Curcumin (Turmeric) Benefits for Gut & Brain Health - Best Dose & Form

Hey everyone, welcome back. Let's discuss curcumin. This is a supplement that I think you should consider taking. I take it daily, have been doing so for a number of years. There's ample research showing this is an impressive anti-inflammatory amongst other mechanisms. So let's run through the dose, the form, and most importantly, the benefits. And starting off with where the benefits come from, where the gut, the brain, the joint, and the inflammatory benefits come from, likely the furthest upstream these benefits come from is how curcumin can modulate the source of inflammation. So not even the inflammation directly, but, and as you're seeing in this diagram, NF-kappa-B is actually upstream to inflammation. If we're calling cytokine, these inflammatory molecules, inflammation, then upstream to inflammation, you have the NF-kappa-B pathway. And this actually regulates genes, creation of inflammatory proteins, and even what's known as the inflammasome, sort of this upstream network of gene regulation and protein transcription that then leads to inflammation downstream. So this might be why curcumin in particular is so powerful as an anti-inflammatory. And again, that's what this diagram is helping to depict, where curcumin modulates the NF-kappa-B pathway. And this leads to improvements in other cytokines that we've discussed before. Things like interleukin beta, interleukin one beta, interleukin six, and tumor necrosis factor alpha, or TNF-alpha. This is what I find compelling and exciting about curcumin. Now, also per the usual, we should probably look to see as exciting as this mechanism is, does it demonstrate significant benefit in placebo-controlled trials? And thankfully curcumin is well-studied enough to where we can pull from the research evidence there. And what we'll do is we'll cover gut benefits, brain benefits, and these sort of systemic anti-inflammatory benefits. But first, in case you haven't heard of curcumin, this is a polyphenol, a compound from plants, that gives, in this case, a very orange color. Turmeric is sort of the less isolated form, and curcumin is what's used in many supplements. Curcumin also has a long history of use in Ayurvedic medicine. But let's juxtapose sort of the traditional Ayurvedic use with randomized current control trials. So firstly, regarding the diversity of the microbiota, you've likely heard that there is a general trend that people who are healthier have a richer microbiota, more species, more plants in the garden, so to speak, and those who are less healthy have a less diverse microbiota. One of the things that can dictate the health of the microbiota is inflammation. In fact, this is one of the pieces that I feel is often incorrectly portrayed to the public. The misportrayal is, eat lots of fiber and prebiotics, feed your gut bacteria, therefore have a healthier microbiota and more diversity. And that's not untrue, but who it disturbs might be people listening to or watching this video. Those who notice they have sensitive digestion might be flared by directly trying to feed those bacteria. But there's another way in which we can optimize the health of the world of bacteria, and that is through reducing inflammation because inflammation is actually, for lack of a better term, poisonous to the microbiota. Inflammation makes it harder for healthy bacteria to live and favors unhealthy bacterial growth. This is likely why at least one randomized control trial that administered curcumin for two months found a 69% increase in bacterial species just from using curcumin alone. Again, likely due to the anti-inflammatory effects, less inflammation, healthier environment, and then healthier bacteria and fungus then grow. There was also one study looking at can curcumin function as an antimicrobial? Can it actively kill bad bacteria? Now, I'll lead by saying the results here are not super strong. We do have a meta-analysis, so that's an impressive data point, looking at Helicobacter pylori or H. pylori, this bacteria that lives in the lining of the stomach mostly and can cause things like bloating and reflux and also ulcers. When combining curcumin with antibiotics, they found an increased clearance rate of H. pylori by 8%. So that's not a lot. It is something, but there does seem to be at least a modest antimicrobial impact that curcumin exerts. And by the way, if this has been helpful, please comment and subscribe. This really does help us reach and help more people, which we are always trying to do. So it's very much appreciated. Okay, so then one of the best encapsulations of gastrointestinal symptoms, this sensitive gut, if you will, what we sometimes call a bacterial-type gut, we'll be looking at the model of IBS, irritable bowel syndrome. So people have food sensitivities, they have bloating, pain, constipation, or diarrhea. Looking at curcumin in a clinical trial, they found that after two months of curcumin, 60% of people no longer had IBS. That's pretty remarkable for an inexpensive and very safe supplement. Now, part of this is almost for certain due to the anti-inflammatory impact that's being had in the gut. However, if you