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“Curcumin influences gut microbiota composition, which plays a role in maintaining intestinal health and reducing inflammation.”

Turmeric, derived from the rhizome of the Curcuma longa plant, has been traditionally used in Ayurvedic and Chinese medicine for thousands of years. Curcumin’s primary mechanism of action involves the downregulation of inflammatory pathways, modulation of immune responses, and enhancement of antioxidant defenses. Additionally, curcumin influences gut microbiota composition, which plays a role in maintaining intestinal health and reducing inflammation. These benefits have been attributed to curcumin’s ability to modulate various molecular targets and signaling pathways in the body. Turmeric has gained popularity as a spice and nutraceutical, often used to manage inflammatory conditions like ulcerative colitis (UC).

The review article titled The Use of Curcumin in Ulcerative Colitis: Current Evidence and Practical Applications was authored by Preetha Iyengar, MD, and Berkeley N. Limketkai, MD, PhD from the Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine at the David Geffen School of Medicine at UCLA. The manuscript was published in the March 2024 Nutrition Reviews in the Practical Gastroenterology issue.

The authors reviewed the existing literature on using curcumin to treat ulcerative colitis. They analyzed various clinical trials and studies to summarize the evidence for curcumin’s efficacy, mechanisms of action, bioavailability, safety, and practical applications. The review included randomized controlled trials (RCTs), observational studies, and meta-analyses that evaluated the effects of curcumin on UC patients.

“Bioenhanced curcumin, when administered with mesalamine, led to a higher rate of clinical remission and endoscopic improvement.”

The review highlighted several key findings from clinical studies on curcumin’s efficacy in UC. In a study by Lang et al., patients with mild to moderate UC who received 1.5g of curcumin capsules twice daily and the anti-inflammatory drug mesalamine showed significant improvement in clinical response and remission compared to the placebo group. Banerjee et al. found that bio-enhanced curcumin, when administered with mesalamine, led to a higher rate of clinical remission and endoscopic improvement compared to placebo with mesalamine. Bio-enhancement formulations involve advanced delivery systems, such as nanoparticles, to increase the bioavailability of curcumin, thereby improving its absorption and efficacy.

Studies have shown that these formulations can significantly improve curcumin’s bioavailability. For instance, bio-enhanced curcumin, such as those containing piperine or curcumin nanoparticles, have been reported to increase curcumin’s bioavailability by up to 2000% compared to standard curcumin. Specific formulations like NovaSol®, CurcuWin®, and LongVida® have demonstrated up to 100-fold higher bioavailability than unformulated curcumin.

The studies reviewed demonstrated that curcumin given as an adjuvant treatment could help achieve endoscopic remission, reducing UC’s mucosal inflammation and ulceration characteristics. Curcumin was generally well-tolerated with no significant differences in adverse events compared to placebo groups. Some mild gastrointestinal side effects were reported, but serious adverse events were rare.

In another study by Sadeghi and co-authors, patients taking 500mg curcumin capsules three times daily (without any additional anti-inflammatory medication) showed a 93.5% clinical response rate compared to 59.4% in the placebo group. They concluded that consuming the curcumin supplement and drug therapy is associated with significant improvement in clinical outcomes, quality of life, and the inflammatory markers hs-CRP and ESR in patients with mild-to-moderate UC.

The review also discussed a study by Masoodi and co investigators, which evaluated the effects of 80mg curcuminoid nano-micelles taken three times daily. Although this study found no significant difference in a commonly used clinical assessment instrument (mean Simple Clinical Colitis Activity Index or SCCAI) between the treatment and control groups, it did report a greater reduction in the urgency of defecation in the treatment group. Kedia and co investigators studied the effect of 150 mg purified curcumin capsules three times daily in the treatment of UC, but found no significant difference in clinical response or remission rates compared to placebo. However, the authors noted that the lower dose of curcumin used in this study might have contributed to the lack of significant findings.

“Curcumin acts as a prebiotic for gut microbes, provides the substrate to generate absorbable molecules with anti-inflammatory effects on the gut, and may act as a topical anti-inflammatory treatment.”

Curcumin is a promising adjunct therapy for managing ulcerative colitis, with evidence supporting its efficacy in reducing inflammation and promoting remission when used alongside conventional treatments. It is important to keep in mind that curcumin is a large molecule that is poorly absorbed or broken down by the human small intestine. Like many other macromolecular structures, gut microbial metabolism at the end of the small intestine and colon is required to generate smaller, absorbable entities. Its benefits in treating chronic inflammatory conditions, like UC, are likely to have three major components: It acts as a prebiotic for gut microbes, provides the substrate to generate absorbable molecules with anti-inflammatory effects on the gut, and may act as a topical anti-inflammatory treatment.

While curcumin’s safety profile is favorable, more large-scale, well-designed trials are needed to establish optimal dosing, the dependence on a particular microbial ecosystem, and the full potential of bio-enhanced formulations.

Practical recommendations include starting patients on low doses of curcumin, gradually increasing, and taking it with meals containing dietary fats and black pepper to enhance absorption. Choose curcumin supplements from reputable brands that provide transparent information on sourcing, purity, and manufacturing practices. Bio-enhanced formulations, such as those containing piperine or curcumin nanoparticles, may offer improved bioavailability but require further investigation.