In a recent article published in the Nutrients journal, authors analyzed the efficacy of alpha lipoic acid (ALA) in treating polycystic ovary syndrome (PCOS).

Study: Alpha Lipoic Acid Efficacy in PCOS Treatment: What Is the Truth? Image Credit: OrawanPattarawimonchai/Shutterstock.com

Background

PCOS is a prevalent female endocrinopathy, affecting 4 to 25% of females of reproductive age. PCOS is diagnosed when a minimum of two criteria are met: irregular menstrual cycles or ovulatory dysfunctions, biochemical or clinical hyperandrogenism, and ovaries exhibiting polycystic morphology at an ultrasound scan.

PCOS has a complex etiology, with each person’s vulnerability being influenced by different environmental and genetic risk factors like lifestyle and diet. PCOS pathogenesis may be significantly impacted by oxidative stress, insulin resistance, and chronic inflammation. 

Endometrial cancer, type 2 diabetes, metabolic syndrome, and cardiovascular diseases are more common in women with PCOS. Furthermore, PCOS may obstruct conception.

Patients with PCOS risk having psychological problems like depressive symptoms, anxiety, eating disorders, and psychosexual dysfunction, along with obstetric illnesses like gestational diabetes and recurrent miscarriages.

About the study

In the present study, the researchers reviewed the existing studies to determine the limitations and efficacy of a PCOS treatment approach relying on ALA, a naturally occurring amphipathic substance with potent antioxidant and anti-inflammatory properties, for reducing androgen levels, enhancing reproductive outcomes, and ameliorating insulin resistance among PCOS patients. 

After reviewing the existing literature, the team included 14 studies carried out between 2010 and 2022, primarily in Italy, for the current analysis. The research followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

The authors systematically searched PubMed, an electronic database, using keywords such as alpha lipoic acid, α lipoic acid, alpha-lipoic acid, polycystic ovary syndrome, and PCOS. Additionally, they included clinical trials in published meta-analyses or systematic review articles. The search was restricted to works published between 2010 and 2022 in English. 

The inclusion criteria for the studies in the research were females with PCOS, English language, evaluation of insulin status, intervention with myoinositol (MYO) with or without D-chiro-inositol (DCI), insulin sensitivity, body mass index (BMI), homeostasis model assessment (HOMA) index, triglycerides levels, oocyte quality, menstrual frequency, hormone levels (estradiol, androstenedione, testosterone, sex hormone-binding globulin plasma, follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-Müllerian hormone (AMH), and dehydroepiandrosterone sulfate(DHEAS)).

The exclusion criteria were studies with duplicate publications, cell culture or animal studies, case reports, and letters to the editors. Two investigators reviewed the papers and extracted the year of publication, author’s name, number of women with PCOS, country, BMI of PCOS patients, ALA and inositol, MYO or DCI dosage, and therapy outcomes. 

Results

The reviewed studies depicted that PCOS patients administering ALA alone or combined with MYO had improved insulin sensitivity, lower triglyceride levels, and an anti-atherogenic impact. ALA supplementation lowers insulin resistance among PCOS patients via controlling glucose utilization and promoting glucose-transporter-4 (GLUT-4) expression through adenosine 5′ monophosphate-activated protein kinase (AMPK), particularly in overweight patients with type 2 diabetes mellitus (T2DM) familiarity.

ALA combined with a higher MYO dose demonstrated better performance in lowering the insulin response following an oral glucose tolerance analysis. Women with PCOS who took MYO and ALA supplements exhibited an improvement in their hormonal levels, including sex hormone binding globulin (SHBG), androstenedione, free androgen index (FAI), DHEAS, and AMH.  

Women’s menstruation cyclicity and frequency have been improved with ALA supplementation. When combined with inositol or MYO, ALA therapy can help PCOS patients with menstrual irregularities and shorten their cycle length.

The antioxidant activity of ALA is probably crucial for enhancing oocyte quality among PCOS patients. According to studies, ALA lowers oxidative stress and boosts oocyte quality in women with PCOS undergoing in vitro fertilization (IVF) therapy.

PCOS patients having IVF therapies depicted higher-quality embryos, enhanced birth and pregnancy rates, and better follicular maturation when ALA was combined with folic acid and MYO.

Since ALA is fat-soluble and water-soluble, it is a unique compound. Moreover, it could function in the cytosol and cellular membranes.

Conclusions

The study found that ALA is a valid therapeutic approach in PCOS treatment. Its multiple effects, including antioxidant, insulin-sensitizing, and anti-inflammatory, may be crucial in PCOS management, an extremely complex syndrome. 

Combining MYO and ALA induced a synergistic impact and improved insulin resistance among PCOS patients. Nonetheless, not all PCOS patients exhibit insulin resistance symptoms, and it is not one of the unique diagnostic markers of PCOS.

Thus, this therapeutic benefit might only be seen in PCOS women displaying a frequent metabolic signature.  

The study emphasizes the significance of early diagnosis of PCOS to accurately determine the appropriate therapeutic options, including non-pharmacological and pharmacological.

Further research is needed to determine the impacts of ALA supplementation alone in PCOS therapy and its effectiveness in combination with inositols upon hormonal pattern regularizations among PCOS patients.