IS INOSITOL GOOD FOR METABOLIC HEALTH?
One of Australia's Most Popular Podcasts with Hundreds of 5 Star Reviews
Grab your FREE Ebook copy now!
Have you struggled to lose weight and keep it off?
Start your journey to boost metabolism and transform your body into a fat-burning powerhouse.
Episode 238:
Show Notes
Episode 238:
Transcript
Dr Mary Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson.
Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.
Both (0:16) And this is the Real Health and Weight Loss podcast!
Dr Lucy Burns (0:17) Good morning beautiful friend, it's Dr Lucy here joining you again on another Tuesday and with me in the studio, well not really in the studio but it sounds sort of posh to say, is my gorgeous friend and colleague, Dr Mary. Hello Dr Mary, how are you this morning?
Dr Mary Barson (00:32) Good, nice and warm, feeling happy about summer, busy, busy with summer but happy, happy and I think we should call it a studio.
Dr Lucy Burns (00:42) Yes, well you are right in the thick of summer, Christmas, celebration, pantomimes, concerts, Kris Kringle, teacher presents, all of that
Dr Mary Barson (00:55) And my daughter's still lamenting the fact that we haven't got a Christmas tree, even though I did low-grade promise we'd have it up by the 1st of December, that just hasn't happened. Not helped by the fact that she wants to get a really big one that won't fit in my car and just the added layers of borrowing a ute, my friend's ute, to go and get it means that it, look it might not happen until January at this rate, I'm not too sure.
Dr Lucy Burns (01:19) It'll be ready for Christmas 2025. That's it, yeah, that's right. That's an interesting example though, isn't it, of sometimes when we make the thing we want to do a bit too hard, or a bit too big in your case, it doesn't get done. Whereas if it was a smaller tree, so if we shrunk it.
Dr Mary Barson (01:42) Totally, it could fit in the boot of my little Nissan, it would have been alright. I really was campaigning for a plastic one that we could get in a box from Kmart but no, no, my little spirit of Christmas is not up for that, so it's okay, I'm just, yep, she has to wait.
Dr Lucy Burns (02:01) Well, maybe a compromise between the plastic and the, you know, the 7-foot gigantic tree could be the smaller, doable, shrink the change, make the steps easy, 4-foot Christmas tree.
Dr Mary Barson (12:13) I tried that a couple of times but the small trees are really popular and they go really fast. So if you, at the end of the day, school run, pop into the garden shop or to the Christmas tree shop, they're all gone. They've only got the enormous ones that nobody can fit in their cars. So it's okay, sorry, I'll get there. This is not even a podcast about my Christmas tree.
Dr Lucy Burns (02:23) No, no, but it is recognising that, you know, there are, everyone has a struggle with something.
Dr Mary Barson (02:44) That's right.
Dr Lucy Burns (02:45) Indeed. So, as many of you know, we are doing a series on supplements and we have another supplement to discuss today which, again, close to your heart, Dr Mary, but a supplement that some of you may have heard about called inositol, often sold as myoinositol or chyro-inositol and we're going to be talking all about the pros, the cons, the fors, the against and, you know, what our thoughts are at the end of all of this. So, Miss, you being the biochemist and the woman with PCOS, let's talk about inositol.
Dr Mary Barson (03:30) Yeah, so inositol is a supplement that you can buy and it's advertised as a weight loss supplement and it's used to treat various aspects of polycystic ovarian syndrome as well. It's also often referred to as vitamin B8 but it's not really a vitamin because we make it ourselves. So inositol, it's not really a vitamin, it's a type of sugar. It's a type of sugar that we make with lots of important functions in our body.
Dr Lucy Burns (03:57) Oh, aren't sugars bad though?
