Denture base resins materials and its mechanism of action
Spice as Medicine: Turmeric, Curcuma longa
1. SPICE AS MEDICINE
TURMERIC
CURCUMA LONGA
By
Kevin KF Ng, MD, PhD
Former Associate Professor of Medicine
Division of Clinical Pharmacology
University of Miami, Miami, FL. USA
email:kevinng68@gmail.com
A slide presentation for HealthCare Provider Seminar Oct 2019
2. Outline of Lecture
▪ What is turmeric?
▪ History, production, consumption
▪ Classification
▪ Nutrient composition
▪ Bioactive compounds
▪ Pharmacological actions
▪ Clinical studies, meta-analysis
▪ Summary
3. What is Turmeric?
Turmeric is a 5–6 ft plant
(Curcuma longa L.), which sends
out rhizomes that are used either
fresh or dried and powdered.
6. The number of publications published since 1995 on
(i) curcumin, (ii) curcumin and clinical trials or animal studies, (iii) curcumin and
formulations, and (iv) curcumin and analysis. (2019)
https://www.mdpi.com/1420-3049/24/16/2930/htm
7. Curcumin: Total-Scale Analysis of the Scientific Literature
The top five contributor journals, organizations, and countries/territories
of the 18,036 manuscripts. (2019)
Molecules 2019, 24, 1393; doi:10.3390/molecules24071393
Journals
Organizations
Countries
8. Scientific misconduct on publications especially those of
curcumin authored by Bharat Aggarwal (2012-2018):
▪ As of April 2018, 19 papers had been retracted.
▪ As of 2019, 28 papers published by Aggarwal have been
retracted, 10 others have received an expression of
concern, and 17 others have been corrected
https://en.wikipedia.org/wiki/Bharat_Aggarwal
9. Major turmeric producing countries (2011-12)
http://www.commoditiescontrol.com/eagritrader/commodityknowledge/turmeric/turmeric.htm
10. Major countries that import turmeric
https://www.quora.com/Which-is-the-major-country-for-exporting-turmeric
12. Anatomy of Turmeric (rhizome)
https://www.etsy.com/listing/640160754/turmeric-plant-poster-floral-wall-decor
Leaf
Flower
Flower
Rhizome
13. Nutritional Value of Turmeric, Curcuma Longa
http://www.phytojournal.com/archives/2017/vol6issue1/PartA/6-1-17-211.pdf
14. Major phytoconstituents of extracts of Curcuma longa
https://pubs.acs.org/doi/pdf/10.1021/acs.jmedchem.6b00975
15. Chemical structures of key volatile components in the
essential oil from Curcuma spp. rhizomes. (2018)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164907/
Turmeric root EO from Kerala, India contained ar-turmerone (46.8%)
Nutrients 2018, 10, 1196
20. Influence of Piperine on the Pharmacokinetics of
Curcumin in Human Volunteers (1998)
Serum concentrations µg/ml (mean ±
SEM) of curcumin 2g oral alone and
with piperine 20mg in humans (n= 8).
Significance as compared to curcumin
alone; *P <0.01 **P <0.001.
https://lumaforlife.com/wp-content/uploads/2018/06/P1.Influence-of-Piperine.pdf
Curcumin
Curcumin+Piperine
21. Pharmacokinetic parameters (mean ± SEM) of oral curcumin 2 g/kg
alone and in combination with piperine 20 mg/kg in
normal healthy volunteers (n=8)) (1998)
https://lumaforlife.com/wp-content/uploads/2018/06/P1.Influence-of-Piperine.pdf
22. Reported half-lives of curcumin at a variety of conditions
(2017)
https://pubs.acs.org/doi/suppl/10.1021/acs.jmedchem.6b00975/suppl_file/jm6b00975_si_001.pdf
24. Modeled time concentration plots of curcumin conjugates detected in
plasma from 12 human subjects treated with a single 10 g (2008)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4138955/
26. Summary of absorption, distribution and excretion of
curcumin in rats. (1980)
Adapted from https://www.ncbi.nlm.nih.gov/pubmed/7423534
27. Major areas of scientific research on
curcumin and ar-turmerone
