Introduction
Information Sources
Biochemical Features in PCOS
Treatment Targets
Treatments
4-Star Treatments	Antiandrogens Metformin XR Actos   Avandia D-Chiro-Inositol NAC	Calcium Citrate   Vitamin D3 Lipoic Acid Chromium Polynicotinate EGCG EPA/DHA
3-Star Treatments	Oral Birth Control Pills Precose   Miglitol Magnesium Citrate	Vitamin K Cinnamon Biotin
2-Star Treatments	Oral Progesterone   Natural Progesterone Cream GLA D-Calcium Pantothenate  Pantethine Vitex Methylcobalamin   Vitamin B6   Folic Acid	Taurine Acetyl-L-Carnitine Flaxseed Lignans Soy Isoflavones Resveratrol Curcumin
1-Star Treatments	L-Arginine B-Complex Astaxanthin Gamma-Tocopherol Nicotinamide Calcium Pyruvate Garlic Extract American Ginseng Kidney Bean Extract Zinc L-Se-Methylselenocysteine	BGOV TMG Tocotrienols Vitamin C Coenzyme Q10 Glucosol Gymnema Sylvestre Vinegar Quercetin Manganese Potassium
Other Treatments	Exercise Lower Carb/Low Glycemic diet   Monounsaturated fats High fiber foods	Eat unrefined, whole foods Increased protein intake The Two Gram Cure
Avoid	CLA Bitter Melon Trans-Fats Saturated Fats	Fructose High glycemic carbs Licorice
Example Supplement Regimen #1
Example Supplement Regimen #2 (Powder)

Antiandrogens:
Star rating: ****

Antiandrogens are not covered in depth here, mainly because they have so many side effects, and this research is focused on agents that have evidence for being generally good for health. Of course, if you have PCOS and an antiandrogen improves your health, then it must be good. Antiandrogens have been shown to substantially improve virtually every symptom of PCOS. No other treatment is more effective for hirsutism. Nonetheless, they have their drawbacks. You must take an OCP with them because you don't want to get pregnant while taking antiandrogens. So, they are not an option if you are trying to get pregnant.

Flutamide (Eulexin) has many articles demonstrating liver damage and death. However, in almost every case they are at doses above 350mg/day. It's too bad because Flutamide is a terrifically potent antiandrogen. If you take it, you need to watch your liver closely. There is no doubt that it can greatly improve PCOS symptoms.

The enzyme your liver uses to process Flutamide is the same enzyme used to process caffeine, Prozac and Echinacea. It may be a good idea to avoid these, or anything that inhibits the CYP1A2 liver enzyme, if you are taking Flutamide. However, even though caffeine is metabolized by CYP1A2, it also increases the activity of CYP1A2 at the same time, and thus "caffeine increases its own metabolism". So, whether caffeine is good or bad to take with Flutamide is unclear. One study notes that "CYP1A2 index was 33% decreased in women who used oral contraceptives." Also, the antioxidant carotinoid, Astaxanthin has been shown to be a strong inducer of CYP1A1 and CYP1A2 liver enzymes. This implies Astaxanthin may help detoxify the byproducts of Flutamide. But, I have no idea if any of this matters in practice.

Spironolactone (Aldactone) is a good antiandrogen. It is safer than Flutamide, but typically a little less effective.

Finasteride (Proscar or Propecia) is a 5 alpha-reductase inhibitor that reduces dihydrotestosterone (DHT). It probably has the least side effects, and is the least effective, but studies show that it has merit.

Saw Palmetto extract (Serenoa Repens) may have effects similar to Finasteride. Two studies suggest it may be beneficial for hirsutism based on Saw Palmetto's ability to inhibit 5 alpha-reductase. A recent study comparing Saw Palmetto to Finasteride found Saw Palmetto was completely ineffective. Previous studies showed effectiveness, however.

Metformin XR: (Glucophage XR)
2000mg (take with B12 and Folate)
Star rating: ****

Metformin is a glucose lowering and insulin sensitizing drug for the treatment of diabetes. Metformin has been shown repeatedly in published studies to increase insulin sensitivity, lower androgens, lower C-Reactive Protein, lower PAI-1, and raise D-Chiro-Inositol and SHBG in PCOS. Numerous studies show improvement in most every PCOS symptoms with doses of 1500-2500mg. There are too many studies to list. Virtually every study on PCOS in the last 5 to 10 years discusses Metformin. Anecdotal reports in various PCOS forums suggest 2000mg or more may be necessary for some. Unfortunately, Metformin lowers folate and B12, and raises homocysteine and TNF-alpha. So, it would be wise to supplement Folate and B12, and possibly other homocysteine lowering agents, like B6, along with agents to lower TNF-alpha. Also, it may be unwise to supplement folate without B12, as folate can mask symptoms of B12 deficiency.

Often, benefits begin to appear after months, not weeks.

Metformin is a very safe drug. However, it does have some degree of toxicity. Kidney toxicity, and less commonly, liver toxicity, is possible.

Reference: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403.

In the study above, involving 3,234 people over an average of 2.8 years, Metformin (1700mg) alone was compared to a placebo, and to lifestyle intervention (diet & exercise). The results showed that lifestyle decreased the incidence of diabetes by 58%, and Metformin by 31%. So, Metformin was good, but diet and exercise was better. The only negative thing about Metformin in this study was the number of deaths:

Deaths (no./100 person-yr): Placebo:0.16 Metformin:0.20 Lifestyle:0.10

The increased deaths on Metformin were not considered statistically significant. But, it makes one wonder.

To avoid nausea, it may help to start with a low dose and increase the dose very slowly. Nausea often goes away with time. The 'XR' form may also help reduce nausea.

Metformin may also cause diarrhea. A study notes that, unlike nausea, diarrhea may occur later even when the dosage has been stable over a long period.

Actos: (Pioglitazone)
15-45mg
Star rating: ****

Avandia: (Rosiglitazone)
4-8mg Avandia
Star rating: ****

These are insulin sensitizing diabetic drugs. These have been shown repeatedly to increase insulin sensitivity, SHBG and other hormonal parameters, and improve PCOS symptoms. They were shown to decrease PAI-1. They can be used in combination with Metformin since they have a different mode of action. The combination has been shown to help PCOS subjects who were resistant to Metformin therapy alone.

These are a class of drug called thiazolidinediones. Actos and Avandia appear to be safer than another discontinued thiazolidinedione, Rezulin. This class of drug is relative new. They are prescribed less often than Metformin for a couple reasons. There are still fears of toxicity and unknown long-term side effects. Also, these drugs do not appear to improve weight as Metformin can, and there may be weight gain with Avandia.

