by Amy Medling, founder of PCOS Diva
There is new research out comparing the benefits of inositol vs metformin. Here’s what you should know.
The first thing doctors typically advise for women with PCOS is manage blood sugar levels (and possibly lose weight) with the intention of mitigating many of the PCOS symptoms that result from these imbalances. This makes sense since women with PCOS have a higher predisposition to symptoms of diabetes, especially insulin resistance (IR). (2) In fact, between 50-70% of women with PCOS have some degree of insulin resistance. While insulin resistance is often associated with obesity, women with PCOS often struggle with IR even if they are lean. (3, 4, 5) Researchers have yet to pinpoint whether PCOS lays the foundation for insulin resistance to happen or if it’s the other way around. Regardless, the risks for developing full blown diabetes is higher in PCOS patients than for those who don’t have PCOS.
To this end, Metformin is commonly prescribed, and many patients do well with it. Others choose not to take a pharmaceutical or cannot tolerate the side effects. Inositols have long been thought to have similar effects to the drug, and many of us have had outstanding results. Now, we know why. Research is finding them to be at least equally beneficial, with inositols typically preferred because of the lack of long and short-term side-effects.
What is Insulin Resistance?
Insulin resistance is an impairment of your body’s ability to control your blood sugar levels. Just like it sounds, your body’s cells begin to resist incoming insulin. This resistance can occur for many reasons including a defect in messaging from your hypothalamus, poor diet, ethnicity, certain diseases, hormones, steroid use, some medications, older age, sleep problems, cigarette smoking, and the birth control pill. (6,7) In all cases, the cells are trying to protect themselves from chronically high levels of insulin as a result of too much glucose (sugar) in the bloodstream since insulin at high levels can be toxic.
Ideally, the body detects if the level of glucose in the blood is too high and signals the pancreas to create more insulin to manage the excess and store the glucose in cells. The hope is that since there is more insulin being produced, more glucose will be picked up.
The result of the body’s attempt to balance blood sugar encountering insulin resistance is a tremendous amount of insulin in the blood. This leads to two problems. This demand on the pancreas to produce higher levels of insulin than normal is not sustainable. If the pancreas
becomes overwhelmed and cannot produce enough insulin to absorb the glucose, or if the cells become insulin resistant as a result of constant bombardment, blood sugar builds up in the bloodstream and could lead to diabetes, prediabetes, and other serious health disorders.
This kicks off the insulin resistance cycle wherein insulin resistance of cells and tissues create chronically high levels of insulin, and those chronically high levels of insulin bombard cells and perpetuate insulin resistance.
The ability to regulate blood sugar levels is probably one of the body’s most important functions, and to have it impaired due to insulin resistance is a lot like throwing a wrench in the works. In fact, insulin resistance is at the heart of most of your PCOS symptoms including infertility, obesity, hirsutism, hyperandrogenism, chronic fatigue syndrome, immune system defects, eating disorders, hypoglycemia, gastrointestinal disorders, depression, and anxiety. In the long term, when insulin levels rise too high, type II diabetes, atherosclerosis and an increased risk of high blood pressure and stroke can result.
What are my insulin management options?
All research indicates that the first line of treatment is diet and lifestyle. No pill can make up for bad habits. The PCOS Diva lifestyle is specifically designed to manage blood sugar while easing all of your PCOS symptoms. Despite what you may have heard, it is not necessary to completely eliminate carbohydrates and fats (in fact, you need them), count calories, or go on a highly restrictive diet. It is a matter of finding the right combinations of food that work for your unique body. For more information about the PCOS Diva lifestyle, visit PCOSDiva.com or sign up for my 7-Day Jumpstart program.
Many women choose to take inositol (most often in the form of Ovasitol) or Metformin in addition to their diet and lifestyle upgrades. Metformin is commonly prescribed, though many of us are not informed of exactly how it works or warned about side effects. Recent studies have shown that myo inositol, a compound found to be a natural insulin sensitizer, can perform just as well if not better than metformin without the side effects.
Should you consider myo-inositol vs. metformin for insulin resistance?
What is Metformin?
Metformin is a drug that was developed to control high blood sugar levels. Metformin works two ways to prevent high blood sugar levels. First, it supports natural restoration of your body’s ability to respond to insulin. Second, it reduces the levels of sugar produced by the liver as well as the amount of sugar you stomach and intestine absorb.
While the dosages vary, metformin is often prescribed to patients who consistently show elevated blood sugar levels on repeated blood tests despite some form of natural intervention. The problem is just like any other drug, metformin is not without side effects.
Nausea, stomach upset, diarrhea, vomiting, and a metallic taste in the mouth are common metformin side effects. People with kidney or liver problems should not take metformin as the body may not be healthy enough to excrete or filter metformin from your system.