Dr Mary Barson (03:59) Oh, no, no, not necessarily. Some are extremely important and this sugar actually has a role in cell signalling it's so important that we make it and our bodies make inositol, almost all of our organs are involved in making inositol. Different types of inositol play a different role in our bodies and it's absolutely essential. So it's an alcohol sugar that's essential for cell signalling, for fat metabolism, for how our body uses glucose and what we do with the glucose. It's involved in the production of molecules that help our cells respond to insulin and basically help manage our hormonal balance. So it is essential and it's so essential that we can get it from our diet. We absolutely can. It's rich in nuts seeds and berries. There's a little bit of it in meat as well, but we can also make it. Our body can synthesise it itself. So we need it. And there are lots of different types of inositol. There are nine. It has a fabulous word for stereoisomers. I love these words, but we don't have stereoisomer. Basically different shaped, different shaped types of inositol that do different things in our body's biochemistry. But the two main ones are myoinositol and d-chironositol. So we'll just science out for a little bit more, I think, just to get a kind of a background about this supplement and its potential use. So our body primarily produces myoinositol, which is made from sugar, in various tissues, especially the brain, the liver and the kidneys. Also, the ovaries, are really important as well. And then we can convert that myoinositol to the d-chironositol where necessary. And there's various enzymes that are important for this. And interestingly, the myoinositol and the d-chironositol both affect insulin signalling in different ways. So they have distinct yet complementary roles in maintaining insulin sensitivity. This might be important if you choose to supplement with this if this is something you want to do. The type of inositol you take can be really important and possibly taking a combined type might be what is useful. So, yeah, we make it, we need it. And there is evidence that in certain conditions, such as polycystic ovarian syndrome, which is something that I have, most symptoms are pretty much in remission these days, but it has been a really significant, had a really significant impact on my life. Having polycystic ovarian syndrome, I started gaining weight when I was in primary school. By the time I was an adolescent, I had obesity and I had infertility as well. And I managed to get two beautiful children despite all of that, but it wasn't necessarily easy. And PCOS has sort of thrown a lot of barriers and difficulties my way. So I am extremely interested in any potential treatments for polycystic ovarian syndrome. This is actually what got me into lifestyle medicine in the first place. It is a fantastic way to help your body heal and get into a beautiful, beautiful metabolic balance. But I love this Lucy just off air before you said that, you know, we don't want to get stuck in ideology. We don't want to be like that, it just has to be lifestyle measures. You know, if you take supplements or take medication, you're somehow failing or we don't want to do that at all. We don't want to get stuck into ideology because we want to remain open-minded to all the potentially useful tools out there. And look, inositol might be one. I don't actually take it, but I find it interesting. And I think that being empowered with the right information would be good for people out there.
Dr Lucy Burns (08:22) Absolutely. And I'm also interested in the fact that it's a sugar alcohol. So I was just having a look that in some cases people use it as a sweetener. Yes, it's quite sweet. Yeah. Yeah. It's not widely commercially used, unlike say erythritol, which is also sugar alcohol or xylitol, which is also sugar alcohol, which our body makes as well and has a role in cell signalling. Yeah. And so again, these products, supplements are in some ways, I mean, you know, we seem to have this distinction between supplements and medicines or supplements and medications or supplements and drugs. And it's worth recognising that, you know, just about everything we put in our body has a role somewhere in some cellular process. Absolutely. So it's about putting things that are helpful into your, more of the helpful things into your body and less of the unhelpful things.
Dr Mary Barson (09:29) Yes. I think that's extremely important. And it kind of makes my brain explode a little bit how in medicine for so long, we've been drawing this distinction between food and medicine. So the kilograms of food that you put in your body, well, it doesn't matter what that is. It's just food. It doesn't do anything, but you know, the milligrams or micrograms of medicine, well, that's the important stuff. That's really potent. But the food that we eat has huge impacts on our biochemistry, huge impacts on our cell signalling, and huge impacts on every single part of us. And so do medications and supplements. It's all important. And I like to kind of think of supplements as medications. I treat them with the same level of respect and curiosity and caution because just because you can easily buy something, you know, online at a supplement website, or you can pick it up from the vitamin aisle at your supermarket, doesn't necessarily make it safe or a good idea. It doesn't mean that it doesn't, but it doesn't mean that it does. So I think that being really deliberate and cautious with the supplements that you take is important for your health.