remember back to our conversation with Dr. Alex Ford, who is over at Leeds University, he shared this shift in irritable bowel syndrome thinking from a gut disorder to one that's being reexamined and recategorized as a gut-brain disorder. So there's likely a significant component of the brain in IBS. Now, it's not to say it's all in your head, but it is to say that regulation of inflammation, motility, and even nociception or pain signaling is being mediated centrally from the brain down to the gut. So it's probably not surprising that we see a different randomized control trial finding improvements in mood. So in this trial, they again gave curcumin versus placebo for two months. They found a 28% decrease in gastrointestinal symptoms. So pain, diarrhea, constipation, indigestion, and reflux. But look at this. They also found a 52% decrease in anxiety. This portrays that there's this interplay between the brain and the gut, and they're likely going to govern together. So if we have this anti-inflammatory impact, in this case, it suggests, given the fact that the reduction in anxiety was greater than the reduction in gastrointestinal symptoms, that some of this may truly flow from the brain down to the gut. One of the ways in which this may occur, this sort of brain-gut flow, connects back to a different series of studies that we've discussed in prior episodes, which found that either stressed or depressed patients had a higher inflammatory response to leaky gut. Essentially, the researchers here administered directly to the blood LPS, lipopolysaccharide. This is part of the bacterial membrane that leaks through leaky gut and elicits an inflammatory response. So they found that people with stress and depression had more of an inflammatory response to the particles that leaked through during leaky gut. So it would make sense that if we're having a positive impact on what's going on in the brain, stress, depression, anxiety, that would lead to improvements in the gut because you're less reactive to the food particles that leak through if leaky gut is present. And we know a degree of permeability accompanies things like food reactivity, IBS, and just general gut symptoms. Along with this, it's also probably not surprising to see another either meta-analysis or randomized control trial, there's a number of them here, finding improvements in memory, attention, and executive function. So again, wonderful outcomes from the anti-inflammatory effects that curcumin has. Let's also discuss the impact on the immune system and more particularly histamine and mast cells. So you've likely heard of antihistamines. If people have allergies, they can take something like Benadryl or Claritin, or maybe you've used a natural agent like quercetin or resveratrol or vitamin C. And notice that your allergies improve. This is in part by how these agents mediate histamine, which is a signaling molecule of the immune system. So it's interesting to see, albeit these studies are in animals or in vitro, but nevertheless, that curcumin has demonstrated the ability to reduce histamine levels in the blood, reduce intestinal mast cell activity, and reduce leaky gut. So all this is probably tied into the same picture where we're reducing leaky gut, we are reducing histamine, mast cells, anxiety, depression, and gastrointestinal symptoms. One case in point here, looking at the power of curcumin juxtaposed to a medication involves omeprazole. And omeprazole is a antacid. In one randomized control trial, they compared omeprazole, Prilosec, versus curcumin. And I'll just quote the paper. Curcumin and omeprazole had comparable efficacy for improving dyspepsia or indigestion. So even when we pit curcumin against a medication, we're seeing similar results for some of these inflammatory mediated conditions. And by the way, part of the reason why people have reflux, indigestion, or dyspepsia, as it's also known, is due to high histamine levels, which is why certain medications block histamine receptors so as to improve reflux and indigestion. I should also just quickly mention that there are meta-analyses finding improvements in inflammatory bowel disease, in inflammatory markers, in joint pain, either in RA, rheumatoid arthritis, or osteoarthritis, and also small improvements on metabolic health, like body weight, blood sugar, and cholesterol. Again, all likely due to that upstream modulation of NF-kappa-B. One of the things I've really appreciated, especially now that we're doing more on YouTube, we can see comments almost in real time. And a concern that I've had is almost every time I discuss a food, someone will comment, well, that food contains X or Y or A or B or C or D. And what I find problematic about this is sometimes people know enough about the contents of a food to proverbially throw the baby out with the bathwater. Curcumin and oxalates is a good example of this. Now, curcumin does contain oxalates. And oxalates, for some people, containing foods, can be a problem. They may spur joint pain, bladder issues, perhaps fatigue. However, the details here matter a lot. So consider this, spinach, a high oxalate food. Per serving, spinach contains 755 milligrams of oxalates. Let's compare