Cutting-edge curcumin combinations

Put a halt to patients’ acute and chronic pain naturally

YOUR PATIENTS KNOW ABOUT PAIN. Whether they suffer from acute pain like pulled muscles and strains from work, or projects around the home, or deal with chronic conditions like rheumatoid arthritis, they look to you and your practice for much-needed help.

In addition to regular therapeutic adjustments, supplemental nutrients can dramatically improve your patients’ quality of life. Curcumin from turmeric (Curcuma longa) is one of them. Curcumin works through a multitude of pathways, which is why it is a favorite in research ranging from rheumatoid arthritis to depression, to reducing tumors and alleviating cancer therapy side effects, to name a few.^{1- 6} 

The importance of curcumin formulations

The form of curcumin used in these studies is important to note, as turmeric only supplies about 2% of curcumin, and even standardized curcumin extracts are difficult to absorb, so the compound requires enhancement to be effective.

The curcumin favored by researchers is enhanced with turmeric essential oil, which improves absorption and blood retention, and also provides turmerones for additional anti-inflammatory action.⁷ Curcumin can be a foundational nutrient for pain relief, because it reduces COX-2 activity without harming the liver or stomach lining or causing issues with addiction. Clinical research shows that it can match — or outperform — prescription medication.

In one case, a 500-mg dosage twice daily of this curcumin (BCM-95) was compared to diclofenac sodium to determine how well the botanical and drug would work in combination for treating patients with rheumatoid arthritis. In the Disease Activity Score in 28 Joints (DAS28) patient assessment, the group taking curcumin alone saw the most reduction in disease symptoms, followed by those using the combination therapy of curcumin with diclofenac sodium. The group using diclofenac sodium alone scored last. In both the curcumin alone and the curcumin/diclofenac groups, there were no dropouts due to adverse effects, but in the diclofenac sodium group, 14% withdrew because of them.

So aside from symptom reduction, there is a protective effect from the curcumin which moderates the side effects seen from the drug when the two are used in combination.³ 

Curcumin and other herbs/nutrients

Curcumin partners well with other nutrients, too, and boswellia (Boswellia serrata) is one of them.

In an osteoarthritis clinical study, the two combined outperformed the prescription drug Celecoxib in relieving pain, walking distance and joint line tenderness scores. In the herbal group, 64% improved dramatically versus only 29% in the drug group.

Those in the curcumin and boswellia group fared so well that they switched from their previously described “moderate to severe arthritis” down to “mild to moderate arthritis.”⁸

Another osteoarthritis clinical study found that a combination of the same curcumin and boswellia improved pain scores, including morning stiffness, joint comfort and overall severity, according to the WOMAC index, in just 12 weeks.⁹

But like curcumin, boswellia comes with qualifications. In boswellia extracts, acetyl-11-keto-beta-boswellic acid (AKBA) is a primary compound that stops 5-lipoxygenase (5-LOX) inflammation. This alone makes it an especially valuable natural medicine for many inflammatory diseases, including respiratory and digestive conditions — aside from stopping acute and chronic muscle and joint pain.^10,11 

But unstandardized boswellia may contain very little helpful AKBA, and it includes up to 20% of a compound called beta-boswellic acid (BBA). BBA interferes with AKBA’s ability to reduce inflammation, and so weakens the benefits. The best boswellia for fighting inflammation is a specialized extract that greatly reduces the interfering compound BBA and naturally boosts AKBA levels. That is the boswellia extract used with curcumin in the studies cited here. 

Other anti-inflammatory pairings

In addition to boswellia, black sesame seed oil has anti-inflammatory actions recognized in Ayurvedic practice and in scientific and clinical research.

For instance, scientific research shows that the botanical’s compounds reduce the activity of TNF-a, an inflammatory cytokine recognized as a prime culprit behind the joint damage of rheumatoid arthritis (RA).¹² Scientific studies show that sesame seed compounds can help increase type II collagen and prostaglandins and prevent the breakdown of beneficial fatty acids that keep joints healthy, so it could help prevent the structural joint damage seen in cases of osteoarthritis.^13-15 And in fact, clinical research found that sesame seed supplementation reduced inflammatory markers, decreased pain scores and relieved symptoms for patients with knee osteoarthritis.^16,17 

The three-combo that equals extra-strength acetaminophen

For acute pain relief, a combination of curcumin, boswellia and black sesame seed oil was shown to be as fast-acting and effective as over-the-counter extra-strength acetaminophen — but without the negative effects.

