Turmeric and Curcumin for Inflammation – Best to Take in Food or Capsule?

Introduction: Turmeric and Curcumin for Inflammation

Asian Indian culture has used turmeric and curcumin for inflammation over many centuries. Curcumin is the chief therapeutic component in Turmeric responsible for the spice’s yellow color and health promoting effects. Turmeric and curcumin has substantial health benefits and medicinal properties that may treat diseases such as cancer, diabetes and diseases related to inflammation. Curcumin has also been shown to interfere with cancer development and cancer growth in-vitro within both animal and human studies. Curcumin may also be useful in gastric inflammation and ulceration. It may help treat rheumatoid arthritis due to its anti-inflammatory properties as well as aid in the natural healing of wounds. Turmeric and it’s bioactive extract curcumin has been known to extend lifespan in worms, fruitflies, and mice. Turmeric and curcumin for inflammation control is known to have anti-cancer activity on breast cancer, colorectal cancer, gastric cancer, and pancreatic cancer, just to name a few. Research may eventually establish turmeric as a chemopreventive agent for cancer.

Inflammaging is a new concept accepted by healthcare authorities as a significant cause of many diseases as we age. What is “inflammaging” you ask? This is the term referring to the low levels of chronic inflammation which occurs in older adults with aging. As we age, higher levels of inflammatory markers occur in the blood and result in this condition. “Inflammaging” leads to higher rates of infections, heart disease, cancers, autoimmune diseases, and dementia. However, inflammation and “inflammaging” can be controlled. Researchers followed subjects using turmeric and curcumin for inflammation who were over 100 years old with dementia and compared them with 100 year olds without dementia. They found that those subjects without dementia had lower inflammatory markers in the blood than those with dementia. Higher markers of inflammation that can be seen in many conditions include C-reactive protein, homocysteine, interleukins, and erythrocyte sedimentation rate. An anti-inflammatory diet, which includes mostly fruits and vegetables, healthy spices (turmeric, ginger and garlic), omega 3 oils, nuts, low sugar, and specific supplements is the best way to control “inflammaging.” A large portion of the population is already taking turmeric in foods and supplements. Some use turmeric and curcumin for inflammation mixed with black pepper to increase absorption, but is absorption with black pepper adequate? Is turmeric best taken in food as part of your diet, or should it be taken as a daily supplement? According to Life Extension, curcumin is absorbed better when taken orally in a special patented formula.

Turmeric and curcumin for inflammation was found to be poorly absorbed in the gastrointestinal tract even at a dose of 8000-mg/day (4). Piperine found in black pepper was found to dramatically increase absorption of turmeric (12,13), but turmeric absorption with black pepper spikes up to a high level, then falls abruptly. Life Extension claims to provide a patented Curcumin formula which has 7 times the absorption rates and higher sustained levels in the blood (20).

credit: Life Extension

Turmeric and Curcumin Supplement for Inflammation

Curcumin Plus Omega-3 Fatty Acids May Help Prevent Pancreatic Cancer

Researchers found evidence that use of turmeric and curcumin for inflammation plus omega-3 fatty acids may prevent pancreatic cancer. The mice injected with pancreatic cancer BxPC-3 cells and fed curcumin (2000 pppm in 18% corn oil) had a 43% reduction in tumor volume. The mice fed fish oil (15% fish oil + 3% corn oil) had a 25% reduction in tumor volume. The mice fed a combination of curcumin and fish oil had the greatest reduction (over 72%) in tumor volume. (1)

25 patients were evaluated in a phase II trial for response to curcumin at an oral dose of 8000 mg per day without toxicities seen. A variation of curcumin levels in patients was present and absorption was limited, but after 4 weeks the level became fairly consistent. One patient had prolonged stable disease, one had a brief significant tumor regression and 2 others had clinical biological activity. (19)

Turmeric and Curcumin for Breast cancer:

Using turmeric and curcumin for inflammation as a dietary supplement may help prevent triple negative breast cancer, an aggressive type of breast tumor. Researchers found that curcumin treatment at a dose of 30 micromol/mL significantly inhibited growth of breast cancer cells, compared to those untreated with this dietary supplement.  The treatment increased the level of programmed cell death from 2.76% in the control group to 26.34% in the treatment group. Additionally, the treatment decreased the expression levels of genes associated with triple negative breast cancer. (2)

