Turmeric, with the active component curcumin, is both a food and a dietary supplement that may promote a better immune response and blood sugar levels, and may also help you manage some side effects of cancer.
How do experts use turmeric and curcumin?
Both medical groups and integrative experts provide recommendations for turmeric or curcumin in treating people with cancer. Learn more about the approaches and meanings of recommendations: Integrative Oncology Programs and Expert Guidelines ›
Clinical practice guidelines
The 2017 Society for Integrative Oncology clinical practice guidelines regarding breast cancer patients state that insufficient evidence is available for recommending curcumin for radiation therapy-induced toxicity outcomes. Similarly, insufficient evidence is available for recommending curcuminoids for quality of life or vasomotor outcomes such as hot flashes.
Researchers from these organizations found insufficient evidence to recommend curcumin to treat oral mucositisinflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy treatment for cancer.
Published protocols, programs, and approaches
Turmeric or curcumin is used in programs, approaches and protocols a package of therapies combining and preferably integrating various therapies and practices into a cohesive design for care from these integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan oncologists, drawing from both scientific research and observations from years or even decades of treating people with cancer.
Lise Alschuler, ND, FABNO, and Karolyn Gazella
Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010.
Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer: A Five-Step Integrative Plan to Reduce the Risk of Recurrence and Build Lifelong Health. Berkeley, California: Ten Speed Press. 2013.
Approaches are described for certain cancer types, or along with certain conventional therapy treatments, or for particular conditions such as insulin resistance.
Uses of turmeric and curcumin:
- Bladder cancer
- Brain cancer
- Breast cancer
- Cervical cancer
- Colorectal cancer
- Lung cancer
- Melanoma
- Ovarian cancer
- Pancreatic cancer
- Prostate cancer
- Detoxification
- Immune enhancement
- Anti-inflammatory
- Radiation sensitizer
Keith Block, MD
Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009.
The integrative Block Program has recommendations to people who are at different places along the cancer continuum:
- Those who’ve been recently diagnosed
- Those in treatment
- Those who’ve concluded treatment and need to remain vigilant to prevent recurrence
Uses of turmeric and curcumin:
- Anti-inflammatory terrain modifier
- Coagulation terrain modifier
- Surgical support program (wound healing)
- Radiation support program
(mucositis inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy treatment for cancer) - Post-treatment program (targeting cancer progression pathways)
- Rehabilitation program (reducing inflammatory response)
- Targeted molecular therapies
- Chemopreventive (breast, colon and pancreatic cancers, melanoma)
- As a targeted therapy when other treatment isn’t working
Gerald Lemole, MD; Pallav Mehta, MD; and Dwight McKee, MD
Lemole GM, Mehta PK, McKee DL. After Cancer Care: The Definitive Self-Care Guide to Getting and Staying Well for Patients with Cancer. New York, New York: Rodale, Inc. 2015.
These doctors present easy-to-incorporate lifestyle changes to help you “turn on” hundreds of genes that fight cancer, and “turn off” the ones that encourage cancer, while recommending lifestyle approaches to address each type.
Uses of turmeric and curcumin:
- Bladder cancer
- Breast cancer
- Colorectal cancer
- Endometrial cancer
- Leukemia
- Lung cancer
- Lymphoma
- Melanoma
- Prostate cancer
- Renal (kidney) cancer
- Thyroid cancer
Barbara MacDonald, ND, LAc
MacDonald B. The Breast Cancer Companion—A Complementary Care Manual: Third Edition. Self-published. 2016.
Naturopathic physician Barbara MacDonald provides information about breast cancer, its conventional treatment, and natural approaches to enhancing treatment, managing side effects, reducing risk of recurrence, and healthy living after cancer treatment is completed.
Marsden Centre
Lee B. Colorectal Cancer: FOLFOX/FOLFIRI and Supportive natural therapies. Marsden Centre for Excellence in Integrative Medicine.
This protocol from Becky Lee, ND, provides information regarding combining FOLFOX/FOLFIRI and supportive natural therapies in treating colorectal cancer.
Uses of turmeric and curcumin during treatment with folinic acid, fluorouracil, and oxaliplatin (FOLFOX) for colorectal cancer.
Neil McKinney, BSc, ND
McKinney N. Naturopathic Oncology, Fourth Edition. Victoria, BC, Canada: Liaison Press. 2020.
