Facing pain: Can turmeric help?

Inflammation-fighting medicines in your spice cabinet

Chronic pain

I am one of 50 million Americans who live with the condition of chronic pain. Defined as pain that lasts beyond three months and extends past normal healing time from injury, chronic pain is one of the most common reasons adults seek medical care and seriously impacts daily life.

People living with chronic pain face several additional challenges:

1. Restricted mobility and ability to engage in daily activities.

2. Anxiety and depression.

3. Reduced quality of life.

4. Risk of dependency on opioids.

Percentage of adults aged 18 and over with chronic pain and high-impact chronic pain in the past 3 months, overall and by sex: United States, 2019. Figure source: CDC

Many diseases, few causes        

Many diseases can be linked to a few underlying causes. Human health is a reflection of the functional efficiency of four fundamental processes:

1. The immune system

2. Inflammation

3. Regenerative potential

4. Oxygen status

Disease symptoms appear when one or more of these processes is out of order.

Chronic Inflammation

Chronic inflammation is a slow, long-term inflammation that lasts for several months to years. Considered the most significant cause of death in the world, chronic inflammatory diseases include cardiovascular diseases, allergies, chronic obstructive pulmonary disease, diabetes, and arthritis and joint diseases.

On a cellular level, chronic inflammation is characterized by the infiltration of a group of cells that release inflammatory signals and cause tissue damage. Translation: The body remains in a constant state of alert and wears down, losing key functions.

How to reduce risk?

The good news is that while some risk factors, like aging, can’t be stopped, other underlying factors are in our power to address:

1. Smoking and heavy drinking: You can see the results of chronic inflammation in the prematurely aged skin of smokers and heavy alcohol consumers; the early signs of aging are due to a bombardment of oxidative stressors (reactive oxygen species) and heightened inflammation.

2. Obesity: Fat tissue is an endocrine organ, and higher body mass is linked to higher levels of inflammatory cell signals in the body.

3. Diet: The typical American diet is rich in pro-inflammatory refined sugars and trans fats.

4. Stress and lack of sleep: Physical and emotional stress contribute to heightened inflammation and disturb sleep, reducing the body’s regenerative capacity.

Can turmeric help?

During a recent visit to a pain specialist I asked for advice on dietary modifications to help better control my osteoarthritic pain. Perhaps unsurprisingly, she recommended that I supplement my diet with turmeric.

What is turmeric?

Turmeric is a plant in the ginger family that originates in southeast Asia. Its scientific name is Curcuma longa L., Zingiberaceae. The orange rhizomes (root parts) of turmeric have been used in food and medicine for millennia. The bioactive molecules found in the rhizomes are called curcuminoids, and the main compound of interest is curcumin.

Chemical structure of curcumin. Figure source.

Curcumin is a bright yellow-colored polyphenol molecule that has exhibited anti-inflammatory, antimicrobial, antioxidant, wound healing, and hypoglycemic properties in many laboratory studies.

The turmeric plant is used in curries, teas, cosmetic ingredients, dyes, colorants, and as a health food for inflammation. I provide an in-depth review of turmeric’s botany, history, and pharmacology on this episode of the Foodie Pharmacology podcast.

How does it work?

Turmeric's active compound, curcumin, has been widely studied by scientists, with over 7,000 research articles published. The research shows that curcumin's promising results in treating various inflammatory diseases may be due to its ability to regulate and decrease pro-inflammatory molecules commonly elevated in individuals with chronic inflammation.

Clinical studies have revealed efficacy in pain trials, especially in the management of osteoarthritis—the most common type of arthritis in the hips, hands, and knees.

• A randomized controlled trial in patients with osteoarthritis compared supplementation with turmeric, ginger, and black paper with that of the anti-inflammatory drug Naproxen and found that both groups reduced levels of an inflammatory indicator, with no significant differences between the groups. Translation: the turmeric mix worked as well as Naproxen.

• A meta-analysis of 15 randomized controlled trials testing curcumin for osteoarthritis in a total of 1621 participants concluded that turmeric and curcumin may be safer and more effective than non-steroidal anti-inflammatory drugs (NSAIDs) for people with osteoarthritis.

Some studies have examined efficacy in managing neuropathic pain in diabetic patients.

• A randomized placebo-controlled trial on diabetic sensorimotor polyneuropathy—a common complication for patients with type 2 diabetes mellitus—found that dietary supplementation with a nanoparticle formulation of curcumin significantly reduced the severity of the neuropathy compared to placebo.

Other clinical trials have assessed the efficacy of turmeric in mitigating menstrual pain, migraines, COVID-19 symptoms, and muscle soreness, with differing outcomes depending upon the disease target. Translation: Curcumin is not a cure-all, but it holds promise for specific conditions.

Is curcumin safe?

Turmeric is classified as GRAS (generally recognized as safe). Dose-escalating studies in which progressively higher doses of the active compound curcumin are consumed have demonstrated safety at doses as high as 12 grams per day over 3 months.  That’s a lot of curcumin! Roughly the weight of a AAA battery!

What’s the challenge?

Curcumin has limited bioavailability (ability to enter the body's circulation), which challenges its medicinal potential. Curcumin has low bioavailability because it:

1. Is not water soluble;

2. Experiences low absorption in the small intestine; and

3. Is rapidly broken down and eliminated once in circulation.

Scientists have made many attempts to improve the bioavailability of curcumin through the preparation of nanoparticles, protein complexes, and the synthesis of curcumin-like molecules in the chemistry lab. However, the easiest and possibly most effective solution to enhance bioavailability could come from the kitchen, not a laboratory.

Black pepper: more than just a spice

Black pepper contains a unique molecule (piperine) that acts as a bio-enhancer of certain drugs. When it comes to curcumin, black pepper increases curcumin’s intestinal absorption rate. It inhibits the enzymes responsible for the body's breakdown and clearance of curcumin. The result is more curcumin circulating in the body to reach different targets.

Is fresh-ground black pepper better than pre-ground?  

In a word, yes!! You can do the taste test yourself at home using chemical sensors in your nose and mouth. Taste pre-ground black pepper and compare it to the flavor of fresh-ground pepper. Though both have the same starting ingredients (black peppercorn), the chemicals responsible for both the flavor (those notes of pine and lemon) and the spiciness (piperine) break down over time in the pre-ground stuff. My advice: invest in a simple peppercorn mill for your home!

How to use turmeric

Many supplement companies sell turmeric products. Read product labels carefully to look for the inclusion of black pepper or piperine in addition to curcumin.

If you prefer to use the turmeric plant as a whole food ingredient, one study found that pure turmeric powder has around 3% curcumin in it by weight. For a dish containing one teaspoon of turmeric powder (~3 g turmeric), you’re getting ~90 mg of curcumin, depending on the source and origins of the spice. Also, if you can find fresh root in your local market, two tablespoons of the freshly chopped root would be roughly equivalent to ½ teaspoon of dry root powder.

I use turmeric to make curry dishes, add a lovely yellow hue to rice, and make delicious golden milk—a household favorite! Integration of those healthy fats (medium-chain fatty acids) characteristic of virgin coconut oil may also help, as curcumin is fat soluble. Using different plant-based oils as a carrier for curcumin is a topic of current and ongoing research.

Whichever way you take it, don’t forget to add a healthy dose of freshly ground black peppercorn to your turmeric dish or golden milk to achieve the most significant effect from your medicinal food. And work on reducing your other risk factors for chronic inflammation and pain (stress, smoking, alcohol, diet, obesity). You’ll get the most benefit from herbal medicines when you also tackle the underlying causes of disease.

Yours in health, Dr. Quave