Synbiotic Supplementation Improves Metabolic Factors and Obesity Values in Women with Polycystic Ovary Syndrome Independent of Affecting Apelin Levels: A Randomized Double-Blind Placebo – Controlled Clinical Trial
Main article: Getting pregnant with PCOS
Studies show an imbalance in intestinal microbiota can cause inflammation which interferes with insulin receptor function and increases insulin levels.
This in turn increases the production of androgens by the ovaries and interferes with normal follicle development, explaining the potential link between PCOS and poor diets.
However studies to date investigating the effect of probiotic and prebiotic (synbiotic) supplementation in women with PCOS have had mixed results and failed to measure any changes in body dimensions.
To assess the effect of synbiotics (probiotics and prebiotics) on glycemic indices, lipids, apelin levels and anthropometric values in women with PCOS.
Women diagnosed with PCOS (Rotterdam criteria), BMI 25-40 kg/m2, aged 20-44 years were actively recruited for this trial.
Following initial assessment, any woman diagnosed with thyroid gland disorders, diabetes, hyperprolactinemia, liver or kidney disease, Cushing’s syndrome, cardiovascular disease, high blood pressure, under gestation and lactation, dieting, drug abuse, taking prescribed medication or supplements, was automatically from the trial.
In total, 68 women satisfied the inclusion exclusion criteria and were randomly divided into 2 groups, based on age and BMI. Pre-trial measurements included weight, height and anthropometric measurements with blood samples for baseline insulin levels and insulin resistance, alongside levels of cholesterol and apelin.
Participants were instructed to continue their usual diet and exercise routine. The validated International Assessment of Physical Activity Questionnaire (IPAQ) was used to estimate each participants physical activity, alongside a separate 24 hour period questionnaire to calculate their daily energy intake: before, during, and at the end of the trial.
The trial went for a total of 8 weeks, with women in the control group receiving a placebo, while women in the treatment group received 500mg of synbiotics daily, in an identical capsule containing;
- Lactobacillus casei 3×109 colony-forming units (CFU)/g
- genus Lactobacillus Lactobacillus rhamnosus 7×109 CFU/g
- Lactobacillus bulgaricus 5×108 CFU/g
- genus Lactobacillus acidophilus 3×1010 CFU/g
- Bifidobacterium longum subsp 1×109 CFU/g
- strainACS-071-V-Sch8b 2×1010 CFU/g
- Streptococcus thermophilus subsp 3×108 CFU/g
- Inulin-type prebiotics (Fructooligosaccharides (FOS))
Trial compliance was monitored weekly via a phone call, and the return of capsule packaging, every fortnight.
Initial patient characteristics showed no significant difference between the placebo and synbiotic group of women, or level of physical activity, with mean BMI of 28.5 and 29.4 kg/m2. Dietary intake however did differ, with the placebo group showing significantly lower daily energy and carbohydrate intake pre-trial. This however increased during the trial period, back to levels no longer classified significantly different between the 2 groups, and thus no longer a confounding factor.
Initial analysis of the results revealed a significant difference in the levels of glucose, insulin, HOMA-IR and HDL cholesterol between the 2 groups. Specifically, symbiotic supplementation reduced glucose levels by 1.35%, insulin 13.92% and HOMA-IR by 15.68%, while increasing HDL cholesterol by 2.88%. Apelin levels however did not show any change, contrary to previous studies, although the standard deviation was wide, indicating a larger number of participants or longer duration study is required in future trials.
Interestingly anthropometric (body proportion) measurements, showed statistically significant improvements in the waist circumference (2.52%), hip circumference and waist to height ratio (1.75%) of women in the synbiotic group, compared to baseline measurements. Similarly, weight (-1.1kg) and BMI (-0.4 kg/m2) also improved significantly whilst in the placebo-controlled group, weight and BMI actually increased, indicating that synbiotic supplementation may in fact reduce adiposity in overweight women with PCOS.
SUMMARY: PROBIOTIC STRAINS FOR PCOS AND WEIGHT LOSS
In this study the following probiotic & prebiotic strains for PCOS: Lactobacillus casei, genus Lactobacillus Lactobacillus rhamnosus, Lactobacillus bulgaricus, genus Lactobacillus acidophilus, Bifidobacterium longum, strainACS-071-V-Sch8b, Streptococcus thermophilus & Fructooligosaccharides, significantly decreased BMI.
- Changes in bacterial flora not assessed.
- Lower dose and duration than previous studies, limiting the interpretation of results.
- Results specific to overweight or obese women with PCOS.
No external funding was declared for this study.
Excessive abdominal fat around the stomach and abdomen.
Proportional measurements of the human body.
A distortion that modifies the estimated measure of an association.
Microorganisms including bacteria, archaea and fungi.
Homeostatic Model Assessment for Insulin Resistance.
Community of micro-organisms.
Esmaeilinezhad Z, et al. (2019). Effect of synbiotic pomegranate juice on glycemic, sex hormone profile and anthropometric indices in PCOS: A randomized, triple blind, controlled trial. https://doi.org/10.1016/j.numecd.2018.07.002
Samimi M, et al. (2019). The Effects of Synbiotic Supplementation on Metabolic Status in Women With Polycystic Ovary Syndrome: a Randomized Double-Blind Clinical Trial. https://doi.org/10.1007/s12602-018-9405-z
Karimi E, et al. (2018). Effects of synbiotic supplementation on metabolic parameters and apelin in women with polycystic ovary syndrome: a randomised double-blind placebo-controlled trial. https://doi.org/10.1017/s0007114517003920
Altinkaya S Ö, et al. (2014). Apelin levels in relation with hormonal and metabolic profile in patients with polycystic ovary syndrome. https://doi.org/10.1016/j.ejogrb.2014.02.022
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