Turmeric
By Dr John Anne
Turmeric is the root (or rhizome) of the Asian plant, Curcuma longa or C. domestica
(red valerian, haldi, jiang huang). When the roots are ground up, they yield a yellowish
powder that resembles saffron; it is sometimes referred to as Indian saffron. Turmeric is
used as a curry component and as a spice in Indian cooking, and can be used as a dye.
Turmeric and its major component, curcumin, are both used as phytomedicines.
Turmeric powder used in Indian cooking, by Sanjay Acharya Sanjay.
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Uses and Benefits:Turmeric has been traditionally
recognized in India as a flavorful, colorful condiment, and as an
Ayurvedic medicine to improve appetite, act as a carminative, and treat
gallstones and other biliary problems, as well as dyspepsia. It is a
traditional remedy in India, China, and other Southeast Asian countries
to treat asthma and colds, and is applied as an ointment, paste, or
poultice for scabies, boils, bruises, insect bites, and other skin
lesions. Turmeric is given orally for many other conditions, including
menstrual problems, pain, epilepsy, respiratory tract infections,
bleeding, diarrhea, jaundice, and rheumatic disorders. More recently,
it has gained a reputation as an anti-inflammatory agent, a treatment
for hypercholesterolemia, an antioxidant, and a cancer preventative,
and is claimed to prevent cardiovascular and other degenerative changes
of aging. Claims also are made for its value in allergy, AIDS,
cataracts, and other diseases. Curcumin is added to foods such as
butter and margarine to prevent oxidation and to improve the color.
Pharmacology:More than 100 components have been
isolated from turmeric. The main medical component of the root is
a volatile oil, containing turmerone, and other coloring agents, called
curcuminoids. Curcumin (diferuloylmethane) is the major constituent,
usually found in a concentration of < 6%.5 Turmeric :;hares some
compounds, such as zingiberene, with ginger, to which it is
related.Turmeric components have been shown in animal studies to
inhibit leukotriene biosynthesis and to inhibit cyclo-oxygenase and
arachidonic acid release; anti platelet aggregation, and
fibrinogenlowering properties have also been demonstrated. It has
been suggested (without adequate evidence, however) that turmeric acts
like a COX-2 inhibitor in the treatment of arthritis. Curcumin and
other turmeric components, such as borneol, curcumene, and azulene,
have been shown in animal studies to have anti-inflammatory properties
and to have protective effects for hepatocytes against toxins,
hepatitis C virus, and HIV. Other hepatic benefits of turmeric
have been described, including inhibition of cytochrome P450 and
glutathione 2-transferase; aflatoxin damage in ducklings has been
reversed by curcumin.
Curcumin
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Clinical Trials:Clinical trials have been primarily
published in local journals from Asian countries. There have been no
clinical studies on turmeric or curcumin from Europe or North America.
Inflammation and Arthritis-In a randomized, double-blind, crossover
trial from India, of 6-month duration and conducted on 42 patients with
osteoarthrits, Articulin-F, an herbal mixture containing turmeric (plus
ashwagandha, frankincense, and zinc) improved pain and disability
scores compared to placebo. Although the results were statistically
significant, the individual effect of turmeric was not evaluated and
the dose of turmeric (300 mg/day) was relatively small. A "preliminary"
double-blind RCT on 18 patients with rheumatoid arthritis suggested
curcumin 400 mg ti.d. was as effective as phenylbutazone 100 mg t.i.d.;
however, upon analyses of the results, phenylbutazone appeared more
effective, and there was no adequate placebo control.
Other Indications-An open study on patients with chronic anterior
uveitis evaluated 53 patients, with 21 lost to follow-up. Eighteen
patients with a weak reaction to purified protein derivative (PPD)
received 375 mg t.i.d. of turmeric alone for 12 weeks, versus 12
patients with a strong PPD reaction who received turmeric combined with
antitubercular drugs for 1 year. The 18 patients receiving turmeric
alone all improved within the initial 12 weeks, compared to 86% of the
combined treatment group. After 3 years of follow-up, there was a
higher recurrence rate in the turmeric group (55%) than the combination
treatment group (36%), with similar rates of vision loss. The authors
suggest that turmeric may be beneficial in treating chronic anterior
uveitis, but the results of this non-blinded and poorly controlled
study are difficult to interpret
Small uncontrolled studies in India and China have reported potential
effects of turmeric or curcumin in lowering serum cholesterol In
an open study of 45 patients that assessed cholesterol as a
secondary endpoint over 4 weeks, triglycerides were reduced, but total
cholesterol was unaffected. An uncontrolled pilot study in India
involving 814 patients reported that a paste of turmeric combined with
neem was beneficial to treat scabies.
Adverse EffectsEncapsulated turmeric or curcumin
administered in the clinical trials was well tolerated; side effects
were qenerally similar to placebo. In one trial of patients with
duodenal ulcers, a burning sensation was reported twice as often in Ihe
turmeric group than in the placebo group (13% and 7%, respectively).
There are rare cases of allergic contact dermatitis reported.
Side Effects and Interactions:
Turmeric has anti platelet effects in vitro, which could have an
additive effect with anticoagulants or antiplatelet drugs. However,
antiplatelet effects have not been demonstrated in vivo, and no adverse
effects or interactions have been reported in the clinical trials or
from individual cases.
Cautions:The safety of the herb (especially the
turmeric extract, curcumin) in pregnancy and during breast feeding has
not been determined. Its choleretic effect may, in theory, cause an
increase in symptoms in patients with gallbladder or biliary disease,
but this has not been reported in humans, and the effect is unlikely.
Preparations & Doses:Turmeric is used in foods,
and is readily available as powders or capsules. Various extracts
containing curcumin are available in liquid form or in proprietary
mixtures. In the clinical trials, turmeric root or powder preparations
were administered in a dose of 1-6 g/day, typically divided three times
daily, whereas doses of about 400 mg t.i.d. of curcumin were used.
Quality turmeric products are allegedly standardized to contain not
less than 3% curcumin, and not less than 3% volatile oils. Much larger
amounts of curcumin can be administered than turmeric; the usual dose
of 1200 mg/day of curcumin is equal to about 40 g/day of turmeric
(containing 3% curcumin). A heaping teaspoon of powdered turmeric is
about 4 g.
Summary EvaluationTurmeric is a valued spicy
condiment that has been traditionally used to improve digestion and to
treat dyspepsia and inflammatory disorders. Turmeric and its major
component, curcumin, are also promoted as antioxidants; cancer, HIV,
and hypercholesterolemia treatments; and cardiovascular disease
preventatives. However, controlled clinical trials are either lacking
for these indications or have not shown convincingly positive
results. A clinical benefit has not been demonstrated for peptic ulcer
disease, and one study was inconclusive for dyspepsia. Controlled
trials for arthritis and inflammation also do not adequately
demonstrate beneficial effects. Other uses have not been evaluated in
controlled clinical trials.
By Dr John Anne
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