The issues with Metformin don’t stop there. As Dr. Felice Gersh explains, “Though it can have its place, it never cures insulin resistance or diabetes, doesn’t seem to improve fertility success or ovulation, and doesn’t give meaningful weight loss. As well, when compared directly with a lifestyle and exercise regimen, lifestyle wins and Metformin loses.” She further states, “Metformin is also widely known as a drug which depletes the body of Vitamin B12, and other nutrients. B12 has taken center stage, and rightly so, as a shortage of B12 is associated with nerve pain, known as neuropathy, cognitive dysfunction, and anemias. B12 is also critical for many of the detoxification pathways and for DNA stability. Shockingly, it is now well recognized that Metformin is an endocrine disruptor. That means that it is a chemical – a man-made drug – which acts as an abnormal hormone-like substance, creating different and unexpected symptoms and effects.”
If you take metformin alongside other supplements or drugs that promotes lower blood sugar levels, you could be at risk for hypoglycemia, so be sure to tell your doctor about any medications or supplements you take. Do not stop taking metformin without consulting your physician.
Myo-inositol is not a pharmaceutical drug. It is a naturally occurring substance produced in the human body that belongs to the vitamin B complex group. Myo-inositol is one of nine different types of inositol and can be found naturally in many foods such as fruits, nuts, and beans.
The current research on PCOS and inositol is very promising. One well-respected team of researchers analyzed the available date and concluded,” According to randomized controlled studies involving inositol supplementation in women with PCOS, inositol provides improvement in almost all pathologic conditions in PCOS such as recovery of reproductive abnormalities, decreased androgen levels, and improved insulin levels.” (8)
A meta-analysis published in Italy on January 2019 proposed to determine if myo-inositol has short-term therapeutic effects on blood markers of insulin resistance in women with PCOS. (1) They also took note of any similarities and/or differences between myo-inositol and metformin.
They found that in women with PCOS, there is no significant difference in fasting insulin between those who took myo-inositol and metformin. There was also no difference in their effects on testosterone, and body mass index.
The researchers did note that the only real difference between metformin and inositol is the adverse effects of Metformin. Those who took myo-inositol did not have any adverse reactions to the supplement. On the other hand, those who took metformin were found to be five times more likely to have side effects such as nausea, diarrhea, and abdominal pain, lactic acidosis, and general weakness in severe cases.
The researchers concluded that myo-inositol and metformin can perform on the same level when it comes to treatment of insulin resistance, but myo-inositol showed a lower tendency to produce adverse reactions.
Is Myo-Inositol a good alternative to Metformin?
Studies conducted within the last decade all point to myo-inositol as a natural treatment to symptoms of insulin resistance, with the latest research proving an efficacy similar to metformin for PCOS patients. Even with similar dosages, you are not as likely to have adverse reactions to myo-inositol than you would with metformin. Regardless of potency, a treatment with the lowest risk of side effects is always better.
Regardless of whether you choose inositol or metformin, it cannot be your only line of treatment. Both myo-inositol and metformin work best in patients who also have a PCOS-friendly diet and lifestyle.
Amy Medling, best-selling author of Healing PCOS and certified health coach, specializes in working with women with Polycystic Ovary Syndrome (PCOS), who are frustrated and have lost all hope when the only solution their doctors offer is to lose weight, take a pill, and live with their symptoms. In response, Amy founded PCOS Diva and developed a proven protocol of supplements, diet, and lifestyle programs that offer women tools to help gain control of their PCOS and regain their fertility, femininity, health, and happiness.
- Facchinetti F, Orrù B, Grandi G, Unfer V. Short-term effects of metformin and myo-inositol in women with polycystic ovarian syndrome (PCOS): a meta-analysis of randomized clinical trials. Gynecol Endocrinol. 2019;35(3):198-206.
2. Conn, Jennifer J., et al. “The Prevalence of Polycystic Ovaries in Women with Type 2 Diabetes Mellitus – Conn – 2000 – Clinical Endocrinology – Wiley Online Library.” Clinical Endocrinology, John Wiley & Sons, Ltd (10.1111), 24 Dec. 2001, onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2265.2000.00884.x.
6. Smith U. Impaired (‘diabetic’) insulin signaling and action occur in fat cells long before glucose intolerance–is insulin resistance initiated in the adipose tissue?. Int J Obes Relat Metab Disord. 2002;26(7):897-904.
7. Prenner SB, Mulvey CK, Ferguson JF, Rickels MR, Bhatt AB, Reilly MP. Very low density lipoprotein cholesterol associates with coronary artery calcification in type 2 diabetes beyond circulating levels of triglycerides. Atherosclerosis. 2014;236(2):244-50.
8. Günalan, Elif, et al. “The Effect of Nutrient Supplementation in Management of Polycystic Ovary Syndrome Associated Metabolic Dysfunctions: A Critical Review.” Journal of the Turkish-German Gynecological Association, 2018, doi:10.4274/jtgga.2018.0077.