Might Turmeric Help Prevent Alzheimer’s?

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There are plenty of anti-inflammatory drugs out there that may reduce the risk of Alzheimer's disease, but stomach, liver, and kidney toxicity precludes their widespread use. So maybe using an anti-inflammatory food like the spice, turmeric, found in curry powder, could offer the benefits without the risks? Before even considering putting it to the test, though, one might ask, "Well, do populations that eat a lot of turmeric have a lower prevalence of dementia?" And indeed, those living in rural India who do just that may actually have the lowest reported prevalence of dementia and Alzheimer's.

In rural Pennsylvania, the incidence rate of Alzheimer's disease among seniors is 19/1000. Nineteen people in a thousand over age 65 develop Alzheimer's every year in rural Pennsylvania. In rural India, using the same diagnostic criteria, that same rate is three, confirming they have among the lowest reported Alzheimer's rates in the world.

Although the lower prevalence of Alzheimer's in India is generally attributed to the turmeric consumption as a part of curry, and it is assumed that people who use turmeric regularly have a lower incidence of the disease, but let's not just assume. As highlighted in my video, Preventing Alzheimer's with Turmeric, a thousand people were tested, and those who consumed curry at least occasionally did better on simple cognitive tests than those who didn't. Those that ate curry often also had only about half the odds of showing cognitive impairment, after adjusting for a wide variety of potential confounding factors. This suggests that curry consumption may indeed be associated with better cognitive performance.

Of course it probably matters what's being curried--are we talking chicken masala, or chana masala, with chickpeas instead of chicks? It may be no coincidence that the country with among the lowest rates of Alzheimer's also has among the lowest rates of meat consumption, with a significant percentage of Indians eating meat-free and egg-free diets.

Studies have suggested for nearly 20 years now that those who eat meat--red meat or white meat--appear between two to three times more likely to become demented compared to vegetarians. And the longer one eats meat-free, the lower the associated risk of dementia, whether or not you like curry.

There's another spice that may be useful for brain health. See my video Saffron for the Treatment of Alzheimer's. What about coconut oil? See Does Coconut Oil Cure Alzheimer's? In terms of preventing cognitive decline in the first place, check out my video How to Slow Brain Aging By Two Years.

I've raised the issue of plant-based diets and dementia in Alzheimer's Disease: Grain Brain or Meathead?

For more on spices and inflammation, see Which Spices Fight Inflammation? and the follow-up, Spicing Up DNA Protection.

What about treating Alzheimer's disease with the spice turmeric? That's the topic of my video, Treating Alzheimer's with Turmeric.

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

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Where are the Lowest Rates of Alzheimer’s in the World?

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The rates of dementia differ greatly around the world, from the lowest rates in Africa, India, and South Asia, to the highest rates in Western Europe and especially North America. Is it all just genetics? Well, the incidence of dementia and Alzheimer's disease is significantly lower for Africans in Nigeria than for African Americans in Indianapolis, for example--up to five times lower.

Alzheimer's rates of Japanese-Americans living in the U.S. are closer to that of Americans than to Japanese. When people move from their homeland to the United States, Alzheimer's rates can increase dramatically. Therefore, when Africans or Asians live in the United States and adopt a Western diet, their increase in Alzheimer's risk suggests that it's not genetics.

Unfortunately, one doesn't have to move to the West to adopt a Western diet. The prevalence of dementia in Japan has shot up over the last few decades. Mechanisms to explain this in Japan include increases in cholesterol, saturated fat, and iron from increases in the consumption of animal products. Traditional diets are generally weighted toward vegetable products such as grains and away from animal products. But since 1960, the diet in Japan has changed from a more traditional rice-based diet to one with a preponderance of meat. From 1961 to 2008, meat and animal fat increased considerably, whereas the rice supply dropped. The dietary factor most strongly associated with the rise in Alzheimer's disease in Japan was the increased consumption of animal fat.

