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If you are one of the millions of women who suffer from polycystic ovaries, there is new evidence supporting a simple, natural and delicious remedy: a glass of sweetly tart pomegranate juice, infused with a live probiotic. It’s simple, effective and yielding serious results
Polycystic ovary syndrome (PCOS) is a common hormonal disorder affecting an estimated 18% of women of reproductive age.[i] Symptoms of PCOS include infrequent menstrual cycles (less than nine cycles per year), abnormally heavy bleeding, enlarged ovaries that fail to produce eggs, excess facial and body hair, and male-pattern baldness.[ii]
Although the exact cause of PCOS is unknown, too much of the male hormone androgen is believed to be a primary causal factor, while obesity, excess insulin, heredity and chronic, low-grade inflammation can be contributing factors.[iii] Women who are diagnosed with PCOS may be affected by other health problems, including insulin resistance leading to diabetes, high blood cholesterol and cardiovascular disease.[iv]
Pomegranates: Nature's First Aid
Pomegranates have a long history of use in traditional medical applications, many of which have been validated in modern times. Fresh pomegranate juice, a powerful antioxidant, has been shown to have blood-sugar regulating properties and to enhance fertility, as well as provide relief to sufferers of hormonal diseases such as prostate cancer and breast cancer, among other studied benefits.
The established links between PCOS and imbalanced blood sugar and sex hormones have spurred researchers to consider pomegranate juice as a potential treatment for PCOS. There is a rigorous scientific process to validate new treatments and pomegranate juice has demonstrated therapeutic potential across several fronts. It was successfully used in scientific trials to reduce cardiovascular risk factors in patients with PCOS and improve testosterone levels and reduce insulin sensitivity.
Promising results such as these led researchers from the Shiraz University of Medical Sciences and School of Agriculture in Shiraz, Iran, to further study pomegranate juice for PCOS. The multi-disciplinary group of researchers conducted a controlled trial, which is now contributing additional peer-reviewed science to the body of evidence supporting the use of this powerful natural medicine.
Science Backs Pomegranate to Balance the Body
Published in the journal Nutrition, Metabolism & Cardiovascular Diseases in February 2019,[v] the study's aim was to determine if synbiotic pomegranate juice might improve symptoms in patients with PCOS. Synbiotic is defined as "a combination of prebiotics and probiotics that synergistically promotes gastrointestinal health by improving survival and adherence of live microbial dietary supplements."[vi]
The addition of active cultures of healthy gut bacteria was posited by researchers as potentially therapeutic in the treatment of PCOS, since previously collected data have shown that dysbiosis of gut microbiota, usually due to a high fat-sugar diet, causes intestinal permeability leading to the chronic inflammation that is a frequent symptom of PCOS.[vii]
Specific symptoms being measured in this randomized, triple-blind, parallel study were glycemic indices, sex hormone profile and anthropometric measurements such as weight-for-age and -height and waist circumference. Methodology for the trial was to create four groups of 23 patients each, aged 15 to 48 years, who had no other condition related to excess androgen and who further met two of the following criteria:
- Oligomenorrhea (interval between two menstrual periods >35 days) or amenorrhea (no vaginal bleeding for >6 months).
- Clinical findings of increased blood androgen levels (hirsutism scores >7 or obvious acne) or increased blood testosterone levels (testosterone levels >2 nmol).
- Polycystic ovaries in ultrasound scan (12 follicles measuring 2 to 9 mm in diameter, or ovarian volume >10 ml in at least one ovary).
Patients were excluded if they were actively taking other treatments, such as corticosteroids, antibiotics and hormone pills, were smokers, lactating or had been diagnosed with other severe disease(s). A final sampling of 92 patients gave their informed consent and participated in the eight-week trial. Participants were randomized into one of four groups:
- Synbiotic pomegranate juice (SPJ): Patients in this group received two, 1-liter bottles of pomegranate juice containing inulin and lactobacillus, per week.
- Pomegranate juice (PJ): Patients in this group received two, 1-liter bottles of pomegranate juice per week.
- Synbiotic beverage (SB): Patients in this group received two, 1-liter bottles of pomegranate-flavored synbiotic beverage per week.
- Control group (CG): Patients in this group received two, 1-liter bottles of pomegranate-flavored placebo beverage per week.
In keeping with "blinded" protocols, all beverages were produced to have the same look, smell and taste. Tests were conducted pre-trial to ensure viability of the live bacteria, wherein it was determined that 108 CFU/ml of Lactobacillus rhamnosus GG, bacillus koagolans and indicous would be combined with 20 grams of inulin for the two synbiotic groups (SPJ and SB).