that to curcumin. Curcumin contains 0.025 milligrams of oxalates per serving. So it is a massive difference. The reason why I mention this is it would be a travesty if someone, let's say, who had joint pain and is on a low oxalate diet was avoiding curcumin because they were sort of inadequately informed of the content. And especially when looking at that in relation to the meta-analysis showing improvements in RA or osteoarthritis from curcumin, it would be such a sad situation if someone avoided supplementation with curcumin because of that. So just one quick note about oxalates for some of our savvy audience. Okay, so then how to take curcumin regarding dose and form. I feel, and this is just essentially what you're seeing used across most of the trials, a dose of 500 milligrams per day up to 1,500 milligrams per day. Most curcumin is anywhere between 250 and 500 milligrams per capsule. So this looks like one to two capsules, maybe one to three times per day. You can use a higher dose. Some trials have actually used 12 grams, that's a very high dose, safely. Regarding term of use, long-term, studies have monitored people for up to 12 months and found safety. So I think it's safe to conclude this can be used long-term. Now to the question of, is higher better? And there are some cases where we want to be aggressive with our dosing. Certain applications of antimicrobial therapy fit this profile. However, this is not all situations and curcumin is one of these, wherein higher dosing does not mean better. There have been numerous meta-analyses that have looked at sort of a dose response, if you will. Do we see a trend line that higher dosing equals better response? And the answer is no. Looking at inflammatory cytokines, inflammatory bowel disease, blood pressure, liver function, and lipids, these meta-analyses have not found a dose response, meaning the higher you go, the better the result is. Hence, 500 milligrams up to 1500 milligrams is probably going to be the best dosing for most people. Then we come to the form. And this harkens to something known as the curcumin paradox, which is curcumin is not very highly absorbed. However, we still see a number of benefits despite the moderate level of absorption. I feel that what is known as the second generation forms of curcumin strike the best balance between research studies and effectiveness. And that's what you're seeing in this schematic. It's a little bit involved, but essentially the first generation curcumins that are the least absorbed have the most research documenting benefit. The third generation curcumins have the least amount of research, but they're the most absorbable. So when looking at the research big picture, bird's eye view, I think compounds such as Meriva, nanocurcumin, theracumin, or lipocurcumin are good examples of that balance between adequate research, moderate bioavailability, probably the sweet spot. The jury here is out. I don't think there's any consensus that has been reached yet, but I will share with you one quote that I found insightful. This comes from a meta-analysis of 165 randomized control trials. So it's a pretty good sampling, and I'll just quote here. Six trials compared the effect of supplementation of various curcumin products in individuals with metabolic syndrome, osteoarthritis, or those suffering from experiencing occupational stress-related anxiety and fatigue. Here's the key point. Half of those trials did not demonstrate any superiority of enhanced products or enhanced absorption on the investigated outcomes. So half the trials isn't really proof or disproof, but I think it tells us that, again, the jury is still out, and we don't know if the more bioavailable forms are going to be better. And especially if you're on a budget, knowing that usually the more bioavailable forms are more expensive, again, I think it's prudent to use the second generation. And what we use in the clinic is essentially either Mariva or theracumin, and that does seem to work pretty well. And then regarding side effects, generally well-tolerated, the most common side effect is gastrointestinal upset. Now, working in a clinic that has a primary focus of GI with sensitive individuals, I can say curcumin appears to be extremely well-tolerated. So I don't really have any concerns about gastrointestinal side effects, but if you are sensitive, just a practical method here would be change just the variable of starting on curcumin and see how you do. So in close, what I find the most exciting about curcumin is that modulation of NF-kappa-B that is upstream and controls the inflammasome, DNA regulation, protein transcription, all of the downstream inflammatory cytokines. And from that, we see localized benefits on leaky gut, histamine mast cells, all in the gut. We see improvements in the IBS symptoms. We see improvements in cognition, anxiety, and stress, and then other nice benefits like metabolic health and reduced joint pain. So for a relatively inexpensive, well-studied and safe natural compound, I would say curcumin is highly worthy of consideration in your supplemental routine. All right, guys, well, I hope you'll comment. And this is Dr. Ruscio. I'll talk to you next time.