A similar analysis in China arrived at the same conclusion. As the authors of the Japan study (highlighted in the video, Alzheimer's Disease: Grain Brain or Meathead?) note, on the basis of these findings, the rate of Alzheimer's disease and dementia will "continue to rise unless dietary patterns change to those with less reliance on animal products." This is consistent with data showing those who eat vegetarian appear two to three times less likely to become demented, and the longer one eats meat-free, the lower the associated risk of dementia.

Globally, the lowest validated rates of Alzheimer's in the world are rural India, where they eat low meat, high grain, high bean, high carb diets. It's possible that the apparent protective association between rice and Alzheimer's is due to the fact that the drop of rice consumption was accompanied by a rise in meat consumption, but other population studies have found that dietary grains appear strongly protective in relation to Alzheimer's disease. In other words, perhaps, don't pass on the grain, but "pass the grain to spare the brain."

A few previous videos on Alzheimer's and maintaining cognitive function:

More on the consequences of carbophobia here:

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

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Preventing and Treating Colon Cancer with Turmeric Curcumin

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The low incidence of bowel cancer in India is often attributed to natural antioxidants such as curcumin, the yellow pigment in the spice turmeric, used in curry powder. However, it is important to remember that the benefits of a diet are seldom produced by a single ingredient in that diet. For example, diets rich in beta-carotene lower the risk of tobacco-related cancers, but beta-carotene pills do not. That doesn't stop researchers from trying, though.

Back in 2001, in a last ditch attempt to save the lives of 15 patients with advanced colorectal cancer that didn't respond to any of the standard chemotherapy agents or radiation, researchers started them on a turmeric extract. The extract appeared to help stall the disease in a third (5 out of 15) of the patients, suggesting that turmeric extract may clinically benefit at least some patients with advanced refractory colorectal cancer.

If we were talking about some new kind of chemotherapy, and it only helped one in three, we'd have to weigh the benefits against chemo side effects, such as losing our hair, the sloughing of our guts, intractable vomiting, maybe being bed-ridden. Therefore, a drug scenario, a one in three benefit may not sound particularly appealing. But when we're talking about plant extract proven to be remarkably safe, it would be worth considering even if it just helped 1 in a 100. With no serious downsides, a one in three benefit for end-stage cancer is pretty exciting.

To see if colon cancer could be prevented, five years later, researchers at Cleveland Clinic and John Hopkins School of Medicine tested two phytochemicals, curcumin (from turmeric) and quercitin, (found in fruits and vegetables such as red onions and grapes) in people with familial adenomatous polyposis, an inherited form of colon cancer in which individuals develop hundreds of polyps that may become cancerous unless prophylactically removed. (See Turmeric Curcumin and Colon Cancer). Researchers gave supplements of curcumin and quercetin to five such patients who already had their colons removed, but still had either polyps in their rectum or in a little intestinal pouch. Each patient had between 5 and 45 polyps each, but after six months on the supplement they ended up with on average fewer than half the polyps, and the ones that were left had shrunk in half. One patient got rid of all polyps by month three, but then they seemed to come back. The researchers asked the patient what's what, and it turned out that the patient stopped taking the supplements. So researchers put the patient back on the phytonutrient supplements for another three months, and the polyps came back down with virtually no adverse events and no blood test abnormalities.

By studying people at high risk for colon cancer, the researchers were able to show noticeable effects within just months. But polyposis is a rare disease; they were only able to recruit five people for the study. Thankfully, smokers are a dime a dozen. After another five years, researchers put 44 smokers on turmeric curcumin supplements alone for a month and measured changes in their colorectal aberrant crypt foci, which may act like the precursors to polyps, which are the precursors to cancer. After just one month there was a significant drop in the number of these abnormal crypt foci in the high dose supplement group but no change in the low dose group. There were also no dose-limiting side effects (although the stools in the participants did turn yellow).

The low cancer rates in India may also be related to phytate consumption (Phytates for the Prevention of Cancer) and plant-centered diets (Back to Our Roots: Curry and Cancer).

More on turmeric and Cancer in Carcinogenic Blocking Effects of Turmeric and Turmeric Curcumin Reprogramming Cancer Cell Death.

