7 Reasons you should take this amazing supplement –

Turmeric and Curcumin – A Clinical Use Guide

By Tieraona Low Dog, M.D.

Turmeric (Curcuma longa, C. domestica) is one of my favorite spices for both its flavor and its amazing health benefits. The rhizomes of this perennial tropical plant have been used as a spice, dye, and medicine for nearly 4,000 years, particularly in India.1

Modern researchers have been intently studying turmeric and its chief active component, curcumin, with more than 3,000 publications written on turmeric or curcumin over the last 30 years.1  Turmeric has been used therapeutically for a wide range of conditions including rheumatoid arthritis, osteoarthritis, chronic anterior uveitis, conjunctivitis, skin cancer, chicken pox, wound healing, urinary tract infections, and liver ailments.2

In my experience, this history of widely varied therapeutic use is often regarded not as a virtue, but as cause for skepticism. Modern clinicians, and particularly specialists, are trained to match specific health conditions with specific pharmaceutical drugs. The concept that a single herbal medicine – in this case, turmeric – could prevent or alleviate a wide variety of conditions seems unlikely from their perspective. This is even further complicated by the fact that turmeric and its active components are not well absorbed from the gastrointestinal tract, and what is absorbed is purported to be rapidly “inactivated.” So how could this one rhizome be of benefit for even a fraction of the conditions it is purported to help?

In this clinical use guide, I’d like to address that concern, and share the reasons why I believe turmeric and its active compounds are excellent therapeutic interventions for the prevention and early treatment of a variety of chronic conditions.

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Inflammation, the Foundation of Disease

Before we dive more deeply into turmeric, let’s step back and look at what is driving much of the chronic disease we are currently witnessing. What links such varied conditions as gum disease, Alzheimer’s dementia, osteoarthritis, autoimmune disorders, type 2 diabetes, depression, cardiovascular disease and certain cancers? Inflammation. Chronic inflammation.

The body’s inflammatory response is a miraculous biological feat and crucial for our survival. It is well designed to eliminate pathogens, remove dead and damaged cells, and allow recovery from injury or illness to occur. However, as with many good things, there is a dark side to inflammation. When the “off switch” isn’t working correctly and the inflammation becomes chronic, it wreaks havoc and the host of disorders listed above can occur.

Our modern lifestyle contributes greatly to persistent inflammation. Lack of exercise, diets high in sugar and low in omega 3 fatty acids, obesity, exposure to environmental pollutants, persistent stress, and poor sleep have all been shown to increase inflammatory markers in the body. This is why a holistic, integrative approach to health is so crucial. Working on all aspects of our patients’ lives will lead to a reduction in the risk for chronic disease and improve overall health and quality of life.

In addition to lifestyle approaches, the strategic use of dietary supplements can be very beneficial and offers a sound alternative to prescription and over-the-counter anti-inflammatory agents. In addition to probiotics, omega 3 fatty acids and adequate intake of micronutrients, I believe that turmeric is a major player when it comes to modulating our body’s inflammatory response.

Turmeric: Mechanisms and More

Plants are complex mixtures of compounds, and turmeric is no exception. Unlike a drug that primarily works via one biochemical pathway, for example a COX-2 inhibitor, turmeric works via multiple pathways. A 2013 review article from researchers at the University of Texas MD Anderson Cancer Center in Houston, TX, reported that in human participants, curcumin, one of the active compounds in turmeric, modulates numerous signaling molecules “including pro-inflammatory cytokines [tumor necrosis factor (TNF)-a, interleukin (IL)-1b, IL-6)], apoptotic proteins, nuclear factor kappa-light-chain-enhancer of activated B cells (NF- κB), cyclooxygenase-2, STAT3, IkappaB kinase beta (IKKb), endothelin-1, malondialdehyde, C-reactive protein, prostaglandin E2, glutathione-S-transferase (GST), prostate specific antigen (PSA), vascular cell adhesion molecule 1 (VCAM1), GSH, pepsinogen, phosphorylase kinase (PhK), transferrin receptor, total cholesterol, transforming growth factor beta (TGF-b), triglyceride, creatinine, hemoxygenase-1, antioxidants, aspartate transaminase, and alanine transaminase.”3

The polypharmacology of turmeric/curcumin is somewhat breathtaking. Many of these biological pathways are involved with the activation of NF-κB, a primary conductor of inflammatory, immune and stress responses in the body. This multifaceted activity is important and also distinct from the action of prescription drugs, which typically target a single enzyme or pathway, making the therapeutic effect generally quite strong, but raising the risk of adverse effects. Because curcumin does not target just one enzyme or pathway, the therapeutic action tends to be more gradual, and the safety profile excellent. The longer someone consumes turmeric/curcumin, the greater the beneficial effects. While highly targeted drugs are necessary for treating serious disease, their risk-benefit ratio is highly questionable when the goal is prevention, health promotion or the management of less serious conditions.

