Turmeric is a powerful herb that's been used in South and Southeast Asia and Iran for thousands of years to treat several chronic diseases. It seems like every month we hear about a potential new benefit, mostly centered on its anti-inflammatory effects, such as for arthritis or autoimmune conditions. But it's also known for its antioxidant, anti-diabetic, anti-cancer, and even neuroprotective effects, and some use it to treat metabolic syndrome and related conditions like PCOS and fatty liver.
%20Do's%20and%20Don'ts%20Latest%20Evidence.jpg "Turmeric (Curcumin) Do's and Don'ts: Latest Evidence")
In this article, I'll go over which of these indications and properties have the strongest evidence behind them. I'll also talk about the best ways to take turmeric and review key considerations when choosing the right supplement or formulation. Lastly, I'll review turmeric's latest safety profile and let you know who should and shouldn't take the supplement.
I am Dr. Leonid Kim, and I review the most up-to-date, evidence-based information on weight loss, metabolic health, and longevity. Let's get into it.
Turmeric for Joint Pain and Osteoarthritis
The strongest evidence for turmeric use is for the treatment of joint pain and osteoarthritis. A systematic review and meta-analysis of 16 randomized controlled trials looked at over 1,800 adults with knee osteoarthritis and found that turmeric extracts significantly reduced knee pain and improved physical function. The effects of turmeric were similar to those of NSAIDs, medications like ibuprofen or Advil.
What makes this exciting is that turmeric extract had 12% fewer adverse events compared to NSAIDs, making it a potentially better option for pain and inflammation control, especially for those who cannot take NSAIDs due to kidney disease, heart disease, or a history of stomach or small intestine bleeding.
Following up on that, another systematic review and meta-analysis, published in December 2021, examined 11 randomized controlled trials involving 1,200 participants with knee osteoarthritis and found that curcumin, the active ingredient in turmeric, was more effective at reducing pain than NSAIDs. However, the studies analyzed only examined short-term use, so we'll need more high-quality randomized controlled trials across different doses to assess their long-term effectiveness.
Turmeric for Metabolic Health and Insulin Resistance
Another exciting area with promising new evidence for the use of turmeric or curcumin is metabolic health, more specifically, insulin resistance and glucose control. Curcumin works by stimulating glucose uptake through GLUT4 transporters in adipocytes (fat cells) and skeletal muscle. It also reduces glucose secretion from the liver by regulating the AMPK pathway, the same pathway targeted by the common diabetes medication metformin. Additionally, it regulates the gene expression of pancreatic glucose transporters, thereby stimulating natural insulin secretion.
A recent meta-analysis of 17 randomized controlled trials showed that turmeric lowers fasting blood glucose, hemoglobin A1c, and HOMA-IR, a measure of insulin resistance.
Turmeric for PCOS
It's no surprise that we're now seeing benefits from turmeric in the treatment of PCOS (polycystic ovarian syndrome), which is associated with insulin resistance and metabolic syndrome. A recent randomized, double-masked, placebo-controlled trial in 60 women with PCOS found that 12 weeks of turmeric administration led to significant reductions in weight, fasting glucose, and insulin resistance, along with improved insulin sensitivity. Another randomized controlled study showed that taking turmeric alongside metformin produced synergistic effects, improving insulin resistance and cholesterol levels in patients with PCOS.
Turmeric for Fatty Liver Disease
When it comes to fatty liver, or non-alcoholic fatty liver disease, now known as metabolic dysfunction-associated fatty liver disease (MASLD), a recent meta-analysis of nine randomized controlled trials, published in 2019, showed that curcumin supplementation produced a significant decrease in liver markers like ALT and AST, and also showed a beneficial effect on metabolic parameters in patients with fatty liver.
The Best Way to Take Turmeric
Now let's talk about the best way to take turmeric, since there are many products on the market with different formulations.
First, the proper dose depends on whether you're taking turmeric or curcumin. Turmeric is a root often used as a spice or food additive, while curcumin is an extract derived from turmeric. Most of the benefits discussed above actually come from curcumin, the active compound in turmeric.
