[ed. note: Michael Jorrin, who I like to call Doc Gumshoe, is a longtime medical writer (not a doctor) who writes about non-financial health and medical issues for us a couple times a month. Like all of our authors, he chooses his own topics and his words and opinions are his alone. Enjoy!]
We’re talking about curcumin, of course. The hype, which comes at us in all directions like no-see-‘ems in hot sticky weather, would have us believe that it’s a cure for every disease under the sun and every other celestial body. The actual scientific backup for these claims is skimpy and insubstantial. I don’t think I would have risen to the bait proffered by this particular lengthy over-the-top promotion, except that it provides an opportunity to delve into at least three potentially interesting questions, to wit:
One, what is really known about the potential benefits of curcumin/turmeric, other than as a pleasing seasoning in many Asian dishes?
Two, is there really a single common pathology that accounts for the harms caused by – in the words of the particular promotional piece that came to my attention – “all 619 known diseases?”
Three, is it the case that, given the insufficiency of micronutrients in our diets, “supplementation is mandatory?” This last injunction comes from a comment to the recent Doc Gumshoe piece about diets, and, although it had nothing to do with the particular micronutrients (if any) in curcumin, it does have specific – if somewhat tangential – relevance.
For Gumshoe denizens who have been paying attention to other perhaps more important matters, such as the fate of the nation and the world, curcumin is a yellow substance in the rhizomes of the turmeric plant, Curcuma longa. Those rhizomes, which are sort of root clumps like ginger, are cooked, dried, and used as spices in many Asian curries. Curcumin is used in cosmetics mostly because of its color, and has recently become one of the darlings of the supplements industry, as per the promotion we’re looking at.
Just to show you what this particular spiel looks like, here’s how it leads off:
You notice that right off the bat it claims to be a pill for every disease – and to have no side effects. Now, you might quibble that it doesn’t actually claim to be a cure for every disease. But wait – there’s more!
“Studies have documented its ability to cure 619 diseases — virtually everything that affects your health.
Kills 16-times more cancer cells than the leading chemo drug Eloxatin — without harming healthy cells (International Journal of Oncology)
“‘It’s 400-times more potent than the diabetes drug Metformin’ — reports Auburn University researchers (Journal of Biochemical and Biophysical Research Communications)
“Performs better in memory tests than the drug Aricept (the most widely prescribed Alzheimer’s drug)— Salk Institute for Biological Studies
“More effectively treats Major Depressive Disorder (MDD) than Prozac — without Prozac’s devastating side effects, according to a randomized, controlled study.
“Lowers cholesterol and triglyceride levels better than the statin drug Lipitor (Journal of Drug Research and Development)
“Treats chronic uveitis — a leading cause of blindness — better than corticosteroids... the only available prescription treatment (Journal of Phytotherapy Research)
“Beats Celebrex for relieving knee arthritis pain (Journal of Alternative and Complementary Medicine)
“Relieves rheumatoid arthritis pain better than Ibuprofen (Journal of Phytotherapy Research)
“‘Therapeutic effects are comparable to pharmaceutical NSAIDs… but with a major difference in that this compound is nontoxic and free of side effects.‘ – Vanderbilt and University of Pittsburgh researchers (Journal of Surgical Neurology International)
“‘Could enhance erectile function with more efficacy and more prolonged duration of action than Viagra’ (International Journal of Impotence Research)
“‘More effective in stopping the protein fragments from forming than many other drugs being tested to treat Alzheimer’s’ – UCLA Alzheimer’s Department and Veterans Affairs researchers (Journal of Biological Chemistry)
“Destroys more colon cancer stem cells than FOLFOX (one of the most widely prescribed chemotherapy protocols) – Baylor University researchers”
And then, to tie it up in a neat bow, this quote:
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“This shows promising effects to prevent and cure every chronic disease including cancer.”
— Biochemist Dr. Bharat Aggarwal, PhD, former researcher at MD Anderson Cancer Center
Where to start the sleuthing process?
