Curcumin as a Treatment for IBD

Curcumin is a substance that is found in the spice turmeric. It has been suggested as a supplemental treatment for several different types of conditions, including the inflammatory bowel diseases (IBD). Curcumin has been studied for its antioxidant and anti-inflammatory properties. Because IBD (Crohn’s disease, ulcerative colitis, and indeterminate colitis) are immune-mediated conditions that cause inflammation, there has been some research into whether curcumin can be helpful. This article will explore the evidence looking into whether or not curcumin is a viable adjuvant treatment option for IBD.

While most supplements are thought of as treatments that might not cause harm, it is important to discuss all alternative and complementary therapies with a physician. In the case of IBD, there is some weak evidence that curcumin may provide a benefit for certain patients and a few providers actually prescribe it.

However, there can be unintended effects from any supplement, even ones that are considered “natural” so it's important that physicians know what their patients are taking. In some cases, a physician may not agree that trying supplements will help, but this is not a reason to not tell them. The patient-physician relationship is a partnership and it requires good communication on both sides. Even if a physician does not think a supplement would be helpful, there should be shared decision-making when it comes to treatment choices. 

About Curcumin 

Curcumin is a substance that is found in the spice turmeric. Turmeric is a bright yellow spice that comes from the root (rhizome) of the Curcuma longa, which is a member of the ginger family. It is used to flavor food and is also used as an additive that can color foods to be a brighter orange or yellow.

Turmeric is often used in cooking, especially in curries and in dishes that originate in Southeast Asia. It has also been used as a complementary therapy, primarily in India, where it is utilized in Ayurvedic medicine to treat many conditions, including gynecological, digestive, blood, and liver disorders, as well as infections. 

Curcumin is one of several substances found in turmeric that may have medicinal properties. However, it is only present in a small amount (approximately 2 to 5% ) in turmeric. For that reason, getting enough turmeric through diet alone in order to get therapeutic amounts of curcumin is quite difficult (and might lead to an upset stomach and other digestive concerns). Curcumin can be isolated in order for it to be used as a supplement.

Some of the problems with the use of curcumin as a supplement are that it is poorly absorbed by the body, is metabolized quickly, is not soluble in water, and is not chemically stable at neutral and slightly alkaline pH levels (which are the pH levels of the body). It is not absorbed well in the intestines and therefore testing has shown that even in people who are receiving large amounts, curcumin is not present in high levels in the blood and in the urine . Therefore, it may not be taken up by other tissues organs in the body, which may limit its use as a treatment.

Curcumin as a Treatment for IBD

Turmeric has been used as a medicinal supplement for digestive problems. Isolating curcumin from turmeric so that it can be used in higher amounts has led to its study in treating IBD and other digestive conditions. Curcumin is not taken up well by the body during digestion. So, while not much of it gets into the blood and into body tissue and organs, it is present at active levels in the intestinal tract, which might make it useful for digestive disease.

One reason why curcumin has been considered as an area for study is because it may have an effect on some of the mechanisms of disease activity in IBD. Curcumin has been shown to suppress the activity of interleukin-1 (IL-1), which is a protein made by white blood cells and is found in greater amounts in people with Crohn’s disease or ulcerative colitis than it is in people who don’t have these diseases.

Curcumin has also been shown to suppress tumor necrosis factor (TNF). TNF is a cytokine produced by white blood cells that is a protein which works in the body like a messenger. It is also implicated in IBD because it is found in greater amounts in the stool of people who have Crohn’s disease or ulcerative colitis, which is why there are several medications used to treat IBD that are TNF-blockers.

In the intestinal tract, curcumin may also have an effect on the NF-κB pathway. The inflammation in IBD may be partially tied to the activation of the NF-κB pathway. This pathway has been shown to be the start of some of the immune dysregulation that causes inflammation associated with IBD. Curcumin may disrupt this pathway and prevent the next steps in the process that continues on to cause persistent inflammation.

One review study looked at the use of curcumin along with the medication Remicade (infliximab), which is a TNF-blocker used to treat IBD. Patients in the studies that were included in the review were adults who had Crohn’s disease. One of the challenges with certain IBD treatments, including Remicade, is that in certain people, over time, it may not work as well as it once did (which is called loss of response). The response to a therapy was measured using a clinical scale called the Crohn’s Disease Activity Index (CDAI), which assigns a number based on different factors such as symptoms and inflammation. A higher CDAI means that the Crohn’s disease is worse. Those patients who were taking a curcumin supplement had a reduction in their CDAI scores. The authors concluded that curcumin was a "cheap and safe way to reduce [Crohn’s disease] CD symptoms and inflammatory markers."

