Explained | Are turmeric supplements advisable?

Is there a risk of liver injury? What do studies on curcumin show? Does it have anti-oxidant properties? 

Updated - August 20, 2023 10:40 am IST

Published - August 20, 2023 03:56 am IST

Australia’s Therapeutic Goods Administration has said that until June 29, 2023, it had received 18 reports of liver problems experienced by consumers taking products containing curcuma longa (turmeric) and/or curcumin.

Australia’s Therapeutic Goods Administration has said that until June 29, 2023, it had received 18 reports of liver problems experienced by consumers taking products containing curcuma longa (turmeric) and/or curcumin. | Photo Credit: The Hindu

The story so far: Australia’s Therapeutic Goods Administration (TGA), the country’s regulator of medicines, medical devices and biologicals, issued a medical advisory last week warning Australians of the risk of liver injury from using medicines and herbal supplements containing turmeric or its active ingredient, curcumin.

Why was this advisory issued?

The TGA said that until June 29, 2023, it had received 18 reports of liver problems experienced by consumers taking products containing curcuma longa (turmeric) and/or curcumin. These followed an investigation the agency undertook to review the safety of the products, after instances of their consumption and liver injury were reported in Australia and internationally. The evidence from nine of these reports had enough information to suggest that a liver injury may have been caused by curcuma longa or a curcumin product. Two of these cases were severe, including one that resulted in death. In four of the nine cases, there were no other ingredients likely to have contributed to the liver injury. The other five cases involved products that contained other ingredients that may have contributed to the liver injury, the advisory noted.

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The TGA’s verdict, following the investigation, is that there is a “rare risk” of liver injury from taking curcuma longa and/or curcumin in medicinal dosage forms. People with existing or previous liver problems were more likely to develop this rare adverse event. This isn’t the last word on turmeric, with the TGA considering further regulatory action, including a potential label warning on turmeric and curcumin supplements, following wider consultation, the results of which will be known later this year. There are over 600 listed medicines, legally available in Australia, that contain these curcuma species and/or curcumin, according to the advisory.

Does turmeric have health benefits?

The TGA warning says that the risk of liver injury did not appear to relate to curcuma longa consumed in “typical” dietary amounts as a food. As a staple ingredient in South and South East Asian cuisine, turmeric is also used in Ayurvedic and Chinese-medicine concoctions. Several studies, over the last five decades, have investigated the properties of curcumin and report it to have anti-oxidant properties that can help with inflammation. These include arthritis and infections. Curcumin-based extracts have also been investigated in leading research labs of India. Research teams at the Indian Institute of Science, Bengaluru have reported that curcumin used along with the drug Artemisinin was effective in treating malaria when tested on mice. There have also been studies investigating the drug as an adjuvant in chemotherapy based on results in mice and animal studies. However, their effect in human trials have been inconclusive.

Why is curcumin being used in supplements?

One of the challenges of turmeric and by extension curcumin is that very little of it is absorbed, or made ‘bioavailable’, by the body. Much scientific effort has been expended over the decades to improve its bioavailability. A popular approach is to use piperine, the major active component of black pepper, which improves bioavailability by 2000%, says a 2017 review in the peer-reviewed journal Foods. However, whether increasing the bioavailability of curcumin and packaging them in supplements makes them effective and safe for use in medicines is still being debated with no conclusive evidence emerging from trials.

Is Australia the only country to warn about turmeric supplements?

The Australian TGA cites reports of 20 hepatitis cases in France and an investigation by ANSES, the French Agency for Food, Environmental and Occupational Health & Safety, into 100 reports of adverse effects, including 15 reports of hepatitis, potentially related to the consumption of food supplements containing turmeric or curcumin. The ANSES report underlines that turmeric has “choleretic” properties, which means it stimulates the secretion of bile to improve digestion, and therefore, it is advisable that those with bile duct disease should avoid turmeric. Curcumin could also interact with medications such as anticoagulants, cancer drugs and immunosuppressants, reducing their safety and effectiveness, they note.

Is there a ‘safe limit’ on the amount of turmeric that can be consumed?

The European Food Safety Authority has set an acceptable daily intake of 180 mg of curcumin per day for a 60 kg adult as the safe level of consumption. The average consumption in France remains low, with 27 mg for heavy consumers of foods containing turmeric. A World Health Organization/Food and Agricultural Organisation advisory recommends 3 mg/kg of body weight. A 75 kg person can have about 200 mg a day. India’s Food Safety and Standards Authority of India has standards that packaged turmeric must comply with but nothing on the recommended dietary allowance.

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