Is Turmeric Safe or Does It Cause Liver Damage?

Curcumin is a naturally-occurring active chemical compound found in the spice turmeric. It is also the effective ingredient used for dietary supplements. I will refer to them both as turmeric for the rest of this article to make it simple, and because many of the unscientific articles and posts I discuss here mistakenly use both names interchangeably.

Turmeric & Curcumin Use Are Not New.

I was first introduced to this brightly colored dietary supplement and spice in 1997. It was presented in a class called “Nutritional Improvement of Health Outcomes – The Inflammatory Disorders”.  It was part of the functional medicine training I was doing, and it was created and taught by the father of functional medicine Dr Jeffrey Bland. It’s fresh in my mind because I came across the workbook recently.  We did not have nearly as much information on using turmeric therapeutically back then, but it was already known to have anti-inflammatory properties. In the 22 years that I have been a Clinical Nutritionist, I have never seen anyone have a liver-related negative health outcome from using a turmeric supplement, so I was beyond concerned to see the sensationalized headlines popping up all over including one from NEWSWEEK titled “Is Turmeric Safe? Supplement May Have Caused Autoimmune Hepatitis in Woman”.

It may surprise you to know that all the current panic is over one report and not a study as the way it’s being presented would suggest.  This type of report is called a “report of unexpected outcome (positive or negative) including adverse drug reactions”. These reports are standard when someone has a reaction to a drug or supplement that is outside expected response. The BMJ report is titled “Drug-induced autoimmune hepatitis associated with turmeric dietary supplement use.” The problem is when you read the actual linked report which I cited and linked below, it makes no scientific sense why the internet has blown up with headlines like “Turmeric Caused Liver Damage in Woman”. People who are taking this supplement are now panicking and for no other reason than the people writing these posts want attention. They want to make you panic and click on their article.

We also have the other big issue that traditional medicine and pharmaceutical companies will publicize anything that brings doubt to the safety of dietary supplements. They would rather biochemically alter a natural substance so that it can be patented and then the price can be inflated and protected for many years. These are two big problems related to the proliferation of false claims regarding natural medicine and nutrition and the lack of regulation on all of this so-called “science” writing.  One media source will see something another one wrote and pick it up and repeat it as if it is a fact. Most of the nutritional claims I see online are not facts. Many of them are not even based on truth.  They are myths, half-truths, and fiction but they are being reported on as if they were based on clinical studies. Turmeric seems to be the most recent supplement to get caught in this cycle.  The authors of the BMJ report are listed as Ashley L Lukefahr, Sean McEvoy, Chelsea Alfafara, Janet L Funk. These Drs are from the University of Arizona.

I find it interesting that the contact person is Dr. Funk and a quick google search shows that she studied turmeric for rheumatoid arthritis in 2006. Here is a link to that story.          https://www.eurekalert.org/pub_releases/2006-10/uoah-tpe102506.php

The press release shows this headline. “Turmeric prevents experimental rheumatoid arthritis, bone loss, University of Arizona study shows”

After reading the 2006 study that seems to advocate for the use of turmeric it doesn’t look like Dr. Funk was against the use of turmeric back then, but now it appears she is seriously warning people against it. I am not sure why the doctors listed wound up on this report. Are they this woman’s doctors?  I am an educated clinical nutritionist with 20 years of experience working with dietary supplements and this BMJ report on turmeric use seems vague and completely inconclusive to me, how is the public supposed to make any sense of reports like this and the sensationalized articles that follow? If I am confused by articles  (or publicity posts) like these, and chasing down studies that don’t exist, how does a person who is not an expert navigate this stuff?

Do You Need To Stop Taking Turmeric? Is it Dangerous to Use Curcumin Supplements?

As far as the turmeric and whether you need to throw yours in the trash or storm your local Whole Foods for a refund – you don’t need to stop taking it based on this report. There some facts here that are being left out of most of the posts and articles on this.

According to a Newsweek article that I have posted an excerpt from here the woman in question was on 20 different medications. Unfortunately, sites like SELF.com wrote articles that did not mention that fact at all. Instead, they only mention the turmeric as if it is the only possible cause of this woman’s (temporary) liver inflammation. Maybe this has something to do with an earlier post from SELF that they refer to which is called “The Health Benefits of Turmeric May Be Wildly Overstated.” Melinda Wenner Moyer says that basically turmeric is benign and that is very hard to consume or absorb much of the curcumin. Is it useless or is it dangerous?  Meanwhile, the Newsweek article says that “The 71-year-old woman in the report read a news story referencing a study on animals that said turmeric may help prevent stroke. She started taking the supplements along with 20 other medicines and supplements she was already taking. Eight months later, a blood test determined she had elevated levels of liver enzymes, which can indicate a liver problem.”

