants got 200 mg of magnesium and 160 micrograms of chromium yeast daily for three months.
Chromium yeast is by far the best choice for supplemental use. According to the European Food Safety Authority (EFSA), organic chromium yeast has up to 10 times better bioavailability than the synthetically manufactured chromium supplements with chromium picolinate or chromium chloride.

Zinc

We get zinc from fish, shellfish, meat, dairy products, nuts, kernels, and beans. Animal sources have better absorption than plant sources. Zinc is involved in over 1,000 enzyme processes that relate to insulin sensitivity, hormone balance, and fertility. Zinc is therefore also important for the development of the eggs in the woman’s ovaries during her menstrual period.
Zinc regulates the aromatase activity in the ovaries, an activity that is reduced in women with PCOS. Aromatase is an enzyme that converts testosterone into estrogen. Zinc is also important for the pancreas and its synthesis and secretion of insulin. Finally, zinc is a powerful antioxidant that protects cells against oxidative stress. Studies show that women with PCOS have low zinc levels in their blood. There are also studies showing that when women with PCOS take high doses of zinc for eight weeks, their hormone therapy (with estrogen and progesterone) has a better effect on cholesterol balance and insulin resistance.
Several studies have also revealed that zinc supplementation helps prevent diabetes.
Zinc deficiencies typically occur as a result of poor diets with too much sugar and lack of animal protein. The reference intake (RI) level for zinc is 10 mg. According to EFSA, the safe upper intake level for adults and pregnant women is 25 mg of zinc daily. It is perfectly safe to consume large quantities of oysters or to take high-dosed zinc supplements for a short period.
Many zinc supplements contain inorganic zinc sources like zinc sulfate or zinc oxide that are not absorbed very well in the body. Zinc gluconate and zinc acetate, on the other hand, are organic sources that the body can easily absorb and utilize. Always look at the label before you make your purchase.

Selenium

Selenium is mainly found in fish, shellfish, offal, eggs, dairy products, and Brazil nuts. Crops grown in Europe, including Denmark, are generally low in selenium because of the nutrient-depleted soil.
Selenium supports 25-30 selenium-containing proteins (selenoproteins) that are essential enzymes and antioxidants. All cells contain selenium, and the highest concentrations are found in sex glands. Women with PCOS have reduced selenium levels in their blood. Two studies of women with PCOS show that daily supplementation with 200 micrograms of selenium for eight weeks has a positive impact on insulin sensitivity and cholesterol balance.
Many women with PCOS do not ovulate, which means they also lack progesterone that is necessary for maintaining stable blood sugar levels and is important for pregnancy. A study of cows showed that selenium supplementation increases the concentration of progesterone in the animals’ blood. The scientists assume that selenium helps increase the progesterone production of the corpus luteum, and it is plausible that this is also the case in humans.
In Denmark, farmers have been feeding extra selenium to their livestock in order to support fertility and prevent a host of selenium deficiency diseases in the animals. Selenium is also important for the metabolism, and many women with PCOS are affected by Hashimoto’s thyroiditis that causes the metabolic rate to slow down. It is therefore vital for patients with PCOS to make sure to get enough selenium.
The best choice for supplementation is selenium yeast with a variety of selenium species because this resembles the natural variety that you get from a diet with many different selenium sources.
It is a good idea to take supplements that combine selenium yeast with organic zinc.

  • An estimated 20 percent of Danes get less selenium than the daily reference intake (RI) level, which is 55 micrograms/day.
  • Many scientists recommend getting as much as 100 micrograms of selenium daily. This is close to the amount that it takes to properly saturate selenoprotein P, which is used as a marker of adequate selenium status.
  • Doses of 200 micrograms daily are often given to Hashimoto’s patients

