Does Turmeric Need a Warning Label?

Many of the more popular pseudoscience websites have a standard article about the powerful benefits of turmeric. Claims about its benefits range anywhere from treating cancer to diabetes, and they abound in these articles, usually followed by a tiny warning at the end of the article that what they said isn't really medical advice, though the tone of the article might say otherwise.

One commenter on the Skeptoid blog pointed out another of the claims, and included a very specific description of the claim. The comment stated that according to some of these websites, turmeric is one of the most powerful NSAIDs known to man. I checked a few of the woo websites, and they all state something similar in mentioning both the pain relieving miracles and the fact that all disease is just inflammation (note: it is not). Stephen Propatier has a great post addressing the shortcomings of acouple of the studies whencethese anti-inflammatory claims originate. The comment really stuck out to me.

It is important to note that inflammation is not always a bad thing. In fact, inflammation is part of the body's response to infection and injury, which is what it needs to do to help fix the issue. Too much inflammation can be bad, such as in a disease like arthritis. Inflammation is also complex and very interconnected to other body processes. Dr. Harriet Hall has a great summary on Science-Based Medicine if you want a good scientific summary on the issue.

TheAmerican Academy of Orthopaedic Surgeonshas a great summary of what an NSAID is and how they work. The most common ones that can be purchased over the counter work by blocking both types of cyclooxygenase (COX) enzymes. While the target is COX-2, which is what helps trigger inflammation, many of these medicines also end up targeting COX-1, which helps protect the stomach lining. This is why many doctors recommend taking the medication with milk or food, and also recommend avoiding alcohol while taking the medication.

One of the claims made by some popular websites is that turmeric is also good for stomach ailments like IBD and Crohn's disease. From one such woo website:

For many patients with IBD (inflammatory bowel disease) corticosteroids reduce their pain symptoms, but damage the intestinal lining over time actually making the condition worse.

However, supplementing with curcumin did not have these side effects and, because of its anti-inflammatory properties, actually helped heal the gut and supported the growth of good bacteria (probiotics).

What?

If we assume for a second that turmeric doesn't have the negative stomach effects because it is specifically a COX-2 inhibitor, I would think it would deserve more close scrutiny. Over a decade ago, the few specific COX-2 drugs on the market all started to show a trend of increased cardiovascular events in those that were taking these medicine. The FDA requires a much stronger warning on the specific ones that are still on the market. So if turmeric is a similar acting medicine, it carries a risk not currently being disclosed.

Even if we assume it is a more general NSAID, the FDA is now seeing a small but measurable increase in cardiovascular events in people taking OTC versions of these drugs. If we again assume the comment and the woo sites are correct, then as an NSAID the risks of taking turmeric should be discussed, and it should not be treated as a miracle cure.

One other thought experiment is one of supplementation with turmeric. If one assumes turmeric is as powerful as these other medications, as claimed, then use should only be done under the advice of a doctor, or at least be labeled as to how much and how long it should be taken before seeking a doctor's advice. Since these woo websites claim taking medicine is bad, why would one want to take medicine daily just because it happens to taste good on food?

The point I want to make is turmeric cannot have it both ways. Either its effect is so small that supplementing with it is more or less a waste of time, or its effect is large enough that at supplementary doses it needs to have more labeling warning people of the risks associated with it.

And it appears there are some possible drug interactions, according to the University of Maryland Medical Center:

Blood-thinning medications: Tumeric may make the effects of these drugs stronger, raising the risk of bleeding. Blood-thinners include warfarin (Coumadin), clopidogrel (Plavix), and aspirin, among others.

Drugs that reduce stomach acid: Turmeric may interfere with the action of these drugs, increasing the production of stomach acid.

Drugs for diabetes (that lower blood sugar): Turmeric may make the effects of these drugs stronger, increasing the risk of hypoglycemia (low blood sugar).

Only about 1/3 of patients disclose their supplements to their doctors. This means there is an increased risk for complications from interactions between drugs and supplements.

We often come down hard on supplements in scientific skepticism circles, and for good reason. Very often, they have very little if no benefit, somecarry undisclosed risks, and there are several significant cases of shoddy production. They are often pitted against medicine as an alternative, leading to a mistrust of doctors. This could lead to a delay in real medical treatment.Listen to Dr. Novella's recent story about a patientwith undiagnosedCreutzfeldt-Jakob disease and how reliance on supplementation may have hastened the patient'sdeath (the story is at about the 16-minute mark of the podcast).

I will end with some standard statements for making reasonable decisions on supplements.

• If you have a medical condition, or think you do, talk to your doctor. Don't get advice from the Internet.

• If supplements worked or do work, your doctor might recommend them based on scientific evidence and should be willing to discuss that evidence.

• If supplements work, science will find a way to concentrate the key ingredients and provide more consistent and effective results.

• Don't forget that supplements can have effects, just not always the ones claimed. Don't forget to tell your doctor and pharmacist about large amounts of anything you take regularly. It is for your safety and health.

I might also recommend a sprinkle of turmeric on fried eggs. It is delicious!