Given the poor systemic absorption of turmeric compounds, what cancers other than that of the digestive tract may be directly affected? See my follow-up video Topical Application of Turmeric Curcumin for Cancer.

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

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Plants as Intellectual Property: Patently Wrong?

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Since ancient times, Mother Nature has been a fertile source for drugs used to treat human diseases. One such remedy is the spice turmeric, specifically known for its naturally-yellow compound, curcumin, which has been used for at least 2,500 years. In light of the long and established experience with curcumin as a foodstuff and safe, low-cost, effective medicine, the spice is moving rapidly from the kitchen shelf toward the clinic.

Curcumin has shown some promising effects against a wide range of diseases, so well in fact that curcumin appears to possess all the desirable features of a designed-from-scratch, multipurpose drug.

If it's so safe and effective, why aren't more studies being done? Part of the delay is attributable to a U.S. patent, granted in 1995 to researchers at the University of Mississippi Medical Center, for curcumin's wound-healing properties, which prevented its development as a therapeutic. In a landmark case, highlighted in my video, Plants as Intellectual Property: Patently Wrong?, the Indian Council of Scientific and Industrial Research spent years arguing and finally proved that curcumin has been part of the Indian traditional system of medicine for centuries and so should be considered part of the public domain. It's like patenting broccoli. The patent was finally over-turned in 1997, a triumph for those trying to stop the misappropriation of traditional knowledge by multinational corporations. But if no one profits, who's going to pay for research?

Given that public knowledge does not involve any intellectual property, drug companies are not interested in its commercialization. You can buy turmeric in any grocery store for pennies a dose. "Unless there is intellectual property to make money, nobody will come forward," said a leading turmeric researcher.

Then how is any research being funded? Although curcumin itself is no longer patentable, derivatives, formulations, delivery systems, and synthetic methods can be. So, if you take some turmeric molecule and tweak it a little bit, you can patent it for your investors. Unless phytonutrients can be converted into new chemical entities for which more specific medical claims are possible, the development of these plants seems unlikely. Sure, they're extensively exploited as active ingredients of innumerable products on ill-regulated food supplement markets, but apart from this, progress through clinical trials remains sluggish. "Such waste of resources on the way of transformation from renewable materials to high tech/high value products ... is deplorable," drug research scientists write.

So maybe it would be good if Frito-lay did own the patent to broccoli. There's a reason we don't see Super Bowl ads for vegetables.

This reminds me of my video The Lie That Heals: Should Doctors Give Placebos? I went into the topic thinking one thing, but realized that there are strong arguments to be made on both sides.

Turmeric is pretty amazing stuff. Even if we won't hear about most of the research because companies can't patent it, we can educate ourselves:

The concept that the curcumin in turmeric is able to target multiple diseases pathways simultaneously is explored further in my video, Magic Bullets vs. Promiscuous Plants.

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my videos for free by clicking here and watch my full 2012 - 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.

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How Fruits and Vegetables Can Prevent Asthma

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Asthma is the most common chronic disease in children and the prevalence is increasing around the world. Despite this, most research dollars are spent on adult chronic disease. "One might ask," a group of researchers posited "whether this is because our politicians and senior administrators feel themselves to be more likely to suffer from the latter, and thus ignore allergic diseases as they mostly impact children and young adults" - who don't vote.

An enormous study about asthma and allergies in childhood, highlighted in my video, Preventing Asthma with Fruits and Vegetables, was published that includes more than a million children in nearly a hundred countries, making it the most comprehensive survey of asthma and allergies ever undertaken. The researchers found striking worldwide variations in the prevalence and severity of asthma, allergies, and eczema--a 20 to 60-fold difference in prevalence of symptoms of asthma, allergic runny nose, and atopic eczema around the world. The large variability suggests a crucial role of local characteristics that are determining the differences in prevalence between one place and another.

What kind of environmental factors? Why does the prevalence of itchy eyes and runny noses range anywhere from 1% in India, for example, and up to 45% of kids elsewhere? There were some associations with regional air pollution and smoking rates, but the most significant associations were with diet. Adolescents showed a consistent pattern of decreases in symptoms of wheeze (current and severe), allergic rhinoconjunctivitis, and atopic eczema with increases in per capita consumption of plant foods. The more their calories and protein came from plant sources, the less allergies they tended to have.

