Alpha Lipoic Acid Efficacy in PCOS Treatment: What Is the Truth?

Abstract

Polycystic ovary syndrome (PCOS) is among the most common female endocrinopathies, affecting about 4–25% of women of reproductive age. Women affected by PCOS have an increased risk of developing metabolic syndrome, type 2 diabetes mellitus, cardiovascular diseases, and endometrial cancer. Given the pivotal role of insulin resistance (IR) in the pathogenesis of PCOS, in the last years, many insulin-sensitizing factors have been proposed for PCOS treatment. The first insulin sensitizer recommended by evidence-based guidelines for the assessment and treatment of PCOS was metformin, but the burden of side effects is responsible for treatment discontinuation in many patients. Inositols have insulin-mimetic properties and contribute to decreasing postprandial blood glucose, acting by different pathways. ALA is a natural amphipathic compound with a very strong anti-inflammatory and antioxidant effect and a very noteworthy role in the improvement of insulin metabolic pathway. Given the multiple effects of ALA, a therapeutic strategy based on the synergy between inositols and ALA has been recently proposed by many groups with the aim of improving insulin resistance, reducing androgen levels, and ameliorating reproductive outcomes in PCOS patients. The purpose of this study is to review the existing literature and to evaluate the existing data showing the efficacy and the limitation of a treatment strategy based on this promising molecule. ALA is a valid therapeutic strategy applicable in the treatment of PCOS patients: Its multiple actions, including antinflammatory, antioxidant, and insulin-sensitizing, may be of utmost importance in the treatment of a very complex syndrome. Specifically, the combination of MYO plus ALA creates a synergistic effect that improves insulin resistance in PCOS patients, especially in obese/overweight patients with T2DM familiarity. Moreover, ALA treatment also exerts beneficial effects on endocrine patterns, especially if combined with MYO, improving menstrual regularity and ovulation rhythm. The purpose of our study is to review the existing literature and to evaluate the data showing the efficacy and the limitations of a treatment strategy based on this promising molecule.

Dietary Patterns and Fertility

“…A correlation has been found between reduced insulin sensitivity and both reduced levels of Sex Hormone Binding Globulin (SHBG) and reduced androgen synthesis in PCOS and diabetic patients. On the contrary, the consumption of products with a high glycemic index may increase insulin resistance, dyslipidemia, and oxidative stress, which are factors that reduce fertility [17,18].…”

Impact of Nutrition on Female Reproductive Disorders

“…Polycystic Ovary Syndrome (PCOS) has been considered in two papers [15,16]. A deficiency in dietary fiber can be associated with a wide range of metabolic abnormalities and with an altered gut microbial ecosystem that can be associated with reproductive abnormalities, including PCOS.…”

“…In the second paper about PCOS, Guarano and colleagues reviewed the existing literature to report the efficacy and the limitations of alpha lipoic acid in PCOS treatment since alpha lipoic acid is considered a promising therapeutic strategy for this very complex syndrome due to its multiple actions, including anti-inflammatory, antioxidant, and insulinsensitizing [16].…”