The combination was as effective in the same amount of time as acetaminophen for reducing symptoms of pain, averaging about one hour before individuals in both the herbal treatment group and the control acetaminophen group felt relief. In fact, the results regarding the relief of pain intensity and magnitude were so close as to be negligible in their differences.¹⁸

These are excellent results to share with your patients, because even though acetaminophen (one brand name is Tylenol) is available everywhere, it isn’t benign or necessarily safe — although your patients may not know it. Acetaminophen is highly toxic, and emergency calls to poison control centers are frequently due to unintentional poisoning from the drug — people simply didn’t realize the danger of acetaminophen overdose or buildup.¹⁹

Patients with chronic conditions like osteoarthritis or rheumatoid arthritis could also greatly benefit from a combination of curcumin, boswellia, DLPA (a combination of d- and l-phenylalanine), and nattokinase. DLPA addresses cognitive aspects of pain; d-phenylalanine appears to block enkephalinase, which would otherwise break down the brain’s natural analgesic enkaphalins, while l-phenylalanine improves mood-elevating chemicals in the brain, including dopamine, epinephrine and norepinephrine.^20-23

Nattokinase is an enzyme that increases microcirculation and can help nutrients like curcumin and boswellia move through the bloodstream to more effectively to reach the sites of pain where they are most needed.^24,25 

Curcumin combinations can work wonders for patients

To say that pain is one of the major reasons for patient visits is obvious. But what might not be obvious to your patients is that there are effective choices that can stop their pain without causing risks to their health.

Curcumin, along with botanicals like boswellia and black sesame seed oil or synergistic ingredients like DLPA and nattokinase, can be part of a protocol for acute or chronic conditions and used safely, every day.

TERRY LEMEROND is a natural health expert with more than 45 years of experience. He has owned health food stores, founded dietary supplement companies and formulated more than 400 products. A published author, he appears on radio and television, and is a frequent guest speaker. He can be contacted through euromedicausa.com.