Reading that paragraph brings up questions that I am not sure were not asked by the original reporter? Questions like these:

Why were none of the 20 different prescription medications the lady was on reported as potential causes of autoimmune liver disease as well? From what I read, she told her doctor that she put herself on the turmeric because she heard it could help her to avoid a stroke. The article then says she took herself off the turmeric (curcumin product to be exact) after reading that it could cause liver issues. And then her autoimmune hepatitis resolved within 6 weeks. A big problem is she reported all of this after the liver was found to be inflamed and had already cleared up. So, in the months that her liver was inflamed no one considered that it could be any of those other medications or the fact that she was on so many medications at once? Since doctors know that all medications must go through the liver it makes sense that this would be a concern.

How does one report of a possible link to liver inflammation translate to 13 million hits on a Google search for “is turmeric safe for the liver?”

Curcumin is a plant component. More than half of all prescription drugs are reported for having adverse effects. Given that, how does one report of a (plant) supplement ’s possible association to liver inflammation translate to 13 million hits on a Google search for “is turmeric safe for the liver”?

My next question is what was this woman being treated for in the first place? When someone is on twenty different medications it’s hard to believe that she would not have another, more obvious reason to be experiencing transient liver inflammation, Dr. Funk, the lead Dr on the report seems to be an oncologist according to her bio when you click on her name. It’s not unheard of for people with cancer to have elevated liver enzymes. Also, anyone undergoing chemotherapy or radiation can experience temporary hepatitis. If you understand health at all then you understand that autoimmune means coming from within your own body. It doesn’t make sense to say that a spice or supplement someone consumed would cause an autoimmune illness. The overall health of this woman and the conditions she is being treated for are big clues as to whether or not turmeric was the cause of her hepatitis. Yet, nobody is mentioning this. Why?

I also ask the first question I ask every person I work with, what was the woman eating and drinking? Many foods and alcohol can cause elevated liver enzymes in some people, especially with certain health conditions. We need only consider the recent proliferation of Non-Alcoholic Fatty Liver Disease (NAFLD) to understand this.

Why weren’t any of these questions researched or mentioned in any of the articles? Maybe because then all we would have is something that needed more research before making any conclusions, instead of sensational and immediate panic-inducing headlines.

I personally have received many questions about this over the past few weeks from people who are reasonably concerned. Meanwhile, I have seen no human clinical studies and no scientific data showing that turmeric or curcumin is responsible for any bad side effects except a small amount of stomach upset when taken in huge doses. If we want to dive very deeply into the research on the effects of curcumin supplements we can discuss that a few studies show low levels of some side effects but there are no conclusive studies that show they are dangerous or that they cause liver disease. The idea that this dietary supplement, rather than the 20 medications she was on at once is responsible for this woman’s transient liver inflammation is ridiculous. There is a huge difference between a report and a study. A woman of 71 taking 20 medications at once, and the way the meds interact with each other, could in and of itself be a risk factor. Then each medication could be a factor or a cause. We don’t know what diseases or health concerns this woman was being treated for with those 20 medications.  Exactly why is the supplement to blame and what proof is there? The answer is there is no proof that curcumin caused any damage in this case. Her doctors can not possibly prove causation when she reported it all months after the fact.  I have been working with people who take curcumin for years and I have yet to see one bad effect on liver enzymes. I have seen people with mast cell activation issues, food intolerances caused by intestinal permeability, and histamine intolerance or overload have mild reactions like red cheeks, itchiness and dizziness similar to what eating a food they were sensitive to would cause. It can be high in oxalates, depending on how it’s manufactured but that will not affect most people. These are all mild, self-reported effects and not even close to causing liver inflammation.  There are countless prescription and over the counter medications that say right on the insert that they can cause liver damage including NSAID pain relievers, antipsychotics,  statins, heart medications and many more. Yet these doctors are prescribing these on a daily basis. And one report of a possible effect from a natural product and the fear mongering starts.