References:
Effect of pioglitazone treatment on the adrenal androgen response to corticotrophin in obese patients with polycystic ovary syndrome. Hum Reprod. 2004 Mar;19(3):534-9. Epub 2004 Feb 12.
Enhanced granulosa cell responsiveness to follicle-stimulating hormone during insulin infusion in women with polycystic ovary syndrome treated with pioglitazone. J Clin Endocrinol Metab. 2003 Dec;88(12):5624-31.
Pioglitazone and metformin in obese women with polycystic ovary syndrome not optimally responsive to metformin. Hum Reprod. 2003 Aug;18(8):1618-25.
Selective effects of pioglitazone on insulin and androgen abnormalities in normo- and hyperinsulinaemic obese patients with polycystic ovary syndrome. Hum Reprod. 2003 Jun;18(6):1210-8.
Correction of insulin resistance and hyperandrogenism in polycystic ovary syndrome by combined rosiglitazone and clomiphene citrate therapy. J Soc Gynecol Investig. 2003 Feb;10(2):99-104. 
[Effect of rosiglitazone on insulin resistance and hyperandrogenism in polycystic ovary syndrome] Zhonghua Fu Chan Ke Za Zhi. 2002 May;37(5):271-3.
Improvement in insulin sensitivity followed by ovulation and pregnancy in a woman with polycystic ovary syndrome who was treated with rosiglitazone. Fertil Steril. 2001 Nov;76(5):1057-9.

D-Chiro-Inositol:
1200mg
Star rating: ****

This is shown in several studies to improve insulin sensitivity and PCOS symptoms. Why did the owner of the patent on its use for PCOS, Insmed, decide not to market it? This is Insmed's statement on record:

"In recently completed clinical trials in patients with PCOS, INS-1 [(D-Chiro-Inositol)] was safe and well tolerated but did not achieve statistical significance on its primary efficacy measures. Although an overall increase in ovulation rates was not achieved, an increased number of pregnancies occurred in the INS-1 treated patients."

This is really all we know. This was surprising since there are several other studies which suggested it was effective, including Insmed's previous phase I and IIa studies which involved more than 1000 subjects. Off record, the company is rumored to be trying to market DCI as a dietary supplement. Also, the doctor who discovered DCI's involvement in insulin action, Dr. Joseph Larner, told me by email that he is trying to make it available as a dietary supplement. The company is also reported to have said, off record, that the reason to discontinue DCI was a business decision.

I suspect that the business decision to discontinue FDA approval may be because it is not more effective than Metformin. Maybe because you could take 3x the amount of Pinitol and get the same effect. Drug companies want a drug they can make a fortune on, and they won't waste their resources on drugs that are very good but not spectacular. There are many examples of drug companies doing this. It does not mean DCI is ineffective.

Often (in studies that showed effectiveness), benefits began to appear after months, not weeks, as is the case with Metformin.

D-Chiro-Inositol is something that your body makes. Some foods have it, but in minute amounts unless it is concentrated. The body will convert myo-inositol (the common form of inositol) to DCI. There is one study and one patent that suggests myo-inositol can help with insulin sensitivity too. But, it is also known that those with diabetes and PCOS are often inefficient at converting myo-inositol to D-Chiro-Inositol. This results in a higher ratio of myo-inositol to D-Chiro-Inositol.

Pinitol (methyl-D-chiro-inositol), the methyl form of DCI, appears to be converted 33% to DCI. So, if you supplement with Pinitol, that suggests you should take 3600mg in order to get the equivalent of 1200mg DCI.

Reference: Ovulatory and metabolic effects of D-chiro-inositol in the polycystic ovary syndrome. N Engl J Med. 1999 Apr 29;340(17):1314-20.

Quote: "D-Chiro-inositol increases the action of insulin in patients with the polycystic ovary syndrome, thereby improving ovulatory function and decreasing serum androgen concentrations, blood pressure, and plasma triglyceride concentrations."

More References:
Role of inositolphosphoglycan mediators of insulin action in the polycystic ovary syndrome. J Pediatr Endocrinol Metab. 2000;13 Suppl 5:1295-8.
D-chiro-inositol--its functional role in insulin action and its deficit in insulin resistance. Int J Exp Diabetes Res. 2002;3(1):47-60.
Insulin-like effect of pinitol. Br J Pharmacol. 2000 Aug;130(8):1944-8.
Insulin-sensitising drugs (metformin, troglitazone, rosiglitazone, pioglitazone, D-chiro-inositol) for polycystic ovary syndrome. Cochrane Database Syst Rev. 2003;(3):CD003053.
chiro-inositol deficiency and insulin resistance: a comparison of the chiro-inositol- and the myo-inositol-containing insulin mediators isolated from urine, hemodialysate, and muscle of control and type II diabetic subjects. Proc Natl Acad Sci U S A. 1993 Jul 1;90(13):5924-8.
Antihyperglycemic effects of 3-O-methyl-D-chiro-inositol and D-chiro-inositol associated with manganese in streptozotocin diabetic rats. Horm Metab Res. 2000 Apr;32(4):129-32.
D-chiro-Inositol enhances effects of hypothalamic toxin gold-thioglucose. Brain Res. 2003 Dec 12;993(1-2):172-6.
Metformin therapy increases insulin-stimulated release of D-chiro-inositol-containing inositolphosphoglycan mediator in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2004 Jan;89(1):242-9.
Buckwheat concentrate reduces serum glucose in streptozotocin-diabetic rats. J Agric Food Chem. 2003 Dec 3;51(25):7287-91.
Dietary myoinositol results in lower urine glucose and in lower postprandial plasma glucose in obese insulin resistant rhesus monkeys. Obes Res. 1996 Nov;4(6):569-75.
Chiroinositol deficiency and insulin resistance. II. Acute effects of D-chiroinositol administration in streptozotocin-diabetic rats, normal rats given a glucose load, and spontaneously insulin-resistant rhesus monkeys. Endocrinology. 1993 Feb;132(2):646-51.
Differential effects of troglitazone and D-chiroinositol on glucosamine-induced insulin resistance in vivo in rats. Metabolism. 1999 Nov;48(11):1418-23.

NAC: (N-Acetyl-Cysteine)
1800mg (take with zinc, and possibly molybdenum)
Star rating: ****

NAC is the acetylated form of the amino acid L-Cysteine. It has a study showing benefit in PCOS at 1800mg. NAC has many other studies showing benefit in diabetes. It can improve insulin sensitivity. It lowers TNF-alpha, suppresses MMP-2 and MMP-9 and inhibits VEGF. It increases Glutathione. It is a potent antioxidant. It can reduce homocysteine. It is a good idea to take amino acids on an empty stomach so they will not compete for absorption with other protein.

As of this date, there are no adequate studies of NAC administration in pregnancy.

There are at least three human studies that used 1800mg NAC which showed positive results. The first study listed below found that doses below 1200mg were beneficial, but in healthy people, 1200mg acted as a pro-oxidant and may lower glutathione. However, other studies at these doses and higher, including ones that post-date that study, found the opposite effect. Furthermore, PCOS is associated with an increased oxidative state, and if NAC can improve the parameters in PCOS, then it seems likely it would lower that oxidative stress caused by PCOS.