This book includes descriptions and uses of many natural and complementary protocols for cancer in general and for specific cancers. It also includes information on integrative support during conventional cancer treatment.
Uses of turmeric and curcumin:
- General cancer
- Breast cancer
- Bladder cancer
- Brain/nerve cancer
- Carcinoid/neuroendocrine cancer
- Cervical cancer
- Colorectal cancer
- Esophageal cancer
- Gallbladder cancer
- Head and neck cancer
- Kidney cancer
- Leukemia
- Liver cancer
- Lung cancer
- Lymphoma
- Melanoma
- Myelodysplastic syndrome
- Ovarian cancer
- Sarcoma
- Stomach cancer
- Thyroid cancer
Also used in Bastyr University Integrative Oncology Research Center protocol for stage IV breast cancer
Gurdev Parmar, ND, FABNO, and Tina Kaczor, ND, FABNO
Parmar G, Kaczor T. Textbook of Naturopathic Oncology: A Desktop Guide of Integrative Cancer Care. 1st edition. Medicatrix Holdings Ltd. 2020.
This book provides information on the treatment of 24 cancers, plus the most effective treatments of the most common symptoms affecting cancer patients while they undergo chemotherapy, radiotherapy, or surgery.
Uses of turmeric and curcumin:
- Brain cancer (primary)
- Breast cancer
- Colorectal cancer
- Lymphoma (Hodgkins and non-Hodgkin)
- Multiple myeloma
- Lung cancer (non small cell)
- Pancreatic cancer
- Prostate cancer
- Thyroid cancer
Other expert assessments
Donald Abrams, MD, and Andrew Weil, MD
This 2014 book by integrative medicine experts and CancerChoices advisors describes a wide variety of complementary interventions to conventional cancer care, including a chapter from the perspective of a cancer patient. Abrams & Weil state that curcumin is among the botanicals most commonly used by oncology naturopathic physicians for colorectal cancer. Based on safety and scientific evidence, most naturopathic physicians include curcumin/turmeric in their core protocol a package of therapies combining and preferably integrating various therapies and practices into a cohesive design for care for reducing the risk of cancer relapse in people who have received primary conventional treatment.
Moss Reports
The Moss Reports conclude that curcumin is effective in reducing inflammation.
Traditional medicine
Turmeric or curcumin is used in traditional Chinese medicine and Ayurveda.
Learn more about traditional medicine and how to find practitioners: Finding Integrative Oncologists and Other Practitioners ›
Dosing
Dosage has not been standardized for use in cancer care, but recommendations are available from these sources as well as the published programs and approaches listed above:
Bayet-Robert M, Kwiatkowski F et al. Phase I dose escalation trial of docetaxel plus curcumin in patients with advanced and metastatic breast cancer. Cancer Biology & Therapy. 2010 Jan;9(1):8-14.
Lao CD, Ruffin MT 4th et al. Dose escalation of a curcuminoid formulation. BMC Complementary Medicine and Therapies. 2006 Mar 17;6:10.
General information about dosing
Find general dosing guidelines regarding natural products and supplements in Dosing Guidelines ›
Expert commentary
Use of black pepper with turmeric
CancerChoices advisor Dr. Andrew Weil advises: “Neither curcumin nor turmeric taken orally is well absorbed unless taken with black pepper or piperine, a constituent of black pepper responsible for its pungency. When shopping for supplements, make sure that the one you choose contains black pepper extract or piperine.”2Weil A. Curcumin or Turmeric? November 1, 2016. Viewed January 12, 2018. However, both Dr. Weil and naturopathic oncologist Lise Alschuler, another CancerChoices advisor, caution that use of piperine may interact with a wide range of prescription medications. Dr. Alschuler does not advise long-term use of piperine.3Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010 p. 115.
Lack of effect with dietary portions
Karen Collins, MS, RDN, CDN, FAND, January 23, 2018: The vast majority of studies on turmeric/curcumin have been in cell studies and rodent studies, and mostly with amounts that are unlikely to be consumed in humans who simply use turmeric as a culinary spice. Human studies are really limited.
I’ve seen one human study show reductions in TNF-alpha (the inflammatory signaling protein) with only 150 mg of curcumin/day—but I’m not sure how to translate the TNF-alpha change as to whether it was clinically significant. Other studies I’ve seen and as reviewed in the Natural Medicines Database tend to use 1000 to 4000 mg/day of curcumin (and some studies use much more).
