You have just heard about the amazing benefits about Inositol, yet confused about what is the difference between Myo-inositol and D-chiro-inositol (DCI) as well as their optimum ratio. Fret not, this article aims to address those issues after some rigorous research and personal experience working with patients.
What is PCOS?
The polycystic ovary syndrome (PCOS) is a disease that causes irregular bleedings, chronic anovulation androgen excess and a typical ovarian ultrasound feature [1]. It is the most common cause of infertility affecting between 5% and 10% of women during their reproductive age [2]. The PCOS etiopathology is not clear, but most probably a strong genetic cause, influenced by gestational environment and lifestyle, seems to be the key factor.
Due to the key role of insulin in the syndrome etiopathology, for many years insulin sensitizers such as metformin, pioglitazone or troglitazone have been considered as possible therapeutic options. Metformin has been widely used on patients with a hyperinsulinemic status for the improvement of ovarian dysfunction with consecutive anovulation, irregular menstrual cycles and infertility problems [3]. Nevertheless metformin, when used in the therapeutically dose range, has shown to have several side effects such as flatulence, diarrhea and nausea, so that many patients are unable to use this treatment option in gynecology for a long period of time [4].
#1 What is Inositol?
Put simply, inositol is a vitamin-like compound found in many plants and animals and is also produced in the human body. Nine different stereoisomer forms have been described, but myo-inositol is the most common found in nature. In fact, myo-inositol is very often found in many plants and in the tissues of animals. The second most common form is D-chiro-inositol.
In PCOS patients, Myo-inositol decreases serum androgen concentrations, reduces circulating insulin and improves glucose tolerance and other metabolic values altered associated with insulin resistance in women affected by Polycystic ovary syndrome.[5]
#2 Relationship between Inositol and Insulin Resistance
Regarding PCOS, several studies have shown that one of the mechanism of insulin deficiency results from in the inositolphosphoglycan (IPG) mediator and that a deficiency of inositol in the IPGs is responsible for insulin resistance. It has been demonstrated that the administration of D-chiro-inositol (intracellularly converted from myo-inositol) reduces insulin resistance[6].
#3 Myo-Inositol and D-chiro-inositol
A study done by Nestler and Carlomagno [7] suggested that D-chiro-inositol may have a negative impact on the quality of oocytes of PCOS women, as the ovarian epimerase function is not altered in PCOS patients so that the myo-inositol levels in the follicular fluids remain low if only D-chiro-inositol is supplemented. The Consensus Conference on Myoinositol and D-chiro-Inositol postulated that the future ideal inositol supplementation should therefore contain a ratio of 40:1 between myo-inositol and D-chiro-inositol [8].
#4 Can Myo-inositol one day replace Metformin?
In a study of Raffone et al. [9], it was found that the number of pregnancies was clearly higher in the myo-inositol group than in the metformin group of patients. So if you are taking metformin for your PCOS, continue to watch this space as development in this area is ongoing.
#5 Myo-inositol in combination with folic acid and melatonin
Gerli et al. [10] showed in a prospective study that 82% patients receiving 4 g myo-inositol with 400 μg folic acid per day experienced ovulation, whereas this was only observed in 63% of the cases in the group of patients who received a placebo. In the same way, 70% of the patients of the myo-inositol group developed regular menstrual cycles after 16 weeks of treatment, whereas only 13% of the women did so in the placebo group.
Rizzo et al. [11] was able to obtain oocytes with a better quality when the PCOS women were treated with a combination of myo-inositol 4 g + 400 μg folic acid +3 mg melatonin per day in comparison to formulations without melatonin.
#5 Inositol can treat depression! Inositol affects the processes that make neurotransmitters, which are molecules responsible for relaying information within your brain. A neurotransmitter known as serotonin, is affected by inositol and also determines our mood and behavior. [12] Several studies have shown that inositol may be able to reduce the number of panic attacks in those with panic disorders.[13] However, mixed results have been reported, and more research is needed.
#6 So how do I take Inositol?
It is important to consult with your doctor before taking any supplement to ensure it won’t interfere with any other medication that your doctor prescribe. As the beneficial effects of Myo-Inositol take several weeks to actually take place, it is important to start taking it as soon as possible if you are trying to conceive.[14]
Currently, no adverse effects of MI have been found in studies that looked at doses of 4000mg of Inositol a day throughout pregnancy. However, doses higher than 12,000mg a day may have some mild gastrointestinal effects such as nausea, flatulence, and diarrhoea.[15]
There are a few Myo-Inositol products on the market, and below are some of more trustworthy ones.
a) Fairhaven Health Myo-Inositol Supplement
Fairhaven Health Myo-Inositol Supplement provides 2 grams of myo-inositol. This is packed in vegetable capsule, meaning it is 100% fully suitable for vegetarians and vegans. It is manufactured in the USA in a GMP-certified facility. The supplement is all natural and contains no wheat, gluten, yeast, soy, dairy, animal products, artificial colors, or artificial preservatives. https://www.fairhavenhealth.com/myo-inositol
What others are saying about this supplement (taken from its website): NW – January 29, 2019We have been “trying” to conceive since we got married in 2015. A friend told me about this product and I ordered it without hesitation thinking if anything, maybe my cycles would be regular making it easier to conceive. I did not even take this product for a full month and we just got our BIG POSITIVE last night, and again this morning. I am not sure if it is a coincidence but after trying to get pregnant for years, this was the ONLY thing we changed. I highly recommend it to anyone struggling with conceiving & see how it can work for you!
