A few years back, my mother-in-law brought me a grocery bag full of supplements. You heard it, a GROCERY BAG of supplements. To boot, this was her monthly supply. Not lifetime, not yearly, her monthly supply. Every month, she was ingesting a grocery bag full pills for various ailments. That’s a lot pills. I was concerned. First, this must be costing $$$? But most importantly, she had very little, if any knowledge of what she actually was taking. What were some of the potential side effects? Were any these interacting with each other? Were these interacting with her prescribed medications for diabetes and thyroid disease?
Now, I don’t know about you but the world of supplements is downright daunting. How do you know whether a supplement works for its intended purpose and is it safe? There’s so much conflicting data out there.
Today, I’d like to show you how I approach assessing the efficacy and safety of any supplement, medication, or procedure.
I’m going to use turmeric, also known as Curcuma, as an example. This is a supplement that is rapidly becoming an important player in the world of supplements. It’s used to treat various different conditions such as osteoarthritis.
First, here are a few safety tips. Herbal supplements are regulated by the FDA but they fall under a category called dietary supplements. When it comes to dietary supplements, manufacturers don’t have to seek FDA approval to put their product on the market. They don’t even need to prove that their product actually works. Manufacturers must follow good manufacturing practices to make sure that the supplement is processed consistently and meets quality standards.
For example, they aren’t allowed to cut their product with pesticides and heavy metals. In the event that they do, the FDA is allowed to take action against the manufacturer or distributor and have the product recalled. Basically the FDA has to make sure dietary supplements aren’t harming or killing anyone.
High risk situations include: you’re pregnant or breast-feeding, you’re about to have surgery, you’re younger than 18 or older than 65, or you’re already taking other medications. Herbal supplements may interact with your other medications and these interactions could be harmful or life-threatening.
The following are items that should always be made available on the labels of all herbal supplements:
- The name of the supplement
- The name and address of the manufacturer or distributor
- A complete list of ingredients
- Serving size, amount, and the active ingredient
When in doubt, ask your doctor or your pharmacist. That’s what they’re there for. I argue that, you should ALWAYS ask your doctor or pharmacist.
Anything you put in your mouth, whether it be FDA approved, regulated, or not, is considered medicine and has the potential to cause good but also cause harm.
Of note, the FDA regulates American manufacturers and distributors. If the supplement comes from anywhere else, all bets are off. Many countries really don’t care whether supplements contain poison. I’m not saying that their supplements necessarily do contain poison, you just can’t really be sure. I’ve included a few websites in the reference section, to help you with your research.
The Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
Osteoarthritis is super common. It affects about a quarter of the worldwide population. There are no known cures. Well maybe joint replacement but that’s kind of extreme and even then, it’s not a magic bullet. Turmeric is a spice that has been used in cooking for a really really long time. Millenia… This spice has different bioactive components, the most important one being curcumin.
Curcumin is actually really interesting. It modulates a completely different inflammatory pathway as compared to standard arthritis medications like naproxen, ibuprofen, or celecoxib. It modifies something called NF-κβ signaling. This pathway is involved in maintaining normal immunity, but it also has been linked to cancer and other diseases such as heart disease, asthma, inflammatory bowel disease, and osteoarthritis. Don’t get me wrong, abnormal NF-κβ activity DOES NOT cause cancer or osteoarthritis. It simply appears to be active when these diseases are present.
That really long header you just read, is the title of a recent study that sought to look at all prospective randomized clinical studies using turmeric for the treatment of arthritis. This type of study is a meta-analysis. The researchers managed to find eight studies: four high quality studies and four moderate quality studies. The severity of arthritis was determined by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). This is how bad the arthritis is general, how it limits your quality of life. Pain was measured with the pain visual analogue score (PVAS). Thankfully the dose of turmeric was similar across the studies: about 1 gram/day without pain killers and about 500 mg/day with pain killers.
What the researchers found was that people receiving turmeric had lower WOMAC scores compared to placebo. People receiving turmeric reported improved morning stiffness and overall ability to move. Moreover, the improvement seen in the turmeric groups were similar to those achieved in ibuprofen and diclofenac groups. These are standard arthritis medications. The problem with them is that they can cause stomach problems, they can affect the liver and kidneys, and they should not be used when someone has coronary artery disease or is on blood thinners. The nice thing about turmeric is that it is not associated with any of these nasty side effects. At high doses it can cause some diarrhea and it has NOT been studied in pregnant or lactating women.
So basically, the study concluded that turmeric or Curcuma more specifically, at dose of 1000 mg per day can help the decrease arthritis symptoms. They also mentioned that the sample size (i.e., number of people) of the various studies they included were rather small and some of the studies weren’t top notch quality.
“Therefore, turmeric extracts and curcumin can be cautiously recommended for alleviating the symptoms of arthritis, especially osteoarthritis.”
A few words of caution:
- Always carefully read the packaging.
- More is not necessarily better. 8 -12 grams of curcumin can cause diarrhea and can cause anemia.
- Notify your doctor when you decide to start a new supplement.
Are there other natural supplements that block NF-κβ?
We know that osteoarthritis is exacerbated by the activation of NF-κβ. So the question is, are there other natural supplements that block NF-κβ? It turns out, there may be: green tea, rosehip, and resveratrol. Whether theory translates into clinical efficacy? Please stay tuned for more!
NIH Dietary Supplement Label Database: https://dsld.nlm.nih.gov/dsld/
National Center for Complementary and Integrative Health: https://nccih.nih.gov/
Office of Dietary Supplements: https://ods.od.nih.gov/
Daily JM, Yang M, Park S. Efficacy of turmeric extracts and curcumin for alleviating the symptoms of joint arthritis: a systematic review and meta-analysis of randomized clinical trials. J Med Food. 2016 Aug;19(8):717-29.