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Turmeric Curcumin and Osteoarthritis

The yellow pigment curcumin in the spice turmeric may work as good or better than anti-inflammatory drugs and pain killers for the treatment of knee osteoarthritis.

January 17, 2014 |
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Supplementary Info

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Sources Cited

F. Berenbaum. Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!). Osteoarthr. Cartil. 2013 21(1):16 - 21.

T. Neogi, Y. Zhang. Epidemiology of osteoarthritis. Rheum. Dis. Clin. North Am. 2013 39(1):1 - 19.

Y. Henrotin, A. L. Clutterbuck, D. Allaway, E. M. Lodwig, P. Harris, M. Mathy-Hartert, M. Shakibaei, A. Mobasheri. Biological actions of curcumin on articular chondrocytes. Osteoarthr. Cartil. 2010 18(2):141 - 149.

P. G. Bradford. Curcumin and obesity. Biofactors 2013 39(1):78 - 87.

M. J. Benito, D. J. Veale, O. FitzGerald, W. B. van den Berg, B. Bresnihan. Synovial tissue inflammation in early and late osteoarthritis. Ann. Rheum. Dis. 2005 64(9):1263 - 1267.

R. I. Issa, T. M. Griffin. Pathobiology of obesity and osteoarthritis: Integrating biomechanics and inflammation. Pathobiol Aging Age Relat Dis. 2012 2:1-21.

E. Dean, R. G. Hansen. Prescribing optimal nutrition and physical activity as first-line interventions for best practice management of chronic low-grade inflammation associated with osteoarthritis: Evidence synthesis. Arthritis. 2012 2012:560634.

S. C. Gupta, S. Patchva, B. B. Aggarwal. Therapeutic roles of curcumin: Lessons learned from clinical trials. AAPS J 2013 15(1):195 - 218.

C.-L. Shen, B. J. Smith, D.-F. Lo, M.-C. Chyu, D. M. Dunn, C.-H. Chen, I.-S. Kwun. Dietary polyphenols and mechanisms of osteoarthritis. J. Nutr. Biochem. 2012 23(11):1367 - 137.

Y. Henrotin, F. Priem, A. Mobasheri. Curcumin: A new paradigm and therapeutic opportunity for the treatment of osteoarthritis: Curcumin for osteoarthritis management. Springerplus. 2013 2(1):56.

G. Belcaro, M. R. Cesarone, M. Dugall, L. Pellegrini, A. Ledda, M. G. Grossi, S. Togni, G. Appendino. Efficacy and safety of Meriva®, a curcumin-phosphatidylcholine complex, during extended administration in osteoarthritis patients. Altern Med Rev. 2010 15(4):337 - 344.

V. Kuptniratsaikul, S. Thanakhumtorn, P. Chinswangwatanakul, L. Wattanamongkonsil, V. Thamlikitkul. Efficacy and safety of Curcuma domestica extracts in patients with knee osteoarthritis. J Altern Complement Med. 2009 15(8):891 - 897.

Acknowledgements

Images thanks to MyArthritis and handarmdoc via Flickr. Thanks to Ellen Reid for her image-finding expertise and Jeff Thomas for his Keynote help.

Transcript

Osteoarthritisis the most frequent cause of physical disability among older adults in the world, affecting more than 20 million Americans, with 20% of us affected in the coming decades, and becoming more and more widespread among younger people.

Osteoarthritis is characterized by loss of cartilage in the joint. We used to think it was just mechanical wear and tear, but it’s now generally accepted as an active joint disease with a prominent inflammatory component as evidenced by, for example, significantly higher production of inflammatory prostaglandins from tissue samples obtained from the knees of people suffering from the disease.

If the loss of cartilage is caused by inflammation, might an anti-inflammatory diet help like it does with rheumatoid arthritis? Using optimal nutrition and exercise as the “first-line” intervention in the management of chronic osteoarthritis could well constitute the best medical practice.

Where's the best science on what optimal nutrition might look like? The China study is a prime example, showing the serious health consequences of high consumption of pro-inflammatory foods—meat, dairy, fat, and junk—and low consumption of anti-inflammatory plant foods, whole grains, vegetables and fruits, beans, split peas, chickpeas, and lentils. The unnatural Western diet contributes to low-grade systemic inflammation, oxidative tissue stress and irritation, placing the immune system in an overactive state, a common denominator of conditions such as arthritis.

