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Curcumin

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Summary

Curcumin is well established as an anti-inflammatory and anti-oxidant. It also is effective in managing side effects and improving the quality of life for people with cancer. We're encouraged by curcumin’s promising role in treating cancer and reducing risk.

Curcumin is the active ingredient in the spice turmeric. Your intestines do not readily absorb it, and so getting it to tumors outside the digestive tract has been difficult. New formulations make it more easily absorbed.

We've rated this therapy on several characteristics.

Evidence of Effectiveness

Treating Your Cancer 

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Optimizing Your Body Terrain 

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Managing Your Side Effects 

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Reducing Your Cancer Risk 

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Use by Integrative Oncology Experts

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Safety

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Affordability and Ease of Access

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Details and Evidence

Curcumin is the major constituent and the active component in turmeric, a seasoning used frequently in Indian and other South Asian cuisines and a main ingredient in curry powder.

Curcumin is not readily absorbed by the intestine,¹ but consumption with either pepper or fats is noted to increase absorption..² However, some sources advise taking turmeric supplements on an empty stomach. Some sources also advise caution in using piperine (the active ingredient in pepper) with certain prescription medications and/or long-term, as described below. Differing advice may derive from different formulations in supplements.³

Solutions are being developed to increase absorption. Consult your physician and the directions on a supplement for guidance. Examples:

• The Meriva®formulation has greatly increased oral absorption in humans and metabolizes to a potent derivative.⁴
• Nanoformulations in colorectal cancer treatment have successfully enhanced water solubility, delivery and efficacy in preliminary studies.⁵
• A 2016 study found that a 40 percent guar gum and curcumin formulation showed better release of curcumin directly into the colon.⁶
• A liposomal form of curcumin—in which an extract of pure curcumin is placed into a small bubble made of at least one lipid (fatty) layer resembling the wall of a cell—is available. Studies of liposomal curcumin have shown greater effects inhibiting tumor growth and promoting apoptosis (programmed cell death) with cancer cells.⁷
• Other curcumin derivatives have been developed to increase absorption and show promising laboratory effects.⁸

Treating the Cancer

Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action

Preliminary findings from many small and uncontrolled studies indicate that curcumin is effective in treating cancer.⁹

Anticancer Activity

Clinical Evidence

• Clinical evidence of treatment effects is still very limited¹⁰ and available mainly with colorectal cancer.¹¹
• Incresed survival among patients with gemcitabine-resistant pancreatic cancer compared to gemcitabine alone¹²
• In several small trials in humans, curcumin has shown anticancer effects with some—but not all—patients with several types of cancer: bladder, cervical, colon, esophageal, oral, pancreatic, skin and stomach cancers.¹³
• Curcumin reduced disease markers in small studies:
  • Cervical neoplasia¹⁴
  • Colorectal cancer:
    
    • Significant tumor marker response and some clinical benefit, although no antitumor activity in a small trial of liposomal curcumin in metastatic advanced cancer¹⁵
    • Increased cell death (apoptosis) in tumor tissue in patients with colorectal cancer after diagnosis and before surgery¹⁶
  • Multiple myeloma¹⁷
  • Pancreatic cancer¹⁸
  • Prostate cancer (in combination with soy isoflavones)¹⁹
• Reduced the creation of new blood vessels to supply tumors (angiogenesis)²⁰

Lab and Animal Evidence

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Conventional Therapy Enhancer

