Curcumin

Author

Nancy Hepp, MS, BCCT Project Manager

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Reviewer

Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher

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Last updated November 19, 2020.

Also known by these names

  • Curry powder
  • Diferuloylmethane
  • Turmeric (sometimes misspelled as "tumeric")

Key Points

  • Before using this therapy, consult your oncology team about interactions with other treatments and therapies. Also make sure this therapy is safe for use with any other medical conditions you may have.
  • Curcumin is a natural constituent of the seasonings turmeric and curry powder.
  • BCCT is interested in curcumin’s promising role in reducing risk and treating cancer and in improving the quality of life for cancer patients.
  • Curcumin has been used along with chemotherapy treatments, with results showing that it enhances the effectiveness of several chemotherapy drugs.
  • Curcumin’s anticancer effects have been seen in colon and colorectal cancer, pancreatic cancer, cervical neoplasia, chronic myeloid leukemia, and Barrets metaplasia.
  • Curcumin has reduced some side effects of treatment, such as nausea, constipation, diarrhea, weight loss, soreness and ulceration.
  • Curcumin is generally regarded as safe by the US FDA, and clinical trials confirm the safety at doses up to 12 grams per day.
  • Curcumin is readily available in seasonings and as a supplement.

Curcumin is the major constituent and the active component in turmeric, a seasoning used frequently in Indian and other South Asian cuisines and a main ingredient in curry powder.

Curcumin is not readily absorbed by the intestine,1 but consumption with either pepper or fats is noted to increase absorption.2 However, some sources advise taking turmeric supplements on an empty stomach. Some sources also advise caution in using piperine (the active ingredient in pepper) with certain prescription medications and/or long-term, as described below. Differing advice may derive from different formulations in supplements.3

Solutions are being developed to increase absorption. Consult your physician and the directions on a supplement for guidance. Examples:

  • The Meriva®formulation has greatly increased oral absorption in humans and metabolizes to a potent derivative.4
  • Nanoformulations in colorectal cancer treatment have successfully enhanced water solubility, delivery and efficacy in preliminary studies.5
  • A 2016 study found that a 40 percent guar gum and curcumin formulation showed better release of curcumin directly into the colon.6
  • A liposomal form of curcumin—in which an extract of pure curcumin is placed into a small bubble made of at least one lipid (fatty) layer resembling the wall of a cell—is available. Studies of liposomal curcumin have shown greater effects inhibiting tumor growth and promoting apoptosis (programmed cell death) with cancer cells.7
  • Other curcumin derivatives have been developed to increase absorption and show promising laboratory effects.8

Treating the Cancer

Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action

Preliminary findings from many small and uncontrolled studies indicate that curcumin is effective in treating cancer.9

Anticancer Activity

Clinical Evidence

Lab and Animal Evidence

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Conventional Therapy Enhancer

Clinical Evidence

  • A safe and tolerable adjunct to FOLFOX (5-fluorouracil, folinic acid and oxaliplatin) chemotherapy in patient-derived colorectal liver metastases40
  • Increased the effectiveness of the chemotherapy imatinib treatment, as shown in cancer markers, in people with chronic myeloid leukemia treated with curcumin (turmeric powder)41
  • Comparable progression-free survival without the adverse effects of steroid-based combination therapies when used in a combination regimen with an immunomodulatory drug or proteasome inhibitor in people with multiple myeloma42
  • Enhanced chemotherapy effects and outcomes in people with metastatic colorectal cancer treated with MB-6, a combination of fermented soybean extract, green tea extract, Antrodia camphorata mycelia, spirulina, grape seed extract, and curcumin extract when combined with leucovorin, 5-fluorouracil, and oxaliplatin compared to chemotherapy alone:43 reduced disease progression rate, incidence of adverse events (at least grade 4) and occurrence of increased serum creatinine (an indicator of kidney toxicity) in a small clinical study44
  • Encouraging survival time among gemcitabine-resistant patients with pancreatic cancer treated with curcumin in combination with gemcitabine-based chemotherapy in a small, uncontrolled study.45

Lab and Animal Evidence

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Managing Side Effects and Promoting Wellness

Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being

Clinical Evidence

Small trials show curumin is effective in promoting wellness, improving quality of life and reducing symptoms.64