There are phytonutrients in plants that appear to help decrease the degradation of the joint cartilage, the inflammatory activity, cell death, and oxidative damage. This is based largely on in vitro studies suggesting protective benefits of soy, pomegranates, citrus, grapes, green tea, and the curry powder spice turmeric. But my patients are people, not petri dishes. What role might the yellow pigment curcumin in turmeric play in the treatment of osteoarthritis?

Well obesity doesn't just put more stress on our joints. Fatty tissue inside our joints, like in the kneecap itself, is a source of pro inflammatory chemicals that have been shown to increase cartilage degradation. Curcumin may not only help prevent the release of inflammatory chemicals, but slow the formation of the fat pad in the first place. But enough with the test tubes. There have been two clinical studies published to date.

The latest took 50 patients suffering from mild-to-moderate knee osteoarthritis and gave them either the best available medical treatment, which included control with anti-inflammatory drugs and pain-killers, or the best available treatment along with some proprietary curcumin supplement. They used a number of different measures, including the karnosfsky scale which goes up to 100, which is normal, no complaints, no evidence of disease, down to zero at which you're dead. The group with the added curcumin did significantly better, and were able to double their walking distance. This is the best medicine had to offer, so Mother Nature made a counter-offer. The curcumin group was able to significantly decrease their drug use, side-effects, swelling, hospitalizations, and other treatments.

But it doesn't have to be some fancy proprietary formula. Here's the other study: The efficacy of turmeric extracts in patients with knee osteoarthritis. About a hundred sufferers were randomized to ibuprofen or concentrated turmeric extracts for six weeks, and the curcumin group did as good or better then the ibuprofen. Even though ibuprofen is over-the-counter, it can cause ulceration, bleeding, and perforation of the stomach and intestines—can eat right through your stomach wall, and in fact that happened to someone in the study. Whereas what are the side-effects of curcumin? Potentially protecting against a long list of diseases.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Ariel Levitsky.

To help out on the site please email volunteer@nutritionfacts.org.

Dr. Michael Greger

Doctor's Note

What about rheumatoid arthritis? That was my last video, Turmeric Curcumin and Rheumatoid. Next, I’ll cover Boosting the Bioavailability of Curcumin and then end with some caveats (Who Shouldn’t Consume Curcumin or Turmeric).

I think the only other video I have on osteoarthritis is Rose Hips for Osteoarthritis.

Those unfamiliar with The China Study should read it! I also mention it in my video China Study on Sudden Cardiac Death.

If, as described, oxidative stress and inflammation both play a role in joint inflammation, then that may help explain the role of turmeric. See my recent videos Which Spices Fight Inflammation? and Spicing Up DNA Protection.

I’d also add nuts (Fighting Inflammation in a Nut Shell) and mushrooms (Boosting Immunity While Reducing Inflammation) to the list of anti-inflammatory plant foods.

If you haven't yet, you can subscribe to my videos for free by clicking here.

  • Dave

    Time for some more curry dishes :-)

    • Tobias Brown

      Full speed ahead with the Dal recipes.

      • http://nutritionfacts.org/ Michael Greger M.D.

        Anyone want to post a dal recipe?

        • Tobias Brown

          I use the following recipe for fat-free dal tadka — but I don’t think the tadka part is accurate because this refers to “tempering” the spices, which means cooking the spices (mustard and cumin seeds) and onions to release their flavor IN OIL. (BTW, a member here suggested that mustard oil isn’t unhealthy to use though I hesitate.)

          LINK: http://blog.fatfreevegan.com/2013/07/fat-free-dal-tadka.html

          • LKSkinner

            The book “Prevent and Reverse Heart Disease” has an excellent Indian dahl recipe (page 259) that I use all the time. The recipe calls for 1teaspoon of turmeric but more can be added without messing up the recipe.

          • Kathi Richards

            Can you post the recipe? I don’t have that book. Thank you

          • Darryl

            Buy the book, its one of the 2 plant-based diet books everyone needs for their lending library.

            The recipes are here.

          • DH

            What is the other one of the 2 plant-based books?

          • Darryl

            T. C. Campbell’s The China Study. Ie the same books that helped turned both Clinton and Gore into vegans.

            Both are a bit on the basic side for those with science backgrounds. The closest I’ve found to a definitive, current, heavily referenced guide to the “why’s” of plant-based nutrition is Mark McCarty’s regularly updated Low-Fat, Low-Salt, Whole-Food Vegan: Staying Lean and Healthy into Ripe Old Age, which has about 1200 pointers for further study.

