Turmeric (Curcuma longa Linn.) and Curcumin

Turmeric (Curcuma longa Linn.) and Curcumin
While some complementary and alternative techniques have been studied scientifically, high- quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards.

Background
• The rhizome (root) of turmeric (Curcuma longa Linn.) has long been used in traditional Chinese medicine to treat gastrointestinal upset, arthritic pain, and "low energy." Laboratory and animal research has demonstrated anti-inflammatory, antioxidant, and anti-cancer properties of turmeric and its constituent curcumin. Preliminary human evidence, albeit poor quality, suggests possible efficacy in the management of dyspepsia (heartburn), hyperlipidemia (high cholesterol), and scabies (when used on the skin).

Scientific Evidence
Uses
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Grade*
Antioxidant
Oxidative stress has been shown to result in abnormal functioning of the cells that line the inner surface of arteries and veins. Given the potential antioxidant effects of curcumin, one clinical trial examined the role of NCB-02, which is a standardized preparation of curcuminoids, on functioning of these cells and markers of this process in patients with type 2 diabetes and demonstrated positive results. More well-designed clinical trials are needed before a recommendation can be made.

Blood clot prevention
Early research suggests that turmeric may prevent the formation of blood clots. However, more research is needed before turmeric can be recommended for these conditions.

Cancer
Several early animal and laboratory studies report anti-cancer (colon, skin, breast)
properties of curcumin. Many mechanisms have been considered, including antioxidant activity, anti-angiogenesis (prevention of new blood vessel growth), and direct effects on cancer cells. Currently it remains unclear if turmeric or curcumin has a role in preventing or treating human cancers. There are several ongoing studies in this area.


Cognitive function
Curcumin has been shown to have antioxidant and anti-inflammatory properties and to reduce beta-amyloid and plaque burden in lab studies. However, there is currently not enough evidence to suggest the use of curcumin for cognitive performance.

Dyspepsia (heartburn)
Turmeric has been traditionally used to treat stomach problems (such as indigestion from a fatty meal). There is preliminary evidence that turmeric may offer some relief from these stomach problems. However, at high doses or with prolonged use, turmeric may actually irritate or upset the stomach. Reliable human research is necessary before a recommendation can be made.

Gallstone prevention/bile flow stimulant
It has been said that there are fewer people with gallstones in India, which is sometimes credited to turmeric in the diet. Early studies report that curcumin, a chemical in turmeric, may decrease the occurrence of gallstones. However, reliable human studies are lacking in this area. The use of turmeric may be inadvisable in patients with active gallstones.

High cholesterol
Early studies suggest that turmeric may lower levels of low-density lipoprotein ("bad cholesterol") and total cholesterol in the blood. Better human studies are needed before a recommendation can be made.

HIV/AIDS
Several laboratory studies suggest that curcumin, a component of turmeric, may have activity against HIV. However, reliable human studies are lacking in this area.

Inflammation
Laboratory and animal studies show anti-inflammatory activity of turmeric and its
constituent curcumin. Reliable human research is lacking.

Irritable bowel syndrome (IBS)
Irritable bowel syndrome (IBS) is a common functional disorder for which there are limited reliable medical treatments. One study investigated the effects of Curcuma xanthorriza on IBS and found that treatment did not show any therapeutic benefit over placebo. More studies are needed to verify these findings.

Liver protection
In traditional Indian Ayurvedic medicine, turmeric has been used to tone the liver. Early research suggests that turmeric may have a protective effect on the liver, but more research is needed before any recommendations can be made.

Oral leukoplakia
Results from lab and animal studies suggest turmeric may have anticancer effects. Large, well-designed human studies are needed before a recommendation can be made.

Osteoarthritis
Turmeric has been used historically to treat rheumatic conditions. Laboratory and animal studies show anti-inflammatory activity of turmeric and its constituent curcumin, which may be beneficial in people with osteoarthritis. Reliable human research is lacking.

Peptic ulcer disease (stomach ulcer)
Turmeric has been used historically to treat stomach and duodenal ulcers. However, at high doses or with prolonged use, turmeric may actually further irritate or upset the stomach. Currently, there is not enough human evidence to make a firm recommendation.

Rheumatoid arthritis
Turmeric has been used historically to treat rheumatic conditions and based on animal research may reduce inflammation. Reliable human studies are necessary before a recommendation can be made in this area.

Scabies
Historically, turmeric has been used on the skin to treat chronic skin ulcers and scabies. It has also been used in combination with the leaves of the herb Azadirachta indica ADR or "neem." More research is necessary before a firm recommendation can be made.

Uveitis (eye inflammation)
Laboratory and animal studies show anti-inflammatory activity of turmeric and its
constituent curcumin. A poorly designed human study suggests a possible benefit of
curcumin in the treatment of uveitis. Reliable human research is necessary before a firm conclusion can be drawn.

Viral infection
Evidence suggests that turmeric may help treat viral infections. However, there is not enough human evidence in this area. Well-designed trials are needed to determine if these claims are true.

Tradition/Theory
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

• Abdominal bloating, Alzheimer's disease, antibacterial, antifungal, antimicrobial,
antispasmodic, anti-venom, appetite stimulant, asthma, boils, breast milk stimulant,
bruises, cataracts, chemoprotective, colic, constipation, contraception, cough, cystic
fibrosis, diabetes, diarrhea, dizziness, dyspepsia, epilepsy, fever, flavoring agent, gas,
gonorrhea, heart damage from doxorubicin (Adriamycin®, Doxil®), Helicobacter pylori infection, hepatitis, high blood pressure, histological dye, human papillomavirus (HPV), hypoglycemic agent (blood sugar lowering), infections (methicillin-resistant Staphylococcus aureus), insect bites, insect repellent, intestinal worms, jaundice, kidney disease, kidney stones, leprosy, liver damage from toxins/drugs, male fertility, menstrual pain, menstrual period problems/lack of menstrual period, multidrug resistance, muscle ache, nutritional support, neurodegenerative disorders, pain, parasites, rheumatic disorders, ringworm, runny nose, scarring, scleroderma, sepsis, skin disorders, stroke prevention, toxicity, urinary disorders, weight reduction, wound healing.

