A group of authors summarized how Traditional Chinese Medicine (TCM) may modulate the gut microbiota (GM) to alleviate insulin resistance (IR) in polycystic ovary syndrome (PCOS) and outlined potential, but as yet unvalidated, translational paths for clinical care.
Study
PCOS is a metabolic, reproductive disorder that involves hyperandrogenism (HA), anovulation, and IR. IR leads to hyperinsulinemia (HI), which causes the ovaries to produce increased levels of androgens, reduces sex hormone-binding globulin (SHBG) in the liver, and alters the neuroendocrine network toward increased production of gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH).
Additionally, the hypothalamic–pituitary–adrenal (HPA) axis can increase adrenal androgen production via adrenocorticotropic hormone (ACTH). Collectively, these systems exacerbate metabolic and reproductive dysfunction associated with PCOS.
Emerging evidence suggests that GM may contribute by showing reduced diversity and fewer short-chain fatty acid (SCFA)-producing strains, alongside increased endotoxin-rich organisms, in women with both PCOS and IR.
Findings
TCM is proposed to promote gut-host interactions through five mechanisms rather than established clinical pathways. First, multi-herb formulas, in preclinical and small clinical studies, remodel GM, enhance gut barrier integrity, and inhibit LPS, TLR4, and NF-κB signaling, thereby promoting SCFA-producing bacteria, estrous cyclicity, and reduced inflammation.
Second, targeted phytochemicals and polysaccharides, including berberine, naringenin, Dendrobium officinale, Cordyceps, Astragalus spp., mangiferin, and curcumin, have been shown, primarily in animal and limited human studies, to decrease IR and increase occludin and ZO-1 expression.
Third, dietary therapy, for example, quinoa and flaxseed oil, has been reported in experimental models to promote populations of Lactobacillus, Bifidobacterium, and Faecalibacterium, suggesting potential benefits for women with PCOS.
Fourth, probiotics, prebiotics, and synbiotics may aid in regulating either LH or follicle-stimulating hormone (FSH) ratios or inflammatory cytokine levels, with Bifidobacterium spp. linked to hormonal modulation and inulin associated with reductions in inflammation and IR.
Fifth, electroacupuncture has demonstrated improvements in visceral adiposity and glucose tolerance in animal models. Clinical trials suggest acupuncture combined with clomiphene may improve hormonal and metabolic outcomes compared with clomiphene alone. Acupuncture has also been reported to cause fewer gastrointestinal side effects than metformin in some studies.
Conclusion
This review illustrates that the GM may be an adjustable factor affecting IR and symptom severity in PCOS.
By repairing the intestinal barrier, reducing inflammation and LPS activity, restoring SCFA production, and engaging bile acid signaling pathways, TCM has shown potential to improve metabolic and reproductive outcomes through a combination of approaches, including herbal formulas, bioactive compounds, dietary therapies, prebiotics, synbiotics, probiotics, and acupuncture.
However, to move TCM toward practical application in clinical care, larger clinical studies, standardized herbal products, rigorous quality-control frameworks, robust dose-response assessments, and ongoing safety evaluations are required.
Accordingly, microbiome-based evidence for TCM must be strengthened and carefully translated into accessible, equitable, and reliable care for individuals diagnosed with PCOS.
Source:
https://www.news-medical.net/news/20251216/How-Traditional-Chinese-Medicine-may-reshape-the-gut-microbiome-to-ease-insulin-resistance-in-PCOS.aspx