A phase I dose escalation trial of docetaxel plus use of turmeric and curcumin for inflammation in 14 patients with advanced and metastatic breast cancer. Curcumin was started at a dose of 500 mg per day which was increased as tolerated until toxicity occureed. Toxicity limiting the dose to 8,000 mg per day was determined by the authors and as a result the recommended dose was 6000 mg per day for 7 days every 3 weeks combined with docetaxel was suggested. Most patients showed improvement and the author believed that 50% of patients would be expected to respond and expressed that a phase II trial should be implemented. (18)

Turmeric, Curcumin, and Colorectal cancer:

A 15-week study conducted on mice found that use of turmeric and curcumin for inflammation with supplementation may have chemopreventative properties against colorectal cancer. Curcumin at 0.1%, 0.2% or 0.5% in the diet of mice was examined. Compared with untreated mice, curcumin at 0.2 and 0.5%, reduced benign tumors by 39% and 40%, respectively. Dietary curcumin also partially restored suppressed hematocrit values (a measure of the percentage of red blood cells in whole blood). Traces of curcumin were detected in the plasma and tissues of the small intestine (between 39 and 240 nmol/g) for 2-8 hours after dosing. The researchers concluded, curcumin may have a beneficial effect against cancer and recommend a daily dose of 1.6 grams of curcumin for benefits to be seen in humans. (3)

Turmeric and Curcumin for Chemoprevention of Cancer:

A phase I clinical trial was performed with curcumin as a chemopreventative agent in 25 patients with high-risk or pre-malignant lesions in different organs. The subjects took curcumin once in the morning on an empty stomach at an initial dose of 500 mg/day. The patients were then moved up into the next dose level (1000, 2000, 4000, 8000, and 12,000 mg/day). However, it was not possible to increase patients to the next level (12,000 mg/day) because the bulky volume of the tablets was unacceptable. Tissue samples were taken from the indicator lesions before and at completion of the 3-month treatment with curcumin. The authors found that curcumin was not well absorbed from the GI tract. The peak serum concentration was only 1.77 microM even at the 8000-mg/day dose. Results indicate that 25% of patients with uterine cervical intraepithelial neoplasm (CIN) and about 14% of patients with oral leucoplakia developed malignancies in spite of curcumin treatment. Improvement was seen in pre-cancerous lesions in 1 out of 2 patients with recently resected bladder cancer, 2 out of 7 patients of oral leucoplakia, 1 out of 6 patients of intestinal metaplasia of the stomach, 1 out of 4 patients with CIN and 2 out of 6 patients with Bowen’s disease. No toxicity was observed up to 8000 mg/day. (4)

Turmeric and Curcumin for Gastrointestinal Health: Ulcerative Colitis:

A randomized, double blind placebo controlled trial was conducted to test the effectiveness of curcumin, a spice also known as turmeric, as a treatment for patients with quiescent ulcerative colitis (UC), a type of chronic, recurring inflammatory bowel disease. In a 6-month study, patients with UC received either curcumin (n=45), 1 gram after breakfast and 1 gram after the evening meal, plus sulfasalazine or mesalamine, or placebo (n=44) plus sulfasalazine or mesalamine. Results were significantly different between treatment and placebo groups. Of 43 patients who received curcumin, 2 relapsed during the 6 months of treatment (4.65%), while 8 of 39 patients (20.51%) receiving placebo relapsed. (5)

Turmeric and Curcumin for Familial Adenomatous Polyposis

The combination of turmeric/curcumin for inflammation and quercetin appears to reduce the number and size of ileal and rectal adenomas in 5 patients with familial adenomatous polyposis without much toxicity. Patients received curcumin 480 mg and quercetin 20 mg orally 3 times a day. The number and size of polyps were assessed at baseline and after therapy. All 5 patients had a decreased polyp number and size from baseline after a mean of 6 months of treatment with curcumin and quercetin. The mean percent decrease in the number and size of polyps from baseline was 60.4% and 50.9%, respectively. Minimal adverse side effects and no laboratory abnormalities were noted. (6)

Turmeric and Curcumin for Heartburn

A randomized, double-blind trial in Thailand tested oral turmeric and curcumin for inflammation on 116 patients with acid dyspepsia, flatulent dyspepsia, or atonic dyspepsia. The patients were divided between a placebo group and a treatment group to take 500 mg curcumin by mouth 4 times daily plus an over-the-counter treatment. After 7 days, 87% percent of the curcumin group developed full or at least partial relief from dyspepsia compared to 53% of the placebo group. The results were statistically significant. (16)