  • Reduced several side effects of chemo- and radiotherapy (including mucositis, pain, erythema, skin lesions, mouth and throat ulcers, swallowing problems, nausea, vomiting, fatigue and weakness), and was protective of the liver65
  • Reduced treatment symptoms such as nausea, constipation, diarrhea, weight loss, soreness and ulceration with the Meriva® formulation66
  • Improved health-related quality of life,67 including in patients with solid tumors under standard chemotherapy regimens68
  • Decreased depression among non-cancer patients with major depressive disorder69
  • Lowered total cholesterol levels in patients at risk of cardiovascular disease,70
  • Breast cancer:
    • Reduced severity of radiation dermatitis in breast cancer patients, although not all studies have found a significant effect.71
    • A topical cream containing turmeric and sandalwood oil [Vicco(®)] significantly reduced radiodermatitis in a pilot study.72 >
    • Reduced pain and inflammation in breast cancer patients receiving adjuvant hormonal therapies in combination with hydroxytyrosol and omega-3 fatty acids73  
  • Colorectal cancer:
    • Increased body weight in colorectal cancer patients after diagnosis and before surgery74 and in general.75
    • Prevented cachexia (weakness and wasting) and increased body weight in colorectal cancer patients after diagnosis and before surgery76
    • Improved quality of life in patients with solid tumors receiving standard chemotherapy regimens and a bioavailability-enhanced curcumin preparation in small studies77
  • Head and neck cancers:
    • A topical turmeric-based cream reduced radiotherapy-induced dermatitis.78
  • Prostate cancer:
    • Milder urinary symptoms in prostate cancer patients undergoing external beam radiotherapy in a small pilot study.79

Lab and Animal Evidence

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Reducing Risk

Reducing the risk of developing cancer or the risk of recurrence

Clinical Evidence

  • Blocks or reduces risk of cancer development84
  • Reduces risk from chemical exposures in colon, urinary bladder and pancreatic cancer, cervical neoplasia and other conditions.85
  • Inhibited breast cancer proliferation in both preclinical and clinical studies86
  • Effects seen in colorectal cancer:
    • Suppressed adenomas in patients with familial adenomatous polyposis (FAP) when used with quercetin87
    • Decreased polyp numbers and size when used with quercetin88
    • Reduced aberrant crypt foci (ACF) formation in smokers; ACF are one of the earliest changes that can be seen in the colon that may lead to cancer89
  • Protected against the DNA damage caused by arsenic90

Lab and Animal Evidence

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Optimizing Your Terrain

Creating an environment within your body that does not support cancer development, growth or spread

See Body Terrain and the Tumor Microenvironment.

Clinical Evidence

  • Anti-inflammatory and antioxidant,99 including greater elevation in enzymes and activity that reduce systemic oxidative stress in patients with solid tumors receiving standard chemotherapy regimens100
  • Decreased serum levels of TNF-α, a protein that may boost immune response and may also cause death of some types of tumor cells101
  • Effects on gene expression and signaling pathways102
  • The Meriva formulation decreased oxidative stress and systemic inflammation in patients with solid tumors undergoing chemotherapy.103
  • Improved insulin signaling104 and reduced development of diabetes among prediabetic individuals105

Lab and Animal Evidence

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Access

Foods containing curcumin—turmeric and curry powder—are widely available in grocery stores. Supplements containing cucumin or turmeric powder are also widely available.

Cautions

Curcumin is generally regarded as safe by the US Food and Drug Administration (FDA). Epidemiological evidence and several clinical trials confirm the safety of curcumin up to 12 grams per day over several months.113 However, compounds in curcumin can bind to iron and reduce iron's availability, a concern to people with anemia or iron-storage problems. Iron levels may need to be monitored with curcumin supplement use.114

Preliminary clinical evidence shows that cucrumin may slightly reduce the effectiveness of tamoxifen. In a study of breast cancer patients, researchers in the Netherlands gave tamoxifen with or without curcumin 1200 mg three times a day. The group taking tamoxifen in combination with curcumin had about an 8 percent decrease in endoxifen levels. If the curcumin was compounded with piperine (often done to substantially improve curcumin absorption), endoxifen levels were further decreased by 12 percent.115 Read more about this study and implications for use during tamoxifen treatment in the Commentary section below.

Naturopathic oncologist and BCCT advisor Dr. Lise Alschuler cautions that curcumin should not be taken with some drugs (cyclophosphaide, anastrozole, exemestane, letrozole or erlotinib, or therapeutic doses of warfarin),116 and the TRC Natural Medicines database lists several interactions with chemotherapy drugs, diabetes medications and other drugs that lower blood sugar, estrogens, drugs that slow blood clotting, and other drugs. Medical supervision is recommended at doses higher than those typically found in foods.

