As more and more people take turmeric in concentrated supplement form, a disturbing trend is emerging: In recent years, turmeric has been linked to an increase in cases of acute liver damage, some of which have led to liver transplants and death.
“Liver damage from turmeric is thought to be rare — maybe one in 10,000 or 100,000 people who take turmeric could get sick, but millions of people are taking turmeric right now,” he said. Jay Hoofnagle“Based on our data, this is one of the most common causes of liver damage from dietary supplements,” said Dr. John F. Kelly, director of the Division of Liver Disease Research in the Division of Digestive Diseases and Nutrition at the National Institutes of Health (NIH).
The supplement contains a lot of curcumin.
A modern preparation of the turmeric plant, which has been used for thousands of years in traditional medicine and as a food spice, combined with genetic susceptibility in certain patients, is most likely to be responsible for the liver damage, experts said.
The supplement contains a highly concentrated purified extract of curcumin, the main component of turmeric. 1 to 7 percent It is a component of the root. Many products also contain additives such as black pepper to promote the absorption of curcumin, which is a substance that is poorly absorbed in the digestive tract.
for example, study In a study where subjects were given 2 grams of curcumin, the compound was barely detectable in blood samples, but after adding black pepper, the percentage of curcumin reaching the bloodstream jumped by 2,000 percent.
“People today are taking 100 times the amount of curcumin that was used in traditional medicine,” Hoofnagle says. “When I go to Costco and see these big jars of turmeric with black pepper that have one gram per serving, I think, ‘Oh my God.'”
Hoofnagle said, Drug-Induced Liver Injury Network (DILIN)an NIH-sponsored effort to collect and analyze cases of severe liver damage caused by drugs and alternative medicines, DILIN reported in 2022. 10 cases of liver damage Cases have been reported associated with turmeric supplements. The most common symptoms were jaundice, nausea, and abdominal pain. Of 10 cases, 5 were hospitalized and 1 died from acute liver failure.
The researchers concluded that turmeric-related liver damage appears to be on the rise in the United States, and that turmeric’s growing popularity over the past five years appears to mirror the increase in reported cases collected by DILIN.
Cases have been reported worldwide. study Seven cases of acute non-infectious hepatitis have been reported in Italy, all of which have been linked to turmeric supplements. In August 2023, the Australian government Safety Tips Consumers and health professionals are being warned that turmeric supplements may cause liver damage in rare cases. The advice comes after the Department of Health and Aged Care received 18 reports of turmeric-related liver problems, one of which had a fatal outcome.
“People think that turmeric is harmless because it’s natural and available commercially, but that’s not true,” he said. Ken Liu“As clinicians, we are seeing an increase in people being admitted to hospital with liver damage caused by herbs and supplements and needing a liver transplant,” said Dr John F Kelly, transplant hepatologist at the Australian National Liver Transplant Unit.
Fadi AlzawiA medical resident at MedStar Union Memorial Hospital in Baltimore, he has also noticed an increase in turmeric-related cases. 66-year-old African American woman Hospitalized A patient visits the emergency room with symptoms of jaundice, nausea, loss of appetite, and dark urine. Tests reveal that the patient’s blood bilirubin level is significantly elevated. The normal range is 0.2-1.1 mg/dL, but the level is high at 29 mg/dL, suggesting liver dysfunction.
After ruling out all other causes and confirming with a liver biopsy, turmeric was found to be the culprit. The patient had started taking half a teaspoon of powdered turmeric as a store-bought herbal remedy six months prior. Upon admission, the turmeric intake was discontinued, but it was too late.
“Typically, once the patient stops taking the turmeric or herbal supplements that are causing the damage, they will see improvement,” Dr. Alzawi said, “but in this case, irreversible liver damage occurred and the patient died within seven days of being admitted to hospital.”
Drug-induced liver injuryLiver failure can be classified as direct or idiosyncratic and is the most common cause of acute liver failure in most Western countries. Direct damage is predictable, dose-dependent, and caused by agents that are inherently toxic to the liver, such as acetaminophen. Idiosyncratic disorders, on the other hand, are much more difficult to diagnose and treat; they only affect susceptible individuals and the causative agent has little or no inherent toxicity.
“Idiosyncratic disorder means that when you take a drug, it can suddenly cause liver damage depending on your gender, age, immune status, etc.,” Alzawi said. “It’s not predictable, and it’s not dose-dependent.”
For example, women More prone to Differences in hormonal status, body composition, metabolism, and other factors make women more susceptible to drug-induced liver injury than men. African American Patient They may be more susceptible than white patients to worse outcomes after drug-related liver injury, including severe liver damage, liver transplantation, and death.
Genetics is also part of the story, as certain genes code for enzymes involved in drug processing. When a drug is ingested, it is absorbed in the digestive tract and enters the bloodstream. The first place it goes is the liver, whose role is to remove toxins and metabolize drugs using certain enzymes. The DILIN study found that 7 in 10 patients had a genetic mutation found in only 10% of the general U.S. population that may have increased their susceptibility to turmeric-related liver damage.
“These liver enzymes are determined by genetics, so the way you metabolize something may be a little different than the way I metabolize something,” Liu says. “You may metabolize curcumin as a completely inert, harmless metabolite, but I may metabolize curcumin as something toxic and inflammatory to the liver.”
Healthcare professionals and consumers should be aware of the possible risks before taking turmeric as a supplement. Al-Ghuzawi even believes that turmeric’s purported benefits do not outweigh the risks and that it should be avoided as a supplement altogether. Other experts espouse a more cautious approach.
“It may not be necessary to completely avoid turmeric supplements, but it is important that patients inform their physician of their use so that monitoring can be performed if necessary.” Angeline Liu“Similarly, when doctors talk to patients, it’s important to take a complete medical history, including routinely asking if the patient is taking any over-the-counter medications or supplements,” says Dr. Gregory, a gastroenterologist at Kaiser Permanente in Southern California.
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