In general, there seems to be an association between an increase in asthma prevalence and a decrease in consumption of fresh fruits, green vegetables, and other dietary sources of antioxidants, helping to explain why the prevalence of asthma and respiratory symptoms are lower in populations with high intake of foods of plant origin. High intakes of fat and sodium, and low intakes of fiber and carbohydrates, are linked with asthma, while traditional and vegetarian diets are associated with lower rates. For example, if we look closer within India, in a study of more than 100,000 people, "those who consumed meat (daily or occasionally) were more likely to report asthma than those who were strictly vegetarian." This also meant avoiding eggs.

Eggs have been associated (along with soft drink consumption) with increased risk of respiratory symptoms and asthma in schoolchildren. On the other hand, consumptions of soy foods and fruits were associated with reduced risk of respiratory symptoms. In fact, removing eggs and dairy from the diet may improve lung function in asthmatic children in as little as eight weeks. Therefore, it may be a combination of eating fewer animal foods and more plants.

High vegetable intake, for example, has been found protective in children, potentially cutting the odds of allergic asthma in half. And fruit has also shown a consistent protective association for current and severe wheeze and runny nose in adolescents, and for current and severe asthma, allergies, and eczema in children.

Why is this? I've talked about the endocrine-disrupting industrial pollutants (see Dietary Sources of Alkylphenol Endocrine Disruptors) building up in the meat supply that may increase the risk of allergic disease, but the increase in asthma may be a combination of both a more toxic environment and a more susceptible population. One review notes that, "The dietary changes which have occurred over recent years may have led to a reduction in these natural antioxidant defenses, resulting in a shift of the antioxidant status of the whole population and leading to increased susceptibility to oxidant attack and airway inflammation."

In adults, for example, the risk of airway hyper-reactivity may increase seven-fold among those with the lowest intake of vitamin C from plant foods, while those with the lowest intake of saturated fats may have a 10-fold protection, presumably because of saturated fat's role in triggering inflammation.

The protective effect of plant-based food may also be mediated through effects on intestinal microflora. It turns out that differences in the indigenous intestinal flora might affect the development and priming of the immune system in early childhood. Kids with allergies, for example, tend to be less likely to harbor lactobacilli, the good bacteria that's found in fermented foods, and naturally on many fruits and vegetables. Lactobacillus probiotics may actually help with childhood asthma, which may help explain why children raised on largely organic vegetarian diets may have a lower prevalence of allergic reactions. Infants raised this way tend to have more good lactobacilli in their guts compared to controls, though they were also more likely to have been born naturally, breastfed longer, and not been given antibiotics, so we can't really tell if it's the diet until we put it to the test (See Treating Asthma with Fruits and Vegetables).

More on preventing allergic diseases can be found in my videos Preventing Childhood Allergies and Preventing Allergies in Adulthood.

More on protecting lung function with fruits and vegetables can be found in Preventing COPD With Diet.

Surprised probiotics can affect immune function? Check out my video Preventing the Common Cold with Probiotics? And if you think that is wild, wait until you see Gut Feelings: Probiotics and Mental Health.

What might be in plants that's so beneficial? See Anti-inflammatory Antioxidants.

What might be in animal products that is harmful to lung function? There are endocrine-disrupting industrial pollutants that build up in the food chain that may be playing a role. See my video Alkylphenol Endocrine Disruptors and Allergies. Also there's an inflammatory omega-6 fatty acid found predominantly in chicken and eggs that may contribute to inflammation as well. See Inflammatory Remarks About Arachidonic Acid.

Choosing fragrance-free personal care products may also help reduce airway reactivity: Throw Household Products Off the Scent.

I compare the efficacy of plants to pills (Treating Asthma With Plants vs. Supplements?) and explore the role an entire diet filled with plants might play in Treating Asthma and Eczema With Plant-Based Diets.

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and From Table to Able.