NAC may increase urinary zinc excretion. A molybdenum deficiency (which is very rare) can cause an accumulation of sulfite from the catabolism of L-cysteine. So, it may be a good idea to supplement zinc and molybdenum with NAC, just to insure you aren't deficient.

References: Effects of oral N-acetylcysteine on cell content and macrophage function in bronchoalveolar lavage from healthy smokers. Eur Respir J. 1988 Jul;1(7):645-50.
N-acetyl-cysteine treatment improves insulin sensitivity in women with polycystic ovary syndrome. Fertil Steril. 2002 Jun;77(6):1128-35.

Quote:"Insulin [area under curve] after [oral glucose tolerance test] was significantly reduced, and the peripheral insulin sensitivity increased after NAC administration, whereas the hepatic insulin extraction was unaffected. The NAC treatment induced a significant fall in T levels and in free androgen index values. In analyzing patients according to their insulinemic response to [oral glucose tolerance test], normoinsulinemic subjects and placebo-treated patients did not show any modification of the above parameters, whereas a significant improvement was observed in hyperinsulinemic subjects. CONCLUSION(S): NAC may be a new treatment for the improvement of insulin circulating levels and insulin sensitivity in hyperinsulinemic patients with polycystic ovary syndrome."

Calcium Citrate:
1500mg
Star rating: ****

Vitamin D3: (Cholecalciferol)
1000IU
Star rating: ****

A study using Calcium and Vitamin D showed improved PCOS symptoms. Their are many other studies on using both together, and using them independently which show improvement in diabetes, insulin resistance, hyperinsulinemia, and glucose tolerance. Several studies show impressive weight loss with calcium supplementation. Vitamin D is also effective at lowering TNF-alpha. Vitamin D deficiency increases C-Reactive Protein, MMP-9 and MMP-2. Calcium may also be helpful in treating PMS.

Coral calcium, which also contains magnesium, has gotten a lot of hype but so far there is no evidence that it is better absorbed or has any other benefits over the citrate or some other forms which are proven to be well absorbed. If you are allergic to shellfish, the Mayo Clinic says coral calcium can trigger an allergic reaction. Some people claim there is a potential for coral to contain heavy metals. Low levels of lead were measured in some samples of coral calcium, but they were within FDA limits.

Calcium is not absorbed very well, in general. The absorption of Calcium Bisglycinate (44% absorption) > Calcium Citrate Malate (CCM) (36%) > Calcium Citrate (24%) > Calcium Carbonate (23%) > Hydroxyapatite (17%) > Calcium Hydoxide/Oxide (10%). You can't really compare the percents listed here because some of them are the percent absorption with meals and others were measured on an empty stomach. But, it should give you a rough idea. There is some evidence that Calcium carbonate cannot be absorbed and utilized until it is converted to calcium chloride in the stomach, and using stomach acid to convert it will interfere with B12 absorption and digestion of foods. The absorbability of calcium citrate is between 20% and 100% better than calcium carbonate, depending on who you ask.

A study in JAMA found that calcium absorption from supplements increases about 10% when taken with meals. However, this may be less of a factor with Calcium Citrate than to other forms, as Citrate basically comes with its own acid to aid digestion.

You should try to take 500mg or less at a time. The more you take at once, the less you absorb. You can take more, but absorption becomes less and less efficient. Taking calcium with meals may also reduce the risk of kidney stones.

Reference: Vitamin D and calcium dysregulation in the polycystic ovarian syndrome. Steroids. 1999 Jun;64(6):430-5.

Quote: "Vitamin D repletion with calcium therapy resulted in normalized menstrual cycles within 2 months for seven women, with two experiencing resolution of their dysfunctional bleeding. Two became pregnant, and the other four patients maintained normal menstrual cycles. These data suggest that abnormalities in calcium homeostasis may be responsible, in part, for the arrested follicular development in women with PCO and may contribute to the pathogenesis of PCO."

Lipoic Acid: (Alpha Lipoic Acid)
900mg (take with Biotin)
Star rating: ****

Many studies show improved insulin sensitivity at doses of 600-1800mg. Lipoic acid lowers TNF-alpha and suppresses MMP-9 and prevents increased VEGF. In some studies, doses below 600 were found to be ineffective, where higher doses were effective. It is a terrific antioxidant. The other benefits are too numerous to list. This is sometimes characterized as an insulin mimic. If it is available, R-Lipoic Acid would be a better choice, and a lower dose could be used. Lipoic Acid can compete with biotin, so you should probably take extra biotin with this. Lipoic acid has a short half-life and a couple studies suggest that sustained release tablets may have an advantage.

Several studies show that when GLA is combined with Lipoic Acid it strongly enhanced the glucose lowering and insulin sensitizing effects beyond using either one individually.

Chromium Polynicotinate:
1000mcg (1mg)
Star rating: ****

Many studies show strong evidence of improved insulin sensitivity. Chromium may reduce fasting insulin levels. Several studies show increased fat loss, yet other studies found no effect on weight. Deficiency can cause insulin resistance. Chromium may lower total cholesterol and LDL-cholesterol. Chromium may have synergy when taken with Biotin. Several studies show no effect from 200mcg per day, while studies on 800 to 1000mcg have shown effect.

In vitro studies and high-dose in vivo animal studies found Chromium Picolinate (as opposed to Polynicotinate) increased chromosomal damage. Other forms of Chromium were shown not to cause this DNA damage. However, in vivo human studies using various measures of DNA damage have not yet found Chromium Picolinate to cause this DNA damage. If you choose to take Chromium, you might as well avoid the Picolinate form and instead take the Polynicotinate, GTF, or Chelavite (glucose-tolerance-factor, chromium-niacin, or chromium-niacin-amino acid chelate) forms. The Chelavite form may be the most absorbable form.

EGCG: (epigallocatechin gallate from green tea)
270mg
Star rating: ****

Many studies show improved insulin sensitivity. It lowers TNF-alpha and MMP-2 and MMP-9. It is a terrific antioxidant. It may increase SHBG. Study shows 90mg taken 3 times per day resulted in impressive weight loss.

Every Green Tea extract will have a different concentration of EGCG. Some Green Tea extracts are only 10% EGCG. Whole green tea will contain much less. And just so you are aware, some contain caffeine and some are (mostly) decaffeinated.

EPA/DHA: (Eicosapentaenoic Acid/Docosahexaenoic Acid from fish oil)
1.8gm EPA, 1.2gm DHA
Star rating: ****

Many studies show increased insulin sensitivity, decreased TNF-alpha, MMP-2, MMP-9 and other inflammatory cytokines, improved blood lipids. Numerous studies show improvement with omega-3 fatty acids in depression. The benefits are too numerous to list.

