Risks and limits of bariatric surgery: old solutions and a new potential option.

The present review focuses on the side effects that ex-obese patients face following bariatric surgery. We searched through the principal medical indexes (SCOPUS, Web of Science, PubMed, MEDLINE) using the following words, both alone and in combinations: bariatrics; bariatric surgery; anemia; vitamin B12; cobalamin; folate; folic acid; iron; iron supplements; gut microbiota; lactalbumin; α-lactalbumin. To perform exhaustive research, we considered articles published since 1985. Bariatric surgery induces states of nutritional deficiencies. In particular, the surgery results in a drastic fall in the levels of iron, cobalamin, and folate. Despite the dietary supplements which can counteract such decrease, some limitations exist in the nutraceutical approach. Indeed, the gastrointestinal side effects of supplements, the alterations in the microbiota, and the reduced absorption induced by the surgery may impair the effect of dietary supplements, exposing the patients to the risk of developing nutritional deficiencies. Recent literature reports the effect of promising molecules to counteract such limitations, which include α-lactalbumin, a whey protein with prebiotic activities, and new pharmaceutical forms of iron supplements, namely micronized ferric pyrophosphate. If on the one hand, α-lactalbumin enhances intestinal absorption and helps in restoring a physiological microbiota, micronized ferric pyrophosphate has a high tolerability and low or null risk of gastrointestinal side effects. Bariatric surgery represents a valid solution to obesity and obesity-related disease. However, the procedure may induce deficiencies in micronutrients. Data exists on the promising activities of α-lactalbumin and micronized ferric pyrophosphate, which may help in preventing bariatric-induced anemia.

Unopposed estrogens: current and future perspectives.

Estrogens and progestogens act on female reproductive tissues in opposite ways. As they counteract each other actions, the correct balance between these two classes of hormones is pivotal to avoid dangerous states. Unopposed estrogens occur when progestogen levels do not balance estrogens, primarily deriving from overproduction of estrogens via aromatase enzyme. In the endometrium, unopposed estrogens induce proliferative or invasive phenomena, which represent the first step toward different diseases. These pathologies include endometrial hyperplasia, endometrial polyps, endometriosis and adenomyosis. Endometrial hyperplasia and polyps are proliferative pathologies, while endometriosis and adenomyosis are characterized by the invasion of other tissues by endometrial cells. Current pharmacological treatments include Gonadotropin-Releasing-Hormone analogs, aromatase inhibitors and progestogens, either alone or in combination with estrogens. As these drugs usually lead to burdensome undesired effects, researchers seek to find new therapeutical molecules. Recent literature highlights the positive effects of metformin, an insulin sensitizing drug that reduces the insulin proliferative stimulus on the endometrium. d-chiro-inositol is an insulin second messenger with insulin sensitizing and mimetic properties, recently described as an aromatase down-regulator. Based on current evidence, d-chiro-inositol may be useful to treat the pathologies responsive to unopposed estrogens.

Inositol treatment for psychological symptoms in Polycystic Ovary Syndrome women.

OBJECTIVE: PCOS women experience different discomfort as a consequence of the illness. During the years, several risk factors and treatments emerged. This review aims at underlining evidence on psychological symptoms in PCOS women and on the effectiveness of therapies. MATERIALS AND METHODS: We reviewed literature searching through different databases. We used different keywords, including: PCOS, PCOS and depression, PCOS and anxiety, PCOS and psychological, PCOS depression and risk factors, PCOS depression therapies, depression and inositol. RESULTS: Based on the collected evidence, PCOS women are more likely to develop psychological symptoms, like depression or anxiety disorders. Furthermore, several risk factors are associated with higher depression or worse psychological conditions. Particularly, the literature highlights BMI, hirsutism, insulin resistance, excess of androgens and lack of serum Vitamin D. Even though several pharmaceuticals find application in psychological symptoms, some of them can impair hormonal condition in PCOS women. Few molecules are able to improve psychological symptoms without impairing hormonal profiles. Among these, myo-inositol appears to be the most interesting, as it is also considered first-line therapy in PCOS women. CONCLUSIONS: Psychological symptoms affect PCOS women more than healthy subjects. Among the different treatments, inositol emerges as a safe approach, being the first-line therapy in PCOS for hormonal improvement and having putative effects also in psychiatrists.

The use of D-chiro-Inositol in clinical practice.

OBJECTIVE: D-chiro-Inositol has been widely used in clinical practice to induce ovulation in women with polycystic ovary syndrome. Only recent evidence established that this molecule acts through two different mechanisms, with potentially different outcomes. On the one hand, under a metabolic perspective, D-chiro-Inositol improves insulin signaling, thus restoring physiological insulin levels in resistant subjects. On the other hand, at a cellular level, it downregulates the expression of steroidogenic enzyme aromatase, which is responsible for the conversion of androgens to estrogens. MATERIALS AND METHODS: We reviewed current literature in different databases, searching for D-chiro-Inositol in relation with one of the following keywords: myo-inositol, PCOS, infertility, insulin resistance, aromatase, androgen and inositol, testosterone, estrogen and inositol, estradiol, hypogonadotropic hypogonadism, fat tissue, estrogens and cancer, anovulation, uterine myoma, endometriosis, endometrial hyperplasia. RESULTS: D-Chiro-Inositol treatment may be helpful in restoring physiological hormonal levels in various clinical disorders. However, D-Chiro-Inositol intervention should be carefully designed to avoid possible undesired side effects stemming from its multiple mechanisms of action. CONCLUSIONS: We evaluated the optimal D Chiro-Inositol administration for different pathologies, defining dosages and timing. Even though further studies are required to validate our preliminary results, this paper is primarily intended to guide researchers through some of the pathways of D-Chiro-Inositol.