Clinical Evidence

• Increased the effectiveness of the chemotherapy imatinib treatment, as shown in cancer markers, in people with chronic myeloid leukemia treated with curcumin (turmeric powder)⁴⁰
• Used with docetaxel in patients with metastatic breast cancer with no disease progression and no increased side effects⁴¹
• Comparable progression-free survival without the adverse effects of steroid-based combination therapies when used in a combination regimen with an immunomodulatory drug or proteasome inhibitor in people with multiple myeloma⁴²
• Colorectal cancer:
  • Well tolerated and effective with FOLFOX (5-fluorouracil, oxaliplatin and gemcitabine)⁴³ with some evidence of improved survival⁴⁴
  • Sensitized tumors to chemotherapy and gamma radiation,⁴⁵ increasing effects of chemotherapy by decreasing the numbers of colorectal cancer stem cells⁴⁶
  • Reduced multidrug resistance and dose-limiting cytotoxicity of 5-Fluorouracil (5-FU).⁴⁷
  • Enhanced chemotherapy effects and outcomes in people with metastatic colorectal cancer treated with MB-6, a combination of fermented soybean extract, green tea extract, Antrodia camphorata mycelia, spirulina, grape seed extract, and curcumin extract when combined with leucovorin, 5-fluorouracil, and oxaliplatin compared to chemotherapy alone: reduced disease progression rate in a small clinical study⁴⁸
• ncouraging survival time among gemcitabine-resistant patients with pancreatic cancer treated with curcumin in combination with gemcitabine-based chemotherapy in a small, uncontrolled study.⁴⁹

Lab and Animal Evidence

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Optimizing Your Terrain

Creating an environment within your body that does not support cancer development, growth or spread

See Body Terrain and the Tumor Microenvironment.

Clinical Evidence

• Anti-inflammatory and antioxidant,⁷⁰ including greater elevation in enzymes and activity that reduce systemic oxidative stress in patients with solid tumors receiving standard chemotherapy regimens⁷¹
• Decreased serum levels of TNF-α, a protein that may boost immune response and may also cause death of some types of tumor cells⁷²
• Effects on gene expression and signaling pathways⁷³
• The Meriva formulation decreased oxidative stress and systemic inflammation in patients with solid tumors undergoing chemotherapy.⁷⁴
• Improved insulin signaling⁷⁵ and reduced development of diabetes among prediabetic individuals⁷⁶
• Protected against the DNA damage caused by arsenic⁷⁷

Lab and Animal Evidence

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Managing Side Effects and Promoting Wellness

Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being

Clinical Evidence

Small trials show curumin is effective in promoting wellness, improving quality of life and reducing symptoms.⁸⁶

Changes in appetite or weight loss

• Reduced weight loss with the Meriva® formulation⁸⁷
• Increased body weight in colorectal cancer patients after diagnosis and before surgery⁸⁸ and in general.⁸⁹

Depression

• Decreased depression among non-cancer patients with major depressive disorder⁹⁰

Fatigue

• Reduced fatigue from chemo- and radiotherapy⁹¹

Gastrointestinal effects, including nausea and vomiting

• Reduced several side effects of chemo- and radiotherapy, including mucositis, mouth and throat ulcers, swallowing problems, nausea and vomiting)⁹²
• Reduced treatment symptoms such as nausea, constipation, diarrhea, soreness and ulceration with the Meriva® formulation⁹³

Pain

• Reduced pain from chemo- and radiotherapy⁹⁴
• Reduced pain in people with breast cancer receiving adjuvant hormonal therapies in combination with hydroxytyrosol and omega-3 fatty acids⁹⁵  

Quality of life

• Improved health-related quality of life,⁹⁶ including in patients with solid tumors under standard chemotherapy regimens⁹⁷
• Improved quality of life in patients with solid tumors receiving standard chemotherapy regimens and a bioavailability-enhanced curcumin preparation in small studies⁹⁸

Other side effects and symptoms

• Reduced several side effects of chemo- and radiotherapy, including swelling (erythema), skin lesions and weakness), and was protective of the liver⁹⁹
• Reduced severity of urinary symptoms and some skin complications¹⁰⁰
• Reduced mucositis grade, pain, redness (erythema) intensity, and ulcerative area with topical use as a gel or mouthwash¹⁰¹
• Lowered total cholesterol levels in patients at risk of cardiovascular disease¹⁰²
• Reduced severity of radiation dermatitis in people with breast cancer, although not all studies have found a significant effect.¹⁰³
• Reduced radiodermatitis with a topical cream containing turmeric and sandalwood oil [Vicco(®)]¹⁰⁴
• Reduced incidence of adverse events (at least grade 4) and occurrence of increased serum creatinine (an indicator of kidney toxicity) in people with colorectal cancer¹⁰⁵
• Prevented weakness and wasting (cachexia) in colorectal cancer patients after diagnosis and before surgery¹⁰⁶
• Milder urinary symptoms in people with prostate cancer undergoing external beam radiotherapy¹⁰⁷

