Superfoods: Turmeric (curcumin)

Turmeric has been used for thousands of years for its medicinal properties. It is commonly found in ayurveda and Chinese medicine for its antioxidant, anti-inflammatory, antimutagenic, antimicrobial, and anticancer properties (Hewlings & Kalman, 2017). Turmeric is derived from the Curcuma longa plant and contains Curcumin; one member of a group of natural compounds called curcuminoids. A multitude of beneficial effects have been attributed to curcumin, such as antiproliferative, anti-inflammatory, anticancer, antidiabetic, hypocholesterolemic, anti-thrombotic, antihepatotoxic, anti-diarrheal, carminative, diuretic, antirheumatic, hypotensive, antimicrobial, antiviral, antioxidant, larvicidal, insecticidal, antivenomous, and antityrosinase effects, and the list goes on! In this article we highlight several key areas of research on turmeric and its health benefits.

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Inflammation and oxidative stress and disease

Inflammation has been identified in the development of many chronic diseases and conditions. Similarly, oxidative stress has been implicated in many chronic diseases, and its disease-causing processes are closely related to those of inflammation, in that one can be easily induced by another (Hewlings & Kalman, 2017). 

One of the most well-established benefits of curcumin is its potent anti-inflammatory properties. Numerous studies have demonstrated curcumin's ability to inhibit inflammatory pathways in the body and reduce pro-inflammatory markers (Sharifi-Rad et al., 2020). Attributed to these effects, numerous in vitro and in vivo studies have shown that curcumin has vast potential for treating numerous inflammatory diseases (Sharifi-Rad et al., 2020). Additionally, its ability to modulate inflammatory processes makes curcumain a promising natural alternative to conventional anti-inflammatory medications. Curcumin also has been found to amplify the effects when used in conjunction with some anti-inflammatory medications (Nandal et al., 2009).

Curcumin’s antioxidant effects have also been widely explored in the literature. Many mechanisms can explain the antioxidant activity as binding free radicals, hydrogen atom donors, and electron donors to neutralise free radicals (Sharifi-Rad et al., 2020). By reducing oxidative stress and inflammation, curcumin has been implicated in helping prevent and treat chronic diseases such as arthritis, cardiovascular disease, neurodegenerative disorders, diabetes, and certain types of cancer. The following sections will outline the current research surrounding these.

Arthritis

While pharmaceutical treatments for arthritis exist, many are expensive and have unpleasant side effects. With substantial evidence to support its anti-inflammatory properties, studies have investigated curcumin as an alternative treatment or synergistic potential in treating arthritis. Indeed, several studies have shown the anti-arthritic effects of curcumin on osteoarthritis and rheumatoid arthritis (Henrotin et al., 2013; Belcaro et al., 2010; Belcaroet al., 2014; Chandran & Goel, 2012). Specifically, several studies have found improvements in participants’ pain, physical function, and decreases in inflammation markers, and some stiffness (Panahi, 2014; Belcaro et al., 2010; Daily et al., 2016). Additionally, it is reported that curcumin has fewer reported side effects than are observed with NSAIDs such as ibuprofen or diclofenac (Hewlings & Kalman, 2017).

Overall, the results of human studies using curcumin to treat arthritis symptoms (especially osteoarthritis) and very promising and encouraging. If this is a concern to you it is worthwhile talking to your doctor about how curcumin supplementation may be able to help you.

Brain health and cognitive function

It has been observed that the consumption of foods containing turmeric is associated with a reduced incidence of cognitive decline (Ng et al., 2006). Curcumin has been shown to cross the blood-brain barrier (Seddon et al., 2019). In doing so, it is suggested that curcumin may offer neuroprotective effects through the mechanisms of preventing cell loss in the prefrontal cortex, lowering oxidised proteins, and decreasing inflammation in the brain (Bassani et al., 2017; Noorafshan et al., 2017; Lim et al., 2001).  Alternative theories have also been proposed in which curcumin is beneficial to the brain through its effects on the gut microbiome (Lopresti et al., 2018).

It is through these mechanisms that it is speculated that curcumin can potentially treat, improve, and delay the onset of cognitive decline; both age-related, and in various neurological disorders, such as dementia, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, and Huntington’s disease (Song et al., 2016; Teter et al., 2019; Salehi et al., 2020a). The research surrounding curcumin and cognitive function in healthy adults is very conflicted. One study found in healthy older adults, curcumin significantly improved attention and working memory tasks, within hours after taking curcumin. After 4 weeks of continuous supplementation, their working memory, mood, alertness, and contentedness were all improved (Cox et al., 2015). Another study observed that healthy adults taking curcumin maintained cognitive function, while the group not taking it deteriorated (Rainey-Smith et al., 2016). Similarly, Tasi et al (2021) found improvements in working memory, and processing speed in their review, but not in overall cognitive function. However, it should be noted that while one group of participants were healthy older adults, one of the groups had Alzheimer’s, and the other had schizophrenia. In light of this one questions how the differences in the underlying conditions affected the results of this particular review.

