Myo-Inositol

Myo-Inositol is a nutrient belonging to the non-essential amino acid class.

Myo-inositol is also known as Inositol, D-chiro-inositol, Inositol hexaphosphate (or "IP6") and Inositol. It is also sometimes known as vitamin B8 but not a vitamin.

Myo-inositol is a specific type of sugar that affects the body's insulin response and several hormones associated with mood and cognition.

Myo-inositol deficiency may lead to Hyperglycemia-related depletion of myo-inositol. It is characterized by symptoms like altered neurotransmitter function, decreased insulin sensitivity, impaired cellular signalling, and possible negative effects on mental health.

Cantaloupe, citrus fruit, and other foods high in fibre (including beans, brown rice, maize, sesame seeds, and wheat bran) naturally possess myo-inositol. It can also be found in dairy products, meat, and eggs.

Myo-inositol is absorbed in the gut, distributed in organs like the brain, converted to other compounds by phosphorylation, and primarily excreted in urine.

The common side effects of Myo-Inositol include nausea, GI disturbances, tiredness, headache, and dizziness.

Myo-inositol is available in tablets, capsules and oral powders.

Biochemical action of Myo-Inositol

Myo-Inositol, belonging to the non-essential amino acid class, acts in several biochemical processes. It works via the phosphatidylinositol pathway (PI) pathway.

Myo-inositol serves as a precursor for synthesising inositol phospholipids, an essential component of cell membranes. It is a precursor to the phosphatidylinositol cycle. It has been shown to have a role in the production of neurotransmitters, although its specific mode of action in brain diseases remains unclear. A change that takes place during this cycle mimics postsynaptic receptor activation without really triggering it. The activity of other neurotransmitters, including monoamines, is regulated by this pseudo-activation.

In diseases like Polycystic Ovary Syndrome (PCOS), insulin resistance is crucial to the progression of the disease. The excess androgen synthesis by the ovaries can be stimulated by hyperinsulinemia, which is linked to PCOS, which can lower levels of sex hormone-binding globulin. Inositol is also hypothesized to treat insulin insufficiency by actively taking part in insulin signalling, which improves tissue absorption of glucose.

The mode of action of Inositol in the context of cancer is not yet fully understood. However, it is hypothesized that inositol supplementation increases levels of lower-phosphate inositol phosphates, which may affect the control of the cell cycle, proliferation, and differentiation of malignant cells. Additionally, through chelating ferric ions and obstructing oxidative stress, the synthesis of inositol hexaphosphate after inositol administration indicates antioxidant properties.

According to studies on preterm newborns, the estimated elimination half-life is 5.22 hours, the clearance rate is 0.0679 L.kg/h, and the volume of distribution is 0.5115 L/kg.

Myo-inositol is available in tablets, capsules and oral powders.

• Tablets: To be swallowed whole with water/liquid, as applicable.
• Capsules: To be swallowed whole with water/liquid, as applicable.
• Powders, oral: Powders must be mixed thoroughly with the appropriate amount of liquid and stirred well to dissolve the powder, as applicable.

Myo-Inositol can be used as a supplement when the amount of Myo-Inositol taken through diet is insufficient.

Taking Myo-Inositol supplements effectively treats Myo-Inositol deficiency caused by specific genetic diseases or other disorders.

Myo-inositol is a nutrient supplement in special dietary foods and infant formula.

Supplemental Myo-inositol improves fertility and controls menstruation, particularly among PCOS-positive individuals and those having difficulty becoming pregnant.

Myo-inositol supplements may help control panic episodes and anxiety in public or wide-open spaces (agoraphobia).

When used as a supplement during pregnancy, Myo-Inositol may help lower the risk of preterm delivery in women more susceptible to diabetes when combined with folic acid.

Vitamins and natural supplements should not replace a balanced diet.

This product is not intended to diagnose, treat or prevent any disease(s).

Myo-Inositol can help to support as a supplement for the following health benefits:

