Could Taking Probiotics Help Improve Insulin Resistance in Women with PCOS?

Polycystic Ovary Syndrome (PCOS) is among one of the most common hormonal disorders that not only impacts your hormones but is a major cause of metabolic disease in women in their reproductive years. In fact, PCOS impacts an estimated 6-21% of all women in their 20s to 40s. Some of the most common symptoms associated with PCOS include irregular cycles, ovulatory dysfunction, androgen-like symptoms including facial hair and acne, as well as polycystic ovaries seen on ultrasound. Although not every patient will experience all of these symptoms, patients who have PCOS are also at risk for other long -term complications including infertility, endometrial cancer, obesity, metabolic disease, diabetes, and cardiovascular disease. 

Although almost 5 million women currently suffer from PCOS, the current available treatment options are relatively limited. If you have PCOS or your doctor has suspected you may have PCOS, chances are they provided you the following options: get on birth control, take metformin and start spironolactone. And although these medications may help mitigate the symptoms of PCOS, they often are a temporary fix to a long term problem. 

Although diabetes has long been associated with PCOS, in recent years, doctors and researchers alike have been equally interested in insulin resistance, a common predisposing factor to the development of diabetes in patients with PCOS. This is likely why we now often not only evaluate for blood glucose levels in patients with PCOS but fasting insulin levels as well. Elevations in insulin levels can occur months to years before the development of diabetes. The goal with assessing insulin levels is to treat the condition before it develops into diabetes. 

Currently, Metformin, an insulin sensitizer, is often the primary treatment option when addressing insulin resistance. However, due to its often unsettling GI symptoms, researchers have been on the hunt for additional treatment options that could not only improve insulin resistance but reduce possible side effects experienced by patients. The other issue with Metformin is that it can cause patients to experience deficiencies in key nutrients, especially B12. Although the complete mechanism by which Metformin interferes with B12 absorption is still unclear, researchers theorize that Metformin interferes with the calcium-dependent binding of intrinsic factors. Intrinsic factor is an important receptor for the absorption of B12 found in the terminal ileum of the small intestine. Although many physicians will have their patients supplement with B12 while taking Metformin, this is not always a common practice and may lead you to experience a B12 deficiency. Some of the common symptoms associated with B12 deficiency include fatigue, lethargy, feeling faint, headaches, heart palpitations and cracked or chapped lips. If you are concerned you may be experiencing a B12 deficiency, you can ask your doctor for a simple blood test to evaluate your B12 levels. If your doctor does deem that you are B12 deficiency or has told you that you should consider supplementing with B12 while on Metformin, we recommend looking for a B12 supplement that includes B12 in its activated form, known as methylcobalamin. Most B12 supplements will contain a synthetic version of B12 known as cyanocobalamin which is not only cheaper to make, but not readily absorbed by up to 40% of the general population who may experience dysfunction in their MTHFR gene. To make it easy, just look at the back of your supplement ingredient list and make sure your B12 is in the form of methylcobalamin. Our favorite B-complex is available here

Researchers have been interested in evaluating other possible treatment options for insulin resistance as an alternative to Metformin. One factor researchers have been particularly interested in is the use for probiotics in the treatment of insulin resistance. This comes from the idea that we know that insulin resistance impacts not only sugar metabolism but it is closely impacted by changes in our intestinal microbiome. In other words, our gut ecosystem can directly impact our cells’s ability to sense insulin. Although more studies are needed, a variety of studies have shown the possible benefit of the use of probiotics for insulin resistance in patients with PCOS. In fact, one randomized double-blind study reported that 12 weeks of synbiotic supplementation significantly improved insulin resistance (HOMA-IR) as well as insulin sensitivity check index (QUICKI). 

In fact, according to a meta-analysis which reviewed 7 different studies, researchers found that of the seven randomized controlled trials, most, if not all of them, showed clinically significant improvement in insulin resistance. They didn’t however see an improvement in BMI or fasting blood sugar when patients were given probiotic supplements. This is important to mention because probiotics may be an important part of your PCOS treatment, however it is not a “cure-all” and should not be treated as such. Some of the most common probiotic strains used in these 7 randomized controlled trials included lactobacillus and bifidobacterium based strains. Researchers believe that part of the way in which probiotics help improve insulin resistance is by reducing intestinal permeability (otherwise known as Leaky Gut), which can not only help maintain the epithelial barrier function of the gut lining but,it can help reduce inflammation caused by the lipopolysaccharides or short-chain fatty acids. Lipopolysaccharides (LPS) is commonly found as the surrounding barrier of gram-negative bacteria. Elevated levels of gram-negative bacteria have long been associated with worsening of PCOS symptoms. 

So not only do these studies demonstrate the power of the use of probiotics as a treatment option for patients with PCOS but, it most importantly provides us important insight about the importance of optimal gut health when treating patients with PCOS. Although we often think about PCOS as a hormonal disorder, we need to start addressing other important factors including gut health for these patients. This is why at NMD Wellness of Scottsdale, we believe in the importance of addressing gut health in all of our patients suffering from PCOS. Not only do we perform comprehensive stool testing, but we focus on nutrition, environmental toxins and digestion to help our patients with PCOS improve their symptoms.  

About the Author: Meet Dr. ZenAlissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...