Unfortunately, Dr Aggarwal is not the ideal choice to endorse this “cure.” Perhaps you notice that he is a “former researcher” at MD Anderson. As it happens, Dr Aggarwal has been charged with fraud, and is no longer at MD Anderson. He is described as a leading researcher into the cancer-fighting properties of plants. Sixty five of his papers have been characterized as fraudulent, and the journal Cancer recently retracted one of those papers with apologies; more retractions are to come. Dr Aggarwal’s investigations of the medicinal properties of curcumin have been cited more than 1700 times, and are at least partly the basis for much of the current interest in curcumin. That’s not to say that the whole proposition that curcumin has valuable medicinal properties is nothing more than fraud and deception, but it does make one wonder.
The person directly behind the lengthy spiel about curcumin is one Al Sears, MD. Needless to say, his objective is not to sell curcumin pills for a buck apiece. No – he wants you to buy his book and subscribe to his service. Here’s a bit about his proposed deal:
“Confidential Cures: Your Guide to Truth and Lies in Medicine from Around the World is my solution for you.
“As a member of this privileged group, you’ll have unrestricted access to information and advice you can act on immediately — information that will come to you on a monthly basis.
“There’s a modest fee I’ll ask you to pay for this exclusive membership service, but it comes to less than the price of your morning coffee.
“Just $3.25 a month — about what you’d pay for a good cup of coffee!
“Confidential Cures is only $39 for a 12-month subscription — an unbelievably modest $3.25 a month, or about the cost of a large coffee, or cappuccino from Starbucks.
“Best of all, Asia’s Wonder Spice: The $1 Cure for Every Disease…Without Side Effects is yours FREE when you subscribe to Confidential Cures today.
“Privileged Information — But Only for a Privileged Few
“Only the members of my inner circle ever see the unique, life-altering discoveries that Confidential Cures is packed with.
“How important and exclusive is this?
“Well, just remember that Confidential Cures offers you an inside look at remedies and treatments you’d never hear about otherwise — remedies that take you beyond the restrictive, “prescription only” tyranny of the big drug companies.
“Only 500 New Openings
“And as I mentioned earlier, today I’m opening our doors to 500 like-minded individuals… who are determined on seizing control of their health and lives. Everyday Americans who don’t want to fall victim to the mainstream medical establishment’s lies.”
Elsewhere he makes the usual claims that Big Pharma is sending its evil agents everywhere in the world to get patents on these precious healing plants so that they can suppress them forever. And that Big Pharma is aided in this campaign of hiding the most valuable health information from the populace by the FDA, and by “leftist elements in the government.” I’m not precisely sure why “leftist elements” would be in cahoots with Big Pharma, since leftists are not usually closely allied with Big Business of any kind. But it’s always best to summon up as many Frankenstein monsters as possible.
“Sears runs something called the ‘Sears Institute for Anti-Aging Medicine’ and proclaims himself as the leading anti-aging physician in the US. If you Google him, you will find numerous self-congratulatory websites as well as several that strongly suggest that he is a quack. More I will not say.
Benefits of curcumin: some possible, some less so
The one medical use for curcumin for which there appears to be reliable evidence is osteoarthritis. A small randomized controlled study (53 subjects) compared a supplement containing curcumin plus glucosamine and chondroitin with placebo; both groups of subjects also received exercise therapy. No surprise, the patients taking the supplement had less pain than those on placebo. (In my PubMed search I could not find the study cited in the promotional piece from Al Sears, which claimed that curcumin was equivalent to NSAIDs, but without side effects.) The glucosamine-chondroitin combination has been reported, in some cases, to provide relief of joint pain by, in effect, lubricating the joint. And curcumin has been reported to have some anti-inflammatory effectiveness.
As to the way curcumin exerts these anti-inflammatory properties, the landscape is shrouded in dense fog from which vague outlines of potential anti-inflammatory pathways may be tentatively inferred. There appears to be evidence, mostly in animals, that treatment with curcumin reduces the presence of some markers of inflammation, such as tumor necrosis factor alpha (TNFα), which is a malefactor in rheumatoid arthritis, and also of the enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST), both of which are implicated in liver damage. A suggested mechanism whereby curcumin achieves this result is through upregulation of peroxisome proliferator-activated receptor gamma (PPARγ), which has been associated with anti-inflammatory effects. I would point out, as a cautionary note, that this particular mechanism was described in a journal entitled PPAR Research, suggesting a certain predisposition.