Iodine

Iodine is mainly found in fish, shellfish, seaweed, and fish sauce. Iodine is an essential micronutrient that is of vital importance to metabolism and the estrogen balance. Ovaries contain large quantities of iodine and so does the thyroid gland. This means that an iodine deficiency may affect the ovaries and their estrogen production. There are not many published studies of the relation between PCOS and iodine deficiency but it is, nonetheless, important to make sure to get enough iodine to support your metabolism and hormone balance.
In 2000, compulsory iodine enrichment of table salt was reintroduced in Denmark as a preventive measure against goiter. The iodine intake did go up a little but not enough, and pregnant women certainly have an increased need for iodine.
The official recommendation for daily iodine intake is 50 micrograms for adults, but leading scientists consider this to be insufficient. Potassium iodide (KI) is available in tablet form. People with Hashimoto’s disease should always consult their physician before taking iodine supplements. It may even be a good idea to combine supplements of iodine with selenium.

Hormone-disrupting substances also upset the mineral balance

Hormone-disrupting substances in the environment also disturb the hormone balance in different ways. The most common hormone disrupters are mercury, fluoride compounds, pesticides, dioxins, phthalates, PVC, parabens, and bisphenol A. Although it is impossible to completely avoid the hormone-disrupting compounds, we should at least try to limit our exposure to a minimum.
Selenium protects against mercury exposure from the environment. In the case of a mercury poisoning where mercury sequesters selenium in the body and prevents this essential micronutrient from carrying out its vital tasks, we need more selenium to make sure that there is enough to fuel all the selenium-dependent selenoproteins. Similarly, exposure to cadmium, lead, and copper increases the need for zinc, and brome and fluoride compounds increase the need for iodine.

Omega-3 fatty acids and fish oils

Omega-3 fatty acids are essential to human health and come in different forms. In cell membranes, we have EPA and DHA that carry out a host of physiological functions. Oily fish and fish oil supplements contain these two kinds of omega-3 that we humans can easily utilize.
The omega-3 fatty acids are also involved in a biochemical interplay with omega-6, and it is vital to get the different omega types in the right balance. If we get too little omega-3, it can set the stage for hormone imbalance and inflammation.
People who do not like fish or do not eat enough of it may want to add a fish oil supplement to their diet to make sure to get enough omega-3. Fish oil based on free fatty acids has excellent bioavailability. Also make sure to choose a supplement that is within the official threshold levels with respect to peroxide value and content of environmental toxins.
Research shows that when patients with PCOS and metabolic syndrome take two grams of fish oil daily as a supplement it significantly reduces their waist circumference and improves their cholesterol balance. This was documented in a study that is published in Journal of Research in Medical Sciences.
Linseed oil contains a form of omega-3 called ALA (alpha-linolenic acid), which many people have difficulty with converting into EPA and DHA because the required enzyme processes needed for this conversion are not functioning properly.

Dietary guidelines for people with insulin resistance and PCOS

Insulin resistance, metabolic syndrome, and type 2 diabetes are spreading like a bushfire. As mentioned earlier, blood glucose imbalance is often seen with PCOS and is often a result of eating a diet that contains far too much carbohydrate.
Since the 1970s, a low-fat diet with plenty of bread, potatoes, and other carbohydrates has been recommended to diabetics and to the general population. However, recent research from Denmark shows that it is better to cut back on carbohydrate intake. These somewhat unexpected study results contradict what health authorities and the Danish Diabetes Association have been recommending for decades. The bottom-line message is that diabetics and people with sensitive blood sugar should try to replace their carbohydrates with more protein and healthy fats.

Summative diet advice for patients with PCOS

  • Eat a healthy diet and keep your blood sugar stable
  • Get plenty of protein and healthy fats
  • Get enough B vitamins, vitamin D, vitamin E, Q10, magnesium, zinc, selenium, iodine, and omega-3
  • Be physically active and get enough sleep
  • Maintain normal body weight and waist circumference (it is the visceral fat around the vital organs that it dangerous)
  • Ask your doctor to check your metabolic rate to rule out Hashimoto’s thyroiditis

References:

Elif Gûnalan et al. The effect of nutrient supplementation in the management of polycystic ovary syndrome-associated metabolic dysfunctions: A Critical Review. Journal of the Turkish German Gynecological Association 2018