Turmeric and Curcumin for Wound Healing

Wound treatment may be enhanced by curcumin taken orally. A study using groups of curcumin-treated and untreated rats and guinea pigs, found faster wound healing in the animals taking 40 mg per kg dissolved in their drinking water compared to their untreated counterparts. This would amount to about 2800 mg of curcumin for a 70 kg person. The researchers found improved blood vessel formation, increased cell migration to the wound site, and higher levels of collagen, a fibrous protein found in connective tissue, bone and cartilage. (7)

Turmeric and Curcumin for Burns:

Use of turmeric and curcumin for inflammation was reported to be a beneficial topical treatment for burns. The study, conducted on rats, found that curcumin applied to a burn resulted in faster healing of the wound compared to non-curcumin treated rats. (8)

Turmeric and Curcumin for Multiple Sclerosis:

Turmeric and curcumin for inflammation is under investigation for use in multiple sclerosis: Multiple sclerosis (MS) is an autoimmune disorder that occurs when the immune system attacks the protective covering of the nerve cells, also known as the myelin sheath. Curcumin, found in the dietary spice turmeric, possesses significant anti-inflammatory and neuroprotective activity and may play an important role in the treatment of MS. Researchers studied the effect of curcumin on the pathophysiological progress of MS. They found curcumin inhibits the differentiation and expansion of Th17 cells which are thought to be related to the process of myelin sheath degeneration in MS as part of an autoimmune inflammatory process. Th17 cells are a type of T-helper cell believed to produce interleukin, an inflammatory agent. The authors found that curcumin inhibited a degree of neuroinflammation of MS. (10)

More studies are needed on the relapse rate and progression of MS before more conclusions can be made (9).

Turmeric and Curcumin for Rheumatoid Arthritis:

Eight weeks of turmeric and curcumin for inflammation provided the same reductions in swelling and pain as the prescription drug diclofenac sodium in a study of 45 people with rheumatoid arthritis. The participants were randomly assigned to receive curcumin (500 mg), diclofenac sodium (50 mg), or a combination of both. Using the Disease Activity Score (DAS), the researchers note that all groups showed improvements in various joint health measure, and there was a trend toward curcumin reducing the symptoms the most. (11)

Turmeric Absorption:

The oral absorption of turmeric was significantly enhanced in the gastrointestinal tract with the addition of piperine contained in black pepper. (12,13). However, turmeric absorption with black pepper appears to spike, then fall abruptly. Life Extension provides a patented Curcumin formula which has 7 times the absorption, with higher sustained levels.

Turmeric Adverse Reactions and Interactions:

Turmeric and Curcumin, like many supplements should be stopped 2 weeks prior to surgery.

Turmeric and curcumin for inflammation has antiplatelet effects and may interact with non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin to increase the risk of bleeding.(14)

Baum L, et al reported that 27 patients were treated over 6 months with either placebo, 1 gram, or 4 grams of turmeric. Out of 27 patients, 4 subjects had various gastrointestinal complaints, 2 had falls or dizziness, 3 had respiratory tract infection, 2 had delusions, 2 had edema, and 1 had hearing impairment. Sodium, potassium, urea, creatinine, protein, albumin, bilirubin, alkaline phosphatase, and alanine aminotransferase/glutamic-pyruvic transaminase were followed without evidence of toxicity. There was less adverse effects on 4 grams of turmeric compared to 1 gram and 0 grams. (15)

A case was reported that transient complete atrioventricular block occurred with taking 20-30 pills containing turmeric 50% (about 75 mg), black soybean 20%, mulberry leaves 10%, garlic 10%, and arrowroot starch 10% (17).

Summary and Conclusion: Turmeric and Curcumin for Inflammation

• Turmeric or curcumin (active ingredient) has substantial health benefits and medicinal properties that has shown in research to be a promising treatment for many diseases.

• Turmeric and curcumin for inflammation as a supplement or spice is well tolerated with minimal side effects. Adverse reactions of turmeric/curcumin have been reported. A theoretical increase risk of bleeding with antiplatelet effects is possible although less than that caused by aspirin was reported (14). One study reported the following with doses of 1-4 grams per day: gastrointestinal complaints, falls, dizziness, respiratory tract infection, delusions, edema, and hearing impairment. Sodium, potassium, urea, creatinine, protein, albumin, bilirubin, alkaline phosphatase, and alanine aminotransferase/glutamic-pyruvic transaminase were followed without evidence of toxicity (15). There was one case reported where transient complete atrioventricular block occurred with taking 20-30 pills containing turmeric 50% (about 75 mg), mulberry leaves 10%, garlic 10%, black soybean 20%, and arrowroot starch 10% (17). One study on dose escalation showed that no toxicity was observed up to 8000 mg/day (4). Turmeric and Curcumin, like many supplements should be stopped 2 weeks prior to surgery.