Interaction with tamoxifen
CancerChoices advisors Gwen Stritter, MD, and Jen Green, ND, FABNO, write of the impact of curcumin on tamoxifen effectiveness, May 9, 2019: Many are aware that tamoxifen is what we call a pro-drug. A pro-drug is ineffective until specific enzymes in your body activate it. Tamoxifen is metabolized to endoxifen, the effective drug that prevents ER+ breast cancer patients from relapse.
An enzyme called CYP2D6 is responsible for the magic that changes tamoxifen to endoxifen. The activity of this enzyme varies from individual to individual. Part of the variance is due to genetics—some people are born with hyperactive CYP2D6; others have an enzyme that is very sluggish. Many medications—antidepressants like fluoxetine (Prozac), paroxetine (Paxil) and citalopram (Celexa) amongst a host of others—as well as assorted foods and dietary supplements can either activate or slow down CYP2D6.
When this information first started causing a stir in the breast cancer world roughly 10 years ago, researchers hypothesized that taking tamoxifen with a CYP2D6 inhibitor would cause an increase in breast cancer relapse. As it turned out, further clinical research did not bolster this theory,4Mayer SE, Weiss NS et al. CYP2D6-inhibiting medication use and inherited CYP2D6 variation in relation to adverse breast cancer outcomes after tamoxifen therapy. Cancer Causes Control. 2019 Jan;30(1):103-112. leading to a new one: genetics, drugs and dietary intake have complex interactions with the body’s enzyme system. They activate some enzymes and inhibit others. This results in a variable net effect on the concentration of important drugs. In a 2016 study, the cause of low endoxifen levels could not be identified over 50% of the time.5Fox P, Balleine RL et al. Dose escalation of tamoxifen in patients with low endoxifen level: evidence for therapeutic drug monitoring-the TADE study. Clinical Cancer Research. 2016 Jul 1;22(13):3164-71.
Because such a complex system is difficult to study, researchers turned away from looking at just CYP2D6 and are focusing on the endoxifen level itself (ignoring the middleman). In one study, researchers in the Netherlands gave tamoxifen with or without curcumin 1200 mg three times a day. The group taking tamoxifen in combination with curcumin had about an 8% decrease in endoxifen levels. If the curcumin was compounded with piperine (often done to substantially improve curcumin absorption), endoxifen levels were further decreased by 12%.6Hussaarts KGAM, Hurkmans DP et al. Impact of curcumin (with or without piperine) on the pharmacokinetics of tamoxifen. Cancers (Basel). 2019 Mar 22;11(3). pii: E403.
Although an 8–12% reduction doesn’t seem like much, if your genetics and/or dietary habits result in levels of endoxifen just barely in the effective range, the addition of curcumin, and especially with piperidine, could tip the scales in favor of breast cancer growth. The authors of this paper conclude: “co-treatment with curcumin could lower endoxifen concentrations below the threshold for efficacy (potentially 20–40% of the patients).”
Do keep in mind that this was a very small study, only 16 patients. However, these results are in line with previous lab and animal research so should not be discounted. On the other hand, curcumin supplementation has documented beneficial effects: decreased depression,7Sanmukhani J, Satodia V et al. Efficacy and safety of curcumin in major depressive disorder: a randomized controlled trial. Phytotherapy Research. 2014 Apr;28(4):579-85. anti-inflammatory effects8Panahi Y, Saadat A, Beiraghdar F, Sahebkar A. Adjuvant therapy with bioavailability-boosted curcuminoids suppresses systemic inflammation and improves quality of life in patients with solid tumors: a randomized double-blind placebo-controlled trial. Phytotherapy Research. 2014 Oct;28(10):1461-7. and lowered cholesterol,9Qin S, Huang L et al. Efficacy and safety of turmeric and curcumin in lowering blood lipid levels in patients with cardiovascular risk factors: a meta-analysis of randomized controlled trials. Nutrition Journal. 2017 Oct 11;16(1):68. to name a few.
The bottom line: if you are taking curcumin with tamoxifen, ask your integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan practitioner if s/he could substitute another supplement. If not, then request to have your endoxifen levels checked, both before and a month after starting curcumin. Quest Diagnostics, a very reputable lab, offers a “tamoxifen and metabolites” blood test.
References