Lab and Animal Evidence

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Reducing Risk

Reducing the risk of developing cancer or the risk of recurrence

Clinical Evidence

• Blocks development or reduces risk of cancer development¹¹³
• Reduces risk from chemical exposures in bladder, colon and pancreatic cancers, cervical neoplasia and other conditions.¹¹⁴
• Inhibited breast cancer proliferation in both preclinical and clinical studies¹¹⁵
• Effects seen in colorectal cancer:
  • Suppressed adenomas in patients with familial adenomatous polyposis (FAP) when used with quercetin¹¹⁶
  • Decreased polyp numbers and size when used alone (in some studies)¹¹⁷ or with quercetin¹¹⁸
  • Reduced aberrant crypt foci (ACF) formation in smokers; ACF are one of the earliest changes that can be seen in the colon that may lead to cancer¹¹⁹

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Access

Foods containing curcumin—turmeric and curry powder—are widely available in grocery stores. Supplements containing cucumin or turmeric powder are also widely available.

Cautions

Curcumin is generally regarded as safe by the US Food and Drug Administration (FDA). Epidemiological evidence and several clinical trials confirm the safety of curcumin up to 12 grams per day over several months.¹²⁸ However, compounds in curcumin can bind to iron and reduce iron's availability, a concern to people with anemia or iron-storage problems. Iron levels may need to be monitored with curcumin supplement use.¹²⁹

Preliminary clinical evidence shows that cucrumin may slightly reduce the effectiveness of tamoxifen. In a study of breast cancer patients, researchers in the Netherlands gave tamoxifen with or without curcumin 1200 mg three times a day. The group taking tamoxifen in combination with curcumin had about an 8 percent decrease in endoxifen levels. If the curcumin was compounded with piperine (often done to substantially improve curcumin absorption), endoxifen levels were further decreased by 12 percent.¹³⁰ Read more about this study and implications for use during tamoxifen treatment in the Commentary section below.

Naturopathic oncologist and BCCT advisor Dr. Lise Alschuler cautions that curcumin should not be taken with some drugs (cyclophosphaide, anastrozole, exemestane, letrozole or erlotinib, or therapeutic doses of warfarin),¹³¹ and the TRC Natural Medicines database lists several interactions with chemotherapy drugs, diabetes medications and other drugs that lower blood sugar, estrogens, drugs that slow blood clotting, and other drugs. Medical supervision is recommended at doses higher than those typically found in foods.

Curcumin can interfere with certain liver detoxification enzymes and interact with substrates of drugs. It also has antiplatelet properties, possibly increasing the risk of bleeding in those on anti-clotting drugs. It can interact with chemotherapy drugs such as cyclophosphamide and doxorubicinc can interfere with CYP450 enzymes and may interact with substrate drugs.¹³²

Side effects are mostly associated with doses higher than four grams per day:¹³³

• Mild and self-resolving gastrointestinal disturbances such as loose stools, reflux, bloating and abdominal discomfort.
• Inhibited sperm motility in cell studies
• Inhibited synthesis of hepcidin (an iron-regulatory hormone), resulting in a dose-dependent drop in hematocrit, hemoglobin, serum iron and transferrin saturation especially in those with a subclinical anemia or iron deficiency. Curcumin should therefore be taken with caution among those with marginally low iron stores or other diseases associated with iron such as anemia of chronic disease. Similarly, curcumin may possibly contribute to iron chelation, with the potential to cause a clinical or subclinical iron deficiency anemia.
• Transient rise in liver enzymes
• Suppressed platelet aggregation, possibly leading to bleeding
• Contact dermatitis, hives (urticaria)

Integrative oncologist and BCCT advisor Dr. Andrew Weil and Alina Health provide these cautions:¹³⁴

• Don’t use turmeric if you have gallstones, bile duct dysfunction, hyperacidity, or stomach ulcers..
• Pregnant or lactating women shouldn’t use turmeric supplements without their doctors’ approval.
• In rare cases, extended use can cause stomach upset or heartburn.
• Piperine can slow the elimination of some prescription drugs including phenytoin (Dilantin), propranolol (Inderal), and theophylline. Some evidence also suggests that curcumin can interfere with certain chemotherapy drugs used to treat breast cancer, so if you’re being treated for this disease, be sure to discuss the advisability of taking curcumin with your physician.