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Testing Turmeric on Smokers

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Researchers are becoming increasingly aware of "plant-derived substances that act as chemopreventive agents." Chemopreventatives are substances that help prevent cancer, as opposed to chemotherapy agents aimed at treating cancer. These plant-derived substances are not only inexpensive, they are also easily available and may have no or limited toxicity.

Since 1987, the "National Cancer Institute has tested more than a thousand different potential agents for chemopreventive activity, of which only a few dozen were moved to clinical trials. Curcumin, present in the Indian spice, turmeric, which is used in curry powder, is one such agent that is currently under clinical investigation for cancer chemoprevention."

According to their mode of action, chemopreventive agents are classified into different subgroups: antiproliferatives, antioxidants, or carcinogen-blockers. Curcumin belongs to all three, given its multiple mechanisms of action. Curcumin appears to play a role helping to block every stage of cancer transformation, proliferation, and invasion, and may even help before carcinogens even get to our cells.

A study back in 1987, highlighted in my video, Carcinogen Blocking Effects of Turmeric, investigated the effects of curcumin on the mutagenicity (DNA mutating ability) of several toxins and found that curcumin was an effective antimutagen against several environmental and standard mutagenic and cancer-causing substances. However, this was in vitro (from the Latin meaning "in glass," as in a test tube or petri dish). What about in people? We can't just take a group of people and expose them to some nasty carcinogen so we can give half of them turmeric and see what happens. We could wait until some toxic waste spill happens or nuclear accident, but 0therwise, how could researchers find people who would voluntarily expose themselves to carcinogens--unless, they smoke! That's why researchers test antimutagenic agents on smokers, who have carcinogens coursing through their veins every day.

If smokers pee on some bacteria, the number of DNA mutations shoot up dramatically. Remember, all life is encoded by DNA, whether bacteria, banana, or bunny rabbit. (When measuring urinary mutagens, it's easier to just pee on some bacteria.)

The urine of nonsmokers caused far fewer DNA mutations. It makes sense: nonsmokers have fewer chemicals running through their system. If we have nonsmokers eat some turmeric for a month, nothing really happens. But what if we do the same for smokers, in just fifteen days the mutagenic potential of their urine noticeably decreases, and it drops even more by day 30. The turmeric the researchers used was not some concentrated curcumin supplement, but just plain turmeric you might buy at the store. They also used less than a teaspoon of turmeric a day, indicating that dietary turmeric is an effective anti-mutagen.

However, in the same study the researchers found an even more effective anti-mutagen: not smoking. Even after eating turmeric for a month, the DNA-damaging power of smoker pee exceeded that of nonsmokers.

To find out more, check out Back to Our Roots: Curry and Cancer and Turmeric Curcumin Reprogramming Cancer Cell Death.

Other foods that may protect DNA include kiwifruit (Kiwifruit and DNA Repair), cruciferous vegetables (DNA Protection from Broccoli), leafy vegetables (Eating Green to Prevent Cancer), garlic (Cancer, Interrupted: Garlic & Flavonoids), green tea (Cancer, Interrupted: Green Tea (but which is better? Antimutagenic Activity of Green Versus White Tea), and plants in general (Repairing DNA Damage).

Smokers are common research subjects for carcinogen studies. But other groups of people following similar lifestyles are used. For example, see what happens to carcinogen levels when those eating processed meat start eating vegetarian in my video Heterocyclic Amines in Eggs, Cheese, and Creatine?

More information on cancer prevention, treatment, and reversal can be found in my latest annual presentations Uprooting the Leading Causes of Death, More Than an Apple a Day: Combating Common Diseases, and From Table to Able.

-Michael Greger, M.D.

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Why are Cancer Rates so Low in India?

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It is estimated that many tumors start around the age of 20. However, detection of cancer is normally around the age of 50 or later. Thus, it takes cancer decades to incubate. Why does it take so long? Recent studies indicate that in any given type of cancer, hundreds of different genes must be modified to change a normal cell into a cancer cell. Although cancers are characterized by the dysregulation of cell signaling pathways at multiple steps, most current anticancer therapies involve the modulation of a single target. Chemotherapy has gotten incredibly specific, but the ineffectiveness, lack of safety, and high cost of these monotargeted therapies has led to real disappointment, and drug companies are now trying to develop chemo drugs that take a multitargeted approach.