References

1. Goel A, Kunnumakkara AB, Aggarwal BB. Curcumin as “Curecumin”: from kitchen to clinic. Biochem Pharmacol. 2008 Feb 15;75(4):787-809. 
2. Hatcher H, Planalp R, Cho J, et al. Curcumin: from ancient medicine to current clinical trials. Cell Mol Life Sci 2008;65:1631-1652. 
3. Chandran B, Goel A. A Randomized, Pilot Study to Assess the Efficacy and Safety of Curcumin in Patients with Active Rheumatoid Arthritis. Phytother Res. 2012 Mar 9. doi: 10.1002/ptr.4639. 
4. Sanmukhani J, Satodia V, Trivedi J, et al. Efficacy and Safety of Curcumin in Major Depressive Disorder: A Randomized Controlled Trial. Phytother Res. 2013 Jul 6. doi: 10.1002/ptr.5025. 
5. Hejazi J, Rstmanesh R, Taleban F, Molana S, and Ehtejab G. A Pilot Clinical Trial of Radioprotective Effects of Curcumin Supplementation in Patients with Prostate Cancer. J Cancer Sci Ther. 2013, 5.10. 
6. Arun P, Sagayaraj A, Azeem Mohiyuddin SM, Santosh D. Role of turmeric extract in minimizing mucositis in patients receiving radiotherapy for head and neck squamous cell cancer: a randomized, placebo-controlled trial. J Laryngol Otol. 2020 Feb 7:1-6. 
7. Antony B, Merina B, Iyer VS, Judy N, Lennertz K, Joyal S. A pilot cross-over study to evaluate human oral bioavailability of BCM-95 CG (Biocurcumax™) a novel bioenhanced preparation of curcumin. Ind J Pharm Sci. 2008:445-449. 
8. Antony B, Kizhakedath R, Benny M, Kuruvilla BT. Clinical Evaluation of a herbal product (Rhulief™) in the management of knee osteoarthritis. Abstract 316. Osteoarthritis Cartilage. 2011;19(S1):S145-S146. 
9. Haroyan A, Mukuchyan V, Mkrtchyan N, et al. Efficacy and safety of curcumin and its combination with boswellic acid in osteoarthritis: a comparative, randomized, double-blind, placebo-controlled study. BMC Complement Altern Med. 2018 Jan 9;18(1):7. 
10. Siddiqui MZ. Boswellia serrata, a potential antiinflammatory agent: an overview. Indian J Pharm Sci. 2011 May;73(3):255-61. 
11. Ammon HP. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006 Oct;72(12):1100-16. 
12. Khansai M, Phitak T, Klangjorhor J, et al. Effects of sesamin on primary human synovial fibroblasts and SW982 cell line induced by tumor necrosis factor-alpha as a synovitis-like model. BMC Complement Altern Med. 2017 Dec 13;17(1):532. 
13. Phitak T, Pothacharoen P, Settakorn J, Poompimol W, Caterson B, Kongtawelert P. Chondroprotective and anti-inflammatory effects of sesamin. Phytochemistry. 2012 Aug;80:77-88. 
14. Khansai M, Boonmaleerat K, Pothacharoen P, Phitak T, Kongtawelert P. Ex vivo model exhibits protective effects of sesamin against destruction of cartilage induced with a combination of tumor necrosis factor-alpha and oncostatin M. BMC Complement Altern Med. 2016 Jul 11;16:205. 
15. Srisuthtayanont W, Pruksakorn D, Kongtawelert P, Pothacharoen P. Effects of sesamin on chondroitin sulfate proteoglycan synthesis induced by interleukin-1beta in human chondrocytes. BMC Complement Altern Med. 2017 May 31;17(1):286. 
16. Eftekhar Sadat B, Khadem Haghighian M, Alipoor B, Malek Mahdavi A, Asghari Jafarabadi M, Moghaddam A. Effects of sesame seed supplementation on clinical signs and symptoms in patients with knee osteoarthritis. Int J Rheum Dis. 2013 Oct;16(5):578-82. 
17. Khadem Haghighian M, Alipoor B, Malek Mahdavi A, Eftekhar Sadat B, Asghari Jafarabadi M, Moghaddam A. Effects of sesame seed supplementation on inflammatory factors and oxidative stress biomarkers in patients with knee osteoarthritis. Acta Med Iran. 2015;53(4):207-13. 
18. Rudrappa GH, Chakravarthi PT, Benny IR. Efficacy of high-dissolution turmeric-sesame formulation for pain relief in adult subjects with acute musculoskeletal pain compared to acetaminophen: A randomized controlled study. Medicine (Baltimore). 2020;99(28):e20373. 
19. Major JM, Zhou EH, Wong HL, et al. Trends in rates of acetaminophen-related adverse events in the United States. Pharmacoepidemiol Drug Saf. 2016;25(5):590-598. 
20. Russell AL, McCarty MF. DL-phenylalanine markedly potentiates opiate analgesia – an example of nutrient/pharmaceutical up-regulation of the endogenous analgesia system. Med Hypotheses. 2000 Oct;55(4):283-8. 
21. Ehrenpreis S. Analgesic properties of enkephalinase inhibitors: animal and human studies. Prog Clin Biol Res. 1985;192:363-70. 
22. Ehrenpreis S. D-phenylalanine and other enkephalinase inhibitors as pharmacological agents: implications for some important therapeutic application. Aupunct Electrother Res. 1982;7(2-3):157-72. 
23. DLPA. In: Hendler SS, ed. PDR for Nutritional Supplements. 2nd ed. Montvale, NJ: Physician’s Desk Reference; 2008:189. 
24. Hsia CH, Shen MC, Lin JS, et al. Nattokinase decreases plasma levels of fibrinogen, factor VII, and factor VIII in human subjects. Nutr Res. 2009 ;29(3):190-6. 
25. Fujita M, Hong K, Ito Y, Fujii R, Kariya K, Nishimuro S. Thrombolytic effect of nattokinase on a chemically induced thrombosis model in rat. Biol Pharm Bull. 1995;18(10):1387-91.