▪ Cancer
▪ Breast
▪ Colon
▪ Colorectal
▪ Pancreas
▪ prostate
▪ Inflammation
▪ Immuno-modulation
▪ Oxidative stress
Molecules 2019, 24, 1393
28. Pharmacological actions of
curcumin and ar-turmerone
▪ Antioxidant activity
▪ Antimicrobial activity
▪ Anti-inflammatory activity
▪ Anti-diabetic activity
▪ Anti-cancer activity
▪ Effects on biotransformation enzymes
▪ Inhibition of proliferation and induction of apoptosis
▪ Inhibition of tumor invasion and angiogenesis
▪ Neuroprotective activity
https://lpi.oregonstate.edu/mic/dietary-factors/phytochemicals/curcumin
29. Effect of curcumin on inflammatory process
https://www.semanticscholar.org/paper/Curcumin%3A-An-Anti-Inflammatory-Molecule-from-a-
on-Basnet-%C5%A0kalko-Basnet/cfd9e11203d1a1c21d073fde514778dd72ae5cf9/figure/5
Aspirin
30. Molecular basis of curcumin action on inflammatory process
https://www.ecrjournal.com/articles/anti-inflammatory-action-curcumin-use
31. Curcumin Extract Inhibits Gene Expression
(CCR7, MMP9, and COX2) in MCF7 (Mammary Tumor-Derived Lung Metastasis Cells). 2019
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6412318/
32. The effects of turmeric (curcumin) on tumor suppressor protein (p53)
and estrogen receptor (ERα) in breast cancer cells. (2017)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5354546/
33. The Effect of Curcumin in the HER-2-Overexpressed Breast Cancer:
An In Vitro and In Vivo Comparison Study with Herceptin
https://www.hindawi.com/journals/ecam/2012/486568/
cancer cell lines
34. Curcumin inhibits skin SCC cell growth in vitro and in vivo
https://www.hindawi.com/journals/jsc/2012/147863/fig1/
35. Effect of Piperine on Skin Permeation of Curcumin from a
Bacterially Derived Cellulose-Composite Double-Layer Membrane for
Transdermal Curcumin Delivery (2018)
https://www.mdpi.com/2218-0532/86/3/39
Piperine increased the permeation rate of curcumin by about 1.89 times
Curcumin
36. Recent research on pharmacological actions of ar-turmerone
▪ Anti-inflammation activities
▪ Cytokines
▪ Enzymes
▪ Anti-cancer activities
▪ Angiogenesis
▪ Cell proliferation
▪ Nerve cell regeneration
37. Anti-inflammatory effects of aromatic-turmerone through
blocking of NF-κB, JNK, and p38 MAPK signaling pathways
in amyloid β-stimulated microglia. (2012)
https://www.ncbi.nlm.nih.gov/pubmed/22728094
39. Aromatic-turmerone induces neural stem cell
proliferation in vitro and in vivo (2014)
Ar-turmerone increases NSC proliferation in vitro
After i.c.v. injection of 3 mg (1 mg/μl) ar-turmerone,
significantly more DCX-positive neuroblasts
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4180255/
41. Current use of Turmeric
Powdered root
Spice
Curry
Dye
Essential oil
Aromatherapy
Topical use
Medicine
Chinese
medicine
Ayurvedic
medicine
42. Medical use of turmeric or curcumin supplements
▪ Disease prevention
▪ Cancer
▪ Type 2 diabetes mellitus
▪ Disease treatment
▪ Cancer
▪ Inflammatory disease
▪ Rheumatoid arthritis
▪ Radiation dermatitis
▪ Ulcerative colitis
▪ Oral health
▪ Oral submucous fibrosis
▪ Cognitive decline and Alzheimer’s disease
▪ Major depressive disorder
▪ Premenstrual syndrome
https://lpi.oregonstate.edu/mic/dietary-factors/phytochemicals/curcumin
43. Problems of ingesting turmeric for health benefits
▪ Only 1 to 6 percent of turmeric is curcumin.
▪ Oral bioavailability of curcumin is about 1%.
▪ Curcumin taken orally is not well-absorbed and is quickly eliminated from the body.
▪ Turmeric may be contaminated with heavy metals such as lead,
▪ Curcumin supplements are not regulated in the same way as medications.
▪ Curcumin may interact with certain medications, such as blood thinners.