All omega-3 oils are not the same. There are a huge number of studies showing a huge range of benefits from fish oil and especially from the EPA and DHA fatty acids. Other oils, like flaxseed oil, have far less evidence of benefits, and nowhere near the degree of benefit seen from fish oil. Despite being an omega-3 oil, Flax does not contain the omega-3 fatty acids EPA and DHA found in fish oil. Many studies show benefits from these specific isolated fatty acids. Flax primarily contains the omega-3 fatty acid alpha-linolenic acid which is partly converted to EPA by the body, and virtually none is converted to DHA. The EPA created by taking Flax can have some of the same benefits as Fish oil. However, fish oil will more effectively raise blood levels of EPA, and fish oil includes DHA which has shown similar, and distinct benefits. Flax lignands (found in flaxseeds not pure flax oil) may have additional benefits, however.

Taking too much will be counterproductive. It is a fat, after all.

It's probably best to take a fish oil concentrate to increase the amount of EPA and DHA in the fish oil and avoid excess vitamin A and D. Some supplements have names like "Max EPA" or "Super EPA". Using a concentrate will require far fewer pills than whole fish oil.

There have been no reports of serious adverse events in those taking EPA supplements, even up to 15 grams daily, for prolonged periods of time. Those side effects that have been reported include mild gastrointestinal upsets such as nausea and diarrhea, halitosis, eructation, "fishy" smelling breath, skin and even urine. The blood-thinning effects can cause occasional nosebleeds and easy bruising. For many people, the gastrointestinal side effects often disappear after a few weeks. It is often recommended to start with one pill per day, and very slowly increase the number of pills over weeks.

Oral Birth Control Pills:
Star rating: ***

OCPs are not covered in-depth here either. There are some good ones that are more antiandrogenic than others. Some have evidence of increased insulin resistance, which you don't want. So, you need to shop around if you want this treatment. They are not worthless if you choose one that is antiandrogenic. They can actually help with almost every symptom. Unfortunately, these may raise C-Reactive Protein and deplete Vitamin C.

Precose: (Acarbose)
50-100mg/meal
Star rating: ***

Miglitol: (Glyset)
50-100mg/meal
Star rating: ***

These prescription drugs have been shown to be effective in the treatment of PCOS by decreasing glucose load which resulted in decreased insulin response, lower androgens and LH, and increased SHBG. These drugs slow the digestion of starches you eat by inhibiting alpha-glucosidase. You take them with the first bite every meal. You typically start out at a low dose until you get used to it and work up to 50-100mg per meal. Side effects were frequent abdominal distension, diarrhea and flatulence. Side effects may lessen over time.

If you take these drugs it is important to understand that they will slow down the digestion of most starches and complex sugars, but not glucose, fructose or corn starch.

References:
Acarbose reduces elevated testosterone serum concentrations in hyperinsulinaemic premenopausal women: a pilot study. Hum Reprod. 1996 Nov;11(11):2377-81.
Clinical, endocrine and metabolic effects of acarbose, an alpha-glucosidase inhibitor, in PCOS patients with increased insulin response and normal glucose tolerance. Hum Reprod. 2001 Oct;16(10):2066-72.

Quote:"This is the first report showing a reduction of the acne/seborrhoea score in hyperinsulinaemic patients with PCOS treated with acarbose. This improvement was associated with a significant decrease of the insulin response to oral glucose load and of LH and androgen serum concentrations and with a significant rise of sex hormone binding globulin concentration."

Magnesium Citrate:
1000mg
Star rating: ***

A study shows Magnesium deficiency in PCOS. There are many studies showing improvement in diabetes, hyperinsulinemia, and impaired glucose tolerance with doses of 500-2500mg. Deficiency can increase MMP-2 and MMP-9 activity, and TNF-alpha. A ratio of 2:1 (calcium to magnesium) is often recommended. In diabetes, and this probably includes PCOS, the recommendation is that the ratio should be closer to 1:1.

Several studies show magnesium levels to be significantly reduced in depressed patients. Also, the calcium:magnesium ratio is often increased in depression. It has been shown to help treat several PMS symptoms, including mood changes.

Magnesium can act as a laxative. If you plan to start a high dose, it may be a good idea to start slow. Things that can affect the digestive system are often good to start slow. It seems the digestive system does not like to be shocked with abrupt changes.

Vitamin K:
500mcg
Star rating: **

Vitamin K has been shown to be improve glucose tolerance, but the evidence is scant. Vitamin K is often taken with calcium and vitamin D for osteoporosis, and to keep calcium in the bones and not in blood vessels. It may be a good idea to take this if you are supplementing with calcium and vitamin D. Low vitamin K intake has been shown to induce a poor early insulin response, and late hyperinsulinemia. Doses range from 100mcg to 10mg. There does not seem to be consensus on what the best dose is. The average diet gets between 300 and 500mcg per day.

Cinnamon:
1/2 teaspoon
Star rating: ***

The active chemical in Cinnamon is MHCP or methylhydroxychalcone polymer. This has been shown to lower blood glucose levels. Cinnamon has been in the news recently, but it has been known about for some time. The cinnamon used in the 2003 study in Diabetes Care was actually Cassia (Cinnamomum cassia) and not "true" cinnamon (Cinnamomum zeylanicum, or Cinnamomum verum). According to reports, the authors said the active agent is in all varieties sold as the spice. Cassia is cheaper and more common in the US. In the US, but not every country, Cassia is allowed to be sold and called Cinnamon. The authors suggested that 1/4 to 1 teaspoon daily may be useful for type 2 diabetes, but it's too soon to know for sure. Specifically, the study used 1, 3 or 6 grams of cinnamon, and all doses showed a response within weeks. It's recommended not to use cinnamon while pregnant, but I don't know why.

Cinnamon was also found to lower triglycerides, LDL cholesterol, and act as an antioxidant.

References:
Cinnamon Extract Prevents the Insulin Resistance Induced by a High-fructose Diet. Horm Metab Res. 2004 Feb;36(2):119-25.
Isolation and characterization of polyphenol type-A polymers from cinnamon with insulin-like biological activity. J Agric Food Chem. 2004 Jan 14;52(1):65-70.
Antihyperglycaemic effect of Cassia auriculata in experimental diabetes and its effects on key metabolic enzymes involved in carbohydrate metabolism. Clin Exp Pharmacol Physiol. 2003 Jan-Feb;30(1-2):38-43.
Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes. Diabetes Care. 2003 Dec;26(12):3215-3218.
Cinnamon extract (traditional herb) potentiates in vivo insulin-regulated glucose utilization via enhancing insulin signaling in rats. Diabetes Res Clin Pract. 2003 Dec;62(3):139-48.
Effect of Cassia auriculata Linn. on serum glucose level, glucose utilization by isolated rat hemidiaphragm. J Ethnopharmacol. 2002 May;80(2-3):203-6.
A hydroxychalcone derived from cinnamon functions as a mimetic for insulin in 3T3-L1 adipocytes. J Am Coll Nutr. 2001 Aug;20(4):327-36.
Insulin-like biological activity of culinary and medicinal plant aqueous extracts in vitro. J Agric Food Chem. 2000 Mar;48(3):849-52.
Regulation of PTP-1 and insulin receptor kinase by fractions from cinnamon: implications for cinnamon regulation of insulin signalling. Horm Res. 1998 Sep;50(3):177-82.
Insulin potentiating factor and chromium content of selected foods and spices. Biol Trace Elem Res. 1990 Mar;24(3):183-8.
Insulin activity: stimulatory effects of cinnamon and brewer's yeast as influenced by albumin. Horm Res. 1992;37(6):225-9.

