MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

We have looked at curcumin several (tumeric) times before (see here, here and here). It seems to have a fascinating spectrum of pharmacological activities. But do they translate into clinical usefulness? To answer this question, we obviously need clinical trials. Unfortunately, not many have become available. Here are two recent studies:

Due to the potential benefits of curcumin in the ischemic heart disease, this study was performed to evaluate whether pretreatment with curcumin may reduce myocardial injury following elective percutaneous coronary intervention (PCI). A randomized clinical trial was performed on 110 patients undergoing elective PCI. The intervention group (n = 55) received a single dose of 480 mg nanomicelle curcumin orally and the standard treatment before PCI, while the control group (n = 55) received only the standard treatment., Serum concentrations of CK-MB and troponin I was measured before, 8 and 24 h after the procedure to assess myocardial damage during PCI. The results showed that the raise of CK-MB in curcumin group was half of the control group (4 vs. 8 cases) but was not significant. There were no significant differences in CK-MB levels at 8 (P = .24) and 24 h (P = .37) after PCI between the curcumin and the control group. No significant difference was also found in troponin I levels at 8 (P = 1.0) and 24 h (P = .35) after PCI between the groups. This study did not support the potential cardioprotective benefit of curcumin against pre-procedural myocardial injury in patients undergoing elective PCI.


Ground and mashed turmeric

Inflammation along with oxidative stress has an important role in the pathophysiology of unstable angina which leads to acute myocardial infarction, arrhythmias and eventually heart failure. Curcumin has anti-inflammatory and anti-oxidant effects and thereby, it may reduce cardiovascular complications. This randomized controlled trial aimed to investigate the effects of curcumin on the prevention of atrial and ventricular arrhythmias and heart failure in patients with unstable angina.

Materials and Methods:

Forty patients with unstable angina who met the trial inclusion and exclusion criteria, participated in this double-blind randomized clinical trial. The patients were randomized into two groups: curcumin (80 mg/day for 5days) and placebo (80 mg/day for 5days). Cardiac function was evaluated by two-dimensional echocardiography devices at baseline (immediately after hospitalization) and 5 days after the onset of the trial. Atrial and ventricular arrhythmias were recorded by Holter monitors in cardiology ward, Ghaem academic hospital, Mashhad, Iran. Progression to heart failure, myocardial infarction, and pulmonary and cardiopulmonary resuscitation events as well as mortality were recorded daily throughout the study.

Results:

There were no significant differences between the two groups in atrial and ventricular arrhythmias (p=0.2), and other echocardiographic parameters (Ejection fraction, E, A, E/A ratio, Em, and pulmonary artery pressure) at baseline and five days after the start of the trial.

Conclusion:

Nanocurcumin administered at the dose of 80 mg/day for five days had no effect in the incidence of cardiovascular complications in patients with unstable angina.

Clinical trials are not a good tool for proving a negative; they rarely can prove that a therapy is totally useless. Therefore, we cannot be sure that the many fascinating pharmacological activities of curcumin do not, after all, translate into some clinical benefit. However, what we can say with a high degree of certainty is this: currently there is no good evidence to show that curcumin is effective in treating any human condition.

Perhaps there is a more general lesson here about herbal medicine. Many plants have exiting pharmacological activities such as anti-biotic or anti-cancer activity which can be shown in-vitro. These are then hyped by entrepreneurs and enthusiasts of so-called alternative medicine (SCAM). Such hype fools many consumers and is thus good for business. But in-vitro activity does not necessarily mean that the therapy is clinically useful. There are many reasons for this, e.g. toxicity, lack of absorption. The essential test is always the clinical trial.

IN-VIVO VERITAS!

13 Responses to Curcumin: in vivo veritas!

  • “currently there is no good evidence to show that curcumin is effective in treating any human condition.”…. after 5 freaking days! Expecting a miracle? Gimme a break.

    • Yes, it is strange that some carefully selective trials are mentioned on this forum with the – now – very boring attempt to discredit anything that has not been tested and approved to be a medical drug of some kind. Yes Roger, you are right… a FIVE DAY trial that chose subjects suffering from Angina is unlikely to prove anything either way in my opinion. However, as we all know, legally practising Doctors prescribe placebo pills and even ‘off label’ drugs to their unsuspecting patients … now you might call that SCAM practice! Concerned about human health? Time to get real!