• Turmeric and curcumin for inflammation was found to be poorly absorbed in the gastrointestinal tract even at a dose of 8000-mg/day (4). Piperine found in black pepper was found to dramatically increase absorption of turmeric (12,13), but turmeric absorption with black pepper spikes up to a high level, then falls abruptly. Life Extension provides a patented Curcumin formula which has 7 times the absorption rates and higher sustained levels in the blood (20).

• In 43 patients with ulcerative colitis, after 6 months of turmeric at a dose of 1 gram after breakfast and dinner, 4.65% of the turmeric group relapsed verses 20.51% on placebo. (5)

• In 5 familial polyposis patients, curcumin 480 mg and quercetin 20 mg orally 3 times a day for 6 months reduced the number and size of ileal and rectal adenomas by about 50-60% without toxicity (6).

• For rheumatoid arthritis: 45 people with rheumatoid arthritis who received 8 weeks of turmeric and curcumin for inflammation at a dose of 500 mg resulted in the same reduction of swelling and pain as the prescription drug diclofenac sodium at a dose of 50 mg (11).

• For dyspepsia: 500 mg curcumin by mouth 4 times daily plus an over-the-counter treatment given for 7 days resulted in full, or at least, partial relief from dyspepsia in 87% percent of the curcumin group compared to 53% of the placebo group (16).

• The majority of breast cancer patients showed a benefit to combining curcumin with chemotherapy to enhance anti-angiogenic activity, but more trials are required to define the use of turmeric and curcumin for this and other various cancers (18). The was also some biologic activity of curcumin seen in pancreatic cancer patients but gastrointestinal absorption was poor (19). Perhaps more research should involve turmeric/curcumin given with piperine (black pepper) or with better methods of direct tumor or systemic delivery with close monitoring for toxicity.

Animal studies:

• For wound healing: Curcumin resulted in faster wound healing in animals when taken in oral form (7), or when placed topically over a wound (8).

• Mice injected with pancreatic cancer cells and fed curcumin had a 43% reduction in tumor volume (1).

• Curcumin reduced benign colon tumors in mice (3).

In vitro studies:

• Turmeric and curcumin has promising applications in other diseases such as triple negative breast cancer and multiple sclerosis but more research is required.

Article References: Turmeric and Curcumin for Inflammation:

1.Swamy MV, Citineni B, Patlolla JM, Mohammed A, Zhang Y, Rao CV. Prevention and treatment of pancreatic cancer by curcumin in combination with omega-3 fatty acids. Nutr Cancer. 2008;60 Suppl 1:81-9. http://www.ncbi.nlm.nih.gov/pubmed/19003584

2.Sun XD, Liu XE, Huang DS. Curcumin induces apoptosis of triple-negative breast cancer cells by inhibition of EGFR expression. Mol Med Report. 2012 Dec;6(6):1267-70. Epub 2012 Sep 26. http://www.ncbi.nlm.nih.gov/pubmed/23023821

3.Perkins S, Verschoyle RD, Hill K, Parveen I, Threadgill MD, Sharma RA, Williams ML, Steward WP, Gescher AJ. Chemopreventive efficacy and pharmacokinetics of curcumin in the min/+ mouse, a model of familial adenomatous polyposis. Cancer Epidemiol Biomarkers Prev. 2002;11:535–540. http://www.ncbi.nlm.nih.gov/pubmed/12050094

4.Cheng AL, Hsu CH, Lin JK, et al. Phase I clinical trial of curcumin, a chemopreventive agent, in patients with high-risk or pre-malignant lesions. Anticancer Res 2001 Jul-Aug;21(4B):2895-900. http://www.ncbi.nlm.nih.gov/pubmed/11712783

5.Hanai et al. Curcumin maintenance therapy for ulcerative colitis: randomized, multi-center, double-blind, placebo-controlled trial. Clin Gastroenterol Hepatol. 2006 Dec;4(12):1502-6. http://www.cghjournal.org/article/S1542-3565(06)00800-7/abstract

6.Cruz-Correa M, Shoskes DA, Sanchez P, Zhao R, Hylind LM, Wexner SD, Giardiello FM. Combination treatment with curcumin and quercetin of adenomas in familial adenomatous polyposis. Clin Gastroenterol Hepatol. 2006;4:1035-1038. http://www.ncbi.nlm.nih.gov/pubmed/16757216

