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- Turmeric (Curcuma longa)
- Boswellia (Indian Frankincense; Boswellia serrata)
- Curcumin
- Chronic Kidney Disease
- Inflammation
- Antioxidant Response
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Date:
01-15-2014 | HC# 091337-488
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Re: Combination of Boswellia and Curcumin in Chronic Kidney Disease
Moreillon
JJ, Bowden RG, Deike E, et al. The use of an anti-inflammatory supplement in
patients with chronic kidney disease. J
Complement Integr Med. 2013;10(1):1-10. doi: 10.1515/jcim-2012-0011.
Chronic
kidney disease (CKD), which affects about 20 million Americans, is expected to
rise in incidence because of the increase in diabetes, hypertension, and
obesity. CKD is characterized by a chronic inflammatory state, with elevated
levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in all
stages of the disease. Patients with CKD also exhibit lower levels of plasma
glutathione peroxidase (GPx) and other antioxidant enzymes. In most patients,
CKD is not diagnosed early when the disease is asymptomatic, which is of concern
because of the relationship between the systemic inflammation of the disease and
the risk for cardiovascular disease (CVD). In addition to pharmaceuticals such
as statins and angiotensin-converting enzyme inhibitors, complementary and
alternative medicine therapies used to treat CKD are gaining interest in the
scientific community. The authors conducted a study to evaluate the
inflammatory and antioxidant responses of 8 weeks of curcumin (from turmeric; Curcuma longa) and boswellia (Indian frankincense;
Boswellia serrata) supplementation in
patients with mild-to-moderate CKD.
Patients
at a community health center in Central Texas who were older than 18 years of
age and had CKD in stages 1 through 5 were recruited for the study. Patients
completed a medical history questionnaire and underwent a general physical
examination by their physician to determine eligibility. The patients were
randomly chosen to receive an herbal supplement of curcumin and boswellia (824
mg purified turmeric extract, 95% curcuminoids, and 516 mg boswellia extract,
10% 3-acetyl-11-keto-β-boswellic acid) or placebo (roasted rice [Oryza sativa] powder). The study
supplement was added to the patients' existing treatment protocols. The study
outcome variables were plasma IL-6, TNF-α, GPx, and serum C-reactive protein
(CRP).
The
patients participated in 2 testing sessions 8 weeks apart. During session 1,
they donated blood after a 12-hour fast and underwent measurements for height,
weight, heart rate, blood pressure, and waist and hip circumferences. They were
then given an 8-week supply of the supplement or placebo and instructed to
ingest 2 capsules daily (1 in the morning with breakfast and 1 in the evening
with dinner) and to continue their usual medications. After 8 weeks, the patients
returned to the clinic for another blood draw and a pill count to determine
compliance. The patients' diets were not standardized; they maintained their
normal dietary habits during the study.
Sixteen
patients (out of an original 23) completed the study. At baseline, the placebo
group (n=7) had significantly higher values for height (P=0.05), body mass
index (BMI) (P=0.01), waist circumference (P=0.03), and hip circumference
(P=0.02). Glomerular filtration rate (GFR), used to determine kidney function, was
not significantly different between the groups. The authors report that
baseline data demonstrated elevated inflammation and low antioxidant levels.
A
significant time effect (P=0.03; effect size [ES]=0.32) and time × compliance
interaction effect (P=0.05; ES=0.30) were observed for IL-6, with a decrease in
the treatment group and an increase in the placebo group. No significant group,
time, or interaction effects were seen for any of the other outcome variables.
Noting that these findings partially support earlier research on the anti-inflammatory
effects of curcumin and boswellia, the authors write: "Reasons for [only] partial
support of previous literature could be due to a dose-response relationship,
short study duration, influence of anti-inflammatory medications, small sample
size, or lack of interaction between curcumin, Boswellia serrata, and some markers of inflammation." CRP and
IL-6 have been shown to be significantly correlated.1 The authors
explain that the lack of change in CRP in this study may be due to the high
prevalence of nonsteroidal anti-inflammatory drug use by the study subjects, as
most patients were taking aspirin to reduce the risk for myocardial infarction,
which may have inhibited curcumin's effectiveness against CRP.
According
to the authors, the lack of a statistical change in GPx levels may be due to
the study duration and sample size: "A supplementation period of 8 weeks
may have been of insufficient magnitude to observe changes in GPx, and the
sample size used in the present study was small, with larger studies needed to
determine if curcumin's antioxidant benefits observed in animal studies carry
over to humans."
Only
minor adverse side effects were reported during the study.
These
results support those of previous studies suggesting that CKD is associated
with an ongoing inflammatory state and impaired antioxidant activity. The study
treatment was well tolerated and resulted in decreased inflammation as measured
by IL-6; however, no changes were observed in any other inflammatory or
antioxidant markers.
―Shari
Henson
Reference
1Heinrich PC, Castell
JV, Andus T. Interleukin-6 and the acute phase response. Biochem J. 1990;265(3):621-636.
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