Stop use before surgery, as curcumin can increase bleeding. 

Dosing

BCCT does not recommend therapies or doses, but provides information for patients and providers to consider as part of a complete treatment plan. Patients should discuss therapies with their physicians, as contraindications, interactions and side effects must be evaluated. Levels of active ingredients of natural products can vary widely between and even within products. See Quality and Sources of Herbs, Supplements and Other Natural Products.

Dosage recommendations are available from these sources:

• Solutions 4 Health:
  • Bladder Cancer Wellness Plan
  • Breast Cancer Wellness Plan
  • Colorectal Cancer Wellness Plan
  • Leukemia Wellness Plan
  • Lung Cancer Wellness Plan
  • Lymphoma Wellness Plan
  • Prostate Cancer Wellness Plan
  • Thyroid Cancer Wellness Plan
• Natural Medicines Database (requires purchase)
• See the protocols listed below.

Integrative Programs, Protocols and Medical Systems

• Programs and protocols
  • Alschuler & Gazella complementary approaches¹³⁵
    • Bladder cancer
    • Brain cancer
    • Breast cancer
    • Cervical cancer
    • Colorectal cancer
    • Lung cancer
    • Melanoma
    • Ovarian cancer
    • Pancreatic cancer
    • Prostate cancer
    • Detoxification
    • Immune enhancement
    • Anti-inflammatory
    • Radiation sensitizer
  • Bastyr University Integrative Oncology Research Center protocol for stage IV breast cancer¹³⁶
  • Block program¹³⁷
    • Anti-inflammatory terrain modifier
    • Coagulation terrain modifier
    • Surgical support program (wound healing)
    • Radiation support program (mucositis)
    • Post-treatment program (targeting cancer progression pathways)
    • Rehabilitation program (reducing inflammatory response)
    • Targeted molecular therapies
    • Chemopreventive (breast, colon and pancreatic cancers, melanoma)
    • As a targeted therapy when other treatment isn't working
  • Lemole, Mehta & McKee protocols¹³⁸
    • Bladder cancer
    • Breast cancer
    • Colorectal cancer
    • Endometrial cancer
    • Leukemia
    • Lung cancer
    • Lymphoma
    • Melanoma
    • Prostate cancer
    • Renal (kidney) cancer
    • Thyroid cancer
  • MacDonald breast cancer program¹³⁹
  • Marsden Centre¹⁴⁰
  • McKinney protocols¹⁴¹
    • General cancer
    • Breast cancer
    • Bladder cancer
    • Brain/nerve cancer
    • Carcinoid/neuroendocrine cancer
    • Cervical cancer
    • Colorectal cancer
    • Esophageal cancer
    • Gallbladder cancer
    • Head and neck cancer
    • Kidney cancer
    • Leukemia
    • Liver cancer
    • Lung cancer
    • Lymphoma
    • Melanoma
    • Myelodysplastic syndrome
    • Ovarian cancer
    • Sarcoma
    • Stomach cancer
    • Thyroid cancer
  • Parmar & Kazcor treatment plans¹⁴²
    • Brain cancer (primary)
    • Breast cancer
    • Colorectal cancer
    • Lymphoma (Hodgkins and non-Hodgkin)
    • Multiple myeloma
    • Lung cancer (non small cell)
    • Pancreatic cancer
    • Prostate cancer
    • Thyroid cancer
• Traditional systems
  • Ayurveda
  • Traditional Chinese medicine

Based on safety and scientific evidence, most naturopathic physicians include curcumin/turmeric in their core protocol for reducing the risk of cancer relapse in patients who have received primary conventional treatment.¹⁴³

Curcumin is among the botanicals most commonly used by oncology naturopaths for colorectal cancer.¹⁴⁴

Commentary

BCCT advisor Dr. Andrew Weil advises: “Neither curcumin nor turmeric taken orally is well absorbed unless taken with black pepper or piperine, a constituent of black pepper responsible for its pungency. When shopping for supplements, make sure that the one you choose contains black pepper extract or piperine.”¹⁴⁵ However, both Dr. Weil and naturopathic oncologist Lise Alschuler caution that use of piperine may interact with a wide range of prescription medications. Dr. Alschuler does not advise long-term use of piperine.¹⁴⁶

Karen Collins, MS, RDN, CDN, FAND, January 23, 2018: The vast majority of studies on turmeric/curcumin have been in cell studies and rodent studies, and mostly with amounts that are unlikely to be consumed in humans who simply add turmeric as a culinary spice. Human studies are really limited.

