Turmeric root has been used medicinally for over 2500 years. It has a long history of use in Ayurvedic and Traditional Chinese Medicine to treat a broad spectrum of health conditions characterised by inflammation.^6,9  

Curcumin is the primary active constituent derived from turmeric. However, it is poorly utilised by the body. Bioavailability-enhanced curcumin supplementation overcomes this obstacle and provides a safe and effective therapy for health conditions characterised by inflammation and pain.^9,10,11 

Curcumin 

Curcuminoids are yellow-coloured polyphenol compounds. They are the primary active constituents of the rhizome of Turmeric (Curcuma longa), a plant belonging to the Ginger (Zingiberaceae) family.^7,9 

Curcumin (diferuloylmethane) is the principal curcuminoid derived from turmeric and demonstrates the greatest biological activity.^7,9 

Biological | Health Effects  

There are well over 8000 studies on curcumin. On review, they describe a broad spectrum of biological effects:^1,7,9,11  

• Anti-inflammatory  
• Antioxidant 
• Antinociceptive 
• Neuroprotective & anti-amyloid 
• Hepatoprotective 

• Nephroprotective 
• Anti-atherosclerotic 
• Anti-diabetic 
• Anti-ulcer 
• Anticancer 

• Antiviral 
• Anti-microbial & Anti-biofilm 
• Anti-ageing 

Because curcumin has a wide range of biological activities, it has an affinity for a wide range of health conditions. Particularly conditions characterised by disordered/chronic inflammation, including:^{1,2,4,6,9,13,14} 

• Musculoskeletal disorders and arthritis 
• Inflammatory bowel diseases 

• Neurodegenerative diseases 
• Metabolic syndrome and associated diseases (including obesity, diabetes, cardiovascular disease) 
• Psoriasis and other inflammatory skin conditions 

Inflammation and Pain  

Researchers have found curcumin effective in treating and preventing conditions characterised by pain and inflammation.⁶  

Inflammation     

Inflammation is an adaptive physiological response by the body to harmful stimuli and conditions such as damage to the tissues and infection. ⁶  Acute inflammation is a short and beneficial response that aims to restore the body to homeostasis.⁶ 

If acute inflammation does not resolve and persists for an extended time, it becomes chronic. This long-term inflammation can contribute to a wide range of chronic health conditions, including metabolic, cardiovascular and neurodegenerative diseases, arthritis and some types of cancer.^6,14 

Curcumin exercises its anti-inflammatory effects by modulating inflammatory signalling pathways and preventing the production of inflammatory mediators.^6,14  

Supplementation  demonstrates significant reductions in inflammatory markers, most notably:³  

• Tumour necrosis factor-ɑ (TNF- ɑ) 
• Monocyte chemoattractant protein-1 (MCP-1) 
• Interleukin 8 (IL-8) 
• Interleukin-6 (IL-6) 

• C-reactive protein (CRP) 

An increase in the anti-inflammatory cytokine IL-10 is associated with these reductions.³  

A note on dosing: long-term dosing of curcumin is most effective. Studies show the greatest effect in treating inflammation, measured by the most significant reduction of CRP levels, is at approximately 13 weeks.³  

Pain

Curcumin effectively decreases neuropathic pain and pain-related symptoms through its antioxidant, anti-inflammatory and analgesic properties. It works by:^7,11 

• Desensitising or inhibiting transient receptor potential ion channels 

• Scavenging free radicals 
• Limiting the production of spinal or local inflammatory mediators 

Spotlight: osteoarthritis (OA)        

No longer considered just a “wear and tear” disease OA is more complex, encompassing mechanical, inflammatory and metabolic factors. OA’s pathogenesis appears to be influenced more by inflammation than previously recognised.⁵ 

Numerous clinical trials support the use of curcumin in OA. With increased physical function, significant relief from joint inflammation, stiffness, and pain has been measured in various standardised scores.^4,5,12,13 Individuals with a higher BMI and advanced age are less likely to respond strongly to curcumin supplementation.¹³ 