  • Here is a good source of information on Turmeric and Curcumins:
    https://pubs.acs.org/doi/pdf/10.1021/acs.jmedchem.6b00975?rand=x3jz5dx3

    The main message is that the stuff cannot get into the body by eating it. Preparing it in micellar form and adding piperine (made from pepper) does not help either. The increase in absorbtion is marginal at best.
    It is a good thing that it cannot get into the body because if it did it would probably wreak havoc with the immune system.
    Summa summarum: Food supplements containing turmeric and derived products are useless, except as a condiment for good food 🙂

    • Sad to read your very blinkered retort. I assume you have never encountered FERMENTED whole Turmeric? If you are prepared to seek out test results of fermented turmeric that can readily be absorbed at the cellular level, then you may take a different view. Micellar you say? Are you confusing Micellar with Liposomal? They are very different from each other and produce different results which is what matters to the patient, not you Sir.

      • please cite your evidence

      • @ Ms. Barker

        🙂 I am sorry that you found such an urge to bark at me but your assumption is wrong.

        Was the article I refered to overly technical, or did you not try to read it at all?
        Here is another, non-technical, more understandable for those without any medical or scientific training: https://sciencebasedmedicine.org/turmeric-tasty-in-curry-questionable-as-medicine/

        You seem not to understand the difference between gastrointestinal absorption and cellular absorption. To get to the cells, the stuff has to get absorbed in the gut. If this does not happen, then cellular absorption does not take place.

        Perhaps your knowledge about turmeric and related issues comes from Joe Mercoal’s marketing department’s inexhaustible fountain of misinformation?
        The platitude (in this context) “absorption at the cellular level” is typical for his snake-oil jargon. Joe is making big money from selling fermented turmeric products by the shipload and his little sales elves pump out sciency sounding tropes to lure gullible buyers (like you?). Just Google the term “Fermented Turmeric” Every other hit is to Mercola marketing material 😀

        And one more thing, no need to use honorifics, just call me Björn. I am neither nobility nor knighted.

  • The second study was tiny and would only detect dramatic results. So we can confidently say curcumin is not a wonder drug for unstable angina. That itself debunks the typical naturopath claims about it.

  • Yes, the in vitro/in vivo conundrum. In vitro tests, which is pre-clinical tests, tend to generate a very high number of false positives. Many herbs seem to work in vitro but completely fails in vivo. But, is it possible that in vitro tests also lead to high numbers of false negatives? eg. does not seem to have much activity in vitro but when tested in vivo you get a remarkable positive result. (now normally you would not do in vivo testing when in vitro results are negative, but some people apparently do this). If so, should one abandon in vitro testing because of too many false positives/negatives?

    I am currently struggling with such a herb, not much in vitro activity to speak of and yet the claim is made that it showed remarkable in vivo (RCT) activity – I am not yet sure what to make of it.

    https://www.sciencedirect.com/science/article/pii/S0378874119324560?via%3Dihub

    • what could be the reason for such false-negatives?

      • Chemical complexity? Plants contain upwards of a thousand unique chemicals, each of which can potentially interfere with in vitro bioassays. This of course also leads to false positives but in the case of false negatives the interference cause a masking effect. For example: the extract may contain a toxic compound which kills the cell before a different ‘active’ compound have a chance to do its magic.

        False positives tend to be an annoyance because you eventually get there (unfortunately after spending time and resources) whilst false negatives tend to pass by unnoticed – normally when something is toxic or inactive you will not spend further time and effort on that particular herb. Don’t know, but the possibility that false negatives may exist in an appreciably number of herbs, has always bothered me.

  • A question for my understanding: You write: “The results showed that the raise of CK-MB in curcumin group was half of the control group (4 vs. 8 cases) but was not significant. There were no significant differences in CK-MB levels at 8 (P = .24) and 24 h (P = .37) after PCI between the curcumin and the control group.” 4 vs. 8 that´s only the half, sounds impressively! Why this decrease isn´t significant yet? Can you explain me? Thank you in advance. Best regards Jens Christian Heuer

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