I've seen one human study show reductions in TNF-alpha (the inflammatory signaling protein) with only 150 mg of curcumin/day—but I'm not sure how to translate the TNF-alpha change as to whether it was clinically significant. Other studies I've seen and as reviewed in the Natural Medicines Database tend to use 1000 to 4000 mg/day of curcumin (and some studies use much more).

BCCT advisors Gwen Stritter, MD, and Jen Green, ND, FABNO, May 9, 2019: Impact of curcumin on tamoxifen effectiveness

Many are aware that tamoxifen is what we call a pro-drug. A pro-drug is ineffective until specific enzymes in your body activate it. Tamoxifen is metabolized to endoxifen, the effective drug that prevents ER+ breast cancer patients from relapse.

An enzyme called CYP2D6 is responsible for the magic that changes tamoxifen to endoxifen. The activity of this enzyme varies from individual to individual. Part of the variance is due to genetics—some people are born with hyperactive CYP2D6; others have an enzyme that is very sluggish. Many medications—antidepressants like fluoxetine (Prozac), paroxetine (Paxil) and citalopram (Celexa) amongst a host of others—as well as assorted foods and dietary supplements can either activate or slow down CYP2D6.

When this information first started causing a stir in the breast cancer world roughly 10 years ago, researchers hypothesized that taking tamoxifen with a CYP2D6 inhibitor would cause a increase in breast cancer relapse. As it turned out, further clinical research did not bolster this theory,¹⁴⁷ leading to a new one: genetics, drugs and dietary intake have complex interactions with the body’s enzyme system. They activate some enzymes and inhibit others. This results in a variable net effect on the concentration of important drugs. In a 2016 study, the cause of low endoxifen levels could not be identified over 50 percent of the time.¹⁴⁸

Read more

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More Information

• CAM-Cancer: Curcumin
• Memorial Sloan Kettering Cancer Center’s About Herbs: Turmeric
• Lone Star Medical Group Health Library: Turmeric
• Nelson KM, Dahlin JL et al. The essential medicinal chemistry of curcumin. Journal of Medicinal Chemistry. 2017 Mar 9;60(5):1620-1637.
• Gurdev Parmar and Tina Kaczor: Textbook of Naturopathic Oncology
• BCCT, KNOW Oncology and Ottawa Integrative Cancer Centre: Patient Education Brochures
• Dr. Deirdre Orceyre: Naturopathic and Integrative Cancer Care
• LifeExtension Nutritional Support: Integrative Interventions for Breast Cancer
• Block KI, Block PB, Gyllenhaal C: Integrative Treatment for Colorectal Cancer
• Keith Block and others: A Broad-Spectrum Integrative Design for Cancer Prevention and Therapy
• Raymond Chang, MD: Beyond the Magic Bullet: The Anti-Cancer Cocktail
• Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
• Neil McKinney, BSc, ND: Naturopathic Oncology, 3rd Edition
• Lise Alschuler, ND, FABNO, and Karolyn Gazella: The Definitive Guide to Cancer, 3rd Edition
• Keith I. Block, MD: Life over Cancer: The Block Center Program for Integrative Cancer Treatment
• Oncolink: Cancer Prevention with Curcumin
• National Cancer Institute: Office of Cancer Complementary and Alternative Medicine
• Therapeutic Research Center: Natural Medicines Database
• American Botanical Council: HerbMed
• Cell Nutritionals: Cell Nutritionals: Pomi-T Study
• ConsumerLab.com
• Cancer Research UK
• Editors: Iris F. F. Benzie and Sissi Wachtel-Galor: Herbal Medicine, 2nd Edition: Biomolecular and Clinical Aspects