That’s just one of 1004 papers listed in PubMed as having something to do with the anti-inflammatory mechanism of curcumin. I could do no more than take a look at a few of them, and mostly just the abstracts. But just to give you an idea of what’s out there, PubMed lists 8695 citations that include some discussion of curcumin. Of these, 1357 discuss the mechanism of action of curcumin. When it comes to human studies, the number shrinks dramatically – only 138 in toto. And the number of randomized controlled human studies is just 21. Of those 21, some report mildly encouraging results, including lowering LDL-cholesterol, reducing gingivitis (but not plaque), and reducing the pain from osteoarthritis. Others were inconclusive. Nearly all emphasized the need for further research.
I should add here that 115 of the papers about curcumin are by that Dr Aggarwal. I do not, by the way, accuse Dr Aggarwal of making fraudulent claims about curcumin in order to enrich himself. I suspect that he is one of the large cohort of researchers that are so absolutely convinced of the essential truth of their assertions that they manipulate evidence to support their convictions. Much of the research on curcumin is done by individuals who are deeply rooted in Ayurvedic medicine. They may acknowledge the need to bolster their beliefs with the trappings of the Western scientific method, but, from their perspective, the Truth is the Truth.
I tried to track down the sources for the assertions in the Al Sears spiel, and, based on what I could find in PubMed, the most positive statement that I can make is that curcumin, when used with some of those standard therapies (such as Metformin and Eloxatin) sometimes enhances the outcomes. It does appear to be quite safe.
However, there is one important problem with using curcumin as a drug: it is very difficult to get enough of the active ingredient into the circulation to have any therapeutic effect whatever. It is very poorly absorbed when taken orally, and it has a very short half-life, meaning that the duration of action is brief. In many laboratory studies, injectable formulations have been employed in an attempt to boost effectiveness. These, however, are not available as supplements and are only used in research settings.
Is Big Pharma interested, or are they putting the lid on the garbage can?
From the Sears spiel, you would think that Big Pharma is quaking in its boots lest the magic curcumin capsules totally put it out of business. Their global strategy, according to Sears, for suppressing “naturopathic” healing is to get patents on every conceivable healing plant and then bury any such treatments under reinforced concrete. Well, not so. They can’t patent the plant or fungus itself, but only the specific medicine that they concoct based on that naturally-occurring substance. And if they can patent it, another outfit can concoct something slightly different, and patent that.
But you can bet that Big Pharma is paying very close attention to the research on curcumin, and when something promising comes up, they will make their move.
Another thing – skip this bit if you already know this elementary factoid – there is no difference whatsoever between the active elements in a drug and those in a supplement. They are chemicals, pure and simple. The healthy nutrients in our food are chemicals. So are the poisons in polluted water and air. Supplements, to the degree that they have physiologic effects, are drugs. The differences between supplements and drugs are mostly definitional, rather than fundamental. The implication of the word “supplement” is that the supplement is something that is missing from our nutrition; the supplement corrects a fault. But what’s in most marketed supplements wouldn’t be present in what we normally eat. Even in curry-eating populations, there’s not nearly enough turmeric in the food to result in the kinds of physiologic effects being described in this promotion.
In the meantime, the supplement makers, who are prevented from directly making claims that their supplements have any medicinal properties at all, need to resort to the likes of Al Sears or his similars. There have been wrangles between the FDA and supplement makers dating back almost 50 years. In the 1970s, the FDA made a move to regulate vitamins, but it was shot down by Congress. And again, in the 1990s, the FDA tried to subject supplements to some of the same regulations with which drugs must comply. Again, Congress would have none of it. The compromise is that the supplement marketers can only claim that they “support health.” To go beyond that, they need “independent” experts to speak on their behalf.