A randomized, double-blind, multicenter trial was done on 89 patients with ulcerative colitis to assess the effectiveness of curcumin. The patients in this trial had “quiescent” disease, meaning that they were having few or no symptoms. Patients were also keeping up with their regular therapies, which included sulfasalazine or mesalamine. Some patients were given curcumin, 1 gram in the morning and 1 gram at night, and others were given a placebo. The trial went on for six months. Of the patients that received curcumin, 5% relapsed, while in the placebo group, 21% relapsed. The study authors concluded that curcumin seems safe and promising in ulcerative colitis but more studies are needed to confirm and strengthen this result.

On the other side of the issue, a study done on patients with Crohn’s disease who had surgery showed different results. A double-blind randomized controlled trial in France looked at 62 patients who had resection surgery for Crohn’s disease. All patients received azathioprine after surgery and some also received curcumin while others received a placebo. After six months, more patients receiving the curcumin relapsed versus the patients who received a placebo. The researchers stopped the study because of these results.

The research that has been conducted so far using curcumin as a treatment for IBD has shown some mixed results. For the most part, researchers think that curcumin is safe, but the jury is still out as to which patients might be helped by it and how much effect it can actually have in the course of IBD. So far the evidence for the use of curcumin to treat IBD is not considered to be "strong."

What to Look for In a Curcumin Supplement

For the most part, curcumin is considered safe to use , even in doses as much as 12 grams a day. Many studies of curcumin and IBD include doses of up to 2 grams per day in order to achieve beneficial effects. In most cases, the dosage is started small and then increased over the course of a few weeks. However, it has low bioavailability, which means that it is not easily absorbed in the digestive tract and used by the body. Numerous approaches have been studied in order to determine how to make curcumin more easily taken up by the body in order to maximize its benefits. Supplements that contain curcumin may also contain black pepper. This is because there is an ingredient in black pepper, called piperine, which may help the body uptake more curcumin. In addition, there is some speculation that eating a food with some fat content when taking the curcumin supplement may help in absorbing the curcumin. 

Potential Side Effects

In most studies, curcumin seems to be tolerated well by patients. In one study of pediatric patients with IBD, there was a report of increased gassiness by two of the patients but the side effects were not seen as "clinically relevant." Other potential adverse events that may be associated with curcumin include:

• Diarrhea
• Nausea
• Skin irritation (when used topically)
• Ulcers

Drug Interactions

Natural substances are not free from the potential for drug interactions. Talk to a doctor and/or a pharmacist about potential interactions between curcumin and other prescription medications or over-the-counter drugs. Some of the drugs that may interact with curcumin include:

• Aspirin
• Blood pressure medicines
• Blood thinners (Warfarin, Coumadin)
• Drugs used to manage diabetes
• Non-steroidal anti-inflammatories (NSAIDs)
• Statins (drugs used to lower cholesterol)

Supplement Interactions

Some people take more than one supplement and it’s important to know that there can be interactions even between over-the-counter preparations. Talking with a doctor and/or a pharmacist about the potential for interactions between supplements can be helpful. In the case of curcumin, there may be interactions with supplements that act like blood thinners and decrease blood clotting. Some of the supplements that may interact with curcumin include:

• Cinnamon
• Garlic
• Ginkgo
• Ginseng

Warnings and Precautions

Because it can act as a blood thinner, and can increase the risk of bleeding, curcumin should not be taken prior to having surgery. It is usually recommended that the curcumin supplement be stopped for two weeks before having surgery. Curcumin does not dissolve in water (it is hydrophobic) so it is not for use intravenously. There have been reports of practitioners giving turmeric or curcumin intravenously, which may be associated with at least one death.

Use in Pregnancy and Breastfeeding

There’s not much evidence about how curcumin will affect a pregnant person, a fetus, or a breastfeeding infant. Curcumin has not been assigned either a pregnancy or a lactation category. For these reasons, it’s important to discuss the use of curcumin while pregnant or breastfeeding with a physician. It may be recommended that pregnant people stop taking curcumin, or lower the dosage being used, for the duration of the pregnancy.

A Word From Verywell

There’s a host of issues yet to be addressed in the use of curcumin to treat any disease or condition, including IBD. There are some interesting studies about how this compound does have properties that might be medicinal. However, the fact that curcumin isn’t taken up well in the intestines and the other chemical properties that make it difficult for the body to use are standing in the way.

For some people, it is generally considered safe to take curcumin as a supplemental therapy to treat IBD. However, it is important to note that it is not considered a first-line therapy and shouldn’t be the only treatment that’s used to treat Crohn’s disease or ulcerative colitis. It is also vital that physicians know when patients are taking curcumin or turmeric in any amount, because it is a chemical and does have effects on the body, as well as the potential to interact with other drugs and supplements.

Some people with IBD, especially while hospitalized, may receive blood thinners, and curcumin may not be compatible with these drugs because of the risk of increased bleeding. There is a need for more study on curcumin as a treatment, so in the meantime, it’s important for patients to discuss all treatment options with their healthcare team.