New Delhi: The Australian government’s departments of Health and Aged Care and Therapeutic Goods Administration issued a joint advisory Tuesday on turmeric supplements, saying that it may be linked with the risk of liver injuries in rare cases.
The advisory comes after two severe cases of liver injury, believed to be associated with the use of turmeric supplements, were reported in the country. One of the cases ended in death, according to reports.
The advisory is targeted at both consumers and health professionals and said that medicines and herbal supplements containing the herb Curcuma longa (turmeric) and/or curcumin (the main active ingredient in turmeric, known for its anti-inflammatory and antioxidant properties) may cause liver injury in rare cases.
It added that this risk also relates to supplements which have other ingredients from the Curcuma species, such as Curcuma aromatica, Curcuma zanthorrhiza and Curcuma zedoaria, as they contain naturally occurring curcumin.
The departments, according to the advisory, had received a total of 18 reports of liver problems experienced by consumers till 29 June following the intake of supplements containing turmeric.
Nine of these reports had enough information to suggest a liver injury that may have been caused by turmeric or curcumin products, the advisory added. Of these, in four cases there were no other ingredients likely to have contributed to the liver injury and two of these cases were severe (as reported above), including one that had a fatal outcome, the departments added.
The other five cases, according to the advisory, involved products that contained other ingredients that may have contributed to liver injury.
In addition to these 18 cases, there have been multiple other cases in Australia and overseas, as reported in scientific literature or reported to regulators in other countries, which indicated to probable liver damage from products containing turmeric or curcumin, the advisory added.
Earlier this year, the United States’s Drug-induced Liver Injury Network had also warned about turmeric supplement-associated liver damage. In late 2022, Italy’s Ministry of Health had ordered public health warnings to be added to turmeric-based supplements and banned health claims following reports of hepatitis cases that were believed to be related to use of turmeric-based products.
ThePrint reached Union AYUSH secretary Rajesh Kotecha over phone for his comments on the development, but received no response till the time of publication of this report. The article will be updated when a response is received.
The Ministry of Ayush was formed in 2014, with “a vision of reviving the profound knowledge of our ancient systems of medicine and ensuring the optimal development and propagation of the Ayush systems of healthcare”.
Sushrut Singh, additional director (gastroenterology) at Noida’s Fortis Hospital, however, told ThePrint that prolonged use of curcumin “in high quantity is toxic for liver and is known in various serious cases to cause severe liver injury”.
Cochin-based gastroenterologist and medical researcher Rajeev Jayadevan added that while curcumin has achieved immense popularity as a health supplement, it is not easily absorbed by the gut, and that’s perhaps why liver damage has remained rare overall.
To improve its absorption from the intestine, curcumin is often combined with a black pepper extract called piperine which is known to cause liver damage in mice, although not demonstrated in humans, he underlined.
Also read: I was constantly nudged to speak in English, my words manipulated, says AYUSH secretary
The Australia advisory
In the latest advisory against consumption of turmeric supplements, the Australian government departments said that in response to the reports of possible turmeric-related liver damage, the department completed a safety investigation of products containing Curcuma longa (turmeric) and curcumin and the risk of liver injury.
“Available evidence shows that there is a rare risk of liver injury from taking Curcuma longa (turmeric) and/or curcumin in medicinal dosage forms. The risk may be higher for products with enhanced absorption or bioavailability and/or higher doses,” it said.
The advisory added: “People with existing or previous liver problems may be more likely to develop this rare adverse event. However, there is not enough information at this time to conclusively identify which medicines are higher risk.”
The advisory further added that in Australia (like in many other countries, including India), medicines and herbal supplements containing these Curcuma species, and/or curcumin, can be bought in supermarkets, health food shops and pharmacies without a prescription and without the advice of a health professional.
There are over 600 listed medicines included in the Australian Register of Therapeutic Goods (ARTG) that contain these Curcuma species and/or curcumin, according to the advisory.
‘Used for over 4000 years’
According to Singh, turmeric is a plant that has been used as a food spice for over 4,000 years, as well as for medicinal purposes in traditional Indian, mainly Ayurvedic, and Chinese medicines.
Curcumin is a naturally occurring component in turmeric and can be isolated and used as an active ingredient in medicines. Curcumin also naturally occurs in other Curcuma species permitted for use in listed medicines, which include Curcuma aromatica, Curcuma zanthorrhiza and Curcuma zedoaria, he added.
“Because these Curcuma species contain curcumin, there is also a risk of liver injury from consuming medicines/herbal supplements that contain any of these Curcuma ingredients,” Singh added.
The doctor pointed out that health regulators in the West have fixed daily consumption of 60 mg to be the acceptable safe limit for curcumin.
Ayurvedic and other herbal medicinal products and supplements, however, may contain much higher amounts, Singh said.
“The safe limit of 60mg is even lower for patients with underlying liver disease/cirrhosis patients, in whom use of curcumin is advocated by AYUSH practitioners, and as little as 20 mg over a few weeks can cause already compromised liver to go into rapid liver failure very frequently requiring urgent liver transplant in some cases,” he cautioned.
While turmeric can cause liver injury directly by Curcumin or curcuminoids (curcuminoids are chemical derivatives in it), Singh said it can also cause damage through other ways such as heavy metals commonly found as adulterants in it and anti-caking agents which are used as preservative to prevent turmeric from clumping.
Combination with pepper may lead to worse results?
Meanwhile, talking about the possible effect of combing curcumin and piperine Jayadevan said the combination of the two compounds in large doses might have caused liver injury in certain individuals who were genetically prone to it.
Certain genetic factors, like the HLA-B*35:01 type (a kind of genetic barcode that is present in only a few people), have been linked to an increased risk of liver injury from such compounds, according to Jayadevan.
This combination of genetic and other factors is perhaps the reason why liver damage occurs only among some people using these products, he stressed.
The latest advisory, said Jayadevan, however, should not mean that we stop using turmeric.
Turmeric is a flavourful spice that has been around for a long time, he said. It does not cause harm when used in small amounts, for cooking purposes.
However, like in the case of many other products whether natural or otherwise, excessive use purportedly for medicinal purposes can result in unexpected, unpleasant and potentially dangerous outcomes, Jayadevan added.
(Edited by Poulomi Banerjee)
Also read: Dope to hope—India is seeing unprecedented boom in CBD. With AYUSH blessing