While more than 300 compounds have been identified in turmeric, most modern research has focused on curcumin (diferuloylmethane), the dominant component of a group of polyphenolic compounds known as curcuminoids. These compounds are responsible for the bright yellowish-orange color of the rhizome and are collectively referred to as simply curcumin.The commercial “curcumin” in the marketplace is generally a blend of the three dominant curcuminoids: curcumin, demthoxycurcumin, and bisdemothycurcumin.4

One of the confounding findings of curcumin research is that even with relatively high oral dosing, serum levels of curcumin are very low. The compound is not well absorbed in the small intestine and what is absorbed is rapidly degraded by the liver. Researchers have turned their attention to the possible systemic effects that may occur as the result of the effect of curcumin in the gut. Animal studies show that curcumin improves microbial diversity, which increases intestinal barrier function and the expression of tight junction proteins.5 Improving gut barrier function results in lower circulating bacterial lipopolysaccharide (LPS) levels and inflammation. Thus, some of the indisputable beneficial effects seen with curcumin may have their roots in the gastrointestinal tract. And while the curcuminoids that are absorbed are rapidly degraded by the liver, some of their degradation products, such as ferulic acid and vanillin, also have demonstrated biological activity.4

While curcumin is certainly one of the main bioactive components in turmeric rhizome, research shows that “curcumin free” turmeric has anti-inflammatory activity.6 The essential oil fraction of turmeric likely plays an important therapeutic role. This is why products often include some whole turmeric rhizome, in addition to curcumin, to ensure a full spectrum of “actives” are present.

While we continue to explore the mechanisms by which turmeric and the curcuminoids work, there is no question that there is good evidence that they have beneficial effects on human health.

 

7 Reasons why you should take Turmeric/ Curcumin

Research on Turmeric/Curcumin and Specific Health Conditions

Research has shown taking supplemental turmeric or curcumin is associated with mitigating symptoms of a wide range of conditions. A small sampling includes:

  • Inflammatory Bowel Disease: Because turmeric/curcumin remain in the gut it would make sense that they exert a beneficial effect in inflammatory bowel disease. One review reported that in patients with Crohn’s disease, those taking curcumin experienced a 55 point mean reduction in the Crohn’s Disease Activity Index and a reduction in IL-1, C-reactive protein, TNF-a and PPMTase, which can improve colorectal cancer outcomes.7 Another review of clinical trials found that patients with ulcerative colitis experienced significant relief when they took turmeric along with mesalamine or sulfasalazine, compared to those taking a placebo with those drugs.8
  • Depression and Mood Disorders: A growing body of research indicates that depression may be due to increased gut permeability and subsequent systemic inflammation. A review of six clinical trials examining the use of curcumin supplements to address major depression showed significantly higher reduction in symptoms in curcumin takers. The highest effect was found in middle-aged patients who took the supplement for a longer duration at higher doses.9 In my view, this significant dose response effect provides yet another data point arguing for curcumin’s efficacy.
  • Knee Osteoarthritis: Turmeric has long been used for alleviation of joint pain in India. Modern science seems to concur with this traditional use. A meta-analysis of nine trials – six using curcumin alone, and three using the combination of curcumin and boswellia – showed statistically significant pain relief in all five of the trials that tracked pain.10 I generally recommend the combination of turmeric and boswellia for joint pain.
  • Post-Bypass Heart Attack Prevention: In one study, 121 patients undergoing coronary artery bypass after myocardial infarction were randomly assigned to receive 4 grams per day curcuminoids or placebo for three days before surgery and for another 5 days after surgery. Incidence of in-hospital MI was 30% in the placebo group and 13% in the curcuminoid group.11
  • Type 2 Diabetes: In one 12-week randomized double-blind placebo-controlled trial, 118 participants with type-2 diabetes were assigned to curcumin (1000 mg/day plus piperine 10 mg/day) or placebo plus standard of care. Compared to placebo, those taking curcumin had a significant reduction in Lp(a) and non-HDL cholesterol, as well as increased adiponectin and decreased leptin and TNF-α levels.12,13 Given the fact that Lp(a) is a significant risk factor for heart disease and is relatively resistant to lifestyle interventions (e.g., diet, weight loss), these results are promising. It is not surprising that one literature review concluded “Curcumin could favorably affect most of the leading aspects of diabetes, including insulin resistance, hyperglycemia, hyperlipidemia, and islet apoptosis and necrosis…In addition, curcumin could prevent the deleterious complications of diabetes.”14
  • Lipid Reduction: Numerous studies show that spices have a beneficial effect on lipids. A meta-analysis of twenty studies found that curcumin significantly reduces plasma triglycerides and increases HDL-C levels.15 Given that heart disease remains the number one cause of death in the US, the addition of turmeric/curcumin to the diet or daily supplement regimen makes sense.
  • Gut Microbiota: The microbiota of the gut plays a pivotal role in maintaining health, and the diversity of the microbiota is vitally important. The greater the variation in microbes, the greater the ability to adapt across a range of physiological challenges and responses. A loss of species diversity has been associated with a number of disease states.16  A study conducted at the University of California at Davis compared the impact of 6 grams turmeric (3 tablets twice daily: each tablet contained 1000 mg turmeric and 1.25 mg BioPerine®), 6 grams curcumin (3 tablets twice daily: each tablet contained 1000 mg curcumin and 1.25 mg BioPerine), or identical placebo on the gut microbiota of 30 healthy individuals. Stool samples were collected and the number of observed microbial species present in each group were recorded pre- and post-treatment. After 8 weeks, the placebo group displayed an overall 15% reduction in species, whereas turmeric-treated subjects displayed a modest 7% increase in observed species, and most notably – those taking curcumin displayed an average 69% increase in detected species.17 Interesting to note that curcumin, not turmeric, led to the greatest increase in species diversity, from an average of 127 species at the beginning of the study to 215 species at the end.