7.Sidhu GS et al. Enhancement of wound healing by curcumin in animals. Wound Repair Regen 1998 Mar-Apr;6(2):167-77. http://www.ncbi.nlm.nih.gov/pubmed/9776860

8.Kulac M, Aktas C, Tulubas F, et al. The effects of topical treatment with curcumin on burn wound healing in rats. J Mol Histol. 2013 Feb;44(1):83-90. Epub 2012 Oct 2. http://www.ncbi.nlm.nih.gov/pubmed/23054142

9.Von Geldern G, Mowry EM. The influence of nutritional factors on the prognosis of multiple sclerosis. Nat Rev Neurol 2012 Oct 2. http://www.nature.com/nrneurol/journal/vaop/ncurrent/full/nrneurol.2012.194.html#B153

10.Lin Xie. Xiao-Kang Lia, Shiro Takahara. Curcumin Has Bright Prospects for the Treatment of Multiple Sclerosis. International Immunopharmacology. 2011 March. 11(3): 323-330. http://www.sciencedirect.com/science/article/pii/S1567576910002675

11.Chandran B, Goel A. A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis. Phytother Res. 2012 Nov;26(11):1719-25. http://www.ncbi.nlm.nih.gov/pubmed/22407780

12.Suresh D, Srinivasan K.Tissue distribution & elimination of capsaicin, piperine & curcumin following oral intake in rats. Indian J Med Res. 2010 May;131:682-91. http://www.ncbi.nlm.nih.gov/pubmed/20516541

13.Shoba G, Joy D, Joseph T, Majeed M, Rajendran R, Srinivas PS. Planta Med. Influence of piperine on the pharmacokinetics of curcumin in animals and human volunteers. 1998 May;64(4):353-6. http://www.ncbi.nlm.nih.gov/pubmed/9619120

14.Abebe W. Herbal medication: potential for adverse interactions with analgesic drugs. J Clin Pharm Ther. 2002 Dec;27(6):391-401. http://www.ncbi.nlm.nih.gov/pubmed/12472978

15.Baum L, Lam CW, Cheung SK, Kwok T, Lui V, Tsoh J, Lam L, Leung V, Hui E, Ng C, Woo J, Chiu HF, Goggins WB, Zee BC, Cheng KF, Fong CY, Wong A, Mok H, Chow MS, Ho PC, Ip SP, Ho CS, Yu XW, Lai CY, Chan MH, Szeto S, Chan IH, Mok V. Six-month randomized, placebo-controlled, double-blind, pilot clinical trial of curcumin in patients with Alzheimer disease. J Clin Psychopharmacol. 2008 Feb;28(1):110-3. http://www.ncbi.nlm.nih.gov/pubmed/18204357

16.Thamlikitkul V, Bunyapraphatsara N, Dechatiwongse T, Theerapong S, Chantrakul C, Thanaveerasuwan T, Nimitnon S, Boonroj P, Punkrut W, Gingsungneon V, et al. Randomized double blind study of Curcuma domestica Val. for dyspepsia. J Med Assoc Thai. 1989 Nov;72(11):613-20. http://www.ncbi.nlm.nih.gov/pubmed/2699615

17.Lee SW, Nah SS, Byon JS, Ko HJ, Park SH, Lee SJ, Shin WY, Jin DK.Int J Cardiol. Transient complete atrioventricular block associated with curcumin intake. 2011 Jul 15;150(2):e50-2. http://www.ncbi.nlm.nih.gov/pubmed/2699615

18.Bayet-Robert M, Kwiatkowski F, Leheurteur M, Gachon F, Planchat E, Abrial C, Mouret-Reynier MA, Durando X, Barthomeuf C, Chollet P. Phase I dose escalation trial of docetaxel plus curcumin in patients with advanced and metastatic breast cancer. Cancer Biol Ther. 2010 Jan;9(1):8-14. Epub 2010 Jan 21. http://www.ncbi.nlm.nih.gov/pubmed/19901561

19.Dhillon N, Aggarwal BB, Newman RA, Wolff RA, Kunnumakkara AB, Abbruzzese JL, Ng CS, Badmaev V, Kurzrock R. Phase II trial of curcumin in patients with advanced pancreatic cancer. Clin Cancer Res. 2008 Jul 15;14(14):4491-9. http://www.ncbi.nlm.nih.gov/pubmed/18628464

20. Life Extension. Super Bio-Curcumin®. Product Information Accessed October 26, 2016.