A basic reason that supplement makers do not want to be regulated like “ethical” drugs is that complying with FDA requirements for an indication is time-consuming and exceedingly expensive. The FDA requires evidence that the candidate drug is safe in relation to the degree of risk presented by the disease or condition that it’s meant to treat; a treatment for acne needs to be safer than a treatment for metastatic cancer. And it requires evidence of effectiveness in human beings with the disease. And, if there are already approved drugs that have demonstrated effectiveness in treating that disease, the candidate drug has to demonstrate some kind of advantage – better, quicker, safer, cheaper. As you have read in previous utterances from Doc Gumshoe, the mean cost of bringing a new drug to market is about $1.5 billion.
Do I think the supplement makers should be required to go through this identical process? I do not. But there should be some rational middle ground, where the benefits of the supplements in terms of supporting health are fairly evaluated, such that the marketers of supplements would be entitled to promote their products on the basis of validated evidence.
Is there a single common pathology involved in “all 619 known diseases?”
The easy answer is “of course not.” However, the pathology referred to in the Sears spiel is inflammation, and inflammation is indeed involved in a great many diseases. Almost without exception, an insult to the body brings about an inflammatory response, regardless of the initial cause of the insult – injury, infection, the malfunction of an organ or body system. However, it’s a bit simplistic to describe inflammation as a single common pathology. In our bodies there are many, many participants in inflammatory responses – certainly hundreds, possibly thousands. Some forms of inflammation are benign, as in the inflammatory response to an infection. The example I cited earlier, in which curcumin decreased levels of TNFα, ALT, and AST, was in a study in which curcumin was given to rats in which sepsis had been induced by creating an infection. Those inflammatory mediators were present in response to sepsis; some of them were recruited to the site of the infection to attack the infective agents, while the mission of some others was likely to clear away the debris. It is by no means clear that reducing the level of those inflammatory mediators in any way contributed to the well-being of the subject rats.
In any case, it is highly unlikely that any single agent, whether curcumin or any other, would be active against the immense range of inflammatory mediators and types of inflammation. Therefore, that first claim – “Studies have documented its ability to cure 619 diseases — virtually everything that affects your health” – is certainly hooey.
But curcumin seems to have a related characteristic that may have some value. It is described as an effective anti-oxidant – an antagonist of the free radicals that lead to harmful oxidative stress. A couple of blogs ago, we kicked around the issue of oxidative stress as a factor in the development of vulnerable plaque in cardiac disease. There are indications that curcumin might mitigate the effects of oxidative stress by inducing the expression of heme oxygenase 1 (HO1) in vascular endothelial cells; this is thought to be a protective reaction. To quote a paper investigating whether curcumin might be useful as a means of preventing the kind of cardiovascular injury due to the disruption of vulnerable plaque, “Thus, it is conceivable that curcumin could be used as a pharmacological ‘preconditioning’ agent to modulate the expression of intracellular pathways in organs or tissues requiring increased protection against oxidant-mediated injury; in vivo experiments are now necessary to address and verify this hypothesis.” (Motterlini R et al, Free Rad Biol Med 2000;28:11303-1312) The author points out, however, that it is very difficult to attain therapeutic concentrations of curcumin from dietary sources.
Nonetheless, the possibility of benefits from curcumin, related both to its anti-inflammatory and anti-oxidant characteristics, appears to be legitimate.
Finally, is supplementation “mandatory?”
What prompted me to poses that particular question was a comment from a Gumshoe citizen on the recent post about diets. But let’s consider that injunction in light of what we know, or think we know, about curcumin.
Proposition: curcumin probably confers some health benefits related to its anti-inflammatory and antioxidant properties. These are as yet unproven in human randomized controlled trials, but the evidence so far supports the view that it is beneficial. It also appears to be quite safe.
Proposition: the amount of curcumin that we humans can absorb from dietary sources, such as putting abundant quantities of turmeric in our chicken tikka massala, doesn’t begin to reach the concentrations in our bodies that are equivalent to the concentrations in the animal studies where those benefits have been observed. Or, to put it another way, we can’t eat enough of it to do much good.
