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Polycystic ovary syndrome (PCOS), as a common metabolic-endocrine disorder, is the main cause of infertility in women (1,2). The prevalence of PCOS was reported 18% based on the Rotterdam criteria in Australia (3). Women with POS often suffer from obesity, hyperandrogenism, and their effects such as hirsutism, acne, and alopecia (4). The pathophysiologic mechanism of PCOS is unclear, but evidence shows reduced insulin sensitivity with hyperinsulinemia among 30%-80% of these women (5). The production of androgen by the ovaries and adrenal glands increases in the presence of hyperinsulinemia (5). In addition, PCOS are associated with a high incidence of hypertension, dyslipidemia, heart disease, visceral obesity, glucose intolerance, insulin resistance, and hyperinsulinemia (6,7). The prevalence of the impaired oral glucose tolerance test in obese women with PCOS is approximately 20% (2). The risk of diabetes mellitus (T2DM) in women with PCOS is 5 to 10 times higher than healthy subjects (5). Studies indicate that 70% of women with PCOS have abnormality at least in one part of their lipid profile because of the negative effect of insulin resistance on the lipid profile (8). A study of women with PCOS showed that lifestyle changes and metformin increase insulin resistance and the number of menstrual cycles while decreasing body mass index (9). Today, the Rotterdam criteria are internationally accepted for the diagnosis of PCOS (3). The angiotensinconverting enzyme (ACE) gene has 3 polymorphisms, the deletion/deletion (DD) genotype of which causes its high activity (10). In the ovarian, there is a renin-angiotensin system but its mechanism is unknown. In addition, it is possible that the high blood pressure associated with the DD genotype from the ACE gene can play a role in the occurrence of PCOS (10). The husk or the seed of “Plantago ovata” or “Psyllium” Abstract Objectives: Polycystic ovary syndrome (PCOS) is the most common cause of infertility in women. In addition, the risk of type2 diabetes mellitus (T2DM), hyperinsulinemia, and insulin resistance is higher among women with PCOS. Psyllium can reduce the levels of fasting blood sugar (FBS), insulin resistance, and lipid profile. Thus, the present study aimed to evaluate the effect of psyllium supplementation on insulin resistance and the lipid profile in non-diabetic women with PCOS. Materials and Methods: In this randomized double-blind placebo-controlled trial, 54 eligible non-diabetic women with PCOS aged 18-45 were recruited from an endocrinology clinic and divided into 2 groups based on their body mass index (BMI) through stratified-block randomization. Participants in intervention and placebo groups received 5 g of psyllium or cellulose microcrystalline twice a day for 8 weeks. Fasting insulin, FBS, and insulin resistance indicators including HOMA1-IR, HOMA2-IR, along with quantitative insulin sensitivity check index (QUICKI) and the lipid profile were evaluated before and after the intervention. Results: In the psyllium group, the FBS, fasting insulin, total cholesterol, low-density lipoprotein cholesterol (LDL-C), HOMA1-IR, and HOMA2-IR indicators decreased significantly (P < 0.05) after 8 weeks, but the changes were not significant in the placebo group. The mean changes in LDL-C ( 0.28±0.58 and 0.11±0.67 in intervention and placebo groups, respectively, P = 0.036) and QUICKI (0.01±0.03 and 0.02±0.06 in intervention and placebo groups, respectively, P = 0.044) were significant between the two groups from the baseline. Conclusions: Psyllium supplementation decreased FBS, fasting insulin, and the lipid profile while improving insulin resistance in non-diabetic women with PCOS.

international journal of women's health and reproduction sciences

Effect of Psyllium Supplementation on Insulin Resistance and Lipid Profile in Non-diabetic Women With Polycystic Ovary Syndrome: A Randomized Placebo-Controlled Trial