 

Practitioner Recommendations

I generally recommend a turmeric extract standardized to 95 percent curcumin, with a potentiator such as BioPerine, a patented black pepper extract, to improve bioavailability. Curcumin supplements including BioPerine have been shown to exhibit 20-fold bioavailability enhancement compared to curcumin alone.18 Generally, for every 500 mg of standardized turmeric, 5 mg of BioPerine is included.

It should be noted that black pepper extract, and more specifically the alkaloid piperine, has a multitude of beneficial health benefits on its own. Research shows that it is an excellent digestive aid, immunomodulator, hepatoprotectant, anti-inflammatory, antiamoebic, antifungal, antibacterial, anti-oxidant, anti-carcinogenic, anti-ulcer, antihyperlipidemic, and antiasthmatic agent.19

As for the dose, most studies show beneficial effects with standardized extracts of turmeric given at a daily dose of 500 mg two times per day. I generally recommend 500 mg before breakfast and dinner, as turmeric/curcumin is an excellent digestive aid, enhancing the secretion of gastric juices and the flow of bile.

Studies have shown that incorporating some turmeric along with curcumin increases curcumin’s bioavailability.20 Thus, I recommend looking for a supplement that also contains some whole turmeric rhizome and recommend that patients learn how to use it in cooking. Golden milk is a delicious drink that anyone can make and most people, young and old, truly love. Above (pictured) is the recipe I use, as well as other suggestions for incorporating turmeric into the diet. Feel welcome to share.

 

Safety

Turmeric and curcumin have both been shown to have an excellent safety profile even when given at higher doses. The review article from the University of Texas MD Anderson Cancer Center in Houston, TX, reported that a human trial with 25 subjects using up to 8000 mg of curcumin daily for three months found no toxicity.3 This is in sharp contrast to the well-documented adverse effects of non-steroidal anti-inflammatory medications (NSAIDs).

While turmeric used as a spice in the diet is considered quite safe in pregnancy, there is not enough data to determine safety of high dose dietary supplements.

Clinicians should be aware that piperine can enhance the absorption of other drugs, particularly with doses of 20 mg of piperine per day or higher.19  Keeping the piperine at a total daily dose of 10-15 mg per day is probably wise if the patient is taking prescription medications.