Therefore: if we want to experience the benefits of curcumin, supplementation is mandatory. Quid erat demonstrandum.
The Gumshoe denizen (Machine Ghost) whose post led me to this commandment supplied the information that in order to achieve sufficient intake of 27 vital micronutrients would require an average caloric intake of 27,575 (± 4,661) calories per day. Removing six micronutrients from the list, and reducing it to 21 would mean that sufficiency could be attained with a daily intake of just 3,475 (± 544) calories per day. Obviously, neither diet is feasible. Machine Ghost’s conclusion was that, therefore, “supplementation is mandatory.”
But there is another conclusion to be reached from that information, which is that many or even most of those micronutrients are not that essential. The micronutrients referred to are mostly the vitamins listed in the FDA’s Reference Daily Intake (RDI) guidelines. If they were all really essential, in the amounts given in the guidelines, we would all be either the size of elephants or dead.
So, with regard to the putative benefits of curcumin, Doc Gumshoe sticks with his syllogism. But with regard to the general principle about supplementation, Doc Gumshoe demurs, politely, and with thanks to Machine Ghost for stirring the pot.
Do promotions like the Al Sears spiel actually do any harm?
In my opinion, they do. Not because they induce people to take the touted miracle pill, which probably won’t do any harm and might do some good, but because some of those people, in the belief that they are doing whatever they need to do to cure their illness and preserve their health, turn their backs on established medical treatment, sometimes with dire outcomes. Demonizing Western medicine and damming the entire pharmaceutical industry as being nothing but profit driven is a marketing strategy that works well for the supplements industry, but does not work well for the populace. When supplements marketers are accused of being deceitful, the response of the alternative health movement is frequently that it’s just an attack by Big Pharma intended to protect their profits. A couple of years ago, in a Doc Gumshoe piece about what I termed the unnecessary feud between mainstream and alternative medicine, I wrote this:
“A black eye for supplements marketers
A recent Canadian study (Newmaster SG et al. BMC Med. 2013; 11: 222) reported that a majority of herbal supplements tested by DNA bar-coding were not as described on the labels. The investigators bought 44 samples of supplements from 12 different manufacturers / marketers, and compared their DNA bar codes with those of the herbs of which they purportedly consisted. The products of only two of the twelve marketers were exactly as described on the label. Two of the twelve contained no authentic ingredients at all – they were 100% fake. The other eight consisted of a mixture of fake ingredients, contaminants, and varying proportions of the labelled herb, sometimes as much as 50%, and sometimes considerably less.
The totally fake ingredients were mostly harmless, including rice, soy, and wheat. The contaminants were another story. One bottle was fraudulently labelled as St John’s wort, which is promoted as an antidepressant (it has been touted as a monoamine oxidase inhibitor; however, this mechanism is disputed). It was found to consist entirely of Alexandrian senna, which is a powerful laxative. Ginko biloba supplements were contaminated with black walnut, which might be fatal for people with nut allergies.”
That study doesn’t seem to have slowed supplements promoters by much; it’s still pedal-to-the-metal for marketers and their spokespersons. (Of course, the pharmaceutical industry has repeatedly shot itself in the foot, as with an AK-47 – see Turing, Shkreli, et al.)
But I stand with Dr KSS, who in a comment a couple of years ago said it was probably okay to take supplements to stay healthy, but when you’re sick, you need doctors and real medicines.
* * * * * * *
Another Gumshoe trooper has just sent a link to a short article about curcumin with particular reference to Alzheimer’s disease. What’s especially interesting about this article is that it includes a number of bona fide references that I may actually be able to track down. I thank Dave for the tip and will report further before long.
At the moment, I am more concerned that I thought I would be about the possible spread of Zika. We learned yesterday that a large fraction of the entire population of Puerto Rico will likely become infected this summer, and the CDC predicts that up to 80% of the entire island may become infected. And then there are all those other viruses – MERS, dengue, not to mention HIV. On balance, I remain optimistic about our risks in Greater Gumshoeland, but seems to me the whole thing is worth a look.