Weight management before, during and after menopause. Supplement hacks : A deep dive into Inositol.

Jan 25

5 min read

By far the most popular support requested by clients in clinic sessions is for weight management before, during and after menopause. For a variety of reasons, women may experience additional body fat at various life stages. Sometimes this is healthy to a degree like during pregnancy but more often than not excess body fat can contribute to fertility issues, PCOS, diabetes, heart conditions or misery at menopause.

Whilst healthy can take on a different meaning at certain life stages, I’m going to highlight a supplement hack that can offer you a helping hand. There are few natural remedies established for weight management from a variety of angles. However, inositol is a nutrient that has been researched with positive outcomes not only in reduction of BMI and central fat deposits but in numerous positive health outcomes. This article will take a deep dive into Inositol.

What is inositol?

Inositol is a type of sugar alcohol naturally present in humans. It plays an important role in various cellular processes including cell growth and survival as well as development and function of some nerves , osteogenesis (bone formation) and reproduction. Myo inositol (MI) is the main form of inositol to initiate biological functions but does break down into other forms such as D- Chiro inositol (DCI) in the body. (1)

Inositol is also present in many foods. One study observed that the greatest amounts of MI were present in fruits, beans, grains, and nuts. Fresh vegetables and fruits were found to contain more MI than did frozen, canned, or salt-free products. (2)

One whole melon with another melon with a segment removed

Inositol Australia rank citrus fruits, kidney beans, artichoke, pinto beans and peas, bran, almonds and peanut butter as some of the go-to sources of dietary MI. They have looked at maximising MI in the daily diet but acknowledge that even with much consideration in regard to dietary planning, its hard to achieve a therapeutic level typically considered efficacious. See their table of inositol containing foods here: https://inositol.com.au/

Inositol’s (INSs), a class of sugars, serve as important secondary messengers in various biological processes and signalling pathways, regulating the activities of hormones such as insulin, follicle‐stimulating hormone (FSH), and thyroid‐stimulating hormone (TSH). (3)

Not surprisingly researchers have established associations between MI deficiency and metabolic dysfunction such as insulin resistance (IR). Human disorders associated with insulin resistance include polycystic ovary syndrome (PCOS), gestational diabetes mellitus or metabolic syndrome. MI deficiency has also been linked to treatment of some diabetic complications (neuropathy, nephropathy, cataracts).

In PCOS

In PCOS, patients appear to over-convert or breakdown MI to DCI in the body, leading to an MI deficiency in the ovaries. Impaired folliculogenesis, anovulation, and decreased oocyte quality is then often the result. This over-conversion is further stimulated by insulin leading to an increase in the DCI/MI conversion rate. (4)

An advantageous effect of MI in improving the metabolic profile of women with PCOS, alongside diminishing their hyper‐androgenism (higher levels of male hormones) has been found. (5) Hyper-androgenism is the cause of some of the typical PCOS presentations of:

· Hirsutism: excess facial/body hair (chin, upper lip, chest, abdomen)

· Acne or oily skin

· Irregular or absent periods

· Thinning hair on the scalp (male-pattern hair loss)

· Weight gain or insulin resistance

· In more severe cases: deepened voice, increased muscle mass

The NHS UK

The St Mary’s Managed Clinical Service, Gynaecology Division supply a patient information leaflet around suggested lifestyle factors for reducing PCOS. Within it, they mention that a supplement called Inofolic (Myo inositol & folic acid) may be helpful for women with PCOS in two ways: ‘A commercially available supplement called Inofolic, which is a combination of Myo Inositol and folic acid, has shown benefit in initial studies to improve the metabolic defect in PCOS and make menstrual cycles more regular.’ (6)

Obesity

There is a close relationship between obesity and insulin resistance (IR). MYO seems to indirectly contribute to reduce IR due to its ability to improve several anthropometric measures including weight and BMI. (7,8) Growing direct and indirect evidence demonstrates that ‘supplementation with both MYO and DCI significantly improves the glycaemic level in the absence of significant health risks’. With one study concluding that myo-Inositol dietary supplement corrects intracellular myo-inositol deficiency and myo-Inositol dietary supplement improves insulin sensitivity. (9,10)

In long-term obesity, enlarged fat cells contribute to a persistent low‐grade inflammatory state that may accelerate the progression from early metabolic dysfunction to type 2 diabetes and associated cardiovascular complications - particularly when central or visceral fat deposits are present. (11,12)

Inositol & Menopause link

Oestrogen supports gut barrier integrity as well as bacterial diversity of the gut. This in turn modulates inflammation. When oestrogen drops around perimenopause and menopause, less diversity of bacteria, and more permeability of the gut lining is seen. Low grade inflammation & possible insulin resistance with central fat deposits may result.

Furthermore, a number of gut bacteria have been found to promote intestinal lipid absorption, thereby leading to obesity. These findings highlight the vital role of microbe-induced myo-inositol deficiency in promoting obesity. (13)

Published analysis of 15 randomised control trials (RCTs) concluded that inositol supplementation has a positive effect on BMI reduction. Within this review, 2 studies looked specifically at postmenopausal women with metabolic syndrome, supplementing 2 grams of myo-inositol per day. Results showed that inositol supplementation reduced BMI more effectively in individuals with overweight and obesity. In comparison to other forms of inositol, MI supplements seemed to have a stronger lowering effect on BMI particularly on participants aged 40+. (14,15)

While MI can support metabolically during the menopause transition of declining oestrogen, it doesn’t replace oestrogen. By improving insulin signalling and lowering sugar spikes after meals, MI supplementation could be considered as an aide to improve visceral fat and body mass index. (16)

In Summary

While Inositol is not a standalone solution, it could be a powerful ally. The inclusion of MI along with other interventions suggested below, may help manage insulin resistance as well as fat storage in midlife:

Dietary starch and sugar reduction, adequate prebiotic fibre & protein
Quality sleep - By influencing serotonin, inositol indirectly affects melatonin production, which is paramount for initiating and maintaining sleep. And sleep deprivation can increase the prevalence of IR.
Resistance exercise to develop lean muscle mass
HRT to replenish oestrogen stores

Safety notes

Please do not supplement with Inositol if you take blood sugar lowering medications. If you take any prescription medications, please seek approval with your GP or specialist before taking Inositol.
Efficacious dosages range from 1g to 4 g per day with some studies showing a dosage of 4 g/day is entirely free of side effects (17)
Start low and increase slowly, having each dose with a meal or snacks that are starch or sugar heavy.

References

1 https://doi.org/10.1016/j.biochi.2013.05.011

2 https://doi.org/10.1093/ajcn/33.9.1954

3 https://doi.org/10.1080/17425255.2016.1206887

4 Elicit-Inositols-Impact-on-PCOS-Symptoms-Report.pdf

5 https://doi.org/10.1002/osp4.569

6 SMPIL-23-034-Polycystic-Ovary-syndrome-PCOS-PIL.pdf

7 https://doi.org/10.3389/fnut.2023.1092544

8 https://doi.org/10.1002/osp4.569

9 https://doi.org/10.1016/j.jtcme.2020.03.005

10 https://doi.org/10.1136/openhrt-2022-001989

11 https://doi.org/10.1172/JCI96139