Inflammatory PMOS — Recalibrate Women's Wellness

Inflammatory PMOS

Immune-Driven Pattern · Nutritional Support Guide

Is This Your Pattern?
  • Normal or near-normal insulin sensitivity; often lean or normal weight
  • Normal or only mildly elevated androgens
  • Gut symptoms: bloating, IBS, food sensitivities, reflux, or alternating bowel habits
  • Elevated hs-CRP or other inflammatory markers on labs
  • Fatigue and brain fog out of proportion to sleep quality
  • Symptoms worsen with certain foods (gluten, dairy, sugar, alcohol)
  • Co-occurring autoimmune conditions (Hashimoto's, rheumatoid arthritis, eczema, psoriasis)
  • Often the 'healthy' patient — reproductive symptoms are the reason PMOS is suspected
  • History of gut infections, parasites, antibiotic overuse, or chronic food restriction
Root Driver

Gut barrier dysfunction allows lipopolysaccharide (LPS) endotoxin from gram-negative bacteria to enter circulation → activates TLR4 receptors → drives NF-κB-mediated systemic inflammation → secondary insulin resistance and androgen excess. In inflammatory PMOS, inflammation is the cause, not the consequence — which means the intervention hierarchy is inverted relative to metabolic PMOS. Targeting insulin first without addressing the gut upstream leaves the root untouched.

Tier 1 — Essential Nutrients

Highest Clinical Priority
L-Glutamine
Primary fuel source for intestinal epithelial cells; maintains tight junction integrity; reduces gut barrier permeability and LPS translocation into circulation. Addressing gut permeability works directly on the upstream driver of inflammatory PMOS — this is the first intervention, not an adjunct.
RDANone establishedTherapeutic5,000–15,000 mg/day on empty stomach
Timing Matters

Take on empty stomach or between meals — glutamine is preferentially taken up by enterocytes before it reaches systemic circulation. Food in the stomach reduces this gut-first delivery. Start low (5 g) and increase over 2 weeks as tolerated.

Best Food Sources
BeefChickenEggsRaw cabbageBeetsBone brothSpinach
Omega-3 (EPA + DHA)
Shifts prostaglandin balance from pro-inflammatory PGE2 to anti-inflammatory PGE1/PGE3; directly suppresses NF-κB signaling; reduces TNF-α and IL-6; lowers hs-CRP. Among the most well-documented anti-inflammatory interventions — this is foundational, not optional.
AI (ALA only)1.1 g/dayTherapeutic2,000–4,000 mg EPA+DHA/day
The ALA Conversion Problem

Plant ALA converts to EPA at <10% efficiency. An Omega-3 Index (red cell fatty acid panel) is the most accurate way to gauge baseline status — target >8%. Western diets typically test at 3–4%.

Best Food Sources
Wild salmonMackerelSardinesHerringAnchoviesAlgae oil (vegan)
Vitamin D3 (with K2 MK-7)
Regulates Th1/Th2 immune balance; suppresses inflammatory cytokine production; maintains gut epithelial tight junctions; modulates NF-κB pathway. In inflammatory PMOS, the target range is the higher end of functional — 60–80 ng/mL — where immune-regulatory effects are strongest.
RDA600 IU/dayTherapeutic3,000–5,000 IU/day; target serum 60–80 ng/mL
Why the RDA Falls Short

The RDA targets bone health at a population level. Immune-regulatory and anti-inflammatory effects require substantially higher circulating 25-OH-D. Autoimmune co-conditions common in inflammatory PMOS further increase demand. Test before dosing — adipose tissue sequesters vitamin D.

Best Food Sources
Wild salmonSardinesEgg yolksBeef liverMackerelFortified milk
Vitamin A (Retinol)
Gut mucosal IgA production; tight junction protein expression; innate immune regulation. Retinol — not beta-carotene — is required. Beta-carotene conversion is significantly impaired by gut dysbiosis, hypothyroidism, and genetic variants that co-occur frequently with this phenotype.
RDA700 mcg RAE/dayTherapeutic3,000–5,000 IU/day as retinol, with fat-containing meal
Why Not Beta-Carotene

Beta-carotene requires enzymatic conversion (BCO1) to retinol. Gut dysbiosis, hypothyroidism, and BCMO1 polymorphisms — all common in inflammatory PMOS — impair this conversion by up to 75%. Carrots and sweet potatoes do not reliably deliver usable vitamin A in this population.