The majority of the studies to date have predominantly been conducted in vitro, and in animals and have been promising. However, in patients with neurological disorders, the results have been mixed. One study found that curcumin did not improve cognitive function tests and biomarkers in patients with Alzheimer’s disease (Ringman et al., 2012). A review of curcumin and neurodegenerative diseases found that the occurrence of motor complications in Parkinson's disease all significantly improved with curcumin supplementation, but had no benefits for patients with Alzheimer’s. (Mohseni et al., 2021).

Overall, promising results exist in vitro and in animal models concerning how curcumin can help cognitive function, particularly in degenerative disorders. However, the clinical applications of curcumin for cognition are still under investigation, and there are bioavailability issues that need solving (see the section below to learn more about the bioavailability of curcumin).

Cardiovascular health

The cardiovascular protective properties of curcumin in cardiovascular disease (CVD) have been indicated in numerous in vitro and animal studies (Li et al., 2020). Key mechanisms of curcumin and its effect on CVD include the activation of a protein (Nrf2) which results downstream in cytoprotective, and anti-inflammatory effects against oxidative stress (Pittala et al., 2018). It has also been found to be protective of, and enhance endothelial function, and be protective against cell death (anti-apoptotic) (Monfoulet et al., 2017). These mechanisms are all protective against cardiovascular dysfunction which often leads to various CVDs including atherosclerosis, aortic aneurysm, myocardial infarction, and stroke (Campbell & Fleenor, 2017; Salehi et al., 2020).

The evidence surrounding curcumin and its cholesterol-lowering properties is encouraging but less clear than those surrounding CVD. Several studies found evidence that curcumin can lead to a reduction in plasma triglycerides, cholesterol (Mohammadi et al., 2013; Sahebkar, 2014; Panahi et al., 2014), an increase in HDL-C (good cholesterol) concentrations (Soni & Kuttan, 1992), and reduced high blood pressure (Hlavackova et al., 2011). However, another study found a reduction in triglyceride concentrations only, not on serum total cholesterol, LDL-C, HDL-C, or high-sensitivity C-reactive protein concentrations (Mohammadi et al., 2013). It should be noted that the authors attributed this to several limitations of the study design. When examining healthy participants specifically, the results are also mixed. While curcumin was found to lower triglyceride levels in one study, it found no effect on total cholesterol, LDL, or HDL levels (DiSilvestro et al., 2012). However, another study observed reduced total and LDL cholesterol in healthy participants (Cox et al., 2015).

Overall, the mechanistic and in vitro studies surrounding curcumin and its protective effect against CVD are well-established and sound. However, more standardised clinical trials are required to fully uncover its potential for the prevention of CVD in humans. Similarly, the mixed results surrounding the potential for curcumin to improve an individual’s lipid profile warrant more clinical studies.

For more information on the research surrounding curcumin and CVD, we recommend this review by Li et al. (2020): https://www.iris.unict.it/retrieve/handle/20.500.11769/364903/269189/Curcumin-the-golden-spice-in-treating-cardiovascular-diseases2020Biotechnology-Advances.pdf

Type II diabetes

In addition to the potential to improve lipid profiles, curcumin has been shown to help several aspects of Type II diabetes (T2DM). Specifically, it has been shown to improve insulin sensitivity (Na et al., 2013; Chuengsamarn et al., 2012; Marton et al., 2021), decrease glucose and insulin levels, and reduce several hormones that are out of balance in T2DM (Hajavi et al., 2017). Chuengsamarn et al. (2012) also found that in prediabetic people, the amount of those who went on to develop T2DM was reduced after 9 months of taking curcumin. The range of beneficial effects of curcumin in diabetes mellitus and its complications has been attributed to its ability to interact with many key molecules and pathways involved in the disordered physiological processes that are characteristic of T2DM, and its capacity to suppress oxidative stress and inflammatory processes (Rivera-Mancía et al., 2018). Additionally, in animal models, studies have reported improvements in diabetes-associated liver disorders, diabetic neuropathy, diabetic nephropathy, and vascular disease (Zhang et al., 2013).

Overall, while research is ongoing, there is a growing body of evidence that suggests curcumin can be used to prevent and manage type 2 diabetes, and its associated metabolic disorders. If this is a concern for you it might be worthwhile talking to your doctor about how curcumin may be beneficial to you.

Anti-cancer

Research into the anti-cancer properties of curcumin is still evolving but so far the results are promising. Observational data have shown a low incidence of several types of cancer in individuals who regularly consume curcumin (Aggarwal and Sung, 2009). Experimental data has indicated that curcumin can inhibit cancer cell proliferation, induce apoptosis (cell death) in cancer cells, and modulate various signalling pathways involved in tumour growth and metastasis.

