The current study investigated the effects of ashwagandha (Withania somnifera, WS), shatavari (Asparagus racemosus, Ar), or the combination of the two, on menopause symptoms, vascular dysfunction, bone turnover, and serum concentrations of inflammatory and oxidative stress markers in postmenopausal women.
Women were aged 40 to 55 years and postmenopausal, and were assigned to one of six treatments: 1) placebo, 2) Ar 250 mg, 3) Ar 500 mg, 4) Ws 250 mg, 5) Ws 500 mg[BL1] , or 6) a combination of Ar 250 mg and Ws 250 mg. Each capsule was given twice daily after meals, for a period of 24 weeks.
Vascular endothelial function was assessed at weeks 0, 4, 8, 12, and 24 using a salbutamol challenge test, using digital volume plethysmography. A 6% or less change in reflection index (RI) post-salbutamol was considered indicative of endothelial dysfunction.
Bone mineral density was measured by dual energy X-ray absorptiometry (DEXA). Bone turnover markers were also measured. Elevated bone turnover levels indicate increased bone turnover[BL2] , which is associated with postmenopausal bone loss. These markers include C-terminal telopeptide of type I collagen (CTX-1), bone alkaline phosphatase (BALP), receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegerin (OPG), and the ratio of RANKL/OPG.
Inflammation and oxidative biomarkers may also contribute to postmenopausal bone loss and impaired vascular function. High-sensitivity C-reactive protein (hsCRP) is a marker of chronic, low-grade systemic inflammation which has been associated with aging, low bone mineral density, and an increased risk of bone fracture. Levels of malondialdehyde (MDA), a byproduct of lipid peroxidation and a marker of oxidative stress were tested. Glutathione (GSH) levels were also measured, as estrogen deficiency is associated with diminished GSH levels, which contributes to oxidative stress and proinflammatory signaling.
Results: A total of 123 women completed the 24-week dietary supplementation period. For MENQOL, improvements in scores were dose-dependent with higher doses of each extract contributing to greater reductions in symptoms. The combination of the two did not show any enhanced response greater than each individually. The ashwagandha extract performed better than the shatavari extract in terms of absolute average score reduction, but all treatment groups performed better than placebo. The 500 mg dose of ashwagandha had a more significant reduction in the psychosocial domain score compared to both the same dose of shatavari and the 250 mg dose of ashwagandha. In addition, a dose-dependent effect was observed for ashwagandha in the physical domain. For shatavari, a dose-dependent effect was noted for vasomotor symptoms in the psychosocial and physical domains. There were no differences between groups for the sexual domain.
All groups supplemented with ashwagandha and shatavari showed significant reductions in the RI compared to placebo, indicating reduced vascular endothelial dysfunction. The higher doses had greater reductions in RI.
Bone metabolism and bone resorption biomarkers were shown to significantly decrease when compared to placebo, and bone protective OPG plasma values increased with all treatment groups. Again, greater responses were seen with the higher doses.
A higher bone mineral density (BMD) at the lumbar spine at 24 weeks vs baseline was observed for ashwagandha 500 mg/day. No effects were seen at the femoral neck.
All supplemented groups showed significantly reduced circulating levels of hs CRP, MDA, GSH and nitric oxide, although greater reductions were seen with ashwagandha compared to shatavari.
Commentary: The effect of select menopause quality-of-life symptoms is not surprising to me. What is the most interesting, is the potential use of these two plants to slow bone turnover and thus bone loss. While they report an effect on bone density at the lumbar spine, it is difficult to take any meaning from it. I do not see T-scores, but rather just reporting on standard deviations, and I do not see distinctions made between how many years postmenopausal each subject was. The most bone loss occurs 3 to 5 years post-menopause, so that is a key piece of missing information in this study.
Aging is associated with increased inflammation and vascular dysfunction, and ashwagandha and shatavari should be considered as part of the general strategy for optimal aging.[BL3]
[BL1]Something missing here, I think Ws
[BL2]I feel that this is redundant, but I don’t know how to correct it. Please take a look
[BL3]Maybe reword this to “…part of the general strategy for optimal aging.”