Many plant-based products, however, accomplish multitargeting naturally and are inexpensive and safe compared to drugs. However, because drug companies are not usually able to secure intellectual property rights to plants, the development of plant-based anticancer therapies has not been prioritized. They may work (and work better for all we know), and they may be safer, or even fully risk free.

If we were going to choose one plant-based product to start testing, we might choose curcumin, the pigment in the spice turmeric (the reason curry powder looks yellow). Before we start throwing money at research, we might want to ask some basic questions, like "Do populations that eat a lot of turmeric have lower cancer rates?" The incidence of cancer does appear to be significantly lower in regions where turmeric is heavily consumed. Population-based data indicate that some extremely common cancers in the Western world are much less prevalent in regions where turmeric is widely consumed in the diet.

For example, "overall cancer rates are much lower in India than in western countries." U.S. men get 23 times more prostate cancer than men in India. Americans get between 8 and 14 times the rate of melanoma, 10 to 11 times more colorectal cancer, 9 times more endometrial cancer, 7 to 17 times more lung cancer, 7 to 8 times more bladder cancer, 5 times more breast cancer, and 9 to 12 times more kidney cancer. This is not mere 5, 10, or 20 percent more, but 5, 10, or 20 times more. Hundreds of percent more breast cancer, thousands of percent more prostate cancer--differences even greater than some of those found in the China Study.

The researchers in this study, highlighted in my video Back to Our Roots: Curry and Cancer, conclude: "Because Indians account for one-sixth of the world's population, and have some of the highest spice consumption in the world, epidemiological studies in this country have great potential for improving our understanding of the relationship between diet and cancer. The lower rates of cancer may, of course, not be due to higher spice intake. Several dietary factors may contribute to the low overall rate of cancer in India. Among them are a "relatively low intake of meat and a mostly plant-based diet, in addition to the high intake of spices." Forty percent of Indians are vegetarians, and even the ones that do eat meat don't eat a lot. And it's not only what they don't eat, but what they do. India is one of the largest producers and consumers of fresh fruits and vegetables, and Indians eat a lot of pulses (legumes), such as beans, chickpeas, and lentils. They also eat a wide variety of spices in addition to turmeric that constitute, by weight, the most antioxidant-packed class of foods in the world.

Population studies can't prove a correlation between dietary turmeric and decreased cancer risk, but they can certainly inspire a bunch of research. So far, curcumin has been tested against a variety of human cancers, including colorectal cancer, pancreatic cancer, breast, prostate, multiple myeloma, lung cancer, and head and neck cancer, for both prevention and treatment. For more information on turmeric and curcumin, check out Carcinogen Blocking Effects of Turmeric Curcumin and Turmeric Curcumin Reprogramming Cancer Cell Death.

I'm working on another dozen or so videos on this amazing spice. This is what I have so far:

Amla, dried Indian gooseberry powder, is another promising dietary addition:

I add amla to my Pink Juice with Green Foam recipe. Not all natural products from India are safe, though. See, for example, my video Some Ayurvedic Medicine Worse than Lead Paint Exposure.

More on the antioxidant concentration in spices in general in Antioxidants in a Pinch. Why do antioxidants matter? See Food Antioxidants and Cancer and Food Antioxidants, Stroke, and Heart Disease.

Which fruits and vegetables might be best? See #1 Anticancer Vegetable and Best Fruits for Cancer Prevention.

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and From Table to Able.

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Who Should be Careful About Curcumin?

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Following flax and wheatgrass, turmeric is the third best-selling botanical dietary supplement, racking up $12 million in sales. Currently, sales are increasing at a rate of 20%.

"Curcumin is a natural plant product extracted from the turmeric root and is used commonly as a food additive popular for its pleasant mild aroma and exotic yellow color. It is widely considered unlikely to cause side effects." However, just because something is natural doesn't mean it's not toxic. Strychnine is natural; cyanide is natural. Lead, mercury and plutonium are all elements--can't get more natural than that! But turmeric is just a plant. Surely plants can't be dangerous? Tell that to Socrates.