The primary outcome measured in this study was insulin resistance; the secondary outcomes included blood glucose, insulin, total testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
Dietary intake was monitored at baseline and at the end of the study via dietary recalls, and fasting blood samples were taken at the beginning and end of the intervention by a laboratory expert. Blood samples were centrifuged and measured for blood glucose, insulin, testosterone, LH and FSH.
Probiotics and Pomegranates Improve Symptoms of PCOS
At the end of the study, 86 patients had remained consistent with protocols throughout the eight-week period and were analyzed. For the anthropometric measurements in comparison with baseline body mass indexes (BMIs), weight and waist circumferences decreased in both synbiotic beverage groups (SPJ and SB). Waist-to-hip ratio decreased in the SPJ group and increased in the control group.
The changes in BMI, weight, waist and waist-to-hip ratio among the two synbiotic groups were statistically improved as compared to the control group, indicating that supplementation with live bacteria is beneficial to metabolism.
Regarding the fasting blood sugar (FBS), changes in the two synbiotic groups were significant compared with control group. Insulin decreased in SPJ and SB groups when compared to the baseline, but in comparison between groups, only the change between SB and the control groups was notable.
A statistically significant increase in insulin sensitivity was measured in the two synbiotic groups, marking a potent health benefit to the pre- and probiotic mixture. High insulin sensitivity allows the cells of the body to use blood glucose more effectively, thereby reducing blood sugar and staving-off onset of Type 2 diabetes.
Another strong benefit observed in the two synbiotic groups was improved hormonal balance. Testosterone levels reduced significantly in SPJ and SB groups in comparison with baseline, while testosterone increased significantly in the control group. There was no significant change in LH and FSH in any of the groups.
Researchers drew their final conclusions from the study and in their report reminded that the gut truly is "the brain" that talks to the rest of the body. In their words, "bidirectional interaction between sex hormones and intestinal microflora has been shown," a finding that is supported by their research.[viii]
These findings strongly suggest that a synbiotic-infused, pomegranate beverage may improve the hormonal balance in patients with PCOS, while adding improved insulin resistance, staving off diabetes and improving BMI and body weight, while also improving the figure. I think we can all drink to that!
[i] Cassar S, Teede HJ, Harrison CL, Joham AE, Moran LJ, Stepto NK. Biomarkers and insulin sensitivity in women with polycystic ovary. syndrome: characteristics and predictive capacity. Clin Endocrinol. 2015;83(1):50e8. https://doi.org/10.1111/cen.12619
[ii] Mayo Clinic, Diseases-Conditions, PCOS, Symptoms-Causes: https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
[iii] Mayo Clinic, Diseases-Conditions, PCOS, Symptoms-Causes: https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
[iv] Tsilchorozidou T, Overton C, Conway GS. The pathophysiology of polycystic ovary syndrome. Clin Endocrinol 2004;60(1):1e17. https://doi.org/10.1046/j.1365-2265.2003.01842.x
[v] Effect of synbiotic pomegranate juice on glycemic, sex hormone profile and anthropometric indices in PCOS: A randomized, triple blind, controlled trial. Esmaeilinezhad Z, Babajafari S, Sohrabi Z, Eskandari MH, Amooee S, Barati-Boldaji R. Nutr Metab Cardiovasc Dis. 2019 Feb;29(2):201-208. doi: 10.1016/j.numecd.2018.07.002. PMID: 30538082
[vi] Science Direct, Synbiotics: https://www.sciencedirect.com/topics/immunology-and-microbiology/synbiotics
[vii] Effect of synbiotic pomegranate juice on glycemic, sex hormone profile and anthropometric indices in PCOS: A randomized, triple blind, controlled trial. Esmaeilinezhad Z, Babajafari S, Sohrabi Z, Eskandari MH, Amooee S, Barati-Boldaji R. Nutr Metab Cardiovasc Dis. 2019 Feb;29(2):201-208. doi: 10.1016/j.numecd.2018.07.002. PMID: 30538082
[viii] Effect of synbiotic pomegranate juice on glycemic, sex hormone profile and anthropometric indices in PCOS: A randomized, triple blind, controlled trial. Esmaeilinezhad Z, Babajafari S, Sohrabi Z, Eskandari MH, Amooee S, Barati-Boldaji R. Nutr Metab Cardiovasc Dis. 2019 Feb;29(2):201-208. doi: 10.1016/j.numecd.2018.07.002. PMID: 30538082