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
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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.
I prefer a bottle of Bordeaux with it.
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
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.
Another good link on the Turmeric/Curcumin hype:
https://gidmk.medium.com/the-bitter-truth-about-turmeric-8cf9256e73c5
I recommend Gideon’s articles.
You can find his blog at medium.com/@gidmk
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:
Do you think that you suffer from acute ignorance, chronic ignorance, or both?
@stan
Have you ever wondered who makes those inexpensive vitamins, supplements and self-treatment medications? You may be in for a surprise …
Have you ever compared prices of commonly used drugs with those of supplements? You may be in for a surprise …
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.
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.
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.
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
interesting article on the subject:
https://www.newscientist.com/article/2343736-turmeric-supplements-have-been-linked-to-liver-damage-in-five-people/
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.
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.