Biotin:
10,000mcg (10mg)
Star rating: ***

Many studies show improved glucose tolerance and improved insulin sensitivity at doses of 8-16mg. These doses are much larger than you will find in a multivitamin. When taking large doses of any one B vitamin, it's a good idea to take the rest of the B-complex with it. It may be a good idea to supplement with Biotin if you are taking either Lipoic Acid or Vitamin B5.

Oral Progesterone:
Star rating: **

Natural Progesterone Cream:
100mg twice a day as directed
Star rating: **

I could not find many clear descriptions of its benefits or what improvements to expect in PCOS symptoms. Many people are enthusiastic about Natural Progesterone Cream and find it very helpful, and those people would give it a higher rating than I did.

Oral Progesterone appeared to work better in one study that compared the Cream and Oral forms, but that may have been only because of the dose of cream used. There is evidence that both can lower LH and increase SHBG. There is some evidence that they may improve insulin levels as well. Several studies suggest it does not improve androgen levels. It has potential to help with many PCOS symptoms. It appears most useful for inducing ovulation and improving menstrual regularity. A study that used the cream at 100mg twice a day appeared to work better than 50mg twice a day. But, you don't use Progesterone every day of the month. If you plan to use this, you will need more information than is discussed here.

I am not a big fan of this treatment, partly because the theory of Progesterone deficiency does not appeal to me as much as the theory of reduced sensitivity to progesterone and estrogen. Personally, I would rather treat the sensitivity problem rather than treating it as a deficiency. But, I could be wrong.

Reference: Vaginal progesterone administration in physiological doses normalizes raised luteinizing hormone levels in patients with polycystic ovarian syndrome Gynecol Endocrinol. 1992 Dec;6(4):275-82.

Quote: "The mean serum LH concentration had fallen significantly after 8 days of treatment, and continued to fall progressively until the end of progesterone administration. Serum LH concentrations had fallen into the normal follicular phase range by 14 days."

GLA: (Gamma-Linolenic Acid found in Borage Oil or Evening Primrose Oil)
140mg (from 1gm Borage oil; take with Fish Oil and Lipoic Acid)
Star rating: **

GLA is an omega-6 fatty acid normally made by the body by converting linoleic acid. Several studies show that when GLA was combined with Lipoic Acid it strongly enhanced the glucose lowering and insulin sensitizing effects beyond using either one individually. The strongest argument for its use in PCOS is in this combination with Lipoic Acid.

There are conflicting studies on whether or not GLA by itself can increase insulin sensitivity. GLA can inhibit TNF-alpha and other inflammatory cytokines, which should, in theory, help improve insulin sensitivity, and is probably good for PCOS in any case. Several studies show benefit for diabetic neuropathy. When used alone, GLA may worsen lipid profiles. GLA has shown benefit in treating PMS in some studies. In other studies it has shown no benefits in PMS.

If you take GLA, you might want to take an EPA/DHA fish oil supplement with it. A recent study suggested a slight increase in mammary carcinogenesis with GLA alone, but not when taken with fish oil. (Fish oil alone reduced the risk of mammary carcinogenesis.) Other studies suggested GLA may have anticancer effects.

Several studies suggest GLA can act as a 5 alpha-reductase inhibitor, and thus lower DHT. However, those studies used free fatty acids, and were either in vitro or topically applied to skin. Digesting borage oil or evening primrose oil has no evidence of acting as a 5-alpha reductase inhibitor. 

D-Calcium Pantothenate: (Pantothenic Acid; Vitamin B5)
2-10gm (3,0000-10,000mg) (take with Biotin)
Star rating: **

This has been shown to lower blood lipids, increase fat loss, and dramatically improve acne at doses of 3-15gm. It may also improve insulin sensitivity, and inhibit TNF-alpha. These doses are much higher than the RDI. High-doses of B5 can lower Biotin. Besides that, the only known side effect of pantothenic acid at any dose is possible diarrhea. There is no known toxic dose of pantothenic acid.

B5 deficiency can cause depression and inadequate amounts of the brain chemical acetylcholine. B5 is needed for hormone formation. The argument made in some of the studies is that Pantothenic acid is used by the body to make coenzyme-A. Coenzyme-A is necessary for lipid metabolism, and for hormone formation. Hormone formation is a high priority for the body, and the body will basically steal B5 away from other functions, like processing oil in your skin. If the theory is correct, since the body is making extra high levels of several hormones in PCOS, it may make sense that stores of B5 would be low.

The adrenal glands also require Coenzyme-A. Large amounts of B5 are stored in the adrenal glands. Stress can deplete the body of B5. B5 may be useful in treating adrenal insufficiency, which may be associated with PCOS.

B5 is a popular treatment discussed in acne forums, and the alt.skincare.acne newsgroup. It's efficacy and safety has been hotly debated over the last couple years. Some are very enthusiastic about it. Others are wary of it safety based on the fact that there are no multi-year long studies at these doses. There are only a couple studies, lasting less than a year that were not terribly in-depth.

If you use B5, you will need to adjust your dose to your body. If your acne has cleared at 2gm, then you may be able to take even less. If your acne does not clear at 2gm, you may need more. After awhile at a dose that works, a lower maintenance dose may be possible, so you could try a lower dose again after some time.

Calcium Pantothenate is not pure Pantothenic Acid. It is Calcium and Pantothenic Acid. If you take this, and are taking Calcium, be aware that Calcium Pantothenate contains 8.5% Calcium and 92% Pantothenic Acid. For each 1mg of Pantothenic Acid from Calcium Pantothenate there is 0.093mg of calcium.

References:
Pantothenic acid deficiency as the pathogenesis of acne vulgaris. Med Hypotheses. 1995 Jun;44(6):490-2.
A Stone That Kills Two Birds: Pantothenic Acid in the Treatment of Acne Vulgaris and Obesity. J Orthomol Med. 1997 Apr;12(2):99-114.
Pantothenic acid as a weight-reducing agent: fasting without hunger, weakness and ketosis. Med Hypotheses. 1995 May;44(5):403-5.
The activity of HMG-CoA reductase and acetyl-CoA carboxylase in human apocrine sweat glands, sebaceous glands, and hair follicles is regulated by phosphorylation and by exogenous cholesterol. J Invest Dermatol. 1998 Jul;111(1):139-48.
Effect of pantothenic acid deficiency on insulin sensitivity and response to ACTH of intact and diabetic rats. Endocrinology. 1956 Apr;58(4):427-34.
Hypolipidemic effect of pantothenic acid derivatives in mice with hypothalamic obesity induced by aurothioglucose. Exp Toxicol Pathol. 2001 Oct;53(5):393-8.

