Chromium picolinate reduces insulin resistance in polycystic ovary syndrome: Randomized controlled trial
Summary by: Dr. Tori Hudson, N.D.
Author: Ashoush S, Abou-Gamrah A, Bayoumy H, Othman N
Reference: Chromium picolinate reduces insulin resistance in polycystic ovary syndrome: Randomized controlled trial. J Obstet. Gyn Res 2016;42(3): 279-285
Design: The current study was a double-blinded randomized controlled trial in which 100 women with polycystic ovary syndrome (PCOS) were selected from 438 women who were approached. Women were randomly assigned to either 1,000 mcg/day of Chromium (group 1) or placebo (group 2). Women underwent a complete clinical, biochemical and pelvic ultrasound evaluation for detection of PCOS, using the Rotterdam diagnostic criteria. Diet was controlled restricting simple sugars and saturated fats, limiting the daily calorie intake to a maximum of 35 kcal/kg/day and exercise of 30 minutes twice weekly. Blood samples were taken at baseline and at the end of the six month period and included fasting glucose insulin ratio (FGIR), fasting glucose, fasting serum insulin and total testosterone. Other examinations included cycle regularity, ovulation, body mass index, pregnancy testing, hirsutism according to the Ferriman-Gallwey score, and serial ultrasounds to assess for ovulating dominant follicle and endometrial thickness
Participants: Women were 20-35 years old, and from the outpatient gynecology clinics in a University Women’s Hospital in Egypt. Women were included if they met the Rotterdam diagnostic criteria for PCOS. Women were excluded if they were receiving corticosteroids, ovulation induction, contraception, insulin-sensitizing agents, adrenergic agonists, psychotropic drugs, diuretics, beta-blockers, HMG CoA reductase inhibitors or any other medications or supplements known to affect insulin sensitivity, or carbohydrate or lipid metabolism. Women who were diagnosed with diabetes mellitus, impaired glucose tolerance, Cushing syndrome, thyroid disease, causes of infertility other than anovulation, congenital adrenal hyperplasia, hepatitis, asthma, renal disease, androgen-secreting tumors or adrenal tumors were excluded from the study.
Primary outcome: The primary outcome was the effect of tri-valent chromium on fasting glucose insulin ratios in reproductive aged women with PCOS, in essence the effect on insulin resistance.
Key findings: Eighty-five women completed the study with 44 in the chromium group and 41 in the placebo group. Use of chromium picolinate at 1,000 mcg/day for 6 months was associated with significant reductions of body mass index and fasting serum insulin and a significant rise in the fasting glucose insulin ratio. For the first 4 months, there were no significant differences in ovulation rates and regulation of the menstrual cycle, but after 5 months, women in the chromium group did have significant increased rates of ovulation by almost twofold and threefold after 6 months. Similarly, menstrual cycle regularity was increased by almost twofold after 5 months and almost 1.5 fold after 6 months in the chromium group. There were also slightly higher cumulative pregnancy rates in the infertile women of the chromium group after months 4,5 and 6, although it did not reach statistical significance. There were no significant changes in fasting glucose in either group. The mean serum free testosterone and Ferriman-Gallway score were statistically unchanged as well.
Practice Implications: Insulin resistance and the hyperinsulinemia that results are key metabolic abnormalities in both lean and obese women with PCOS, although it is more accentuated in obese PCOS women. Insulin resistance is correlated with hyperandrogenism and the degree of clinical effects of the syndrome including ovulation rates, cycle regularity and hirsutism. The current study shows that chromium picolinate is an effective treatment in women with PCOS and results in a significant rise in fasting glucose insulin ratio, a significant reduction in fasting serum insulin and body mass index, significantly improved ovulation rates and regular menstrual cycles. These effects appear to start after 4 months of treatment but better results after 5 and then 6 months. The effects on serum testosterone were non-significant. However, we have other document evidence based natural therapies for reducing androgens in women with PCOS including the inositols, licorice root and spearmint tea, to name a few of my favorites. Mainstays of natural treatments for improving insulin sensitivity should also include a lower carbohydrate/higher protein diet, daily 30-90 minutes of aerobic exercise, strength training twice weekly, N-acetyl cysteine… and chromium!