Inflammation: The Friend Who Overstays Their Welcome

This article was written by Michelle Wentrcek, SPT – a student physical therapist who recently finished a clinical rotation with Symmetry.

I want you to picture your body as your home.  On a profound level, your body quite literally is your home because you’ll be living in it for your entire life.  But specifically for this analogy, I want you to picture your body as a physical house.  Now you’re living in this house, and then something goes wrong.  Maybe a pipe bursts or a massive tree limb falls over your fence or your AC unit is on the fritz.  Luckily, you have a very capable friend who is very handy and can help you out.  So you give them a holler, and they come over and tell you they’ll have the problem resolved soon.  Some time passes, and you go to check on your helpful friend.  You find they’ve fixed the original problem but have now moved on to “helping” with other things.  They’ve flipped all your wall décor upside down because they think it’s more artistic that way, and they’ve rearranged your living room furniture because they think it makes the home flow better—little projects that aren’t in their repertoire and weren’t truly problems to begin with.  You’re perturbed but thank your friend for helping to fix the original problem, trying to get them to leave so you can put your coffee table back in its little nook where it belongs.  However, your friend insists it’s no trouble and continues to “help.”  In this scenario, inflammation is The Friend Who Overstayed Their Welcome. 

              Now, just like your friend, inflammation is vitally beneficial and healthy in small doses and for specific “projects”.  Any time we have an initial injury or an invader gets introduced, our body recognizes that and sends help via inflammation.  Inflammation brings blood flow filled with cells that specialize in clearing out things that don’t belong, as well as nutrients to heal the involved area.  When the process works like it’s supposed to, that inflammation goes away once its job is done.  However, repeated trauma can happen to the same area and irritate the same structures over and over, prolonging the healing process.  Your body can also present with chronic inflammation if you have other systemic conditions – leading to inflammation throughout your entire body–not just at the involved site.  This can occur with conditions ranging from cardiovascular disease to obesity to chronic, unmanaged stress1.  Whatever the case, this is your body’s way of telling you some underlying condition needs to be addressed.  But in the meantime, you’re experiencing the side effects of inflammation, including redness, tenderness, pain, swelling, and restrictions to your mobility and function—things you probably don’t want to stick around once you’re aware there is a problem and are actively troubleshooting the solution. 

              The physiological process of inflammation involves something called the COX-2 pathway.  Here is a brief summary of the science of how that pathway works.  Phospholipids in your cells are converted to arachidonic acid, which combines with the COX-2 enzyme to create prostaglandins.  These prostaglandins are responsible for controlling inflammation in your body.  The mechanism of an anti-inflammatory medication is to block that process, specifically to inhibit the COX-2 enzyme so it can never join with the acid it needs to become prostaglandin.  No prostaglandins mean no cells calling in inflammation as reinforcements.  There are several options to disrupt this pathway, most commonly used are NSAIDs like Aspirin and Ibuprofen.  The benefit of using a COX-2 inhibitor is it’s more specific in its mechanism, which generally leads to fewer side effects than a medication with a broad approach2.  There are many folks that prefer to consider alternatives to the more traditional medications.  Symmetry’s patients periodically ask about the efficacy of alternative, natural methods to decrease inflammation, specifically the use of Turmeric. 

Before I talk about the efficacy of Turmeric, or its active ingredient Curcumin, I want to discuss pitfalls when it comes to “natural remedies”.  “Natural” carries the connotation that it’s healthier and of better quality for your body.  However, realize that our manufactured pharmaceutical drugs are also derived from natural things, often plants and herbs, and are presented in a condensed version for ease of use.  There is the potential for unwanted interactions between manufactured medications and natural remedies – particularly if the practitioner prescribing one or the other is unaware of what a patient is already taking.  Some people also tend to carry the belief about natural remedies that “more is better” that can subsequently increase the likelihood of creating toxicity and the risk of unintended overdoses3 I if taking an unprescribed or unmonitored dose.  Manufactured medications come with directions and toxicity information; plants and herbs don’t come with directions or a warning label.  Anything in excess can be detrimental to our bodies, be it medications, natural supplements, food, drink—you name it.  If you ever have any questions about drug interactions or recommended dosages, please consult with your doctor and/or pharmacist. 

              Turmeric, or its main active compound Curcumin, is a yellow spice within the ginger family.  It is native to India and is a common ingredient in curry.  Several studies have shown it to be effective in decreasing pain, inflammation, and edema4,5.  Studies analyzing the concentration of curcumin in the bloodstream after ingestion revealed poor uptake, secondary to our systems breaking it down before it can be absorbed in the gut.  Participants taking 4000-6000mg daily doses demonstrated less than 1 microgram of Curcumin in the bloodstream.  The same study had participants take Curcumin with Piperine, a compound commonly found in black pepper.  This strategy resulted in increased concentration of Curcumin in the bloodstream as it blocked the deconstruction and allowed for increased absorption in the gut.  This study further observed that the dosages given were effective in decreasing pain and inflammation by interrupting the COX-2 pathway as described above4.  This study did not report any perceived changes in the body, as it was specifically concerned with the actual absorption rather than on the potential effects of taking the substance. 