Curcumin has been shown to inhibit cancer cell proliferation by affecting cancer cell growth, and vessel formation (Kandoth et al., 2013). It also suppresses cancer cell metastasis and stimulates cancer cell apoptosis (Sharifi-Rad et al., 2020). Cancer cells are well known for producing new blood vessels that support their proliferation and growth and curcumin has been shown to work against that process. Curcumin induces cancer cell apoptosis through one of the most important tumour suppressor protein genes (p53) (Kandoth et al., 2013).

Curcumin can also enhance the effect of some cytotoxic drugs used in chemotherapy (Sharifi-Rad et al., 2020). One study found that when curcumin was supplemented with paclitaxel (Taxol), it significantly inhibited breast and lung cancer metastasis more than when curcumin or paclitaxel was used alone (Aggarwal et al., 2005).

However, the news is not all positive. Although several studies have shown that curcumin can amplify the effect of some chemotherapy treatments, sometimes it might lessen and inhibit their effectiveness (Lopez-Lazaro, 2008). Additionally, several studies have found that higher curcumin doses increase reactive oxygen species which are connected to carcinogenesis (Ahsan & Hadi, 1998; Fang et al., 2005; Lopez-Lazaro, 2008; Dance-Barnes et al. (2009).

Results are promising for curcumin and its anti-cancer effects. However, if you are looking to use curcumin alongside your cancer treatment or as a cancer preventative, we strongly recommend that you do this in consultation with a medical professional.

To read more about curcumin’s effects on cancer, we encourage you to refer to the paper by Zoi et al., 2021 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8464730/)

Other potential benefits

Curcumin has also been indicated to have other health benefits relating to:

• Liver function (Sharifi-Rad et al., 2020)

• Digestive health (Lopresti et al., 2021)

• Exercise recovery (Hewlings & Kalman, 2017)

Bioavailability

The bioavailability of curcumin on its own is unfavourable. Several studies have revealed low oral bioavailability due to its poor solubility in water, low permeability and absorption, fast metabolism, and excretion (Lo Cascio et al., 2021; Bučević Popović et al., 2024; Sharifi-Rad et al., 2020). When reading the different studies in researching this article we noticed that many of them did not report the participants’ levels of curcumin in the body as part of the study design. Perhaps the limited bioavailability of curcumin could explain the varied results often found in the studies on humans.

While challenges still remain when looking for ways to enhance the bioavailability of curcumin, several compounds have been found that can significantly improve its absorption and retention in the body. When selecting a curcumin supplement, it is important to choose a reputable brand and look for additions such as piperine, or supplements with a liposomal delivery system to aid in its absorption (Hewlings & Kalman, 2017; Bučević Popović et al., 2024). Additionally, taking curcumin with food (particularly with fats) is recommended to help maximise its absorption.

Here are some suggestions for good bioavailable options:

• Codeage organic turmeric supplement: https://amzn.to/48NzOPE

• Life Extension super bio-curcumin supplement: https://amzn.to/3TsbHS4

• THORNE curcumin phytosome supplement: https://amzn.to/3Is0nPy 

In summary, choosing a good brand of curcumin with additives that enhance its bioavailability is essential.

Dosages and safety

Curcumin has been found to be safe, even in high doses of up to 8 grams/day (Cheng et al., 2001). However, in high doses and with sensitive individuals it can cause some unpleasant side effects such as abdominal pain, nausea, and diarrhoea. This is one of the reasons it is recommended that curcumin supplements during mealtimes. Curcumin can also interact with certain drugs, and such and can inhibit or magnify their effects (Sharifi-Rad et al., 2020). It is important to talk to your doctor before starting curcumin supplementation if you are on any medications for this reason.

The dosages in studies treating different health issues are very variable, ranging from 400mg/day – 12,000mg/day (Sharifi-Rad et al., 2020). Therefore, to treat any specific medical condition we recommend talking with your doctor to advise you on the most appropriate dosage for you.

For healthy individuals, a dosage of 400 mg powder per day containing 80 mg curcumin is considered appropriate (Hewlings & Kalman, 2017).

Conclusion

Curcumin is a potent compound with a wide range of potential health and wellness benefits. These mostly stem from its anti-inflammatory and antioxidant properties that are indicated to positively effect on brain health, cardiovascular function, and cancer prevention. However, while studies in vitro, and on animals have produced promising results, trials on humans have proven to be more variable (perhaps due to its bioavailability challenges). Incorporating curcumin into one's diet or supplement regimen may prove to be a valuable addition to a healthy lifestyle but it should be done in consultation with a medical professional. The research on curcumin is continuously progressing and curcumin’s role in human health is likely to become more certain in the near future.

We invite any questions or comments in the section below!

*Disclaimer*

The information presented in this article is for educational purposes only and is based on our interpretation of the current research. Individuals are recommended to consult with a qualified healthcare professionals or registered dietitians for personalised guidance and recommendations tailored to their individual needs and circumstances.

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