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

Turmeric is a commonly used herbal product implicated in causing liver injury. The aim of this case series was to describe the clinical, histologic, and human leukocyte antigen (HLA) associations of turmeric-associated liver injury enrolled in the U.S. Drug Induced Liver Injury Network (DILIN).

All adjudicated cases enrolled in DILIN between 2004-2022 in which turmeric was an implicated product were reviewed. Causality was assessed using a 5-point expert opinion score. Available products were analyzed for the presence of turmeric using ultra-high-performance liquid chromatography. Genetic analyses included HLA sequencing.

Ten cases of turmeric-associated liver injury were found, all enrolled since 2011 and six since 2017. Of the 10 cases, 8 were women, 9 were White and the median age was 56 years (range, 35-71). Liver injury was hepatocellular in 9 patients and mixed in one. Liver biopsies in 4 patients showed acute hepatitis or mixed cholestatic-hepatitic injury with eosinophils. Five patients were hospitalized, and one patient died of acute liver failure. Chemical analysis confirmed the presence of turmeric in all 7 products tested; 3 also contained piperine (black pepper). HLA typing demonstrated that 7 patients carried HLA-B*35:01, 2 of whom were homozygous, yielding an allele frequency of 0.450 compared to population controls of 0.056-0.069.

The authors concluded that liver injury due to turmeric appears to be increasing in the United States, perhaps reflecting usage patterns or increased combination with black pepper. Turmeric causes potentially severe liver injury that is typically hepatocellular, with a latency of 1 to 4 months and strong linkage to HLA-B*35:01.

Turmeric or curcumin is said to cause multiple effects, such as inhibiting inflammation, oxidative stress, tumor cell proliferation, cell death, and infection. Yet, sound clinical trials to test whether these effects might translate into health benefits are rare. In addition, the bioavailability of oral turmeric supplements is known to be low.

Turmeric has been used in food for millennia and is thus generally considered to be safe. Known adverse effects include gastrointestinal problems such as nausea and diarrhea and allergic reactions. Clearly, the new case series casts considerable doubt on the safety of turmeric. Yet, one ought to point out that the number of cases is low (but, on the other hand under-reporting can be assumed to be high). Furthermore, we should take into account that the quality of commercially available products is often low. One must therefore ask whether the liver injuries were truly caused by turmeric itself or by contaminants.

My conclusion is that turmeric is unquestionably an interesting plant with considerable potential as a medicine. At present, there is much hype surrounding it. Yet, hype is almost always contra-productive. If we want to know the true value of turmeric, we need to solve the bioavailability problem and do much more research into its safety and efficacy for defined conditions.

22 Responses to Liver Injury Associated with Turmeric: a case-series

  • This raises rather more questions than it answers, in particular how much turmeric those patients used. Unfortunately, the full text is not available AFAICT.
    From what I understand, curcumin bioavailability is very low when taken orally, way less than 1% (although additional piperine appears to increase this). On the other hand, it seems that any curcumin that is absorbed is almost immediately processed by the liver, explaining its potential for liver damage.
    I’d say that the best (and by far the simplest and cheapest) way to stay healthy is following the usual lifestyle recommendations about eating varied and in moderation, with regular exercise. Don’t fall for food hypes and the false promises of supplement pushers.

  • I believe the bioavailability problem has been address previously.
    Turmeric needs to be consumed alongside a fat, preferably a healthy fat. Fats (preferably fat in the form of oils) will increase the bioavailability of turmeric. Anybody consuming large amounts of turmeric supplements need to know this.
    Black pepper is also known to increase the bioavailability of turmeric.
    Personally, I prefer to consume in the natural form, along with the fiber. God only knows what goes into making capsules.

    • and don’t forget: you need to consume it during a full moon and have a 70-year-old virgin by your side!!!

      OR PERHAPS YOU WANT TO SHOW US THE EVIDENCE FOR YOUR STATEMENTS?

    • I like to consume my turmeric in a good curry or dal. Made with mustard oil ( sod the external use only label ). Perhaps with a nice Rhone red.

      I don’t think it helps my aching joints, but for a while I don’t seem to mind them so much.

