Curcumin is one of the natural compounds found in turmeric, a herb native to India and Southeast Asia. The compound has a long history of traditional use in Ayurvedic medicine as a treatment for a range of conditions, including digestive, blood, and liver disorders.
Curcumin has drawn increased clinical interest due to its beneficial antioxidant, anti-inflammatory, anticancer, and neuroprotective properties. It has especially drawn interest as a treatment for Crohn’s Disease and ulcerative colitis.
How Curcumin Relieves Intestinal Inflammation
With many IBD patients failing to respond to pharmaceutical therapy, there is a demand to validate promising complementary treatments such as curcumin. There’s much anecdotal evidence of treatment success with curcumin, and growing clinical evidence that curcumin is a successful add-on treatment for IBD when the compound is developed specifically as a gut-directed formula to increase availability in the intestinal mucosa, where inflammation occurs in IBD.
Gut-directed curcumin significantly raises the likelihood of remission and long-term maintenance, due to its wide spectrum of anti-inflammatory effect, inhibiting multiple cytokines linked to inflammation caused by Crohn’s Disease and ulcerative colitis. For example, curcumin is an inhibitor of the NF-kB signaling pathways, the activation of which appears to be one of the origins of the immune dysregulation that can cause extreme inflammation from IBD. This indicates that curcumin may prevent further activation that causes persistent and damaging inflammation in IBD patients.
Additionally, curcumin suppresses the activity of interleukin-1 (IL-1β), a protein produced by white blood cells which has been found in higher quantities in those with Crohn’s or ulcerative colitis. It’s also been shown to suppress tumor necrosis factor (TNF), a cytokine and protein messenger found in larger amounts in the stool of those with IBD. As TNF is the main target of both Remicade and Humera, curcumin has potential to provide a safer option.
The research so far is immensely promising, showing that gut-directed curcumin does appear to induce and maintain remission when used alongside first-line medication. This is especially important for patients who do not respond to first-line medication, as the complementary use of curcumin may spare them from detrimental side effects of more extreme treatments further down the line.
Curcumin as a treatment for ulcerative colitis
Curcumin in Combination With Mesalamine Induces Remission in Patients With Mild-to-Moderate Ulcerative Colitis in a Randomized Controlled Trial
Researchers in Israel designed a randomized controlled trial on gut-directed curcumin in combination with mesalamine to treat patients with mild-to-moderate ulcerative colitis. All participants were on mesalamine therapy, and failing to respond. Of the 26 patients receiving curcumin, 53.8% achieved clinical remission at 4 weeks, compared to none in the placebo group. Clinical response was achieved by 17 patients 65.3%, and endoscopic remission was observed in 38% of the curcumin group.
The study concluded that gut-directed curcumin used alongside mesalamine was significantly more effective than mesalamine on its own in achieving clinical and endoscopic remission. They were the first study to use gut-directed curcumin and the first to study curcumin for remission induction on active UC patients failing pharmaceutical treatment.
The results were so promising that for the first time curcumin as an add-on therapy was included in the European Crohn’s & Colitis Organization (ECCO) guidelines in 2021–a huge step for natural medicine in IBD.
Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial
This 6+ month trial administered curcumin to UC patients (ages 18-64) in remission, with the aim to test curcumin for remission maintenance. Subjects were given curcumin or placebo alongside sulfasalazine or mesalamine for a period of 6 months followed by another 6 months observational period.
The trial showed significantly less relapses in the curcumin group compared to placebo during the 6 month treatment. In the follow-up 6 months later, they found higher rates of relapse after discontinuation of curcumin treatment. The study concluded that curcumin as an add-on treatment maintains remission longer than pharmaceutical treatment alone.
The effect of curcumin supplementation on clinical outcomes and inflammatory markers in patients with ulcerative colitis
This randomized controlled trial in Iran tested curcumin along with pharmaceutical medication to treat patients with active, mild-to-moderate ulcerative colitis. They measured disease clinical activity, quality of life, serum levels of TNF-α, CRP, ESR values, and complete blood count.
The results showed significant improvement in clinical outcomes in the curcumin group, with decreased disease activity, higher quality of life, and generally improved symptoms. Additionally, participants in the curcumin group had a reduction in serum CRP, and ESR levels compared to the control group.
Curcumin With Mesalamine for Induction of Clinical and Endoscopic Remission in Mild-to-Moderate Ulcerative Colitis: A Randomized Double-Blind Placebo-controlled Pilot Study
This study tested the efficacy and safety of curcumin as an add-on therapy to induce remission in mild to moderate UC. Patients were assessed at 6 weeks and again at 3 months. Follow-up evaluations took place 6-12 months to assess long-term maintenance of remission.
Of 69 patients, 34 were given curcumin alongside mesalamine. At six weeks, 15 patients experienced clinical remission (44.1%), and 14 experienced endoscopic remission (35%), compared with none in the placebo group. Clinical response was also significantly higher in the curcumin group. The 6-month follow-up showed that 95% of responders to curcumin maintained clinical remission. These results indicate that curcumin as an add-on therapy can induce sustained remission for patients with mild-to-moderate UC when used alongside mesalamine.
Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial
This randomized controlled, multicenter trial in Japan tested curcumin for remission maintenance. They recruited 89 patients with ulcerative colitis who were in remission and gave 45 curcumin with sulfasalazine or mesalamine. The trial measured clinical activity index (CAI) and endoscopic index (EI) at entry, at every 2 months, at the conclusion of the 6-month trial, and again at the 6-month follow-up.
Patients in the curcumin group had less occurrence of relapse and improvements in both CAI and EI. The study found curcumin to be a safe and promising therapy for maintaining remission in patients with UC.
Curcumin as a treatment for Crohn’s Disease
Curcumin as a treatment for Crohn’s Disease: A systematic review
A review of curcumin as a potentially safe, complimentary add-on therapy for Crohn’s disease patients treated with infliximab (Remicade). Remicade reduces IL-1 and CRP levels of inflammation in patients, inhibits TNF-a, and significantly reduces the Crohn’s disease Activity Index. The levels of IL-1, a molecule that promotes inflammation of the gut and other tissues, increase in patients losing response to infliximab. Because curcumin reduces levels of this pro-inflammatory molecule, the authors suggest the addition of curcumin to Remicade may be a possible safe strategy to reduce the risk of loss of response to Remicade
Administration of dietary antioxidants for patients with inflammatory bowel disease: A systematic review and meta-analysis of randomized controlled clinical trials
A meta-analysis investigating the effect of curcumin on patients with IBD reviewed data from a number of trials. They found that curcumin resulted in a significant increase in clinical remission in patients with IBD, as well as significant remission in clinical symptoms and endoscopic remission, compared to control groups. Additionally, curcumin supplementation showed significant improvements in clinical response, and quality of life compared to control groups.