Best Food Sources
Liver (highest)Egg yolksDairyMackerelSardines
N-Acetyl Cysteine (NAC)
Glutathione precursor; directly inhibits NF-κB — the master transcription factor driving inflammatory cytokine production; reduces oxidative stress from LPS-activated macrophages; supports Phase II hepatic detoxification of inflammatory byproducts.
RDANone establishedTherapeutic600–1,800 mg/day
Food Sources (as cysteine precursor)
PoultryEggsDairyLentilsOatsSunflower seeds
Zinc
Tight junction protein synthesis (occludin, ZO-1); intestinal barrier integrity; innate immune regulation and inflammatory resolution; direct NF-κB modulation. Zinc deficiency is both a cause and consequence of gut dysbiosis — it creates a self-perpetuating loop.
RDA8 mg/dayTherapeutic25–40 mg/day (+ 1–2 mg copper long-term)
Phytate Competition

Phytates in plant foods reduce zinc absorption by up to 45%. In this phenotype, gut dysbiosis further impairs zinc uptake. Serum zinc is an unreliable marker — clinical response to supplementation is more informative.

Best Food Sources
Oysters (highest)BeefPumpkin seedsHemp seedsLentilsCashews
Glycine
Inhibits NF-κB signaling via glycine-gated chloride channels on macrophages; directly reduces inflammatory cytokine release from activated immune cells; gut mucosal healing; third glutathione precursor alongside NAC/cysteine and glutamate; calming neurotransmitter for the anxiety common in inflammatory states.
RDANone establishedTherapeutic3,000–5,000 mg/day (split or evening)
Mechanism Note

Glycine's anti-inflammatory effect is direct and cell-specific — it chloride-hyperpolarizes macrophages, making them less responsive to inflammatory signals. This is a mechanism distinct from general antioxidant activity and is not replicated by other amino acids.

Best Food Sources
Bone brothCollagen peptidesGelatinSkin-on poultrySpinachCabbage
Selenium
Glutathione peroxidase cofactor; reduces TPO antibody levels in Hashimoto's; suppresses inflammatory cytokine production; thyroid hormone activation (T4→T3). Consistently low in PMOS; critical in the presence of autoimmune co-conditions.
RDA55 mcg/dayTherapeutic100–200 mcg/day (upper limit 400 mcg/day)
Soil Depletion Note

Agricultural soil selenium varies dramatically by region — published food selenium values are often higher than what's actually present. Two Brazil nuts provide a reliable, measurable selenium dose. Do not exceed 400 mcg/day without serum selenium testing.

Best Food Sources
Brazil nuts (1–2 = ~100 mcg)TunaSardinesShrimpBeefTurkeyCottage cheese