The anti-inflammatory and cartilaginous protective effects of curcumin are understood to decrease oxidative stress and inflammation, contributing to a slowing of OA’s evolution and clinical progression. In this respect, curcumin supplementation also provides a potential preventative function.^4,5 

Spotlight: inflammatory bowel disease (IBD) 

The aetiology of inflammatory bowel disease is not fully understood; what is understood is that inflammatory mediators such as TNF- ɑ drive disease progression.²  

In mild to moderate cases of IBD, especially ulcerative colitis, curcumin improves both symptoms and clinical outcomes, induces remission in mild to moderate cases, and enhances quality of life.^4,6 

A potential replacement or adjunct to anti-inflammatory medications 

Studies in vitro have demonstrated the ability of curcumin to have a similar effect to non-steroidal anti-inflammatory drugs through modulation of the NF kappa-β response.⁵ 

Curcumin has been compared to the action of both ibuprofen and diclofenac in human studies, showing equivalence to these drugs without adverse effects such as gastrointestinal symptoms.⁴ 

Curcumin can be safely used in conjunction with NSAIDs, decreasing their requirement and alleviating some of their adverse side effects.^5,12 

Ageing and “inflammaging”           

The physiological ageing process is complex and characterised by decreasing cellular function as the regenerative and repair potential of tissues throughout the body diminishes. These changes can lead to many age-related diseases, including arthritis, cardiovascular disease, neurodegenerative diseases, metabolic diseases, chronic obstructive pulmonary disease and cancer.^1,14 

Both oxidative stress and inflammation are hallmarks of ageing. Their interplay gives rise to the phenomenon called “inflammaging”.^1,14 

When cells age, their ability to proliferate diminishes, and they are termed “senescent”. This process promotes the secretion of pro-inflammatory mediators, which in turn stokes chronic inflammation, independent from the activation of immune cells.^1,14 

Chronic inflammation results in raised levels of reactive oxygen species.^1,14 Oxidative stress occurs when the body’s ability to detoxify reactive oxygen species (ROS) becomes inadequate. This, in turn, results in an excessive accumulation of ROS that can promote oxidation and cellular damage and further enhance inflammation and cell senescence.^1,14  

Damage caused by oxidative stress is one of the most important causes of ageing and age-related diseases. Bioenhanced curcumin supplementation is a primary strategy for combating oxidative stress and inflammation.  

The importance of choosing the right curcumin supplement  

Curcumin has low bioavailability due to four main factors:^9,10,11 

1. Low absorption  

2. Fast metabolism 

3. Rapid systemic clearance  

4. Limited blood-brain barrier penetration  

Clinical trials show that bioavailability enhanced curcumin improves therapeutic efficacy.^9,10,11 There are four primary strategies for enhancing the bioavailability of curcumin: ¹⁰ 

1. Cyclodextrin complexes 

2. Lipid-based formulations 

3. Nanocarriers  

4. Piperine combination  

Choosing a bioenhanced curcumin supplement will ensure the best possible clinical outcomes.  

Improving the quality of life  

Curcumin ameliorates and inhibits disease progression in numerous health conditions characterised by pain and inflammation, increasing quality of life.⁸ 

Supplementing bioavailability enhanced curcumin in place of standard curcumin significantly improves health-related quality of life.⁸ 

REFERENCES 

1. Benameur, T., Soleti, R., Panaro, M.A., La Torre, M.E., Monda, V., Messina, G. and Porro, C. (2021). Curcumin as Prospective Anti-Aging Natural Compound: Focus on Brain. Molecules, [online] 26(16), p.4794. doi:10.3390/molecules26164794. 