"In considering the validity of the widely accepted notion that complementary and alternative medicine is a safer approach to therapy, we must remind ourselves and our patients that a therapy that exerts a biologic effect is, by definition, a drug and can have toxicity." It cannot be assumed that diet-derived agents will be innocuous when administered as pharmaceutical formulations at doses likely to exceed those consumed in the diet.

Traditional Indian diets may include as much as a teaspoon of turmeric a day. Doses of turmeric that have been used in human studies range from less than just a 16th of a teaspoon a day to two tablespoons a day for over a month. On the other hand, the curcumin trials have used up to the amount found in cups of the spice, around 100 times more than what curry lovers have been eating for centuries.

Studies have yet to show overt serious side effects in the short-term. However, if we combine high dose curcumin with black pepper, resulting in a 2000% boost in bioavailability (See Boosting the Bioavailability of Curcumin), it could be like consuming the equivalent of 29 cups of turmeric a day. That kind of intake could bring peak blood levels to the range where you start seeing some significant DNA damage in vitro.

So just incorporating turmeric into your cooking may be better than taking curcumin supplements, especially during pregnancy. The only other contraindication cited in the most recent review on curcumin was the potential to trigger gallbladder pain in individuals with gallstones.

If anything, curcumin may help protect liver function and help prevent gallstones by acting as a cholecystokinetic agent, meaning that it facilitates the pumping action of the gallbladder to keep the bile from stagnating. In one study, profiled in my video, Who Shouldn't Consume Turmeric or Curcmin?, researchers gave people a small dose of curcumin, about the amount found in a quarter teaspoon of turmeric and, using ultrasound, were able to visualize the gallbladder squeezing down in response, with an average change in volume of about 29%. Optimally, though we want to squeeze it in half. So the researchers repeated the experiment with different doses. It took about 40 milligrams to get a 50% contraction, or about a third of a teaspoon of turmeric every day.

On one hand that's great--totally doable. On the other hand, that's some incredibly powerful stuff! What if you had a gallbladder obstruction? What if you had a stone blocking your bile duct? If you eat something that makes your gallbladder squeeze so much, it could cause pain. So patients with biliary tract obstruction should be careful about consuming curcumin. For everyone else, these results suggest that curcumin can effectively "induce the gallbladder to empty and thereby reduce the risk of gallstone formation and ultimately even gallbladder cancer."

Too much turmeric, though, may increase the risk of kidney stones. As I mentioned in Oxalates in Cinnamon, turmeric is high in soluble oxalates which can bind to calcium and form insoluble calcium oxalate, which is responsible for approximately 75% of all kidney stones. "The consumption of even moderate amounts of turmeric would therefore not be recommended for people with a tendency to form kidney stones." Such folks should restrict the consumption of total dietary oxalate to less than 40 to 50 mg/day, which means no more than at most a teaspoon of turmeric. Those with gout, for example, are by definition, it appears, at high risk for kidney stones, and so if their doctor wanted to treat gout inflammation with high dose turmeric, he or she might consider curcumin supplements, because to reach high levels of curcumin in turmeric form would incur too much of an oxalate load.

If we are going to take a supplement, how do we choose? The latest review recommends purchasing from Western suppliers that follow recommended Good Manufacturing Practices, which may decrease the likelihood of buying an adulterated product.

I previously discussed the role spices play in squelching inflammation and free radicals in Which Spices Fight Inflammation? and Spicing Up DNA Protection. Then out of the lab into the clinic with attempts to test the ability of turmeric extracts to treat joint inflammation with Turmeric Curcumin and Rheumatoid Arthritis and Turmeric Curcumin and Osteoarthritis.

I wish there was more science on wheatgrass. I just had that one unhelpful anecdote in my video How Much Broccoli Is Too Much? There is good science on flax though. See:

More on gallbladder health can be found in my video Cholesterol Gallstones. And those who are susceptible to kidney stones should try to alkalinize their urine by eating lots of dark green leafy vegetables. See Testing Your Diet with Pee & Purple Cabbage.