Tier 2 — Supporting Nutrients

Secondary Stack
Vitamin C
Reduces hs-CRP; collagen synthesis for gut mucosal repair; antioxidant recycling. Divide into two doses for better absorption — 500 mg absorbs more efficiently than 1,000 mg at once.
Therapeutic500–1,000 mg/day divided
Food Sources
Red bell pepperGuavaKiwiStrawberriesCitrusBroccoli
Magnesium (Glycinate)
Inflammatory mediator regulation; reduces CRP; HPA axis support. Deficiency independently elevates CRP and IL-6 — depleted by both inflammation and stress.
Therapeutic350–400 mg/day, evening
Food Sources
Pumpkin seedsAlmondsSpinachDark chocolateAvocadoBlack beans
Niacin (NR or NMN)
NAD+/SIRT1 pathway inhibits NLRP3 inflammasome activation — a direct anti-inflammatory mechanism. NR or NMN preferred over nicotinic acid in inflammatory context.
Therapeutic250–500 mg/day NR or NMN
Food Sources
LiverChickenTunaMushroomsPeanutsNutritional yeast
CoQ10 (Ubiquinol)
Mitochondrial protection from inflammatory ROS; antioxidant in lipid membranes under inflammatory load.
Therapeutic200–400 mg/day with fat-containing meal
Food Sources
Heart & liverSardinesMackerelBeefPeanuts
Vitamin E (Tocotrienols)
Inhibits NF-κB via tocotrienol-specific (not tocopherol) mechanism; membrane antioxidant. Seek mixed tocotrienols (delta + gamma) from palm, rice bran, or annatto.
Therapeutic200–400 mg/day mixed tocotrienols
Food Sources
Rice bran oilAnnattoPalm oilWheat germ oilSunflower seeds
5-MTHF + Methylcobalamin
Homocysteine reduction (pro-inflammatory at elevated levels); immune cell methylation and regulation; bypass of MTHFR polymorphism.
Therapeutic800 mcg 5-MTHF + 500 mcg methylB12
Food Sources
LiverSpinachAsparagusClamsSardinesAvocado
Selenium + Iodine (thyroid)
Pair for thyroid support in Hashimoto's co-occurrence — selenium must accompany iodine to protect against excess iodine worsening TPO antibodies.
Therapeutic100–200 mcg selenium; 150–300 mcg iodine, together
Food Sources
Brazil nuts (Se)Sardines (Se)Seaweed (I)Dairy (I)Eggs (I)
L-Arginine
Endothelial nitric oxide production; vascular inflammation resolution; follicular blood flow. Impaired arginine-to-NO conversion is common in inflammatory endothelium.
Therapeutic1,000–3,000 mg/day
Food Sources
Pumpkin seedsTurkeySoybeansPeanutsSpirulinaChickpeas
Iron (assess ferritin first)
Inflammatory cytokines sequester iron — functional iron deficiency with normal serum iron is common in chronic inflammation. Check ferritin AND serum iron AND TIBC together for the full picture.
TherapeuticProvider-guided per ferritin + iron panel
Food Sources
LiverRed meatOystersLentilsSpinach (with vitamin C)
Myo-Inositol
Secondary insulin sensitization; follicular support. Lower priority in this phenotype than in metabolic PMOS — gut and inflammation work first.
Therapeutic2,000–4,000 mg/day, split
Food Sources
GrapefruitCantaloupeOrangesBeansBrown riceAlmonds
Timing & Combinations
  • L-Glutamine: on empty stomach or between meals — gut mucosal delivery drops when competing with food digestion
  • Fat-solubles (D+K2, A, E tocotrienols): with largest fat-containing meal — absorption requires dietary fat
  • Vitamin C: split into 2 doses (500 mg morning, 500 mg evening) — 500 mg absorbs significantly better than 1,000 mg at once
  • Omega-3: with largest meal; refrigerate fish oil capsules to reduce oxidation and GI effects
  • Iron: with vitamin C to enhance non-heme absorption; separate from calcium, zinc by 2 hours
  • Zinc: with food; separate from iron by 2 hours (competing transporter)
  • Magnesium: evening — reduces CRP and supports sleep
  • Selenium + Iodine: take together, with food — selenium buffers against iodine excess risk in Hashimoto's
  • NAC: with or without food; split dosing if GI-sensitive
  • Glycine: can split (3 g morning, 2 g evening) or take full dose in evening for sleep benefit
Lab Priorities — Ask Your Provider
  • hs-CRP — sensitive inflammatory marker; functional optimal <0.5 mg/L; >1.0 = elevated; >3.0 = high risk
  • ESR — broader inflammatory signal; tracks response to intervention over time
  • Comprehensive stool analysis (Genova, Doctor's Data, or similar) — gut dysbiosis characterization
  • Calprotectin — gut mucosal inflammation marker; distinguishes IBS from IBD
  • Zonulin or lactulose:mannitol ratio — gut permeability assessment
  • Omega-3 Index (red cell fatty acid panel) — target >8%; most PMOS patients test at 3–4%
  • ANA panel + thyroid antibodies (TPO ab, TG ab) — autoimmune co-condition screening
  • Ferritin + serum iron + TIBC — pattern of low ferritin, normal/high serum iron = inflammatory sequestration
  • 25-OH-D — target 60–80 ng/mL in inflammatory phenotype
  • Homocysteine — pro-inflammatory at elevated levels; functional <8 µmol/L
  • Thyroid panel: TSH, free T3, free T4, TPO ab — Hashimoto's is common PMOS co-condition
Recalibrate Women's Wellness · recalibrateher.health
For educational purposes only. Review all supplement doses with your provider before starting.
Therapeutic ranges reflect PMOS-specific clinical evidence, not general population RDAs.