Curcumin can interfere with certain liver detoxification enzymes and interact with substrates of drugs. It also has antiplatelet properties, possibly increasing the risk of bleeding in those on anti-clotting drugs. It can interact with chemotherapy drugs such as cyclophosphamide and doxorubicinc can interfere with CYP450 enzymes and may interact with substrate drugs.117

Side effects are mostly associated with doses higher than four grams per day:118

  • Mild and self-resolving gastrointestinal disturbances such as loose stools, reflux, bloating and abdominal discomfort.
  • Inhibited sperm motility in cell studies
  • Inhibited synthesis of hepcidin (an iron-regulatory hormone), resulting in a dose-dependent drop in hematocrit, hemoglobin, serum iron and transferrin saturation especially in those with a subclinical anemia or iron deficiency. Curcumin should therefore be taken with caution among those with marginally low iron stores or other diseases associated with iron such as anemia of chronic disease. Similarly, curcumin may possibly contribute to iron chelation, with the potential to cause a clinical or subclinical iron deficiency anemia.
  • Transient rise in liver enzymes
  • Suppressed platelet aggregation
  • Contact dermatitis, urticaria

Integrative oncologist and BCCT advisor Dr. Andrew Weil and Alina Health provide these cautions:119

  • Don’t use turmeric if you have gallstones, bile duct dysfunction, hyperacidity, or stomach ulcers..
  • Pregnant or lactating women shouldn’t use turmeric supplements without their doctors’ approval.
  • In rare cases, extended use can cause stomach upset or heartburn.
  • Piperine can slow the elimination of some prescription drugs including phenytoin (Dilantin), propranolol (Inderal), and theophylline. Some evidence also suggests that curcumin can interfere with certain chemotherapy drugs used to treat breast cancer, so if you’re being treated for this disease, be sure to discuss the advisability of taking curcumin with your physician.

Dosing

BCCT does not recommend therapies or doses, but provides information for patients and providers to consider as part of a complete treatment plan. Patients should discuss therapies with their physicians, as contraindications, interactions and side effects must be evaluated. Levels of active ingredients of natural products can vary widely between and even within products. See Quality and Sources of Herbs, Supplements and Other Natural Products.

Dosage recommendations are available from these sources:

Integrative Programs, Protocols and Medical Systems

For more information about programs and protocols, see our Integrative Programs and Protocols page.

Based on safety and scientific evidence, most naturopathic physicians include curcumin/turmeric in their core protocol for reducing the risk of cancer relapse in patients who have received primary conventional treatment.127

Curcumin is among the botanicals most commonly used by oncology naturopaths for colorectal cancer.128

Commentary

BCCT advisor Dr. Andrew Weil advises: “Neither curcumin nor turmeric taken orally is well absorbed unless taken with black pepper or piperine, a constituent of black pepper responsible for its pungency. When shopping for supplements, make sure that the one you choose contains black pepper extract or piperine.”129 However, both Dr. Weil and naturopathic oncologist Lise Alschuler caution that use of piperine may interact with a wide range of prescription medications. Dr. Alschuler does not advise long-term use of piperine.130

Karen Collins, MS, RDN, CDN, FAND, January 23, 2018: The vast majority of studies on turmeric/curcumin have been in cell studies and rodent studies, and mostly with amounts that are unlikely to be consumed in humans who simply add turmeric as a culinary spice. Human studies are really limited.

I've seen one human study show reductions in TNF-alpha (the inflammatory signaling protein) with only 150 mg of curcumin/day—but I'm not sure how to translate the TNF-alpha change as to whether it was clinically significant. Other studies I've seen and as reviewed in the Natural Medicines Database tend to use 1000 to 4000 mg/day of curcumin (and some studies use much more).

BCCT advisors Gwen Stritter, MD, and Jen Green, ND, FABNO, May 9, 2019: Impact of curcumin on tamoxifen effectiveness

Many are aware that tamoxifen is what we call a pro-drug. A pro-drug is ineffective until specific enzymes in your body activate it. Tamoxifen is metabolized to endoxifen, the effective drug that prevents ER+ breast cancer patients from relapse.

An enzyme called CYP2D6 is responsible for the magic that changes tamoxifen to endoxifen. The activity of this enzyme varies from individual to individual. Part of the variance is due to genetics—some people are born with hyperactive CYP2D6; others have an enzyme that is very sluggish. Many medications—antidepressants like fluoxetine (Prozac), paroxetine (Paxil) and citalopram (Celexa) amongst a host of others—as well as assorted foods and dietary supplements can either activate or slow down CYP2D6.

When this information first started causing a stir in the breast cancer world roughly 10 years ago, researchers hypothesized that taking tamoxifen with a CYP2D6 inhibitor would cause a increase in breast cancer relapse. As it turned out, further clinical research did not bolster this theory,131 leading to a new one: genetics, drugs and dietary intake have complex interactions with the body’s enzyme system. They activate some enzymes and inhibit others. This results in a variable net effect on the concentration of important drugs. In a 2016 study, the cause of low endoxifen levels could not be identified over 50 percent of the time.132

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Non-cancer Uses of Curcumin

BCCT has not reviewed the effectiveness of this therapy for non-cancer uses.

  • Infections
  • Inflammation
  • Kidney stones
  • Gastrointestinal gas

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