Kayne McIntosh – November 29, 2018My husband and I tried for a baby for over 2 years. I took myo-inositol for 3 weeks and was pregnant!! This is the only thing we did different for 2 years so I know this had to play a big part in this pregnancy!! I am now 9 weeks 2 days pregnant with a healthy baby!!
b) Life Extension, Inositol Caps, 1,000 mg, 360 Vegetarian Capsules
Life Extension Inositol Caps is also 100% vegetarian, using vegetable cellulose as capsule. What others are saying about this supplement: (taken from website)
Posted by Mickey the unwise guy from Bellingham, WA 1 year ago| Verified Purchase Helps relaxation so that I can sleep better and stops me worrying too much
Posted by Healthy Exerciser from Atascadero, CA on 2 years ago| Verified Purchase I've been taking inositol for many years, so this sale deal for a year's supply was too good to pass up. https://www.lifeextension.com/Vitamins-Supplements/item01674/Inositol-Caps
[1] Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005;352:1223–36.
[2] Homburg R. Polycystic ovary syndrome – from gynecological curiosity to multisystem endocrinopathy. Hum Reprod. 1996;11:29–39
[3] Genazzani AD, Battaglia C, Malavasi B, Strucchi C, Tortolani F, Gamba O. Metformin administration modulates and restores luteinizing hormone spontaneous episodic secretion and ovarian function in nonobese patients with polycystic ovary syndrome. Fertil Steril. 2004;81:114–9
[4] Strugaru AM, Botnariu G, Agoroaei L, Grigoriu IC, Butnaru E. Metformin induced lactic acidosis – particularities and course. Rev Med Chir Soc Med Nat Iasi. 2013;117:1035–42.
[5] Centro Salute della Donna, Azienda USL, Ferrara. Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial.European Review for Medical and Pharmacological Sciences 2009; 13: 105-110
[6] Baillargeon JP, Nestler JE, Ostlund RE, Apridonidze T, Diamanti-Kandarakis E. Greek hyperinsulinemic women, with or without polycystic ovary syndrome, display altered inositol metabolism. Hum Reprod. 2008;24:139–44.
[7] Nestler JE, Unfer V. Reflections on inositol(s) for PCOS therapy: steps toward success. Gynecol Endocrin. 2015;31:501–5.
[8] Facchinetti F, Bizzarri M, Benvenga S, D’Anna R, Lanzone A, Soulage C, et al. Results from the International Consensus Conference on Myo-inositol and D-chiro-inositol in Obstetrics and Gynecology: the link between metabolic syndrome and PCOS. Eur J Obstet Gynecol Reprod Biol. 2015;195:72–6.
[9] Raffone E, Rizzo P, Benedetto V. Insulin sensitizer agents alone and in co-treatment with r-FSH for ovulation induction in PCOS women. Gynecol Endocrinol. 2010;26:275–80.
[10] Gerli S, Papaleo E, Ferrari A, Di Renzo GC. Randomized, double blind placebo-controlled trial: effects of Myo-inositol on ovarian function and metabolic factors in women with PCOS. Eur Rev Med Pharmacol Sci. 2007;11:347–54.
[11] Rizzo P, Raffone E, Benedetto V. Effect of the treatment with myo-inositol plus folic acid plus melatonin in comparison with a treatment with myo-inositol plus folic acid on oocyte quality and pregnancy outcome in IVF cycles. A prospective, clinical trial. Eur Rev Med Pharmacol Sci. 2010;14:555–61.
[12] National Center for Biotechnology Information. PubChem Database. Serotonin, CID=5202,
[13] Benjamin J, Levine J, Fux M, Aviv A, Levy D, Belmaker RH.Double-blind, placebo-controlled, crossover trial of inositol treatment for panic disorder. Am J Psychiatry. 1995 Jul;152(7):1084-6.
[14] V. Unfer et al., ‘Myo-inositol effects in women with PCOS: a meta-analysis of randomised controlled trials’, 2017, pp. 647-658.
[15] P.A. Regidor et al., ‘Management of women with PCOS using myo-inositol and folic acid. New clinical data and review of the literature’, Horm Mol Biol Clin Investig., 2018.
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