Since most curcumin gets metabolized before it can be absorbed, the easiest way to take it is in supplement form, and there are important considerations to keep in mind when choosing the right one:
- Take it with piperine. Since curcumin absorption is so tricky, it's important to take it with piperine, a natural alkaloid found in black pepper. Piperine protects curcumin from digestive enzymes and can increase curcumin's bioavailability by up to 2,000%. Some supplements advertise BioPerine, a synthetic piperine extract.
- Take it with fat. Curcumin is lipophilic, meaning it can only dissolve in oils and fats. The best way to take the supplement is with meals containing at least 15 grams of fat or oil.
- Choose a verified supplement. Make sure your supplement is third-party tested and either USP- or NSF-verified. This verification confirms that the supplement actually contains the ingredients listed on the label at the declared dosage, that it isn't contaminated with toxins or metals, and that it has been manufactured in accordance with FDA good manufacturing practices.
Safety and Who Should Avoid Curcumin
Now let's talk about the safety of curcumin and turmeric and discuss who should and shouldn't take the supplement.
Curcumin has been declared Generally Recognized as Safe (GRAS) by the FDA, with some studies showing it to be safe even at high doses of up to 8 grams per day. That said, the actual dosage you need depends on what you're taking it for, so it's worth talking to your doctor about the right dose for you.
When it comes to side effects, curcumin can cause GI issues like abdominal pain, nausea, and diarrhea, which should improve if taken with meals. Curcumin also has several important interactions to be aware of:
- Be careful taking it with blood thinners and antiplatelet medications like aspirin and Plavix, as well as with warfarin or other blood thinners like Eliquis or Xarelto, as it may increase your risk of bleeding.
- Curcumin can interact with certain diabetes medications and cause hypoglycemia, or low blood sugar.
- Since curcumin has a blood pressure-lowering effect, be careful if you're taking it alongside other blood pressure medications.
- Curcumin can increase stomach acid and worsen gastroesophageal reflux.
- Curcumin is not recommended for people with kidney stones or gallstones, and I would avoid it during pregnancy or breastfeeding, as there are no reliable studies on its effects in that population.
Conclusion
Based on the current research, curcumin is a genuinely powerful supplement with a growing body of evidence behind its benefits, particularly for joint pain and osteoarthritis, metabolic health, insulin resistance, PCOS, and fatty liver disease, and in some cases performing comparably to or better than standard medications like NSAIDs, with fewer side effects. That said, we've only scratched the surface of curcumin's potential benefits, which may also extend to inflammatory bowel disease, Alzheimer's, heart disease, and cancer prevention, areas that deserve their own deeper dive. For most people, curcumin appears safe when taken appropriately, ideally with piperine and a source of fat to improve absorption. Still, anyone on blood thinners, diabetes medications, or blood pressure medications, or with kidney stones, gallstones, or who is pregnant or breastfeeding, should talk to their doctor before starting it.
FAQ
What's the difference between turmeric and curcumin?
Turmeric is the root, commonly used as a spice or food additive. Curcumin is the active compound extracted from turmeric, and it's responsible for most of the health benefits associated with turmeric.
Does turmeric or curcumin really help with joint pain?
Yes. Multiple systematic reviews and meta-analyses show curcumin can reduce knee pain and improve physical function in osteoarthritis, with effectiveness similar to or better than NSAIDs, and notably fewer adverse events.
Can turmeric help with blood sugar and metabolic health?
Research suggests yes. Curcumin appears to improve glucose uptake and reduce glucose production in the liver through pathways similar to metformin. Studies show it can lower fasting blood glucose, HbA1c, and insulin resistance markers.
Why should curcumin be taken with black pepper or fat?
Curcumin is poorly absorbed on its own. Piperine, found in black pepper, can increase curcumin bioavailability by up to 2,000%, and since curcumin is fat-soluble, taking it with meals containing at least 15 grams of fat further improves absorption.
Is curcumin safe to take?
Curcumin is Generally Recognized as Safe (GRAS) by the FDA, even at doses up to 8 grams per day in some studies. However, it can interact with blood thinners, diabetes medications, and blood pressure medications, and isn't recommended for those with kidney stones, gallstones, or during pregnancy or breastfeeding.
Who should avoid taking curcumin or talk to a doctor first?
People taking blood thinners, anti-platelet drugs, diabetes medications, or blood pressure medications should consult their doctor first, as should those with kidney stones, gallstones, acid reflux, or who are pregnant or breastfeeding.