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Sohaei S, Amani R, Tarrahi MJ, Ghasemi-Tehrani H. The effects of curcumin supplementation on glycemic status, lipid profile and hs-CRP levels in overweight/obese women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled clinical trial Study.Supplement Ther Med. 2019;47:102201.
Draft
A 6-week, randomized, double-blind, placebo-controlled clinical trial
Objective
Researchers conducted this study to determine the effect of curcumin supplementation on glycemic status, lipid profile, and high-sensitivity C-reactive protein (hs-CRP) levels in overweight/obese women with polycystic ovary syndrome (PCOS).
Participant
Sixty women with PCOS, diagnosed according to the Rotterdam criteria, aged 18 to 40 years and with a body mass index (BMI) between 25 and 35 kg/m2participated in the study. Exclusion criteria included pregnancy, lactation, hyperprolactinemia, thyroid disease, digestive problems, type 2 diabetes mellitus, congenital adrenal hyperplasia, and overt infection. Use of any of the following in the 3 months prior to the study also resulted in exclusion: oral contraceptives, antioxidant supplements, and any intervention that could alter insulin sensitivity, inflammation, or oxidative stress status.
intervention
The experimental group (n = 30) received 500 mg of standardized turmeric extract 95% twice daily (475 mg of curcuminoids containing curcuminoids in the following proportions: 70%-80% curcumin, 15%-20% demethoxycurcumin, 2.5%-6.5% bisdemethoxycurcumin). The control group (n=30) followed the same dosing schedule but with placebo. Participants should take the supplements with 2 main meals.
Target parameters
Primary outcome measures included total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), LDL/HDL ratio, TG/HDL ratio, fasting blood glucose, insulin, homeostasis model of assessment Insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI) and hs-CRP. Investigators obtained measurements at baseline and week 6.
Key insights
Fifty-one of the 60 participants completed the study, 27 in the curcumin group and 24 in the placebo group. Three discontinued the intervention due to pregnancy, and the remainder withdrew for unspecified personal reasons. In the experimental group, 3 participants reported gastrointestinal symptoms; otherwise, no other adverse effects were noted.
After 6 weeks of intervention, statistically significant changes in serum insulin (P=0.020) and QUICKI (P=0.003), baseline vs. end of study, occurred in those taking curcumin. All other parameters were not significantly improved and the differences between groups were not significant.
Practice implications
Polycystic ovary syndrome is a complex, multifactorial endocrine disorder that affects up to 18% of women of reproductive age.1It is characterized by hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology, with 2 of the 3 required for diagnosis according to the Rotterdam criteria.2Metabolic disorders, including dysglycemia and dyslipidemia, are common in people with PCOS, as is chronic inflammation. Given the predisposition to cardiometabolic diseases, treatment goals should include normalization of blood glucose, lipid and inflammatory status.3
There was no mention of combining a curcumin supplement with either dietary fat or black pepper for improved bioavailability.
Metformin, a conventional first-line treatment for PCOS, has been shown to regulate serum glucose and insulin levels, normalize lipids, and reduce inflammation, although not all patients tolerate the drug.4.5Alternative interventions such as inositol have become a topic of interest among researchers because they produce comparable results with fewer side effects.6The authors of the article, currently under review, hypothesized that curcumin would function similarly, given its anti-inflammatory, antioxidant, and hypolipidemic properties. However, the benefits in this study were limited to improvements in insulin levels only.7
The overwhelming results may be due to limitations of the study design. A 6-week intervention period is probably not sufficient to evaluate the effectiveness of a dietary supplement. The authors acknowledge this, although they also cite several studies that found effects within 1 month of starting curcumin treatment. Based on these previous results, the trial duration was considered appropriate. The authors also acknowledge the likelihood of variability in absorption. They did not perform metabolite testing to determine curcumin levels, although this may have proven useful. The researchers instructed participants to take supplements with meals to maximize absorption, but there was no mention that curcumin supplementation should be combined with either dietary fat or black pepper for improved bioavailability.8
Since this article was published in 2019, two randomized control trials have been conducted on curcumin and overweight/obese PCOS women. Jamilian et al. found a significant benefit on metabolic parameters after 12 weeks of daily intake of 500 mg curcumin. They noted improvements in glycemic control, lipid parameters (except triglycerides and very low-density lipoprotein [VLDL] cholesterol), weight, and peroxisome proliferator-activated receptor gamma (PPAR-γ) gene expression.9The second study involved 3 months of 1,500 mg TID curcumin and resulted in upregulated activity of proteins and enzymes that serve as modulators of oxidative stress.10
It is evident that research on curcumin and PCOS is emerging, with the results of these studies serving as preliminary evidence. Further research is necessary to elucidate its role in altering PCOS pathophysiology and to determine therapeutic dosage. Given that there are numerous other therapies with well-documented benefits, it may be prudent to reserve the recommendation for those who have concurrent comorbidities known to respond to curcumin. That being said, encouraging patients to add a few extra dashes of turmeric to their diet may be a useful addition to a well-rounded treatment plan, without being expected to have a significant effect on PCOS pathophysiology.