          • DH

            Thank you, Mr. Darryl, for bringing my attention to this document, which I am eager to read and pore over.

          • Kathi Richards

            Thank you for the link. Right now we are downsizing, in a big way. No more new books until many others are gone. I do have The China Study.

          • DanielFaster

            There are ahem actually THREE must have PB books for your lending library, Lisle and Goldhamer’s The Pleasure Trap.

          • Kathi Richards

            Thank you for that link. I will have to try it out. I think that it would be fine without the oil.

        • http://www.eatandbeatcancer.com/ Harriet Sugar Miller

          Here’s a recipe I’m tweaking for my upcoming book. Anybody want to try it and make suggestions?

          Harriet, health journalist, Montreal
          http://www.eatandbeatcancer.com

          Ingredients

          · 1 cup dried yellow
          or orange lentils

          · 4 cups water

          · 1 T olive oil

          · ¼ tsp mustard seeds

          · 2-3 small yellow
          onions, diced

          · 1/4 tsp each:
          turmeric, cumin, coriander powder

          · 2 cloves garlic,
          chopped plus extra for garnish

          · ½ tsp chopped
          ginger

          · 1-2 lemons – juice
          only

          · ¼ tsp cayenne

          · salt and pepper

          · handful cilantro,
          chopped

          Spice Prep (Hi, folks. I do this so you can easily figure out which spices to grab and how to measure them.)

          · 1/4 tsp each:
          mustard seeds, turmeric, cumin, coriander powder, cayenne

          · 1/2 tsp chopped
          ginger

          Method

          1. Spread the beans on
          a baking sheet, pick out the misfits, then wash the keepers several times in
          warm water and drain them.

          2. To sprout (optional but
          healthful and tasty): Put the washed beans in a large, shallow bowl and
          add 3 cups warm water (3 times the amount of beans), cover with a cloth towel, then
          place away from sunlight and soak overnight. Rinse and drain, then place
          soaked beans in a large sprouting jar with a mesh lid. Turn jar upside
          down in a bowl and tilt it slightly on an angle so the moisture will drain.
          Continue rinsing and draining at least twice a day for 2-3 days. When the
          beans’ tails are about ¼” long, they’re ready. (They’ll keep in the fridge for
          a couple of days until you’re ready to use them.)

          3. Put beans and 4
          cups water in a pot and bring to a boil. Lower the heat and simmer, covered,
          approximately 20 minutes, adding a little salt at the end of the cooking
          process.

          4. In a separate pan,
          heat oil on low to medium heat and then add the mustard seeds. As the seeds
          pop, add the onions and saute for a minute or so. Add turmeric, cumin and
          coriander powder and mix, then add garlic and ginger and continue sauteeing.
          Your onions should cook for 4-5 minutes max.

          5. Combine cooked
          onion mixture with warm, cooked lentils and stir well. Add cayenne, lemon juice
          and salt to taste, and then let the soup sit.

          6. Garnish with
          cilantro, black pepper and freshly minced garlic. Goes well with side of leafy
          greens. Or just throw the greens right into the soup.

  • sally

    would you recommend the curcumin supplements?

  • Liz

    What is the most effective form of curcumin and at what dosage?

    • Ron

      The bioavailability of curcumin is very low according to a clinical study done in Molecular Pharmaceutics 2007,4 (6),807-818.
      BCM-95 is a highly absorbable form of curcumin which is 10 times more absorbable than the standard 95% curcumin.

  • chisong

    My friend read yesterday’s post…and commented that she’d taken turmeric capsules until she realized her white hair was turning yellow…anyone else had this result?

    • fred

      No…but I did once take ~ 25,000 IU / day beta-carotene during summer and I had a very deep tan…didn’t affect hair color.

    • luveggies

      It could only be from the turmeric if the color change was only at the roots of her hair – like the way the real color of hair shows up in the roots as dyed hair is growing out.

  • yardplanter

    In general, how are larger molecules -specifically proteins ( e.g. hormones from milk ) – absorbed ? They are/should too large for diffusion in the absence of leaky gut. Endocytosis ? Should not they be broken down to amino acids or short peptides thus loosing their biologic if not antigenic activity ?

