Turmeric, a popular spice and herbal supplement, has been linked to liver injury in some cases. A recent study, conducted by the Drug-Induced Liver Injury Network (DILIN) Prospective Study, suggests that turmeric-associated liver injury may be increasing in the United States since 2017. The study provides a reliable description of the clinical presentation, laboratory features, liver histology, and outcomes of turmeric-associated liver injury from well-characterized cases.
Turmeric is a spice that has been used in traditional medicine for centuries.
It is commonly used as ingredient in curry. In recent years, turmeric has become increasingly popular for its claimed health benefits, including for conditions such as arthritis, pain relief, and even the prevention or treatment of COVID-19.
The study found that the typical injury occurs in women who use turmeric for arthritis, pain relief, or general health. The symptoms typically appear after a latency period of 1 to 4 months, and present as a hepatocellular pattern of injury. Autoantibodies, such as antinuclear antibody and smooth muscle antibody, are frequent in these cases, but with normal immunoglobulin levels.
Most cases of turmeric-associated liver injury are self-limited, meaning they improve quickly once turmeric is discontinued. However, in rare cases, the injury can be severe and result in death. The presence of turmeric was confirmed in all 7 products tested, and the detection of piperine in several cases raises the possibility that it increased the bioavailability and toxicity of the turmeric.
The study only pertains to turmeric supplements.
The study excludes turmeric as a spice commonly used in cooking. The amount of turmeric typically used in cooking is considered safe for most people. However, turmeric supplements often include piperine (black pepper), which can increase its systemic bioavailability. For eg, only 20 mg of piperine taken with turmeric is reported to increase its bioavailability 20-fold in serum which could potentiate liver injury.
The study was limited by its small sample size, but it was notable that 7 out of the 10 patients carried the HLA-B*35:01 allele, which has been implicated in liver injury from other herbal products. Carriage of this allele may be a risk factor for liver injury from several herbal components.
Despite the increasing popularity of turmeric, it is important to note that there is limited evidence to support its effectiveness for the many conditions it is claimed to treat. According to the American Botanical Council’s 2020 Herb Market Report, consumers spent an estimated $11.261 billion on herbal and dietary supplement sales in 2020, with turmeric noted as one of the top 10 ingredients in sold supplements.
In conclusion, while turmeric has a long history of safe use, the recent study by the DILIN Prospective Study suggests that it may be linked to liver injury in some cases. Consumers should be cautious when using turmeric or any other herbal or dietary supplements and consult with their healthcare provider before starting any new supplement regimen. Additionally, consumers should be aware that the evidence to support the efficacy of turmeric for various conditions is limited, and that it is not an approved therapeutic agent.