 

Citations:

  1. Prasad S, Aggarwal BB. Turmeric, the Golden Spice: From Traditional Medicine to Modern Medicine. In: Benzie IFF, Wachtel-Galor S, editors. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Boca Raton (FL): CRC Press/Taylor & Francis; 2011. Chapter 13.
  2. Dixit V. P, Jain P, Joshi S. C. Hypolipidemic effects of Curcuma longa L. and Nardostachys jatamansi, DC in triton-induced hyperlipidaemic rats. Indian J Physiol Pharmacol. 1988;32:299–304.
  3. Gupta SC, Kismali G, Aggarwal BB. Curcumin, a component of turmeric: from farm to pharmacy. Biofactors 2013; Jan-Feb;39(1):2-13. doi: 10.1002/biof.1079.
  4. Cavaleri F. Presenting a New Standard Drug Model for Turmeric and Its Prized Extract, Curcumin. Int J Inflamm 2018 Jan 15; 2018:5023429.
  5. Feng W, Wang H, Zhang P, et al. Modulation of gut microbiota contributes to curcumin-mediated attenuation of hepatic steatosis in rats. Biochem Biophys Acta. 2017;1861:1801–1812. doi:10.1016/j.bbagen.2017.03.017.
  6. Aggarwal BB, Yuan W, Li S, Gupta SC. Curcumin-free turmeric exhibits anti-inflammatory and anticancer activities: Identification of novel components of turmeric, Mol Nutr Food Res 2013; Sep;57(9):1529-42.
  7. Hossain I, VanderMolen J, Nicol K. Comparison of remicade to curcumin for the treatment of Crohn’s disease: A systematic review. Complement Ther Med. 2017 Aug;33:32-38.
  8. Kumar S, Ahuja V, Vishnubhatla S, Prasad K, Kumar A. Curcumin for maintenance of remission in ulcerative colitis. Cochrane Database of Systematic Reviews. 2010. doi:10.1002/14651858.cd008424.
  9. Al-Karawi D, Mamoori DAA, Tayyar Y. The Role of Curcumin Administration in Patients with Major Depressive Disorder: Mini Meta-Analysis of Clinical Trials. Phytotherapy Research. 2015;30(2):175-183. doi:10.1002/ptr.5524.
  10. Curcumin for knee osteoarthritis: hope or hype. Bannuru, R.R. et al. Osteoarthritis and Cartilage, Volume 24, S352
  11. Wongcharoen W, Jai-Aue S, Phrommintikul A, et al. Effects of Curcuminoids on Frequency of Acute Myocardial Infarction After Coronary Artery Bypass Grafting. The American Journal of Cardiology. 2012;110(1):40-44. doi:10.1016/j.amjcard.2012.02.043.
  12. Panahi Y, Khalili N, Sahebi E, et al. Curcuminoids Plus Piperine Modulate Adipokines in Type 2 Diabetes Mellitus. Curr Clin Pharmacol. 2017;12(4):253-258.
  13. Panahi Y, Khalili N, Sahebi E, et al. Curcuminoids modify lipid profile in type 2 diabetes mellitus: A randomized controlled trial. Complement Ther Med. 2017 Aug;33:1-5
  14. Zhang D, Fu M, Gao S-H, Liu J-L. Curcumin and Diabetes: A Systematic Review. Evidence-based Complementary and Alternative Medicine: eCAM. 2013;2013:636053. doi:10.1155/2013/636053.
  15. Simental-Mendia LE, Pirro M, Gotto AM Jr, et al. Lipid-modifying activity of curcuminoids: A systematic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr 2017; Nov 29:1-10.
  16. Mark L. Heiman, Frank L. Greenway. A healthy gastrointestinal microbiome is dependent on dietary diversity. Molecular Metabolism, 2016; 5(5):317-20
  17. Peterson CT, Vaughn AR, Sharma V, et al. Effects of Turmeric and Curcumin Dietary Supplementation on Human Gut Microbiota: A Double-Blind, Randomized, Placebo-Controlled Pilot Study. J Evid Based Integr Med. 2018 Jan-Dec;23:2515690X18790725
  18. Shoba G, Joy D, Joseph T, Majeed M, Rajendran R, Srinivas P. Influence of Piperine on the Pharmacokinetics of Curcumin in Animals and Human Volunteers. Planta Medica. 1998;64(04):353-356. doi:10.1055/s-2006-957450.
  19. Meghwal M, Goswami TK. Piper nigrum and piperine: An update. Phytother. Res. 2013;  27: 1121–1130
  20. Antony B, Merina B, Iyer VS, et al.  A pilot cross-over study to evaluate human oral bioavailability of BCM-95CG (Bio-curcumax), a novel bioenhanced preparation of curcumin. Indian J. Pharm. Sci. 2008; 70: 445 – 449.

BioPerine® is a trademark of the Sabinsa Corporation. U.S. Patents #5,536,506, #5,744,161, #5,972,382, and #6,054,585

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