Based on this new science on turmeric (lots more to come!), I now try to include it in my family's daily diet.

-Michael Greger, M.D

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and From Table to Able.

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Why Pepper Boosts Turmeric Blood Levels

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"Historians from all around the world have produced evidence to show that apparently all primitive peoples used herbs-often in a sophisticated way. Quinine from Cinchona bark was used to treat the symptoms of malaria long before the disease was identified, and the raw ingredients of a common aspirin tablet have been a popular painkiller for far longer than we have had access to tablet-making machinery. Indeed, today many pharmacological classes of drugs include a natural product prototype that we originally discovered through the study of traditional cures and folk knowledge of indigenous people."

There's a plant in South Asia called Adhatoda (from adu meaning "goat," and thoda meaning "not touch" because it's so bitter even the goats won't eat it). It has compounds that help open one's airways and as such, Adhatoda tea has been used traditionally to treat asthma, where the leaves are steeped with black peppercorns. Leaves steeped with black peppercorns? That sounds gross to me--why would they do that? Because they're smart. Back in 1928, scientists discovered what the people evidently already knew, that adding pepper increased the anti-asthmatic properties of the leaves. Black pepper alone didn't work: it was the combination. And now we know why.

Just like approximately 5% of the spice turmeric is composed of an active compound called curcumin, about 5% of black pepper by weight is comprised of this compound called piperine. Curcumin is responsible for the yellow color of turmeric and piperine for the pungent flavor of pepper. Piperine is a potent inhibitor of drug metabolism. One of the ways our liver gets rid of foreign substances is making them water soluble so they can be more easily excreted. But this black pepper molecule inhibits that process.

And it doesn't take much. If people are given a bunch of turmeric curcumin, within an hour there's a little bump in the level in their blood stream. We don't see a large increase because our liver is actively trying to get rid of it. But what if the process is suppressed by taking just a quarter teaspoon's worth of black pepper? Then you see curcumin levels skyrocket (See Boosting the Bioavailability of Curcumin). The same amount of curcumin consumed, but the bioavailability shoots up 2000%. Even just a little pinch of pepper--1/20th of a teaspoon--can significantly boost levels. And guess what a common ingredient in curry powder is besides turmeric? Black pepper.

Another way to boost the absorption of curcumin is to consume it in the whole food, turmeric root (fresh or dried as a powder) because natural oils found in turmeric root and turmeric powder can enhance the bioavailability of curcumin seven to eight fold. When eaten with fat, curcumin can be directly absorbed into the bloodstream through the lymphatic system thereby in part bypassing the liver.

How is it prepared in India? With fat and black pepper. Amazing how they could figure that out without double blind trials. (Though maybe it just tastes good, and it's merely coincidence?) Their traditional knowledge certainly failed them with ghee, however, which is practically pure butter fat, which may explain India's relatively high rates of heart disease despite all their turmeric.

Why would we care about boosting curcumin levels? Learn why in my videos Which Spices Fight Inflammation? and Spicing Up DNA Protection, Turmeric Curcumin and Rheumatoid Arthritis, and Turmeric Curcumin and Osteoarthritis. It's also good to know Who Shouldn't Consume Curcumin or Turmeric.

I've previously covered this topic of food synergy in videos such as Apples and Oranges: Dietary Diversity and Garden Variety Anti-Inflammation that emphasize the importance of eating a variety of plant foods to take advantage of some of these interactions.

The black pepper mechanism reminds me of the grapefruit (Tell Your Doctor If You Eat Grapefruit) and broccoli (The Best Detox) stories. A testament to the power of plants.

The painkilling properties of aspirin mentioned in the video are actually found throughout the plant kingdom: Aspirin Levels in Plant Foods.

In some circumstances, traditional medicine wisdom seems incredible (Tomato Effect); in others, dangerous (Get the Lead Out). But that's what we now have science for!

-Michael Greger, M.D

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and From Table to Able.

Image Credit: John Loo / Flickr

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