• Deficiency- The body's availability of Myo-inositol can be reduced by hyperglycemia or high blood sugar levels. Myo-inositol supplements, which increase insulin sensitivity, can help prevent this depletion. Myo-inositol can help control blood sugar levels, which is particularly beneficial for those who suffer from diseases like Polycystic Ovary Syndrome (PCOS) and diabetes. In addition, supplementing with it may help female reproductive and mental well-being.
• Mental Health Disorders- An inositol substance called myo-inositol may affect how the brain regulates mood. Compared to other mood disorder drugs, such as those for depression, anxiety, and bipolar disorder, it could have fewer adverse effects. The "feel-good" neurotransmitters serotonin and dopamine may be affected; however, further research is needed to determine the exact pathways. Also, a selective serotonin reuptake inhibitor (SSRI) frequently used for anxiety and depressive disorders, Inositol has been investigated in a number of research. However, research hasn't fully established an antidepressant effect. In addition, limited research has also suggested that Inositol might alleviate bipolar symptoms, as seen in a study with children using Inositol and omega-3 fatty acids. Inositol may also alleviate psoriasis in people taking lithium, a medication for various mental health conditions.
• Metabolic disorders- In treating metabolic abnormalities associated with diseases like high blood pressure, diabetes, and other metabolic syndrome, Myo-inositol has shown potential benefits. According to a 2016 pilot trial, people with type 2 diabetes who took Myo-inositol and d-chiro-inositol along with their diabetic meds had notable benefits. Myo-inositol significantly improved diastolic blood pressure (11%), triglycerides (20%), and "good" HDL cholesterol (22%) in women with metabolic syndrome. These improvements indicate more excellent management of the metabolic disorders and lower the risk of cardiovascular disease (CVD).
• Type 2 Diabetes- Inositol may benefit those with type 2 diabetes. For instance, in a study in a small population, individuals with type 2 diabetes were given an inositol tablet twice daily for three months. The results showed that their haemoglobin A1C levels and fasting blood sugar levels significantly decreased throughout those three months. The volunteers reported no adverse effects. However, more research is needed in a larger sample size to confirm these outcomes.
• Fertility- Myo-inositol stimulates ovulation, the critical reproductive period when eggs transfer for possible fertilisation, helping to increase fertility. Myo-inositol can also help individuals with low sperm counts by boosting sperm function and motility, thereby increasing fertility.
• Cancer- Myo-inositol (MI) has demonstrated potential in preventing carcinogenesis in several organs. For instance, it prevented the development of lung tumours in rats caused by a tobacco-derived carcinogen and decreased liver carcinogenesis in mice. Furthermore, MI acted as a defence against inhibitory effects on human small airway epithelial cells, making it a possible preventative agent for early pulmonary diseases. A strong anticancer impact was also seen when MI and IP6 were combined in colon, breast, and metastatic lung cancer models. These effects included reduced cell proliferation and increased apoptosis, particularly in prostate cancer cells.

Myo-inositol supplementation may be administered orally.

Orally: Myo-inositol supplements are available as tablets, capsules and powders that can be taken orally. Myo-inositol supplements are often taken in divided doses throughout the day, either in the morning or night. Still, it is best taken on an empty stomach and at least 30 minutes prior food to maximize absorption and effectiveness.

The dosage and duration of treatment should be as per the clinical judgment of the treating healthcare professional).

Vitamins and natural supplements should not replace a balanced diet

This product is not intended to diagnose, treat or prevent any disease(s).

• Tablets: 300 mg, 1000 mg, 4000 mg
• Capsules: 250 mg, 500 mg, 650 mg, 750 mg, 1000 mg, 1500 mg, 2060 mg
• Powder, oral: 3.5 oz (100g)

Dosage Adjustment for Adult Patients

By Mouth:

For panic disorder: 12-18 g/day.

For obsessive-compulsive disorder (OCD): inositol 18 g/day.

For symptoms associated with polycystic ovary syndrome (PCOS): D-chiro-inositol 1200 mg/ day.

For treating lithium-related psoriasis: 6 g/day.

For metabolic syndrome: 2 g BID

Myo-inositol supplements are available in tablets, capsules and oral powders.

Myo-inositol should be a supplement that helps in several biochemical processes and appropriate dietary restrictions.

• Avoid alcoholic beverages.
• Stay within your daily calorie needs.
• Since these may hinder absorption, avoid food containing caffeine and sugary or highly processed foods.
• While taking Myo-Inositol supplements, limit the consumption of Myo-Inositol-rich foods to avoid excessive intake.

Recommended Daily Allowance (RDA)

As per FSSAI, the estimated RDA of Myo-Inositol is not established.

Upper Tolerable Intake (UTL):

The UTL of Myo-Inositol needs to be established.

Myo-inositol supplementation may be contraindicated under the following conditions:

• Hypersensitivity: sensitive to Myo-Inositol-related allergy.
• Chronic liver disease
• Chronic kidney disease (CKD)
• Kidney failure
• Bipolar Disorder
• Hypoglycemia
• Electrolyte disorder

Myo-inositol supplements should be cautiously taken in pregnant and breastfeeding mothers and under the supervision of a healthcare professional.

Before taking Myo-Inositol, individuals with renal or liver disorders should see a physician since the dosage may need to be adjusted to prevent adverse effects.

Individuals with mental disorders like bipolar and depression should take this supplement cautiously.

Myo-inositol supplements should be given cautiously to people with preexisting metabolic conditions or taking medications.

Individuals with a history of allergies or sensitivities to amino acids should be vigilant and used cautiously.

To avoid potential interactions, it is recommended to use only one amino acid supplement or dietary supplements.

There is no sufficient scientific evidence traceable regarding the use and safety of Myo-Inositol for breastfeeding populations.

There is no sufficient scientific evidence traceable regarding the use and safety of Myo-Inositol for pregnant populations.

Limit the consumption of alcohol, caffeine, sugary foods, processed meals, and foods containing a high Myo-inositol content while taking myo-inositol supplements to prevent overdosing.

The adverse reactions related to Myo-Inositol can be categorized as:

• Common: GI disturbances like nausea, bloating or stomach upset
• Less common: Headaches and dizziness
• Rare: Chest tightness, difficulty in breathing and allergic reactions (rashes or itching)

Myo-inositol is generally considered safe and doesn't have many known drug interactions.

