Kurkumin za crijeva – kako kurkumin liječi upale i bolesti

Turmeric (Curcuma longa) is a bright yellow spice that is obtained from the underground stem (rhizome) of the plant of the same name characteristic of India and Southeast Asia. It has an aromatic bitter-sweet taste and a mild smell reminiscent of ginger (to which it is related), and it is used as an independent spice in the preparation of dishes, but also as one of the ingredients of curry powder.

Turmeric owes its characteristic yellow color to the polyphenol curcumin, a biologically active polyphenol from the group of curcuminoids attributed to strong anti-inflammatory and antioxidant activity.

Curcumin has a wide spectrum of biological effects, mainly anti-inflammatory, antioxidant, immunomodulatory, pro-apoptotic, antiproliferative, antimutagenic, anticoagulant, antibacterial, antimycotic, antiviral, hypotensive and hypocholesterolemic effects. It is effective for many diseases, which is why it is curcumin for the gut which are inflamed is an excellent medicine.  

Since curcumin is a harmless natural active biological compound that has a strong anti-inflammatory effect, it has the potential to be used in the prevention and supportive therapy of inflammatory bowel diseases. This is evidenced by numerous scientific studies, from those conducted in the laboratory and on animals, to clinical studies conducted on humans. The action of curcumin is aimed at numerous cellular targets associated with the reduction of disease progression (eg NF-κB, JAK/STAT, MAPK, TNF-α, IFN-γ, IL-6, PPARγ, and TRPV1). 

During the last fifteen years, scientific interest in the role of curcumin as an auxiliary medicinal substance in inflammatory bowel diseases has grown significantly. Numerous placebo-controlled randomized clinical studies have shown that curcumin for the intestines is safe and effective in the treatment of their diseases.

Kurkumin za bolesti – kliničke studije s kurkuminom u bolesnika s ulceroznim kolitisom (UC)

The first multicenter study that had promising results with the use of curcumin in ulcerative colitis patients was published in 2006. Eighty-nine patients with ulcerative colitis were collected in different clinical centers, half of whom received 1 g of curcumin twice a day along with sulfasalazine or mesalamine therapy. The other half of the subjects took a placebo in addition to the basic therapy. The study lasted 6 months, and from the initial number of respondents, 82 respondents remained until the end.

The results showed that the relapse rate was significantly higher in the placebo group (20.5% (8/39)) compared to the curcumin group (4.7% (2/43)).

These observations were accompanied by an objective reduction in the clinical activity of the disease and endoscopic indices.

Another double-blind controlled clinical study showed that the administration of curcumin is useful in inducing remission in UC patients on aminosalicylate therapy. The study involved 50 patients with mild to moderate UC on 5-ASA therapy who were divided into two groups. One group received 3 g of curcumin and the other a placebo for four weeks.

After this intervention, in the group receiving curcumin:

• 54% (14/26) of patients entered into clinical remission, while in the placebo group not a single patient entered into remission (0/24).
• clinical response in the curcumin group was 65.3%, while in the placebo group it was 12.5%
• endoscopic remission was achieved in 38% of subjects who received curcumin, compared to 0% of patients on placebo

These significant results demonstrate the potential for curcumin to be beneficial to the gut without adverse side effects in patients with mild to moderate ulcerative colitis.

In another randomized clinical trial, 70 patients with mild to moderate UC took 1,500 mg of curcumin or a placebo daily for eight weeks. The results showed that the Clinical Activity Index (CAI) was significantly higher in the curcumin group compared to the placebo group. In addition, when compared with the control group, taking curcumin significantly reduced the concentration of high-sensitivity C-reactive protein (hsCRP) and the rate of erythrocyte sedimentation, but also generally improved the quality of life of patients with ulcerative colitis.

Banerjee et al investigated the safety of use and the effect of a more bioavailable formulation of curcumin on reducing the clinical and endoscopic picture of ulcerative colitis. 69 patients with mild or moderate symptoms of the disease who received more biologically available curcumin (n=34) or placebo (n=35) participated in the study. After six weeks of taking curcumin, clinical remission was recorded in 44.1% (15/34) of subjects in the group receiving curcumin, while endoscopic remission was recorded in 35.3% (14/34) of subjects. For comparison, not a single case of disease remission was recorded in the placebo group. Therefore, based on this, it can be stated that curcumin for the intestines, i.e. its inflammations and diseases, is convincingly effective.

Likewise, the clinical response of subjects in the curcumin group was significantly higher (18/34, 52.9%) than in the placebo group (5/35, 14.3%). Three months after the start of the study, the rates of endoscopic remission, clinical response and clinical remission were 55.9% (19/34), 58.8% (20/34) and 44% (16/34) in the group receiving more bioavailable curcumin, while in the placebo group the rates were 5.7% (2/35), 28.6% (10/35), 5.7%, respectively. (2/35). Furthermore, 95% and 84% of the subjects who took the more bioactive curcumin maintained a state of clinical remission after six and 12 months, respectively. The authors of the study came to the conclusion that a more biologically available formulation of curcumin is a safe option that does not cause unwanted side effects.