Pantethine:
800mg
Star rating: **

Pantethine is described as the active form of Pantothenic Acid (Vitamin B5). The body creates Pantethine from Pantothenic Acid. Pantethine is necessary for the metabolism of carbohydrates, proteins, and most importantly, fats. Several studies have shown that Pantethine can significantly lower levels of both cholesterol and triglycerides at doses of 600-1200mg. Though there are no studies directly showing increased insulin sensitivity from Pantethine, there are studies showing that when blood lipids level improve, it results in higher insulin sensitivity.

If it means anything, Atkins includes Pantethine in many of their supplement products.

Pantethine, which is a more direct precursor to coenzyme-A, may share many of the same benefits of Vitamin B5, including improvement in acne and adrenal insufficiency. However, anecdotal reports are that Pantethine is not as effective for acne as high-dose B5.

Unfortunately, Pantethine is expensive. 

Vitex: (Agnus Castus; Chasteberry; Chaste Tree)
Star rating: **

There are many enthusiastic users of Vitex who would give it a higher rating. Studies show it can increase LH, lower FSH, and thus raise progesterone. The raised progesterone raises the progesterone/estrogen ratio which may improve menstrual regularity and ovulation. Some experts argue that in the case of PCOS, Vitex works more by normalizing hormone levels than by simply increasing LH. It has also shown to help PMS symptoms. One study found reduced acne. The common advice is that this herb starts to work slowly over months.

Vitex has also been shown to lower prolactin, which is increased in PCOS and may be partly responsible for infertility. There is evidence that Vitex decreases prolactin by virtue of it being a dopamine agonist. Prescription dopamine agonists like bromocriptine or cabergoline, have been shown to help induce ovulation, but they are not very effective at treating PCOS overall.

The reason I did not give this a higher rating is the lack of evidence of weight loss, improved hirsutism, insulin sensitivity, or lowered insulin levels. Also, it may increase LH which is already increased in PCOS and lower FSH which is already decreased in PCOS. But, again, its been suggested that Vitex may not work this way in PCOS. Nonetheless, it appears to have benefits, and it may be that some of the benefits simply have not been studied yet.

Interestingly, Vitex appears to stimulate melatonin secretion, which suggests that it could make a person sleepy.

Methylcobalamin: (Vitamin B12)
1mg
Star rating: **

Folic Acid: (Folate)
1000mcg (1mg)
Star rating: **

Vitamin B6:
100mg
Star rating: **

Several studies show elevated homocysteine in PCOS. B12, Folic Acid and B6 all work to lower Homocysteine. Metformin further increases homocysteine and is shown to lower B12 and Folic Acid.

Homocysteine is neurotoxic and accumulates in several neurological disorders. B12, B6 and especially folic acid have all been shown to help treat neurological disorders, including depression.       

Taurine:
2000mg (2gm) (take with NAC)
Star rating: **

Several studies show improved insulin sensitivity in animal models. Taurine can act as an antioxidant. It can decrease TNF-alpha and VEGF. It is neuroprotective. Taurine is lower in diabetics. Although the evidence is weak, it can increase the production of serotonin, and may be effective at treating bipolar disorder, depression, and anxiety. It has a claming effect on the nervous system. One study suggests that if you take Taurine, you should take it with NAC. Because, on one measure of oxidation, Taurine by itself showed neutral or negative results, but when combined with NAC it was more beneficial than with NAC alone. It is a good idea to take amino acids on an empty stomach so they will not compete for absorption with other protein.

Reference: N-acetylcysteine and taurine prevent hyperglycemia-induced insulin resistance in vivo: possible role of oxidative stress. Am J Physiol Endocrinol Metab. 2003 Oct;285(4):E744-53. Epub 2003 Jun.

Acetyl-L-Carnitine:
1000mg (1gm) (take with Lipoic Acid)
Star rating: **

Many studies show increased insulin sensitivity. It can increase energy and fat loss, and lower TNF-alpha. It may be useful in depression and improving cognitive performance. Diabetics are often deficient in Carnitine, so it's likely lowered in PCOS as well. It is a good idea to take amino acids on an empty stomach so they will not compete for absorption with other protein. An animal study shows that Acetyl-L-Carnitine increased ROS (Reactive Oxygen Species) production in older animals. Lipoic Acid was shown to prevent the increased oxidative stress caused by Acetyl-L-Carnitine. If you choose to take this, it may be a good idea to also take Lipoic Acid.

Flaxseed Lignans:
Star rating: **

These are phytoestrogens. This is not flaxseed oil, though you can find high-lignan oil. A study found "Three anovulatory cycles occurred during the 36 control cycles, compared to none during the 36 flax seed cycles." Lignans may increase SHBG. They may be 5 alpha-reductase inhibitors, although the evidence is not strong. These may have many of the same benefits as soy isoflavones.

Soy Isoflavones:
Star rating: **

These are phytoestrogens. There is evidence these can increase SHBG. They may inhibit TNF-alpha. Soy Isoflavones have been studied for prevention of breast cancer. However, there are few studies on their possible benefits in PCOS. One study shows it may contribute to menstrual irregularity. Most of the benefits are antidotal, but that may only mean the science needs to catch up.

Resveratrol:
20mg
Star rating: **

Many studies show Resveratrol lowers TNF-alpha and suppresses MMP-2 and MMP-9. It is an excellent antioxidant.

Curcumin:
1600mg
Star rating: **

This is a potent anti-inflammatory. It reduces TNF-alpha, and down regulates MMP-9 and MMP-2. It has anticancer effects. It is an excellent antioxidant. Perhaps its biggest drawback is that it is very poorly absorbed. Taking it with piperine has been shown to dramatically improve absorption, and then a lower dose could be used.

L-Arginine:
2000mg (2gm)
Star rating: *

Several studies show increased insulin sensitivity and other improvements in diabetic conditions. In some cases it may decrease TNF-alpha. Arginine is a precursor to nitric oxide. Nitric oxide is a chemical messenger used in many reactions in the body. Having extra nitric oxide available for your body to make when it needs it can have a positive impact on many conditions. It is a good idea to take amino acids on an empty stomach so they will not compete for absorption with other protein.

This is probably more useful if you have high blood sugar. Hyperglycemia depletes SOD and nitric oxide and arginine. Supplementing arginine has been shown to reverse the inhibition of high glucose on nitric oxide production.

B-Complex:
Balanced formula
Star rating: *

It's a good idea to supplement the entire B-complex when supplementing any individual B vitamins. Most of the B vitamins may be useful in treating depression.