  • A link I keep for waving when the hype about Curcumin/Turmeric comes up:

    The Essential Medicinal Chemistry of Curcumin:
    https://pubs.acs.org/doi/full/10.1021/acs.jmedchem.6b00975

    Abstract:
    Curcumin is a constituent (up to ∼5%) of the traditional medicine known as turmeric. Interest in the therapeutic use of turmeric and the relative ease of isolation of curcuminoids has led to their extensive investigation. Curcumin has recently been classified as both a PAINS (pan-assay interference compounds) and an IMPS (invalid metabolic panaceas) candidate. The likely false activity of curcumin in vitro and in vivo has resulted in >120 clinical trials of curcuminoids against several diseases. No double-blinded, placebo controlled clinical trial of curcumin has been successful. This manuscript reviews the essential medicinal chemistry of curcumin and provides evidence that curcumin is an unstable, reactive, nonbioavailable compound and, therefore, a highly improbable lead. On the basis of this in-depth evaluation, potential new directions for research on curcuminoids are discussed.

    As has been said, the bioavailability of Curcuminoids with oral ingestion is exceptionally poor, which is a good thing seeing that the muck is potently toxic.
    RG’s is right (for once) that there are methods of increasing the uptake and plasma resilience of the stuff. But this fails to be significant on the simple fact that even a 50% increase in almost nothing is still negligible. The biovailability boost of known methods e.g. as lipid encapsulation, protein carriers or addition of piperin is mostly far less than that.

  • This should probably be titled “Liver injury associated with stupidity or ignorance”. Most likely they overdosed on it, as you can with any substance. I self-treated with vitamin B6 and overdosed due to ignorance. Previous to overdosing I went a long ways towards curing my depression using high dose B6. I got so that I was functional again. Something like this article on turmeric gets highlighted because the pharma industry wants to scare anyone away from inexpensive vitamins, supplements and self-treatment. Keep everyone on the reservation paying for expensive drugs that also cause liver injury, often even when used as directed. Keep up the good work, Edzard.

    • ‘stan’ kindly informed us:

      I self-treated with vitamin B6 and overdosed due to ignorance…

      Something like this article on turmeric gets highlighted because the pharma industry wants to scare anyone away from inexpensive vitamins, supplements and self-treatment.

      Do you think that you suffer from acute ignorance, chronic ignorance, or both?

    • @stan

      … because the pharma industry wants to scare anyone away from inexpensive vitamins, supplements and self-treatment.

      Have you ever wondered who makes those inexpensive vitamins, supplements and self-treatment medications? You may be in for a surprise

      Keep everyone on the reservation paying for expensive drugs …

      Have you ever compared prices of commonly used drugs with those of supplements? You may be in for a surprise

      … that also cause liver injury

      Have you ever looked up the potential side effects of those inexpensive vitamins, supplements and self-treatment medications? You may be in for a surprise

    • @stan

      Couldn’t agree more. I self-administered a secret cocktail of cheap over-the-counter multivitamins and managed to grow a prehensile tail. I can now climb trees with ease!

      • I was expecting one of you [expletive deleted] would respond in this way. I would guess that at least half of those reading this blog are on the scale of depression. When you can cure your depression naturally and permanently (40 years), without being reliant on psychoactive drugs, then you can start calling names. I would say those relying on the drugs suffer from chronic ignorance especially those reading this who immediately attack anyone standing up for natural treatments.

        • When you can cure your depression naturally and permanently (40 years), without being reliant on psychoactive drugs,

          Right, you have shown us a lot of evidence to support your statement.

          So did I, for growing prehensile tails. In fact I am typing these words with it. Don’t take my word for it, experience it for yourself. If you don’t trust me, do a proving to generate “evidence” for yourself.

          • So you want me to post my medical records? I will if you post your picture of your prehensile tail with your face and photo ID.

            As far as homeopathy goes, I have software with 850 books and other publishings with clinical evidence accumulated over the last 220+ with well-documented case histories of cured cases of serious acute and “incurable” chronic diseases. It also includes the many provings that have been done over the years with extremely dilute remedies showing virtually everyone experiencing effects. Any time you feel motivated you can dive into that literature and see for yourself.

          • So you want me to post my medical records? I will if you post your picture of your prehensile tail with your face and photo ID.

            You can put up all the straw men you want but you very well know that if you make a statement, burden of proof is solely on you.

            BTW stan, I learned how to use a computer mouse with my newly grown prehensile tail.

          • Any time you feel motivated you can dive into that literature and see for yourself.

            No thanks. Id rather read literature pertaining to witchcraft and occult, it is more entertaining than the ramblings of deluded water shakers role-playing as a doctor.