Curcumin in patients with Crohn's disease (CD)

Curcumin has also been investigated in patients with Crohn's disease, in combination with anti-TNF-alpha therapy (infliximab) and it was shown that in patients on combined therapy with curcumin and biological therapy, a lower disease activity index (Crohn's Disease Activity Index, CDAI) was recorded.

In a small pilot study designed by Holt et al., the efficacy of curcumin was examined in five patients with CD. Subjects were given 360 mg of curcumin three times a day during the first month and then four times a day during the second month of the trial. Out of five subjects, four of them improved their condition, and the positive effect of curcumin was manifested in a decrease in the CD activity index, with a mean value of 55%, as well as in the erythrocyte sedimentation rate, with a mean decrease of 10 mm/h.

Why are vitamin D and curcumin a good pair?

The role of vitamin D in reducing inflammation is well researched. Therefore, vitamin D is often researched and used in patients with inflammatory bowel diseases, because a low concentration of vitamin D in the blood is associated with elevated inflammatory markers and clinical activity of the disease. Low blood vitamin D concentration correlates with elevated calprotectin values ​​in UC and CD patients and with higher CRP values ​​in UC patients.

Furthermore, vitamin D deficiency is associated with greater disease activity, a greater chance of relapse and hospitalization, and the need to introduce glucocorticoid therapy. Therefore, it is advisable to check the concentration of vitamin D in the blood of patients with inflammatory bowel diseases and to apply appropriate doses of vitamin D3 in order to achieve and maintain an optimal concentration of vitamin D in the blood.

It is believed that curcumin and vitamin D have a synergistic effect in protecting the digestive system. Namely, back in 2010, it was observed that curcumin can bind to vitamin D receptors in a colon cancer cell model and thus have a chemopreventive effect.

Curcumin for the gut in combination with vitamin D3, they are useful medicines in addition to the basic therapy of inflammatory bowel disease or as a dietary supplement in periods of remission.

Literature:

Banerjee, R.; Pal, P.; Penmetsa, A.; Kathi, P.; Girish, G.; Goren, I.; Reddy, D.N. Novel Bioenhanced Curcumin With Mesalamine for Induction of Clinical and Endoscopic Remission in Mild-to-Moderate Ulcerative Colitis: A Randomized Double-Blind Placebo-controlled Pilot Study. J. Clin. Gastroenterol. in 2020

Bartik L, Whitfield GK, Kaczmarska M, Lowmiller CL, Moffet EW, Furmick JK, Hernandez Z, Haussler CA, Haussler MR, Jurutka PW. Curcumin: a novel nutritionally derived ligand of the vitamin D receptor with implications for colon cancer chemoprevention. J Nutr Biochem. 2010;21(12):1153-61.

Bommelaer, G.; Laharie, D.; Nancey, S.; Hebuterne, X.; Roblin, X.; Nachury, M.; Peyrin-Biroulet, L.; Fumery, M.; Richard, D.; Pereira, B. Oral curcumin no more effective than placebo in preventing recurrence of Crohn's disease after surgery in a randomized controlled trial. Clin. Gastroenterol. Hepatol. 2020, 18, 1553–1560.e1.

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Jadhav P, Jiang Y, Jarr K, Layton C, Ashouri JF, Sinha SR. Efficacy of Dietary Supplements in Inflammatory Bowel Disease and Related Autoimmune Diseases. Nutrients. 2020;12(7):2156.

Lang, A.; Salomon, N.; Wu, J.C.; Kopylov, U.; Lahat, A.; Har-Noy, O.; Ching, J.Y.; Cheong, P.K.; Avidan, B.; Gamus, D. Curcumin in combination with mesalamine induces remission in patients with mild-to-moderate ulcerative colitis in a randomized controlled trial
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Peterson, C.T.; Vaughn, A.R.; Sharma, V.; Chopra, D.; Mills, P.J.; Peterson, S.N.; Sivamani, R.K. Effects of Turmeric and Curcumin Dietary Supplementation on Human Gut Microbiota: A Double-Blind, Randomized, Placebo-Controlled Pilot Study. J. Evid. Based Integr. Honey. 2018, 23

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Sugimoto, K.; Ikeya, K.; Bamba, S.; Andoh, A.; Yamasaki, H.; Mitsuyama, K.; Nasuno, M.; Tanaka, H.; Matsuura, A.; Kato, M. Highly bioavailable curcumin derivative ameliorates Crohn's disease symptoms: A randomized, double-blind, multicenter study. J. Crohn's Colitis 2020, 14, 1693–1701.