We as consumers and healthcare professionals should not be circulating the kind of half information that we are seeing about turmeric.  Why are there are no consequences, agencies, or people regulating reports and articles on natural supplements?  I know that the benefits of dietary supplements and natural products are often exaggerated to the point of being fraudulent by shady companies and people. But that does not make it OK to make false claims against supplements either. Because natural products are natural, and therefore cannot be profited upon to the extent that a synthetic pharmaceutical drug can there has historically been no real funding for the studies or the writing to validate the safety and efficacy. They have had to compete with the huge research, development, marketing and science budgets of the pharma companies. The NIH has had some studies going on and I hope more funding for studies is in the pipeline from them or similar sources if they can be objective. The problem with only having supplement companies do the studies is again objective would be preferred. Some entity with no skin in the game so to speak. I don’t know what the answer to this massive issue is. For now, all I can do is point it out and try to separate the fact from fiction.

The fact that supplements are being ripped apart in the media much more often than medications are even though the reported side effects of medications are so much more severe and more often widely known and reported is not baffling to me. I think it boils down to clickbait, sensationalism, and everyone wanting their 10 minutes of fame. To the point where any sensational information is put out there even if it’s incorrect or at best questionable and vague. I urge you to follow the links when you read articles like this one that went viral on Facebook recently

Delish.com put out this incorrect and irresponsible article. https://www.delish.com/food-news/a23515053/turmeric-supplements-liver-disease-hepatitis/

While Prevention.com put out a much more balanced article on this subject. https://www.prevention.com/food-nutrition/a23505656/turmeric-supplements-liver-disease-hepatitis/

They both have inflammatory headlines designed to inspire fear “Turmeric Supplements Linked to Liver Damage” is Preventions title. And the negative article from DELISH.com got 18k hits while the Prevention has noticeably fewer hits at the time I wrote this.

Only the consumers can really stop this. We need to shop with our wallets and our attention. Refuse to follow or even read articles that are not cited with real sources, are clearly biased, are unclear or too vague. Try to distinguish between real science and fake news. Do your best to not hit share on social media unless you are sure it is true. I know it can be hard to tell. Find a handful of experts who are honest and follow their blogs or Instagram pages to see what they say about the studies and posts like these. Ask them their opinion on issues like these when they come up. I can’t believe how much incorrect diet, nutrition and supplement information is being disseminated online. It’s 2018 and suddenly everyone is a self-proclaimed nutritionist or health expert. Be selective about what you read and the people whose writing you read. Look up credentials and education. If they are writing about nutrition and supplements make sure they have the education and some years of experience to back it up.

Also, remember that all medicines, dietary supplements, herbs, and vitamins should be reviewed with all your doctors. If a doctor is prescribing medications to you and or treating you they should know all the medications and supplements you are taking. If you don’t want to tell a certain doctor because he or she disapproves of your use of supplements, I recommend you get an experienced functional medicine doctor.  This doctor can also be called a naturopathic medical doctor (ND, NMD or MD)or an integrative medical doctor needs to understand how supplements work and how to use them clinically. This should be an MD, a medical doctor who has the extra education and training. I am not saying fire your other doctors. You have a specialist for things like gastrointestinal health and endocrinological diseases, why not have a doctor on your team who understands the role that diet plays in your health, the root causes, and prevention of disease as well as the safe and effective use of natural supplements and methods?  As a Clinical Nutritionist, I work closely with medical doctors and I encourage and sometimes insist that each of my patients make their doctors aware of the supplements that they take. Oftentimes, the patient gives permission for me to confer with their doctors. This is when healthcare is the safest and most effective. When we all work together to do what is best for the patient.

As the internet has become the chosen hub for nutritional and medical research we all have to be savvier about how we use it and the information we will read and trust. And in the meantime, in my opinion, I will be using my curcumin and recommending that the people I work with do the same until I see real human clinical studies that show that it may be a problem.

Juli Keene Nutritionist                                                                                                                                                    Juli Keene BSc, CN October 9, 2018

• https://www.consumerreports.org/cro/2012/05/are-prescription-drugs-safe-not-necessarily/index.htm
• http://casereports.bmj.com/content/2018/bcr-2018-224611.short?g=w_casereports_current_tab
• Drug-induced autoimmune hepatitis associated with turmeric dietary supplement use
• https://www.prevention.com/food-nutrition/a23505656/turmeric-supplements-liver-disease-hepatitis/
• https://www.eurekalert.org/pub_releases/2006-10/uoah-tpe102506.php
• https://www.delish.com/food-news/a23515053/turmeric-supplements-liver-disease-hepatitis/
• Drug-induced autoimmune hepatitis associated with turmeric dietary supplement use
• Lukefahr et al. BMJ Case Reports 2018 2018 (sep10_1), p. bcr-2018-224611
• https://www.self.com/story/turmeric-supplements-liver-disease
• https://www.self.com/story/health-benefits-of-turmeric-wildly-overstated