Astaxanthin:
4mg
Star rating: *

Astaxanthin is a carotenoid with strong antioxidant activity. It has also been shown to have strong antiinflammatory activity and to inhibit TNF-alpha and suppress I-kappa B kinase activity. It was shown to lower LDL and raise HDL cholesterol. It may also be neuroprotective. There is some evidence that it may have anticancer activity.

Gamma-Tocopherol: (Gamma E, Vitamin E)
800mg (mixed tocopherols with greater than 50% Gamma-tocopherol)
Star rating: **

Vitamin E, especially Gamma E, has been shown to improve glycemic control, reduce TNF-alpha, decrease PAI-1, and reduce C-Reactive Protein. Vitamin E deficiency can increase MMP-2 and MMP-9 activity. It is a very good antioxidant. In one study Vitamin E was shown to protect hypothalamic beta-endorphin neurons from estradiol neurotoxicity, which may be an issue in PCOS.

Nicotinamide: (Niacin; Vitamin B3)
250mg
Star rating: *

Nicotinamide is a no-flush form of the B vitamin Niacin. The other form of Niacin is Nicotinic Acid. Nicotinamide may have benefits for PCOS distinct from Nicotinic Acid.

Nicotinamide has been demonstrated, in one study, to affect glucose tolerance and slowing down diabetes progression. However, these benefits may only apply to type-1 diabetes.

Among other benefits, Nicotinamide has been shown to have antioxidant activity. Nicotinamide has demonstrated a number of anti-inflammatory activities. Nicotinamide has been shown to inhibit TNF-alpha. Nicotinamide may have a calming effect and help with anxiety.

In one study, high doses of Niacin (1gm or more) were shown to increase Homocysteine.

Calcium Pyruvate:
10gm (10,000mg) (Contains aprox. 7,800mg Pyruvate and 1,700mg Calcium)
Star rating: *

Calcium Pyruvate has some evidence of increased insulin sensitivity, fat loss, and lipid lowering effects. It may also have a positive effect on mood. The evidence is not strong for any of its reported effects. Some human studies show no effect. In studies that did show an effect on weight, the results were not impressive. Doses used were bulky: 6-44gm Pyruvate (that's just Pyruvate, not Calcium Pyruvate). 6gm Pyruvate was shown to be somewhat effective when combined with exercise. In powder form, this dose costs as little as $10/month. If you're going to take calcium anyway, this form may have advantages over Calcium Citrate.

This can cause gas, bloating, and other intestinal distress.

References:
Effects of pyruvate on the metabolism and insulin resistance of obese Zucker rats. Am J Clin Nutr. 1994 Feb;59(2):331-7.
Pyruvate supplementation of a low-cholesterol, low-fat diet: effects on plasma lipid concentrations and body composition in hyperlipidemic patients. Am J Clin Nutr. 1994 Feb;59(2):423-7.
The effects of pyruvate supplementation on body composition in overweight individuals. Nutrition. 1999 May;15(5):337-40.
Body composition, energy utilization, and nitrogen metabolism with a 4.25-MJ/d low-energy diet supplemented with pyruvate. Br Med J (Clin Res Ed). 1988 Jan 23;296(6617):235-7.
Effect of pyruvate supplementation on body composition and mood. Curr Ther Res 1998;59:793&endash;802.

Garlic Extract:
Star rating: *

Several studies show antidiabetic, blood sugar lowering, and antioxidant effects. It may partly work by increasing insulin secretion. So, if you don't have high blood sugar, this may or may not have as much benefit.

American Ginseng:
1gm per meal (taken with each meal)
Start rating: *

Several studies show improved insulin sensitivity, glucose disposal, and weight loss. Apparently American Ginseng (Panax quinquefolius) is more effective for hyperglycemia than the Asian varieties. Ginseng may also have an unwanted estrogenic effect.

Kidney Bean Extract: (Phaseolus Vulgaris Extract)
Star rating: *

This is a common ingredient in "carb blocker" type products. It inhibits the digestion of starch by inhibiting alpha-amylase. It has been shown in some studies to improve glucose metabolism. It may lower triglicerides. You take this with your first bite of each meal. A study by the Mayo Clinic confirmed that kidney bean extract can work to lower blood sugar, but that the commercial products they tested were not potent enough to have an effect. I don't know if there is an effective brand or not, or how much you would have to take.

Zinc:
25mg
Star rating: *

There is some evidence of increased insulin sensitivity, and lowered TNF-alpha. There is minimal evidence that these benefits are seen with zinc supplementation even in those who are not zinc deficient. High doses of 50mg or more were shown to elevate HbA1c levels, which is a sign of worsening diabetic symptoms. High intakes of zinc will decrease copper absorption.

L-Se-Methylselenocysteine: (Selenium)
200mcg
Star rating: *

L-Se-Methylselenocysteine is probably the best form of Selenium to take, but any common form should be fine. Several studies show increased insulin sensitivity, and lowered TNF-alpha and C-Reactive Protein. Selenium may act as an insulin mimic, but the evidence is weak. 

BGOV: (Bis-Glycinato Oxovanadium Complex, Vanadium)
Star rating: -

Vanadyl Sulfate is a more common and available form of Vanadium than BGOV. There appears to be no safe and effective dose of Vanadyl Sulfate. Doses shown in studies to be effective for insulin resistance and glucose tolerance are all 100mg or more. Yet, there is concern that 10mg may cause kidney toxicity. I could not find dose information for BGOV, but it is thought to be less toxic.

At any rate, Vanadium supplements may not be very effective in patients with PCOS who are not yet diabetic. In one study, oral vanadyl sulfate improved insulin sensitivity in NIDDM but not in obese non-diabetic subjects.

TMG: (Trimethylglycine, Betaine)
2000mg
Star rating: *

This has been shown to reduce Homocysteine, treat depression by raising SAMe levels, and to treat and prevent nonalcoholic fatty liver disease. Insulin resistance and obesity are major risk factors for the development of nonalcoholic fatty liver disease, so it may be more common in PCOS. Doses in most studies range from 6-20gm. However, doses between 1.5-3gm have also been shown to have an effect. TMG is produced by the body. It is present in many foods but not in high amounts.

References:
Low dose betaine supplementation leads to immediate and long term lowering of plasma homocysteine in healthy men and women. J Nutr. 2003 Dec;133(12):4135-8.
Nonalcoholic fatty liver disease: relationship to insulin sensitivity and oxidative stress. Treatment approaches using vitamin E, magnesium, and betaine. Altern Med Rev. 2002 Aug;7(4):276-91.
Betaine, a promising new agent for patients with nonalcoholic steatohepatitis: results of a pilot study. Am J Gastroenterol. 2001 Sep;96(9):2711-7. 

Tocotrienols:
100mg
Star rating: *

Tocotrienols have been shown to improve glycemic control and reduce TNF-alpha. They are excellent antioxidants.   

Vitamin C:
1500mg
Star rating: *

There is minimal evidence that it can increase insulin sensitivity by reducing oxidative stress. Low levels of vitamin C and produce depression. OCPs can deplete vitamin C. Low Vitamin C can raise PAI-1, and high doses were shown to lower it.     