▪ Curcumin has never been shown to be conclusively effective in a randomized,
placebo-controlled clinical trial for any indication.
https://www.consumerreports.org/dietary-supplements/does-turmeric-really-reduce-inflammation/
44. Number of publication articles in PubMed on Turmeric, curcumin and
studies on effect of curcumin on diabetes, arthritis and cancer
https://www.ncbi.nlm.nih.gov/pubmed/?term=curcumin%2C+cancer
Turmeric, curcumin
Diabetes, arthritis
Cancer
No data available for ar-turmerone
45. Cognitive Function of Nondemented Elderly Subjects
and Their Self-Reported Curry Consumption
According to the study authors, “although the results are suggestive of a biological therapeutic effect, we emphasize that they
do not establish a clear and direct causal effect of curry consumption on improving cognitive function.” The difference in
MMSE between those who rarely use turmeric and those that often use it is not significant
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346970/
46. A Potential Role of the Curcumin in
Alzheimer’s Disease (2005)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1702408/?_escaped_fragment_=po=11.4035
47. Effect of oral Curcuma extract in patients with
colorectal cancer. (2001)
https://www.ncbi.nlm.nih.gov/pubmed/11448902/
48. Curcumin: A Review of Its’ Effects on Human Health (2017)
▪ Turmeric, a spice that has long been recognized for its medicinal properties, has received interest
from both the medical/scientific world and from culinary enthusiasts, as it is the major source of
the polyphenol curcumin.
▪ It aids in the management of oxidative and inflammatory conditions, metabolic syndrome, arthritis,
anxiety, and hyperlipidemia.
▪ It may also help in the management of exercise-induced inflammation and muscle soreness, thus
enhancing recovery and performance in active people.
▪ In addition, a relatively low dose of the complex can provide health benefits for people that do not
have diagnosed health conditions.
▪ Most of these benefits can be attributed to its antioxidant and anti-inflammatory effects.
▪ Ingesting curcumin by itself does not lead to the associated health benefits due to its poor
bioavailability, which appears to be primarily due to poor absorption, rapid metabolism, and rapid
elimination.
▪ There are several components that can increase bioavailability. For example, piperine is the major
active component of black pepper and, when combined in a complex with curcumin, has been
shown to increase bioavailability by 2000%. Curcumin combined with enhancing agents provides
multiple health benefits.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664031/
49. How does curcumin work with poor bioavailability?
Clues from experimental and theoretical studies.(2016)
Inhibitive effects of human fAβ(1–42) formation by curcumin, its degradation products mixture and ferulic acid, evaluated by ThT fluorescence
assay.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4757858/
fAβ=amyloid-β peptide fibril
Curcumin degradation products
50. Efficacy of Turmeric Extracts and Curcumin for
Alleviating the Symptoms of Joint Arthritis:
A Systematic Review and Meta-Analysis of Randomized Clinical Trials. (2016)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003001/figure/f2/
Mean differences in PVAS
between curcuma and placebo.
Mean differences in PVAS and
WOMAC between curcuma and
placebo
Mean differences in PVAS and
WOMAC between curcuma
and pain medicine.
PVAS=pain visual analogue score
WOMAC=Western Ontario and McMaster Universities OA Index
51. Meta-analysis for comparison of plasma Total cholesterol
concentrations between experimental and control groups (2017)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637251/figure/Fig5/
Although a random-effect model was used,
pooled analysis of data from 6 studies [15,
23–27] showed no significant between-group
differences in terms of plasma TC
concentrations (P = 0.054), ostensibly owing
to the significant heterogeneity among these
studies (I 2 = 73.8%, n = 218 for both
experiment and control groups,
52. Meta-analysis for comparison of plasma LDL-C concentrations
between experimental and control groups (2017)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637251/figure/Fig2/
53. Meta-analysis for comparison of plasma Triglyceride
concentrations between experimental and control groups (2017)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637251/figure/Fig4/
54. Meta-analysis for comparison of plasma HDL-C concentrations
between experimental and control groups (2017)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637251/figure/Fig3/
55. Meta-analysis of glycemic outcomes in
prediabetes and type 2 diabetes mellitus. (2019)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478379/
This study indicated that daily administration of 1500 mg curcumin has positive
effects in reducing fasting blood glucose and weight in patients with type 2 diabetes.
prediabetes
type 2 DM
60. Summary
▪ Turmeric is the rhizome of a plant belonging to the species Curcuma longa.
▪ The bioactive compounds of turmeric are non-volatile curcuminoids and volatile
essential oil.
▪ The main non-volatile curcuminoid is curcumin whereas the main volatile constituent
is aromatic(ar-) turmerone.
▪ Multiple pharmacological activities have been shown in these bioactive compounds:
▪ Antioxidant, antimicrobial, anti-inflammatory, anti-cancer,
▪ Anti-hyperlipidemic, anti-diabetic
▪ Neuroprotective, hepatoprotective
▪ The low oral bioavailability of curcumin makes it unsuitable for therapeutic use.
▪ However, its flavor, aroma and medicinal properties have been used as a culinary
spice and traditional Chinese and Ayurvedic medicines for thousands of years.