Dr Lucy Burns (10:45) Absolutely. And as we've spoken about over the last couple of podcasts, the phrase significant, when we're talking about studies and statistical analyses, doesn't necessarily mean clinical effect. So a statistical significance doesn't necessarily convey a clinical significance. And it's worth remembering that sometimes companies will manipulate that phrase, and they'll go, you know, such and such, you know, causes significant weight loss or causes significant improvement in yada yada. And they're talking about a statistical significance, which is completely different to what, you know, we would just use significance in lay terms.
Dr Mary Barson (11:40) Yeah. Exactly. Yes, it is. Indeed. Got to look out for these things.
Dr Lucy Burns (11:45) Yeah. And I think what I love is that you're also just elucidating again, even further, is it really is, it's not this or that, you know, I get annoyed by, you know, Facebook or Instagram memes where there's, we've talked about this before, the way there's people lining up, you know, it's a cartoon, there's people lining up on one side for medications. And there's like, you know, 50 people in the line, and one person lining up for lifestyle or no people lining up for lifestyle. And the story that that creates is that people who become unwell, or people that need medications, that it's their fault. And they just didn't try hard enough in lifestyle stuff. And look, honestly, that's a little bit of bullshit.
Dr Mary Barson (12:39) Yes. It totally is. It is. I would call BS on that. You can absolutely double down on all of your lifestyle factors, which I think you should do regardless if you want good health, people can do that, but still have problems with infertility from PCOS, for example, they can, you know, improve their metabolic health, they can do fantastic things that still not get to exactly where they need to go. And things like, if we're using PCOS, for example, things like inositol, we'll go through this more in a minute, can be useful. So can metformin. So can ovulation induction. So can laser hair removal. So can the contraceptive pill. So can IVF, it depends on which polycystic ovarian symptoms you want to treat. And all these things can work beautifully hand in hand with lifestyle changes. If you don't get all the way that you want to be with lifestyle changes, that doesn't make you a failure. It just means you need more tools and the tools are there. So let's use them. This goes for everything, not just PCOS, it goes for, you know, obesity, it goes for, you know, menopausal symptom management, all of these things. Use all your tools, use them wisely.
Dr Lucy Burns (13:52) Yeah, absolutely. I love that. And I love that. The other thing to sort of note for people is that sometimes using the medication or the supplement or the medical therapy device, such as CPAP, can help you implement then your lifestyle choices or your lifestyle improvements. So we see this all the time. So there'll be people who really, really want to improve their lifestyle. They really want to do some exercise. They really want to improve their nutrition, but they're exhausted because they've got sleep apnea and they're not sleeping properly. Introduce CPAP and suddenly they're sleeping better and then they can do their lifestyle. Then they can change their nutrition. Then they can do their walking or whatever it is they want to do. They can lose maybe some weight and in fact, may not need their CPAP. But if you just spent all the time hammering them to do lifestyle and you won't need CPAP, that day will never come for some people. So you're absolutely right around ideology. Like, I think it's really important to note that sometimes people get trapped in ideology. They can't see, they actually close the door to all their options because they're stuck down their one way of doing things.
Dr Mary Barson (15:14) And I do see this, and I think you have too, with people who are big fans of the carnivore diet, for which we've talked about before. You know, we've got, our views are really moderate. It can be a useful tool for some people. It might not be for others. But there are pockets of ideology where people will really want to close the door to absolutely everything else, including plant foods, which may or may not be helpful. So I think open-mindedness is really essential to have good health in our complex modern daily lives.
Dr Lucy Burns (15:51) Absolutely. Absolutely. And I think you've just elucidated it perfectly. It's not this or that, it's this plus that. And at the end of the day, what we want for everybody, and I think this should be a philosophy of all medical professionals, is that pharmaceuticals are extremely important, but the aim should be the lowest effective dose. And the lowest effective dose does two things. One, it reduces the risk of side effects and drug interactions for people. And two, it's cheaper. It saves people a lot of money. It saves the government a lot of money. The way that we can ensure that we achieve that aim of the lowest effective dose is to really look at the lifestyle factors and help people be able to achieve those. Again, there's so much judgment around there. If you've got lifestyle factors that could be optimised, but for whatever reason you're not doing them, it's not because people are lazy or that they don't want it enough. There are barriers and untangling and helping them unravel those barriers is so important. And the barriers can be psychological, they can be environmental, they can be physical. And if we can help people address, so identify and address their barriers, then they are far more likely to make improvements rather than just being shamed into the fact they're not doing their lifestyle stuff.