Sunali Wadehra. Hashimoto´s Thyroiditis and PCOS: Is there a Connection? Endocrineweb 2019

Y.H.M Krul-Poel et al. Vitamin D and metabolic disturbances in polycystic ovary syndrome (PCOS): A cross-sectional study. PLoS One 2018

Selimoglu H et al. The effect of vitamin D replacement therapy on insulin resistance and androgen levels in women with polycystic ovary syndrome. J Endocrinol Invest 2010

Cicek N et al. Vitamin E effect on controlled ovarian stimulation of unexplained infertile women. J Assist Reprod Genet 2012

Izadi A et al. Hormonal and metabolic effects of coenzymeQ10 and/or Vitamin E in patients with polycystic ovary syndrome. J Clin Endocrinol Metab 2018

Qi Dai el al. Abstract CT093: Bimodal relationship between magnesium supplementation and vitamin D status and metabolism: Results from randomized trial. Cancer Research July 2018

Dou M et al. Combined chromium and magnesium decreases insulin resistance more effectively than either or alone. Asia Pac J Clin Nutr 2016

Preconception zinc deficiency could spell bad news for fertility. American Physiological Society April 2018

Guler I et al. Zinc and Homocysteine levels in Polycystic Ovarian Syndrome Patients with Insulin Resistance. Biol Trace Elem Res. 2014

Chausmer AB. Zinc, insulin and diabetes. J Am Coll Nutr 1998

Stapleton SR. Selenium: an insulin-mimetic. Cell Mol Life Sci. 2000

Zadeh Modarres S et al. The Effects of Selenium Supplementation on Gene Expression related to Insulin and Lipid in Infertile Polycystic Ovary Syndrome Women Candidate for In Vitro fertilization: a Randomized, Double-Blind, Placebo-Controlled trial. Biol Trace Elem res 2018

Kamada H, Hodate K. Effect of dietary selenium supplementation on the plasma progesterone concentration in cows. Journal of Veterinary Science 1998

Christensen BT et al. Selenanvendelse i dansk landbrug. Rapport fra DJF 2006. Videncentret for landbrug.

Drutel, A et al: Selenium and the thyroid gland: more good news for clinicians. Clinical Endocrinologi. 2013.

Claus Jørgensen. Hormonforstyrrende stoffer. Derfor er de problematiske. Forbrugerrådet Tænk Kemi 2019

Nicholas V.C. Ralston, Laura J. Raymond. Mercury´s neurotoxicity is characterized by its disruption of selenium biochemistry. 2018

Rychlik W. The need for iodine supplementation. OMS 12.06.2017

Christine Traxier. The Relationship Between Iodine Intake and PCOS.
https://natural-fertility-info.com/the-relationship-between-iodine-intake-and-pcos.html. 2019

Frederick R. Stoddard et al. Iodine Alters Gene expression in the MCF7 Breast Cancer Cell Line: Evidence for an Anti-Estrogen Effect of Iodine. International Journal of Medical Sciences. 2008

Weiping Teng et al. Effect of Iodine Intake on Thyroid Diseases in China. New England Journal of medicine 2006

Anne Krejbjerg. Den Danske Jod – genundersøgelse af befolkningen efter jodberigelsen. Thyreoidea Landsforeningen 2014

Behnaz Khani et al. Omerga-3 supplementation effects on polycystic ovary syndrome symptoms and metabolic syndrome. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences. 2017

Bispebjerg Hospital. Færre kulhydrater forbedrer type-2 diabetikeres evne til at regulere blodsukkeret. Nyhedsbrev 10. august 2019

Mads J Skytte et al. A Carbohydrate-reduced high-protein diet improves HbA1c and liver fat content in weight stable participants with type 2 diabetes: a randomized trial. Diabetologica. 2019

Lars Dahlager. Fire årtiers kostråd til diabetikere er forkerte. Politiken. 9. august 2019

Pernille Lund. Sund og smuk hele livet. Ny Videnskab 2016

Pernille Lund. Sådan får du styr på dit blodsukker. Ny Videnskab 2013