  • http://stephenjones2013.wordpress.com/ Stephen Jones

    Thank you Dr Gregory! My wife and I have been taking a brand by Life Extension containing 500mg Nigella sativa, an organic black cumin seed oil, combined with 200 mg Curcuma longa, an extract root with “Curcuminoids Complex with Essential Oils of Turmeric Rhizome…” for a few weeks, and I can’t tell if it’s really making much of a difference. I have some moderate osteoarthritis in all my finger joints, as does my wife, and she has moderate to severe osteoarthritis in one knee. Time will tell, but maybe it makes more sense to begin enjoying curry dishes more often. :-)
    Thanks again for the work you do here at NutritionFacts.

    • Psych MD

      I’m interested in this as well. In PubMed a search for “curcumin” yields 6277 studies and “Nigella” 624. I also tried to find info re: black cumin seed oil vs. the whole (ground) seed. Maybe Gr. Greger has some insight.

  • Geoffrey Levens

    Isn’t curcumin very hard to absorb much of? I know there have been ongoing tweaks to extracts/supplements to overcome this (adding peperine, phosphystidyl serine, super critical CO2 extraction) so as to get a truly therapeutic dose. I would also like to know if you, Dr Greger have any suggestions along those lines. Just turmeric in diet shows as demographically good for prevention, but what about individuals who have a current problem and wish to alleviate/reverse it?

    • luveggies

      Dr Greger discusses research about how black pepper DRAMATICALLY increases bioavailability of curcumin. See his answer to the question: What about pepper plus turmeric in V8 juice. .

  • Loyal Fan

    Please fix the broken link to Who Shouldn’t Consume Curcumin or Turmeric. A word search does not result in a definitive video for this topic.

    • luveggies

      I believe that’s because it hasn’t been “published” online yet, it’s only available on his newest DVD, Volume 16. BUT, I think it will be the video Dr Greger will be posting tomorrow – Monday 1-20-14.

  • narrative

    Many of these articles relate to a derivative of the core product i.e. “Curcumin”, from “Turmeric”, which turn out to be pricey products from pharma or health stores. What amount of turmeric do we actually need to eat for it be effective in our diet?

  • Barton van Buskirk

    I TAKE TUMARIC FROM WALMART BEEN TAKING 1 TO 2 PILLS A DAY FOR ALMOST THREE MONTHS .I DONT NEED TO WERE WRIST BRACES ANY MORE TO SLEEP ..MY HANDS DONT FALL ASLEEP ANY MORE .GAVE THE ARCH IN MY FEET BETTER FLEX MY KNEES HAVE FULL RANGE MOTION ITS COST 7 DOLLARS A BOTTLE …I TRIED IN FOOD IT STAINS AND IS HARCH TASTE TO IT .I DID LIKE IN A STRAWBERRY SMOOTHIE BUT I LIKE BITTER ..

  • deborahconner

    Ibuprophin also implicated in kidney cancer.

  • deborahconner

    http://nutritionstripped.com/turmeric-milk/

    I make this w soy or almond milk. I try to stay with real foods rather than pills or extracts.

  • HereHere

    This is a very useful article, since about many of us will have to deal with OA at some point in our lives. I have some work-induced OA in my finger joints. I wish I could turn back the clock, and I am hoping nutrition will come up with an answer to repair damaged cartilage. The vegan diet immediately (2-3 weeks) halted all symptoms for 6 months. Now, I only have morning stiffness for a few seconds, but I’m only in my early 40′s so having a progressive chronic condition is unsettling. This article shows I really must work harder on my major weakness (sugar).

  • Stitches

    Is there a definitive answer to what dosage of curcumin supplements are effective for osteoarthritis? I have been following a vegan diet for the better part of a year, but I seriously doubt I will be incorporating tumeric into my cooking in a daily or even regular basis. Have been taking 375mg supplements for about a month without strong evidence of improvement, so I am curious about whether to increase the dosage or if it is even recommended.

    • Psych MD

      In the 8 month study cited above Meriva 500 mg twice a day was used. That formulation showed a 20-fold increase in bioavailabilty vs. plain curcumin. These studies are available on Pubmed.

  • lively1

    Dr. Greger, are there any studies on the benefits of kefir? Does kefir affect the absorption on phytonutrients similar to milk products?

    • Thea

      lively1: Kefir is just another form for dairy. While it may have some probiotics, the food is a package deal. You have to take the bad with the good. And oh boy, is there plenty of bad. for more information about dairy:

      http://nutritionfacts.org/topics/dairy/

      If you really like kefir, I would recommend checking out non-dairy kefir. You might look into a coconut based commercial one or maybe even check out making your own water based kefir. Some people really love that stuff.

      Good luck.

  • Shelley