2. Fallahi, F., Borran, S., Ashrafizadeh, M., Zarrabi, A., Pourhanifeh, M.H., Khaksary Mahabady, M., Sahebkar, A. and Mirzaei, H. (2021). Curcumin and inflammatory bowel diseases: From in vitro studies to clinical trials. Molecular Immunology, [online] 130, pp.20–30. doi:10.1016/j.molimm.2020.11.016 

3. Ferguson, J.J.A., Abbott, K.A. and Garg, M.L. (2020). Anti-inflammatory effects of oral supplementation with curcumin: a systematic review and meta-analysis of randomized controlled trials. Nutrition Reviews, 79(9), pp.1043–1066. doi:10.1093/nutrit/nuaa114 

4. Marton, L.T., Barbalho, S.M., Sloan, K.P., Sloan, L.A., Goulart, R. de A., Araújo, A.C. and Bechara, M.D. (2020). Curcumin, autoimmune and inflammatory diseases: going beyond conventional therapy – a systematic review. Critical Reviews in Food Science and Nutrition, pp.1–19. doi:10.1080/10408398.2020.1850417. 

5. Paultre, K., Cade, W., Hernandez, D., Reynolds, J., Greif, D. and Best, T. (2021). Therapeutic effects of turmeric or curcumin extract on pain and function for individuals with knee osteoarthritis: a systematic review. BMJ Open Sport & Exercise Medicine, [online] 7(1), p.e000935. doi:10.1136/bmjsem-2020-000935. 

6. Peng, Y., Ao, M., Dong, B., Jiang, Y., Yu, L., Chen, Z., Hu, C. and Xu, R. (2021). Anti-Inflammatory Effects of Curcumin in the Inflammatory Diseases: Status, Limitations and Countermeasures. Drug Design, Development and Therapy, [online] 15, pp.4503–4525. doi:10.2147/DDDT.S327378. 

7. Razavi, B.M., Ghasemzadeh Rahbardar, M. and Hosseinzadeh, H. (2021). A review of therapeutic potentials of turmeric ( Curcuma longa ) and its active constituent, curcumin, on inflammatory disorders, pain, and their related patents. Phytotherapy Research. doi:10.1002/ptr.7224. 

8. Sadeghian, M., Rahmani, S., Jamialahmadi, T., Johnston, T.P. and Sahebkar, A. (2021). The effect of oral curcumin supplementation on health-related quality of life: A systematic review and meta-analysis of randomized controlled trials. Journal of Affective Disorders, 278, pp.627–636. doi:10.1016/j.jad.2020.09.091. 

9. Sohn, S.-I., Priya, A., Balasubramaniam, B., Muthuramalingam, P., Sivasankar, C., Selvaraj, A., Valliammai, A., Jothi, R. and Pandian, S. (2021). Biomedical Applications and Bioavailability of Curcumin-An Updated Overview. Pharmaceutics, [online] 13(12), p.2102. doi:10.3390/pharmaceutics13122102. 

10. Tabanelli, R., Brogi, S. and Calderone, V. (2021). Improving Curcumin Bioavailability: Current Strategies and Future Perspectives. Pharmaceutics, 13(10), p.1715. doi:10.3390/pharmaceutics13101715. 

11. Urošević, M., Nikolić, L., Gajić, I., Nikolić, V., Dinić, A. and Miljković, V. (2022). Curcumin: Biological Activities and Modern Pharmaceutical Forms. Antibiotics, 11(2), p.135. doi:10.3390/antibiotics11020135. 

12. Wan, Y., Sun, W., Yang, J., Ren, J. and Kou, Q. (2022). The comparison of curcuminoid formulations or its combination with conventional therapies versus conventional therapies alone for knee osteoarthritis. Clinical Rheumatology. doi:10.1007/s10067-022-06105-2. 

13. Wang, Z., Singh, A., Jones, G., Winzenberg, T., Ding, C., Chopra, A., Das, S., Danda, D., Laslett, L. and Antony, B. (2021). Efficacy and Safety of Turmeric Extracts for the Treatment of Knee Osteoarthritis: a Systematic Review and Meta-analysis of Randomised Controlled Trials. Current Rheumatology Reports, 23(2). doi:10.1007/s11926-020-00975-8. 

14. Zuo, L., Prather, E.R., Stetskiv, M., Garrison, D.E., Meade, J.R., Peace, T.I. and Zhou, T. (2019). Inflammaging and Oxidative Stress in Human Diseases: From Molecular Mechanisms to Novel Treatments. International Journal of Molecular Sciences, [online] 20(18). doi:10.3390/ijms20184472.