Herb
Ashwagandha
An adaptogenic herb (Withania somnifera) used in Ayurvedic medicine to support stress resilience, energy, and cognitive function.
Moderate Evidence
Moderate Evidence Herb
Turmeric (Curcumin)
A bright yellow spice derived from the Curcuma longa plant, widely used in Ayurvedic and traditional medicine for its anti-inflammatory properties.
Updated February 20, 2026This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.
Benefits & Uses
- Osteoarthritis symptom relief: Research suggests curcumin extracts may modestly reduce knee osteoarthritis pain and improve function compared with placebo, with some trials showing effects comparable to low-dose NSAIDs but with fewer GI complaints. Supported by multiple randomized trials and several meta-analyses (evidence: moderate).
- Inflammation biomarkers: Meta-analyses indicate small-to-moderate reductions in CRP and some pro-inflammatory cytokines (e.g., IL-6) in various inflammatory/metabolic conditions (evidence: moderate).
- Ulcerative colitis (adjunct): When added to standard therapy (e.g., mesalamine), curcumin may increase rates of clinical response and remission and reduce relapse risk; effects are not consistently seen in Crohn’s disease (evidence: moderate for UC; limited for Crohn’s).
- Metabolic health: Some meta-analyses show modest improvements in glycemic control (e.g., fasting glucose, HbA1c) and lipid parameters (triglycerides, LDL-C) in type 2 diabetes/metabolic syndrome populations (effect sizes small; evidence: moderate-to-emerging).
- Nonalcoholic fatty liver disease (NAFLD): Several RCTs suggest small improvements in liver enzymes and hepatic steatosis scores with curcumin adjunct therapy, but heterogeneity is high (evidence: emerging).
- Depressive symptoms (adjunct): Small RCTs and pooled analyses suggest a modest reduction in depressive symptoms when used as adjunctive therapy; larger, higher-quality trials are needed (evidence: emerging).
Side Effects & Precautions
- Common (generally mild, dose-related): Dyspepsia/acid reflux, abdominal discomfort, nausea, diarrhea, flatulence. Headache or dizziness can occur. GI effects increase with higher doses (>1 g/day of curcumin) and with piperine-enhanced products.
- Less common: Skin rash or pruritus, yellow stool discoloration.
- Rare but serious: Elevated liver enzymes and idiosyncratic drug-induced liver injury (hepatitis) have been reported with turmeric/curcumin supplements (including enhanced-bioavailability formulations); resolves after discontinuation in most cases. Clinically significant bleeding has occurred when combined with anticoagulants/antiplatelets. Hypoglycemia is possible when combined with glucose-lowering therapies.
- Other considerations: Turmeric (spice) is relatively high in oxalate; high intakes may increase urinary oxalate and kidney stone risk in susceptible individuals.
Dosage & Administration
- Curcumin extracts (standardized ~95% curcuminoids): Commonly used ranges in clinical studies are 500–2,000 mg per day, usually divided 1–3 times daily. Trials in osteoarthritis often use 500–1,500 mg/day of curcuminoids; ulcerative colitis adjunct trials commonly use 1,000–2,000 mg/day.
- Enhanced-bioavailability formulations (e.g., curcumin-phospholipid complexes, micellar/colloidal curcumin, BCM-95, Theracurmin): Typically studied at lower nominal doses (about 200–1,000 mg/day of product), reflecting higher absorption; dosing is not interchangeable across brands.
- Turmeric powder (root/rhizome): Trials have used roughly 1.5–6 g/day, though curcumin content is low (often 2–8%).
- Bioavailability enhancers: Some studies combine curcumin with piperine (black pepper extract, ~5–20 mg) to increase absorption; note that piperine can also increase absorption of many drugs, raising interaction risk.
- Administration: Often taken with meals and dietary fat to aid absorption. Optimal dosing varies by individual and condition; clinical supervision is advised for chronic use or when on medications.
Contraindications
- Bleeding risk: Avoid or use only with medical supervision in patients with bleeding disorders or those taking anticoagulants/antiplatelets (e.g., warfarin, DOACs, clopidogrel, high-dose aspirin). Stop at least 1–2 weeks before elective surgery.
- Gallbladder disease: Avoid in bile duct obstruction or acute biliary colic; use caution with gallstones due to choleretic effects.
- Active peptic ulcer disease or significant GERD: May worsen GI symptoms.
- Pregnancy and breastfeeding: Culinary amounts are generally considered safe; high-dose supplements lack robust safety data—avoid unless advised by a clinician.
- Diabetes/hypoglycemia: Use caution with antidiabetic drugs; monitor for low blood glucose.
- Kidney stones/hyperoxaluria: Limit high-dose turmeric powder; monitor in patients with history of calcium oxalate stones.
- Iron-deficiency anemia: Curcumin may reduce non-heme iron absorption; separate from iron supplements and monitor ferritin/hemoglobin.
- Liver disease or prior supplement-related liver injury: Use cautiously; consider baseline and periodic liver function tests, discontinue if enzymes rise or symptoms of hepatitis occur.
Known Interactions
| Substance | Type | Severity | Description |
|---|---|---|---|
| Warfarin | caution | severe | Additive anticoagulant/antiplatelet effects and possible CYP2C9 inhibition may raise INR and bleeding risk. |
| Clopidogrel or high-dose aspirin | caution | moderate | Additive antiplatelet effects may increase bleeding/bruising risk. |
| NSAIDs (e.g., ibuprofen, naproxen) | caution | moderate | Potential additive GI irritation and bleeding risk when combined with curcumin’s antiplatelet effects. |
| Insulin or oral antidiabetic drugs (e.g., metformin, sulfonylureas) | synergistic | moderate | Curcumin may modestly improve insulin sensitivity and lower glucose, potentially enhancing hypoglycemic effects; monitor blood sugar and adjust therapy as needed. |
| Cyclosporine or tacrolimus | caution | severe | Curcumin may inhibit P-glycoprotein and CYP3A4, potentially increasing levels of these narrow-therapeutic-index drugs; monitor troughs closely. |
| Iron supplements | antagonistic | moderate | Curcumin can chelate iron and may reduce non-heme iron absorption; separate dosing and monitor iron status if clinically relevant. |
| Ginkgo biloba (and other antiplatelet herbs/supplements) | synergistic | moderate | Additive antiplatelet effects may increase bleeding risk. |
| Piperine (black pepper extract) | synergistic | moderate | Enhances curcumin bioavailability substantially; may amplify both benefits and risk of drug interactions via CYP3A4/P-gp inhibition. |
Sources
- Systematic review and meta-analysis of curcumin for knee osteoarthritis symptom relief versus placebo/NSAIDs (meta-analysis) , 2016
- Meta-analysis of curcuminoids on systemic inflammation markers (CRP, IL-6) in randomized trials (meta-analysis) , 2016
- Systematic review and meta-analysis of curcumin as adjunct therapy in ulcerative colitis (induction and maintenance of remission) (meta-analysis) , 2019
- Meta-analysis of randomized controlled trials on curcumin and glycemic control/lipid profile in type 2 diabetes or metabolic syndrome (meta-analysis) , 2019
- Randomized trials of curcumin in nonalcoholic fatty liver disease showing changes in liver enzymes and steatosis indices (rct) , 2018
- Narrative review of turmeric/curcumin safety, pharmacokinetics, and reports of supplement-associated liver injury (review) , 2020
- Traditional Ayurvedic texts describing Curcuma longa for digestive and inflammatory conditions (traditional) 0
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Health Disclaimer
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.