Effects of Synbiotic Supplementation and Lifestyle Modifications on Women With Polycystic Ovary Syndrome

Izabela Chudzicka-Strugała; Anna Kubiak; Beata Banaszewska; Barbara Zwozdziak; Martyna Siakowska; Leszek Pawelczyk; Antoni J. Duleba

Disclosures

J Clin Endocrinol Metab. 2021;106(9):2566-2573. 

In This Article

Discussion

The principal finding of this study is the observation that synbiotic supplementation significantly augments effects of lifestyle modifications on weight loss and leads to a nearly 60% greater reduction of BMI than lifestyle modifications alone. This finding is important because young women are particularly vulnerable to weight gain and often have the greatest difficulty attaining significant weight loss.[22,23] Women with PCOS, when compared with those without PCOS, are at significantly greater risk of accelerated weight Gain.[24] The consequences of obesity in young women can be especially severe and include not only increased risks of metabolic disorders such as type 2 diabetes and dyslipidemia, but also cardiovascular diseases and cancers of the breast, colon, uterus, and other organs, as well as PCOS, infertility, and pregnancy complications.[25,26] In women aged 20 to 39 years (comparable to subjects of the present study), estimated number of life-years lost ranges from 2.6 (for BMI of 25-<30) to 6.1 (for BMI > 35); however, the number of lost healthy life-years is far greater: from 5.5 (for BMI of 25-< 30) to 13.7 (for BMI > 35).[27]

One of the most challenging aspects of clinical care for overweight and obese patients is the accomplishment of meaningful weight loss. Lifestyle interventions such as dietary modifications and exercise are usually considered to be the first line of treatment; however, the outcomes of such approaches are often disappointing. Among the most prominent predictors of adherence to such programs is the early weight loss.[23] Hence, the significantly more rapid weight loss following the combined use of synbiotic supplementation and lifestyle modifications is likely to improve long-term prognosis.

Another important finding of the present study is the observation of a significant 32% reduction of testosterone in women taking synbiotic supplementation. Hyperandrogenism is the key feature of PCOS and, in addition to its adverse cosmetic effects, androgen excess is likely to play a significant role in metabolic dysfunction.[28] In particular, high androgen levels may contribute to increased global adiposity, larger adipocytes, and adversely affect production of adipokines and thus promote insulin resistance.[29–31] Notably, in the present study, synbiotic supplementation was associated with a trend toward reduced hirsutism and improved insulin sensitivity; however, these effects did not reach statistical significance.

Although identification of mechanisms mediating beneficial effects of probiotics and synbiotics on weight and testosterone production is beyond the scope of this study, it is likely that these effects are mediated by the alteration of the gut flora.[14,32,33] One of the important effects of bacteria introduced by probiotics is the restoration of normal function of gastrointestinal mucosa and thus reduction of gut wall permeability.[34] Both obesity and PCOS are characterized by dysbiosis of gut microbiome.[35–39] Consequently, it is likely that synbiotic supplementation may contribute to reduction of weight and testosterone via restoration of healthier gut flora.

The present study, although presenting promising findings, has notable limitations, including significant dropout rate. Indeed, interventions involving strict lifestyle modifications are often difficult to study because of patients' poor attendance and adherence rates.[23] Our finding of 40% dropout rate is unfortunately in line with those of many lifestyle intervention programs for overweight and obese patients reporting attrition rates of up to 77%.[40–42] Another limitation of our study is a relatively short duration of follow-up for 3 months. Evaluation of several outcomes, such as effects on hirsutism and improvement of lipid profile, may require longer therapeutic interventions.

The strengths of our study include randomization and blinding of patients and investigators to synbiotics vs placebo, close supervision of participants, and lifestyle modifications consisting of a combination of diet and exercise. Indeed, programs including supervising and monitoring attendance had significantly greater adherence rates compared with self-monitoring programs.[43] Furthermore, meta-analysis of randomized controlled trials revealed that outcomes of combinations of diet and exercise were superior to programs involving either diet or exercise alone.[44]

In conclusion, this study supports the notion that synbiotic supplementation potentiates effects of diet and exercise on weight loss and reduces hyperandrogenemia in women with PCOS a-nd elevated BMI.

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