However, the most common clinically relevant drug interactions of Myo-Inositol are briefly summarized here:

• Antidiabetes drugs- Blood sugar levels may be reduced with Inositol. Blood sugar levels might be deficient if Inositol is combined with anti-diabetic medications. Maintain normal blood sugar levels.
• Acetylsalicylic acid: This drug may decrease the excretion rate of Myo-inositol, which could result in a higher serum level.

The common side of Myo-Inositol include the following:

• Nausea
• Tiredness
• Stomach pain
• Gas
• Upset stomach
• Gastrointestinal discomfort
• Headache
• Dizziness
• Difficulty sleeping

Myo-inositol should be prudent in the following group of special populations.

• Pregnancy:

Without specific health recommendations, Myo-Inositol supplements are typically not advised for children. There is no sufficient scientific evidence traceable regarding the use and safety of Myo-Inositol for pregnant populations. Avoid Myo-Inositol supplements unless advised by a healthcare professional while pregnant.

• Paediatrics:

In children, Myo-Inositol is vital for cell growth and survival; it also enhances the development of numerous surfactant maturation, which are crucial in fetal and early neonatal life. Infants with Respiratory Distress Syndrome (RDS) may have a decrease in Myo-inositol levels, indicating that the condition will worsen.

Dosage Adjustment for Paediatric Patients

When used orally for up to 12 weeks, it is safe for kids aged 5 to 12. Also, it may be safe when administered to preterm newborns who have acute respiratory distress syndrome, or ARDS, for up to 10 days in the hospital. On the other hand, using it for more than 10 days in preterm newborns with ARDS is unsafe.

• Geriatrics:

There is no sufficient scientific evidence traceable regarding the use and safety of Myo-Inositol for geriatric populations. Avoid supplements unless advised to do so by a healthcare professional.

• Lactating mothers:

There is no sufficient scientific evidence traceable regarding the use and safety of Myo-Inositol for lactating mothers populations. Avoid Myo-Inositol supplements unless advised by a healthcare professional while lactating.

Dosage Adjustment in Kidney Impairment

There are no specific dosage adjustments provided.

Dosage Adjustment in Hepatic Impairment

There are no specific dosage adjustments provided.

The physician should be vigilant about the knowledge about identifying and treating overdosage of Myo-Inositol. Overconsumption of Myo-Inositol could lead to gastrointestinal symptoms like diarrhoea, nausea or stomach pain.

There is no specific antidote or treatment for excessive intake of supplemental Myo-Inositol.

Myo-inositol supplements should be terminated immediately when an overdose is suspected or experience any unusual symptoms after Myo-Inositol supplement use or dietary intake. Supportive therapy should also be given, addressing any symptoms that persist or worsen. Physical treatment might be added if necessary.

Biochemistry profile of Myo-Inositol

Myo-inositol is a cyclic sugar alcohol with six carbon atoms known as a hexahydroxycyclohexane. It consists of a six-membered carbon ring with a hydroxyl (OH) group attached to each carbon atom, which gives myo-inositol its characteristic six-fold symmetry, making it an essential chemical for various biological processes in the human body.

Myo-inositol, a naturally occurring sugar alcohol, is essential for several cellular functions. It acts as a secondary messenger in signal transduction pathways and is integral to cell membrane phospholipids. For insulin signalling, which controls glucose metabolism, to work properly, myo-inositol is necessary. It influences mood and cognitive function by helping neurotransmitter signalling in the brain. Myo-inositol also synthesises inositol phosphates, which are essential for calcium control, cell proliferation, and differentiation. It is considered a beneficial dietary supplement for conditions including PCOS, mental problems, and metabolic disorders.

Kinetic profile:

• Absorption: Myo-inositol, once ingested, is absorbed from the gut through the small intestine.
• Distribution: Once absorbed, it is distributed across various body tissues, with the brain and the central nervous system having the highest concentration of myo-inositol.
• Metabolism: It is metabolized predominantly by the phosphorylation process. It can be converted into inositol phosphates, which are essential for intracellular signalling and cellular processes.
• Elimination: The kidneys filter excess myo-inositol that the body cannot use, which is then eliminated in the urine.

1. Chhetri, Dhani Raj. “Myo-Inositol and Its Derivatives: Their Emerging Role in the Treatment of Human Diseases.” Frontiers in pharmacology vol. 10 1172. 11 Oct. 2019, doi:10.3389/fphar.2019.01172
2. https://www.ncbi.nlm.nih.gov/books/NBK234937/
3. Phelps DL, Ward RM et al.: Safety and pharmacokinetics of multiple-dose Myo-inositol in preterm infants. Pediatr Res. 2016 Aug;80(2):209-17. doi: 10.1038/pr.2016.97. Epub 2016 Apr 13. (PubMed ID 27074126)
4. Giordano D, Corrado F, Santamaria A, et al. Effects of myoinositol supplementation in postmenopausal women with metabolic syndrome: A prospective, randomized, placebo-controlled study. Menopause. 2011;18(1):102-104. doi:10.1097/gme.0b013e3181e8e1b1
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613728