Rheumatoid arthritis sufferers seeking relief without harmful side effects may find it in the Indian spice curcumin (the curry-flavored powder derived from the root turmeric), according to a new study published in the journal Phytotherapy Research. The first-of-its-kind trial, conducted at Nirmala Medical Centre in India, found that 1,000 mg of curcumin daily worked far better than pharmaceutical treatments for easing arthritis symptoms.
NFM: What prompted you to conduct this trial?
Ajay Goel: Curcumin is a potent anti-inflammatory; it reduces oxidative stress, and we already know it plays an important role in various inflammatory diseases including cancer. I hear from people all the time who have arthritic conditions and say that it works. But, surprisingly, there has not been a single human clinical trial done on rheumatoid arthritis, which is essentially driven by inflammation. There was a big gap in knowledge, so we wanted to start by doing a pilot study to determine its safety and efficacy.
NFM: How is rheumatoid arthritis treated?
AG: The typical treatment starts with prescription anti-inflammatory drugs (NSAIDS) and later on, once people stop responding, advances to more complex regimens (such as TNF inhibitors). The side effects of NSAIDS include stomach damage, susceptibility to infection in the intestinal lining and higher cardiovascular risk. Close to 20,000 Americans die of excessive long-term NSAID use each year. Because this is a chronic disease, and people who are on medication are going to be on it for a long time, they need something safe and efficacious.
NFM: How did you do the study?
AG: It was a randomized three-arm study of 45 patients diagnosed with rheumatoid arthritis. (None were taking any medication at the onset of the study). In group one, patients received 50 mg of the NSAID diclofinac sodium for eight weeks. In the second group they received 500 mg twice a day of BCM-95 curcumin (a proprietary form of the nutrient shown in some studies to be more bioavailable). In the third group, we used a combination. We measured efficacy by looking at Disease Activity Scores (28 clinical parameters) and American College of Rheumatology criteria for reduction of tenderness and swelling of joints.
NFM: What did you find?
AG: In terms of safety, not a single patient dropped out of the curcumin group. In the diclofinac sodium group, 15 percent dropped out because of discomfort or lack of tolerance. When we looked at scores in all three groups, curcumin had the greatest effect on easing symptoms, followed by combination therapy, and then the diclofinac sodium group. This was completely unexpected and extremely encouraging.
NFM: What shortfalls do you see with this study?
AG: There was no placebo arm, and the sample size was too small. We are now planning another placebo-controlled trial.
NFM: Could curcumin be used for other forms of arthritis?
AG: Yes. It has been reported to be effective in alleviating pain in patients with knee osteoarthritis.
NFM: Do you recommend it for rheumatoid arthritis?
AG: Would I recommend they give up their conventional drug and start taking this? No. Start off with a combination therapy and then taper off the NSAIDs in time.
NFM: Would you suggest a dose?
AG: 500 mg to 1 g per day. Even if you are healthy and have no symptoms, spreading a little curcumin on your food or taking a supplement might be a good idea. There are close to 70 curcumin clinical trials underway on different diseases—including Alzheimer’s, cancer, type 2 diabetes, cardiovascular disease, and Multiple Sclerosis—and 5,000 articles examining it.
NFM: What should a retailer look for in a curcumin supplement?
AG: Pick one that has been shown to be highly bioavailable, and look for a curcumin blend that contains the full spectrum of curcuminoids. (Aside from curcumin, which makes up about 80 percent of the curcuminoids found in turmeric, there are two minor siblings which have been shown in some studies to be effective.) Also, use naturally sourced curcumin. There are a lot of trials that have come out negative because they were using synthetic curcumin.
Unbelievable numbers, low potency drive curcumin questions
Dr. Sharon Kolasinski, head of the rheumatology division at Cooper Medical School in Camden, N.J., sees the research thus far on curcumin for rheumatoid arthritis as “very intriguing,” but she’s not ready to recommend it.
“There have been multiple studies that have suggested that there is a scientifically plausible reason to use this ingredient,” she says. “But I’d like to see longer term human studies in a larger population.”
She notes that the benefit demonstrated in the curcumin group, if accurate, would surpass even that of the revolutionary new rheumatoid arthritis drugs called TNF inhibitors—“so high as to be questionable,” she says. “It suggests a very high placebo effect.”
She also takes issue with the fact that the study frames NSAIDs as the “standard of care” for rheumatoid arthritis. In reality, she says, many patients take newer drugs that get at the root of the problem (the body’s immune system attacking itself) rather than just treating the symptoms. At best, she can see curcumin someday used as an adjunct to medication, but only when product quality and purity improve.
She points to a recent Consumer Labs report that found that 20 percent of curcumin supplements tested contained less than 15 percent of the promised ingredient.
“The problem now is knowing what you are really getting.”