Dosing
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (over 18 years old)
• Doses used range from 450 milligrams of curcumin capsules to 3 grams of turmeric root daily, divided into several doses, taken by mouth. As a tea, 1 to 1.5 grams of dried root may be steeped in 150 milliliters of water for 15 minutes and taken twice daily. Average dietary intake of turmeric in the Indian population may range between 2 to 2.5 grams, corresponding to 60 to 200 milligrams of curcumin daily. A dose of 0.6 milliliters of turmeric oil has been taken three times daily for one month and a dose of 1 milliliter in three divided doses has been taken for two months.
• One reported method for treating scabies is to cover affected areas once daily with a paste consisting of a 4:1 mixture of Azadirachta indica ADR ("neem") to turmeric, for up to 15 days. Scabies should be treated under the supervision of a qualified healthcare professional.
Children (under 18 years old)
• There is no proven or safe medicinal dose of turmeric in children.

Safety
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always
read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies
• Allergic reactions to turmeric may occur, including contact dermatitis (an itchy rash) after
skin or scalp exposure. People with allergies to plants in the Curcuma genus are more likely to have an allergic reaction to turmeric. Use cautiously in patients allergic to turmeric or any of its constituents (including curcumin), to yellow food colorings, or to plants in the Zingiberaceae (ginger) family.

Side Effects and Warnings
• Turmeric may cause an upset stomach, especially in high doses or if given over a long period of time. Heartburn has been reported in patients being treated for stomach ulcers. Since turmeric is sometimes used for the treatment of heartburn or ulcers, caution may be necessary in some patients. Nausea and diarrhea have also been reported.
• Based on laboratory and animal studies, turmeric may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary. Turmeric should be stopped prior to scheduled surgery.
• Limited animal studies show that a component of turmeric, curcumin, may increase liver function tests. However, one human study reports that turmeric has no effect on these tests. Turmeric or curcumin may cause gallbladder squeezing (contraction) and may not be advised in patients with gallstones. In animal studies, hair loss (alopecia) and lowering of blood pressure have been reported. In theory, turmeric may weaken the immune system and should be used cautiously in patients with immune system deficiencies.
• Turmeric should be used with caution in people with diabetes or hypoglycemia or people taking drugs or supplements that lower blood sugar.
• Turmeric may increase the risk of kidney stone formation in people prone to kidney stones.
Pregnancy and Breastfeeding
• Historically, turmeric has been considered safe when used as a spice in foods during pregnancy and breastfeeding. However, turmeric has been found to cause uterine stimulation and to stimulate menstrual flow and caution is therefore warranted during pregnancy. Animal studies have not found turmeric taken by mouth to cause abnormal fetal development.

Interactions
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
• Based on laboratory and animal studies, turmeric may inhibit platelets in the blood and increase the risk of bleeding caused by other drugs. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
• Based on animal data, turmeric may lower blood sugar and therefore may have additive effects with diabetes medications.
• In animals, turmeric protects against stomach ulcers caused by non-steroidal anti-
inflammatory drugs (NSAIDs) such as indomethacin (Indocin®) and against heart
damage caused by the chemotherapy drug doxorubicin (Adriamycin®).
• Turmeric may lower blood pressure levels and may have an additive effect if taken with drugs that also lower blood pressure.
• Turmeric may lower blood levels of low-density lipoprotein (LDL or "bad" cholesterol) and increase high-density lipoprotein (HDL or "good" cholesterol). Thus, turmeric may increase the effects of cholesterol-lowering drugs such as lovastatin (Mevacor®) or atorvastatin (Lipitor®).
• Based on animal studies, turmeric may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be increased in the blood and may cause increased effects or potentially serious adverse reactions. Patients using any medications should check the package insert and speak with a healthcare professional or pharmacist about possible interactions.
• When taken with indomethacin or reserpine, turmeric may help reduce the number of stomach and intestinal ulcers normally caused by these drugs. However, when taken in larger doses or when used for long periods of time, turmeric itself can cause ulcers.  Interactions with Herbs and Dietary Supplements
• Based on animal studies, turmeric may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, some cases with garlic, and fewer cases with saw palmetto.
• Based on animal data, turmeric may lower blood sugar. Individuals taking other herbs or supplements or diabetes medications should speak with a healthcare professional before starting turmeric.
• Turmeric may lower blood levels of low-density lipoprotein (LDL or "bad" cholesterol) and increase high-density lipoprotein (HDL or "good" cholesterol). Thus, turmeric may increase the effects of cholesterol-lowering herbs or supplements such as fish oil, garlic, guggul, or niacin.
• Based on animal studies, turmeric may interfere with the way the body processes certain herbs or supplements using the liver's "cytochrome P450" enzyme system. As a result, the levels of other herbs or supplements may become too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.
• Turmeric may lower blood pressure and may therefore have an additive effect if taken with herbs that also lower blood pressure.


• This information is based on a systematic review of scientific literature edited and peer- reviewed by contributors to the Natural Standard Research Collaboration
(www.naturalstandard.com).
References
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about
alternative and complementary therapies on the professional level, go to
www.naturalstandard.com.