Remedy · root & spice
Turmeric and curcumin: what the evidence says about joints and inflammation
Curcumin capsules have eased knee osteoarthritis pain in trials, but cooking with turmeric delivers very little curcumin, and some high-absorption products have been linked to liver injury.
By the editors of Alimentotherapy Last reviewed 3 min read Not medical advice
Turmeric
Curcuma longa
Best-supported use: Knee osteoarthritis pain
The short answer
In randomized trials of people with knee osteoarthritis, curcumin supplements reduced pain scores more than the comparison treatments, though NCCIH says higher-quality studies are still needed before firm conclusionsHsiao 2021; NCCIH. Turmeric used as a spice in food delivers little curcumin to the blood, and the supplements that are engineered to be absorbed better are the ones linked to liver injuryShoba 1998; Halegoua 2023.
The evidence, use by use
Each claim graded on human studies only. How we grade
| Use | Grade | What the research found |
|---|---|---|
| Knee osteoarthritis pain | Moderate | A meta-analysis of 11 randomized trials (1,258 people with knee osteoarthritis) found curcuminoids lowered pain scores more than comparators. Daily doses of 1,000 mg or more did no better than lower doses. Hsiao 2021; NCCIH |
| Lowering blood markers of inflammation (CRP) | Limited | Pooled trials report lower C-reactive protein with curcumin supplements in people with inflammatory conditions, but the products, doses and patient groups vary widely, and a lower marker is not the same as feeling better. Gorabi 2022 |
| General health from turmeric in cooking | Not supported | There are no trials showing a health effect from culinary amounts. In volunteers given 2 g of curcumin alone, blood levels were undetectable or very low. Shoba 1998; NCCIH |
Turmeric is not the same as curcumin
Turmeric is a dried, ground root in the ginger family. Curcumin is one of the yellow compounds in it, and it is curcumin, usually as concentrated capsules, that most trials tested NCCIH. A spoonful of turmeric in a curry is a different thing from a capsule standardized to hundreds of milligrams of curcuminoids.
Curcumin is poorly absorbed. In a small study in healthy volunteers, 2 g of curcumin on its own produced blood levels that were undetectable or very low; adding 20 mg of piperine, a compound from black pepper, raised bioavailability by 2,000% Shoba 1998. That is why many supplements now add black pepper extract or use other high-absorption formulas.
In the kitchen
Cooking with turmeric, black pepper and a little fat is a fine tradition and safe at food amounts. Just do not expect a curry to behave like the capsules in the trials.
Joints: the strongest case
Knee osteoarthritis is the use with the most trials. In the 2021 meta-analysis, curcuminoids reduced pain and improved WOMAC pain scores compared with the control groups, and higher daily doses were no better than lower ones Hsiao 2021. NCCIH describes the evidence as initially positive but says better studies are needed, partly because products differ so much in what they contain NCCIH.
If you are considering curcumin for joint pain, tell your doctor or pharmacist, especially if you take a blood thinner or have liver problems. See what the evidence says about inflammation for the food patterns with better support.
Liver injury reports
The US Drug-Induced Liver Injury Network found 10 cases of liver injury linked to turmeric products, all enrolled since 2011. Five people were hospitalized and one died of acute liver failure. Three of the seven products tested also contained piperine Halegoua 2023. NCCIH notes that liver damage has been reported with high-absorption curcumin formulations and advises stopping and calling your provider if you notice fatigue, nausea, poor appetite, dark urine or yellowing skin NCCIH.
Before you try it: safety and interactions
Who should avoid it or ask first
- You have liver disease or have had liver injury from any supplement.
- You take a blood thinner or antiplatelet drug: ask your prescriber before using curcumin supplements.
- You have surgery coming up: tell your surgical team about any turmeric or curcumin supplements.
Possible side effects
- Nausea, vomiting, acid reflux, stomach upset, diarrhea or constipation from oral supplements.
- Hives or itching from topical curcumin.
- Rare but serious liver injury, mainly reported with supplements, often high-absorption ones.
Pregnancy and breastfeeding
Turmeric in food amounts is fine, but NCCIH says turmeric supplements may be unsafe in pregnancy, and little is known about amounts above food levels while breastfeeding. NCCIH; Halegoua 2023
Medicine interactions
Check another food or medicine in the interactions list.
Common questions
Does cooking with turmeric reduce inflammation?
There is no trial evidence that turmeric in cooking amounts changes inflammation. The positive trials used concentrated curcumin supplements, and curcumin on its own is so poorly absorbed that blood levels in volunteers given 2 g were undetectable or very low.
Why do turmeric supplements contain black pepper?
Black pepper contains piperine, which in a small 1998 study raised curcumin bioavailability by 2,000%. Better absorption is also why high-absorption products are the ones most often linked to liver injury reports.
Is turmeric safe for the liver?
Turmeric in food is considered safe, but the US Drug-Induced Liver Injury Network has documented serious liver injury from turmeric supplements, including one death. Stop and call your provider if you develop fatigue, dark urine or yellow skin while taking one.
Sources
Primary research and government sources, each checked on the date this page was reviewed.
- PubMedHsiao AF, et al. The efficacy of high- and low-dose curcumin in knee osteoarthritis: a systematic review and meta-analysis. Complement Ther Med. 2021. PMID 34537344.
- PubMedGorabi AM, et al. Effect of curcumin on C-reactive protein as a biomarker of systemic inflammation: an updated meta-analysis of randomized controlled trials. Phytother Res. 2022. PMID 34586711.
- PubMedShoba G, et al. Influence of piperine on the pharmacokinetics of curcumin in animals and human volunteers. Planta Med. 1998. PMID 9619120.
- PubMedHalegoua-DeMarzio D, et al. Liver injury associated with turmeric: a growing problem. Ten cases from the Drug-Induced Liver Injury Network [DILIN]. Am J Med. 2023. PMID 36252717.
- NCCIHNational Center for Complementary and Integrative Health. Turmeric: Usefulness and Safety.
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