Dr Mary Barson (17:35) Absolutely. And my brain went back to my Christmas tree that I hadn't put up. And the barriers that exist to that, are totally overcomable. And perhaps I do need some help to overcome these barriers, but I don't want to trivialise it. These mindset barriers really can be broken down, made smaller, and overcome, and people can get the support they need to make healthy changes stick and to spit into their busy everyday lives. That may or may not include you having to get and decorate Christmas trees.
Dr Lucy Burns (18:08) Absolutely. So as far as Inositol goes, just to bring it back to that, because that is the topic of our conversation today, it seems that there are a number of studies on it. The benefits seem to be largely at this stage confined to people with PCOS and potentially gestational diabetes. So we're looking there for insulin resistance at an ovarian level. I guess it would make sense that those benefits are likely to be transferable through to other causes of insulin resistance or conditions related to insulin resistance, but we don't have a lot of data on that yet.
Dr Mary Barson (18:56) That's it. Yeah. There is like some, it is conflicting. There's some data saying that Inositol supplementation does help with fat loss, but it's not yet conclusive. I think that is probably where we're at, at this stage. I would love some more randomised controlled studies to be done to get a little bit more information on this. That would be fantastic. But as of yet, it's still a bit inconclusive, but we can still talk a little bit more about, you know, I guess the risks and benefits, I suppose, so people could have a bit more of an idea about if there's something they wanted to look into more.
Dr Lucy Burns (19:34) Yeah. Okay. So benefits. So let's start with the best, the benefits. What have you got for me?
Dr Mary Barson (19:40) So, well, enhancing insulin sensitivity. This is particularly true in people with PCOS. So it seems that there is evidence looking, suggesting that people with PCOS and metabolic syndrome. So both of those have difficulty converting from the myonositol to the D-chironositol. And that this is one of the mechanisms that actually leads to insulin resistance and hormonal imbalance. So it is thought that supplementing with both forms of Inositol at the right ratios could potentially help restore that balance. And the evidence shows this is more the case in treating polycystic ovarian syndrome than it is in treating overweight and obesity. So yeah, the potential benefit is that it can improve fertility and ovulation rates for women with polycystic ovarian syndrome. And there are some studies saying that it does it better, worse, and the same as metformin. So it is still, I think at this stage, it's still a bit inconclusive, but it is certainly interesting to watch and it can also help reduce androgen levels, the increased testosterone is something that many women with polycystic ovarian syndrome have. And that can cause symptoms like contributing to infertility as well as hair growth in places we don't want it and acne. And it's also a major contributor to the weight gain. So Inositol can help regulate those hormonal levels. Also may help with mood. So Inositol has been shown to influence neurotransmitters like serotonin and dopamine. And there's some evidence that it potentially has a role, a supplementary role in treating depression and anxiety. Although there are a few cautions around that because possibly some people with bipolar disorder, it might increase their risk of mania. So it's still all a bit new. But so, you know, key benefits I think would be the restoration of ovulation and fertility in women with polycystic ovarian syndrome. Inositol can improve ovarian function and help promote regular ovulation. So that I think is a pretty important benefit, low-grade evidence that it can do this can help lower those androgen levels to an extent. Still unclear how much that actually clinically helps, but it is interesting and potentially has a role in weight loss. And mechanistically it makes sense because Inositol helps us burn fat. It helps the liver break down fatty acids. It helps improve insulin signalling and helps lower insulin resistance. So all of this could lead to improved fat metabolism and support that weight loss. So the evidence as to what actually happens in the real world with Inositol supplementation is still a bit unclear. So they're my summary of the benefits.