Coenzyme Q10:
100mg
Star rating: *

This has been shown to improve insulin resistance. However, there are several other studies showing no benefit, and one showing negative results.     

Glucosol:
Star rating: -

Studies show improved insulin sensitivity, others show conflicting results.   

Gymnema Sylvestre: (gymnemic acid)
Star rating: -

This is shown to benefit diabetics who are not making enough insulin by causing increased insulin secretion. Studies show it does not improve insulin resistance. It has been shown not to cause hypoglycemia. So, it should not increase insulin secretion in those who do not have high blood sugar, and it should not contribute to hyperinsulinemia. This implies it will not be of any value if you don't have high blood sugar. However, it shouldn't do any harm if you don't have high blood sugar.   

Vinegar:
with food
Star rating: *

In a few studies, vinegar was shown to reduced the postprandial glucose and insulin responses probably by slowing digestion.

Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes. Diabetes Care. 2004 Jan;27(1):281-2. No abstract available.
Delayed gastric emptying rate may explain improved glycaemia in healthy subjects to a starchy meal with added vinegar. Eur J Clin Nutr. 1998 May;52(5):368-71.   

Quercetin:
1000mg
Star rating: *

This has anti-inflammatory and antioxidant effects. It reduces TNF-alpha, and inhibits MMP-9. It has benefits in some diabetic conditions.   

Manganese:
2mg
Star rating: *

This has shown benefits in some diabetic conditions in combination with other agents.   

Potassium:
from food
Star rating: *

A Potassium deficient diet can lead to insulin resistance. Low potassium is also implicated in depression.

If you are taking Spironolactone, you need to be careful with your Potassium intake. Excessive potassium intake may cause hyperkalemia in patients receiving Spironolactone.     

Exercise:

Exercise every day 30-45 minutes. It is much better to exercise a little every day than a lot every few days. You cannot make up for skipped days and the effect on blood sugar by working out harder the next day.

Lower Carb/Low Glycemic Index diet:

Low glycemic index foods cause less insulin to be released.

Monounsaturated Fats:

Substitute these fats for Poly or Saturated fat (For example: replace butter with olive oil). Diets high in monounsaturated fats have been shown to increase insulin sensitivity. It will also slow digestion and lower the overall glycemic index of a meal.

High fiber foods:

High fiber diets increase SHBG. Fiber can lower PAI-1. Various fibers have also been shown to lower cholesterol and blood lipids.

Eat unrefined, whole foods:

These foods will generally have a lower glycemic index, more fiber, and more nutrients.

Increased protein intake:

Low protein diets are shown to contribute to insulin resistance and adversely affect body weight. Compared to low protein diets, higher protein diets have been shown to increase weight loss and to help maintain that weight loss. Protein also slows digestion and lowers the overall glycemic index of a meal. Unfortunately, a high protein diet was shown to lower SHBG. Interestingly, carb intake itself was not associated with SHBG levels.

The Two Gram Cure:

Starving? Try the "Two Gram Cure"

CLA: (Conjuated Linoleic Acid)

This has conflicting evidence. Animal studies are encouraging, but some human studies are negative.

References: (negative)
CLA and body weight regulation in humans. Lipids. 2003 Feb;38(2):133-7.
Efficacy and safety of dietary supplements containing CLA for the treatment of obesity: evidence from animal and human studies. J Lipid Res. 2003 Dec;44(12):2234-41. Epub 2003 Aug 16.

Quote: "Overall, CLA appears to produce loss of fat mass and increase lean tissue mass in rodents, but the results from 13 randomized, controlled short term (<6 months) trials in humans revealed only little evidence to support that CLA reduces body weight or promotes repartitioning of body fat into fat free mass in man. However, from mice and human studies there is increasing evidence that the CLA isomer t10,c12 may produce liver hypertrophy and insulin resistance via a redistribution of fat deposition that resembles lipodystrophy."

Effects of two conjugated linoleic Acid isomers on body fat mass in overweight humans. Obes Res. 2004 Apr;12(4):591-8.

Quote: "A daily consumption of a drinkable dairy product containing up to 3 g of CLA isomers for 18 weeks had no statistically significant effect on body composition in overweight, middle-aged men and women."

A study out in June 2004 suggests it is benefical for weight loss after 1 year.

Reference: (positive)
Conjugated linoleic acid supplementation for 1 y reduces body fat mass in healthy overweight humans. Am J Clin Nutr. 2004 Jun;79(6):1118-25.

Bitter Melon: (Momordica charantia)

This has been described as being "structurally similar to animal insulin". Too high of a dose can cause hypoglycemia, which is further evidence that it acts just like insulin. The problem is, if it's too much like insulin, then it may contribute to insulin resistance and raise testosterone in PCOS. An insulin mimic can be a good thing if it only increases glucose uptake without any of the negative effects of insulin. If you don't have high blood sugar, avoid this.

Trans-Fats:

Trans-fats are especially bad -- worse even than saturated fats as far as their impact on diabetes. Trans-fats have evidence of decreasing HDL and generally increasing diabetes risk. Margarine is a major source of trans fatty acids. Reducing trans fats has been show to reduce the risk of developing diabetes.

Saturated Fats:

If not offset by adequate monounsaturated fats, saturated fat can be toxic to your pancreas by forming cerimide which kills pancreatic beta cells.

Fructose: (and high fructose corn syrup)

This is found in many junk foods. It may be worse than other sugars because it has been shown to raise triglycerides.

High glycemic carbs:

High glycemic carbs, like white bread, pasta, etc., can be just as bad, or worse, than refined sugar as far as its effect on insulin response and blood sugar.

Licorice:

It may do some good things. There are at least two (supposedly there is a third somewhere) studies showing lowered androgens and improved menstrual regularity and ovulation. The problem is, it can dangerously raise blood pressure. It can lower potassium to life threatening levels, and cause fluid retention. If you plan to take this, you might want to have doctor supervision. Note that Licorice candy sold in the US does not have real licorice root in it unless it says so, and then it may have been deglycyrrhizinated, which may make it ineffective for PCOS applications. So, you need to make sure you are taking an effective form. If Licorice works by virtue of it being an antiandrogen, you may be better off using a prescription antiandrogen. Small doses are probably okay, but also probably not effective for PCOS. Higher doses which may be effective, appear dangerous.

References:
[Effect of traditional herbal medicine on serum testosterone levels and its induction of regular ovulation in hyperandrogenic and oligomenorrheic women (author's transl)] Nippon Sanka Fujinka Gakkai Zasshi. 1982 Jul;34(7):939-44.
Effect of a traditional herbal medicine (shakuyaku-kanzo-to) on testosterone secretion in patients with polycystic ovary syndrome detected by ultrasound. Nippon Sanka Fujinka Gakkai Zasshi. 1988 Jun;40(6):789-92