Probiotics, synbiotics may reduce insulin resistance in PCOS treatment
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Women with polycystic ovary syndrome who take probiotics and synbiotics may see some “partially beneficial effect” on indices of insulin resistance, according to a meta-analysis published in the Journal of International Medical Research.
Insulin resistance (IR) is a key etiological component of PCOS, the researchers said. The disorder affects approximately 6% to 21% of reproductive-age women worldwide, and approximately 40% to 70% of women with PCOS also have IR.
“PCOS increases the risk of long-term complications such as infertility, endometrial cancer, obesity, metabolic disease, dyslipidemia and cardiovascular disease. These symptoms and complications seriously affect patients’ lives,” Chenyun Miao, MD, PhD, of the department of gynecology at Hangzhou Hospital of Traditional Chinese Medicine in Zhejiang Province, China, and colleagues wrote. “Despite the high prevalence and marked impact of PCOS, its pathogenesis and treatment vary and remain poorly defined.”
Previous studies have examined the use of probiotics and synbiotics as an alternative, prompting this meta-analysis of seven randomized controlled trials (RCTs) involving 486 participants to investigate their efficacy. Six studies were based in Iran, whereas one was completed in China.
The researchers considered homeostatic model of assessment of insulin resistance (HOMA-IR), serum insulin and fasting blood sugar (FBS) as indicators of IR. They also used BMI, waist circumference and hip circumference as indicators of indices of central obesity.
In five of the studies with 325 participants, probiotic and synbiotic supplementation reduced HOMA-IR compared with placebo (mean difference = –0.37; 95% CI, –0.69 to –0.05; P = .02).
Additionally, synbiotic supplements reduced serum insulin levels compared with placebo (standardized mean difference = –0.66; 95% CI, –1.19 to –0.12; P = .02) in four of the studies with 270 participants.
But the studies also showed that probiotic and symbiotic supplementation did not affect BMI, waist circumference, hip circumference or FBS.
The researchers further noted the study’s limitations, including its significant heterogeneity, the limited geographic and ethnic groups involved, the small number of studies and potential for selection bias.
Future studies should include larger sample sizes, different ethnic groups and long-term RCTs, the researchers said. Still, they concluded, probiotic and symbiotic supplementation could be effective in treating PCOS.
“Despite its limitations, this current meta-analysis illustrated that probiotic and synbiotic supplementation was somewhat effective for IR in patients with PCOS,” Miao and colleagues wrote.
Perspective
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Jessica L. Chan, MD
Current treatment for IR includes lifestyle modifications, including nutrition and exercise. For some patients, despite intensive modifications, IR is still an issue.
Metformin, one drug often prescribed for IR or for those at increased risk for developing type 2 diabetes, has some significant gastrointestinal side effects, which may prevent some patients from adhering to the treatment.
Other insulin sensitizers such as the thiazolidinediones have shown some benefit for IR in PCOS, but clinical data on this population are limited, and weight gain is a possible side effect. Therefore, these drugs aren’t usually used in PCOS unless the patient has frank diabetes.
Unfortunately, because the seven studies included in this one study took place outside the United States with six in Iran and one in China, it is difficult to generalize these results to PCOS patients here.
Additionally, while this one study pooled the results of the seven smaller ones, the overall study size was quite small, so it is difficult to apply the results to large groups of people.
Finally, the probiotic and symbiotic regimens, doses and duration of use were different in each of the studies, so it’s hard to know which ones would be considered truly beneficial to recommend to patients.
Probiotics and synbiotics could have potential as alternatives. However, a well-designed study needs to be performed to shed more light on their true usefulness.
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