Dr Lucy Burns (22:37) Yeah. And I think it's interesting to always, again, reflect back on what happens in the real world. And we have a beautiful example of this with leptin, which is one of our hormones that is good for satiety. And again, leptin was only really discovered in the 1990s. So not, you know, we haven't known about it forever. I certainly didn't learn about it when I went through medical school in the eighties because we didn't know about it. And it's made by our fat cells and tells our brain, well, you know, Lucy's got enough fat stores. You don't need to keep eating. You don't need to keep looking for food. You know, it's good for satiety. So if you know that you would think more is better, obviously more satiety, great. Except that what the study, well, the studies didn't work. So that didn't translate into real life. And actually what we know is that too much of a good thing, you develop resistance to it. And so this is why mechanistically sometimes things sound so promising, but if they don't translate into the real world, well, they can actually not only not give you the benefit they want, but sometimes give you the opposite of what you're looking for, which is what happens with leptin resistance. So one of the tricky things we have with supplements is that they're drug trials, supplement trials, nutrition trials. They're so expensive. They are really, really expensive to run. They're time-consuming. There's a lot of methodology that needs to be accounted for. And so we don't always have the studies to support what we're looking for. And we may never get those studies either, which is a bit tricky.
Dr Mary Barson (24:32) It is tricky. So I mean, it is really hard. What do you do with this information? I think we should also just talk about the potential risks as well. Risks that we know about, are generally well tolerated, but gastrointestinal discomfort seems to come up a fair bit in the literature, bloating, nausea, and diarrhea. Some people experience that. Some people experience headaches and fatigue. As I mentioned before in rare cases, the worsening of thematic symptoms in people with bipolar disorder is probably just one to be aware of. And then I guess I suppose beyond that, we don't exactly know. There are trials looking at it for treatments or prevention of gestational diabetes in pregnant women. It seems to be well tolerated without any adverse effects in pregnancy. But I think what you should do with this information then is, this could be potentially something that is helpful, but it's a good idea to have a chat with your doctor and your treating team about it and treat it with respect. I think, don't pop it with lollies willy-nilly, treat it with respect and monitor how you go. And it might be that people need to do their own N equals one scientific experiment that you have to find yourself and say if it is helpful for you.
Dr Lucy Burns (25:54) Yeah, absolutely. And I think it's also worth recognising two things, one, the side effects for inositol are very similar to the side effects for berberine, very similar to the side effects for metformin. So there's obviously some mechanism in there that is part of its effect. They all produce similar outcomes, according to the limited studies we have on berberine and inositol, metformin, and many more studies available. So I wouldn't be taking all three at once. If you're thinking, oh, right, well, I've got PCOS, I can take metformin and inositol and berberine and that will help me improve my life. Might not. But as you said, you can absolutely, when you're taking a supplement, test and measure, that's how we really should be treating them. So as an example, you could, and again, this is, this is just an example. You could do a fasting insulin level, and start one of those three things. Then in three months time, measure your fasting insulin level or measure your HOMA-IR, which is better, which is a combination. It's a, so HOMA-IR is a formula that looks at fasting insulin and fasting glucose and plugs it into a formula and gives you a number that gives you your likelihood of insulin resistance. If the number is over two, you are insulin resistant, under two, you're not really. The bigger the number, the worse your insulin resistance essentially. So it's pretty good, it's not perfect, but it's a pretty good measure of improvement or not improvement. So if you were to take something, take it for three months and then there's no change, well, then stop taking it. You're wasting your money. If there's a change and it's better and you're happy with it, well, then you need to probably keep taking it because it only works while you take it. It's not something you can take for a month and then stop taking. So I think there are ways for individuals to measure whether a supplement or even a medication is valuable for them. That's it.
Dr Mary Barson (28:16) Yep. You have to be your own scientist.
Dr Lucy Burns (28:20) Sometimes. Sometimes. All right, my lovely friends, I think that's enough on the inositol. So inositol, I guess for polycystic ovarian syndrome, probably gets a yay for us if that's something that you want to treat. For everyone else, again, be your own scientist and decide whether it's worth it for you. There's certainly some potential. The side effect profile is reasonable and caveat, of course, with, well, there's not a lot of long-term data.
Dr Mary Barson (28:52) Yeah. So we're still learning more about this.
Dr Lucy Burns (28:56) Indeed. All right, my lovely friends, I think we'll skedaddle and see you all next week.
Dr Mary Barson (29:01) See ya.
Dr Lucy Burns (29:41) The information shared on the Real Health and Weight Loss Podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