          • ‘stan’ wrote “I have software with 850 books and other publishings…”

            The following (essential reading) are hosted at Wikisource:

            Homœopathy and Its Kindred Delusions (1842) by Oliver Wendell Holmes, Sr.
            https://en.m.wikisource.org/wiki/Homoeopathy_and_Its_Kindred_Delusions

            Quackery Unmasked (1858) by Dan King, MD., especially Ch. VI
            https://en.m.wikisource.org/wiki/Quackery_Unmasked/Chapter_VI

            QUOTE
            Homœopathy and Its Kindred Delusions is a work by Oliver Wendell Holmes, Sr., based upon two lectures he gave in 1842, Medical Delusions and Homœopathy. The work criticizes homeopathy, which he considered to be akin to “astrology, palmistry and other methods of getting a living out of the weakness and credulity of mankind and womankind”. It is considered to be a classic text, one of Holmes’ most important works, as well as one of the earliest criticisms of homeopathy.
            Wikipedia
            END OF QUOTE

            Quackery Unmasked (1858) by Dan King, MD., Ch. VI:
            [my formatting for clarity]

            Now Homœopathy does not gain proselytes by teaching its true principles. Such a course would be suicidal, and soon exterminate the sect; but it is propagated by other means. It is obvious that the public are always desirous for something new in every department of science and business. They see that all the means which have hitherto been employed for the restoration of the sick, often fail; the healing art is acknowledged to be imperfect; the sick bed, with all its medical appliances, is a subject of dread.

            Every one would prefer to be treated by remedies more agreeable and more sure, and Homœopathy, like every other species of quackery, promises all this. It points to the improvements that are continually being made in mechanics, and beguiles the patient with the notion that Homœopathy is a new discovery, which compares with regular medicine as the most perfect machine does with the rudest ancient model. Such are the considerations which induce many intelligent persons to try this kind of medical practice. They are assured that the medicine is powerful to cure, but always perfectly safe, and can never do the least harm. It is easy to take, and subjects the patient to no inconvenience.

            If true, it is the kind of medication which every one would choose. The patient has neither the time nor the means of examining the principles of the proposed method; but believing it to be something new, he concludes, of course, that it must be an improvement upon all former methods. Here is where the mistake is made—instead of being new, Homœopathy is at least half a century old; and instead of being an improvement known only to homœopathists, the whole has long been known, examined, tried and rejected by all competent judges throughout the world.

            It is not a system founded upon actual discoveries, for its originator never made a single new discovery; on the contrary, every particle of knowledge which its practitioners possess (when they have any at all) has been derived wholly from that system of rational medicine which they pretend so much to despise. Homoeopathy itself is as destitute of all truth and of everything that is valuable, as Sahara is of herbage. In itself, it is a boundless desert; without a single oasis—having neither flowers, nor fruits, nor springs of water, to refresh the fainting traveller.

            If it is still insisted that the number and respectability of the supporters of Homœopathy are proofs in its favor, we might urge, with much more propriety, the truth of Divination, Sorcery and Witchcraft. The believers in these delusions have been far more numerous, and their attestations far more imposing. …

    • And here’s a very interesting, more general article about ‘promiscuous components’, or substances that show effects in wildly differing in vitro trials: https://www.nature.com/articles/513481a

      Curcumin is one such substance. No matter what biochemical activity you test for, curcumin shows effects.

      As can be expected, the alternative world takes this as a reason to promote curcumin as a panacea. The scientific world is more careful, and has come up with the far more appropriate designation PAIN, from Pan-Assay INterference compounds.

      I’d almost say that there are parallels with respondents on this blog: there are some who will immediately show strong, extremely positive and quite prolific responses to virtually anything alternative that is brought up, no matter how ludicrous. And yes, they can be quite a PAIN.

      • Conventional medicine is just looking for magic bullet drugs that do one thing and one thing only with lttle or no side effects. Unfortunately for them they dont exist. Life is messier. All drugs are a PAIN since they act on all levels – mental, emotional and physical. And they are toxic at some dosage. Dr Hahnemann recognized this early on and started dilution. Maybe conventional medicine will catch up to him someday.

        • … parallels with respondents on this blog: there are some who will immediately show strong, extremely positive and quite prolific responses to virtually anything alternative that is brought up, no matter how ludicrous …

          QED

          Thank you.

          • And some who lose their sh!t when anyone defends alt med, despite how conventional medicine is Evidently Baseless Medicine (EBM) in many areas of its practice.

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Subscribe to new posts

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”

The most recent comments from all posts can be seen here.

Archives
Categories