Another study looked at half-marathon runners taking either a placebo or Curcumin extract 29 days before and on the day of their race to determine the effect on muscle inflammation, which occurs as a natural part of rebuilding muscle to increase strength and endurance.  Dosages were set at 500mg Curcumin capsules or a 500mg placebo dose.  Participants were instructed to continue their previous dietary intake and content, and participants received 2 doses with lunch and 1 with dinner.  They were also told to not exceed 75-80% max intensity during their workouts leading up to the race.  They had their plasma analyzed for IL-10 and IL-6 at various points before and after the race.  Simply put, IL-10 slows down inflammation whereas IL-6 calls in inflammation.  The results showed IL-10 was increased and the IL-6 was decreased compared to the placebo group when blood was drawn immediately after the race, demonstrating that both sides of the coin were dialed to “decrease inflammation”.  No side effects were reported during the intervention period6. 

A different study examined participants with osteoarthritis taking Flexofytol, a medication with Curcumin extract.  The study found the participants demonstrated decreased pain and edema leading to improved quality of life with 6 weeks of taking 4-6 capsules per day7.  Another study looking at osteoarthritis compared the effects of 800 mg Ibuprofen and 2000 mg Curcumin extract between two groups of participants diagnosed with either knee or hip osteoarthritis (OA).  The results revealed comparable effects between the two interventions.  The study further found that 44% of participants taking Ibuprofen experienced side effects, whereas only 33% of the Curcumin group experienced side effects8. 

Yet another study looked at the effects of 500mg Curcumin for Rheumatoid Arthritis.  This study had three groups:  one receiving Curcumin only, one receiving only an NSAID Diclofenac, and one receiving a combination of the two.  The Curcumin-only group demonstrated the most decrease in joint pain and swelling after 8 weeks.  However, 20% of the Curcumin group dropped out of the study due to side effects.  No mention was made of side effects for the other two groups9. 

For any medication or supplement, there is always the risk of side effects.  Side effects of Turmeric or Curcumin range from no study participants reporting side effects to 1/3 of participants experiencing mild side effects, including diarrhea, nausea, and one participant experiencing vomiting4.  Another study found that Curcumin may downregulate breast milk production7.  A study researching Curcumin and its benefits for inflammation regarding cardiovascular disease and condition discovered it can increase the QT interval of your heartbeat, essentially meaning there is a discernable delay between the electrical pulses in your system responsible for initiating heart beats10.  For reference, the average QT interval is around 0.4 seconds, so a discernable delay would be a mere fraction of that11.  That would be less cause for concern for healthy individuals and more of a consideration for someone with a pre-existing cardiopulmonary condition. 

The bottom line of this literature review is that your body’s natural inflammatory process is the same throughout your body, so taking Turmeric or Curcumin would theoretically be beneficial for inflammation as a result of a variety of things.  It is important to recognize that inflammation is your body’s way of signaling there’s an underlying condition that should be addressed.  Current research supports that Turmeric/Curcumin could be beneficial in the short-term to address your symptoms while a long-term game plan to remedy the causes of inflammation is being established or carried out.  That long-term game plan can certainly include your physical therapist, who can help you to improve your level of function and to manage your symptoms.  When considering the use of Turmeric or Curcumin, remember that it’s always best to consult with your doctor or pharmacist for dosages and recommendations, especially if you are concerned about any known side effects.  Current research suggests that dosages ranging from 1000-8000mg a day could be beneficial, depending on your current situation, overall health condition, and specific needs.  For reference, Curcumin comprises approximately 2-5% of Turmeric1.  While a bowl of curry probably wouldn’t be enough for Curcumin supplementation, it would still be a tasty thing to incorporate into your diet. 

References:

  1. Hae Young Chung, Dae Hyun Kim, Eun Kyeong Lee, et al. Redefining Chronic Inflammation in Aging and Age-Related Diseases: Proposal of the Senoinflammation Concept. Aging & Disease. 2019;10(2):367-382. doi:10.14336/AD.2018.0324
  2. McDowell, D. (2020, February/March). Management of Pain and Inflammation. Lecture presented at PT 7263: Body Systems III in TXST Campus, Round Rock.
  3. McDowell, D. (2020, February/March). Complimentary & Alternative Meds (CAMs). Lecture presented at PT 7263: Body Systems III in TXST Campus, Round Rock. 
  4. Eke OUJ, Raffa RB, Pergolizzi JJV, Breve F, Taylor JR, the NEMA Research Group. Curcumin in turmeric: Basic and clinical evidence for a potential role in analgesia. Journal of Clinical Pharmacy & Therapeutics. 2018;43(4):460-466. doi:10.1111/jcpt.12703
  5. Ali Attiq, Juriyati Jalil, Khairana Husain, Waqas Ahmad. Raging the war against inflammation with natural products. Frontiers in Pharmacology. 2018;9(September):976. doi:https://www.frontiersin.org/articles/10.3389/fphar.2018.00976/full
  6. Faria FR, Gomes AC, Antunes A, et al. Effects of turmeric extract supplementation on inflammation and muscle damage after a half-marathon race: a randomized, double-blind, placebo-controlled trial. European Journal of Applied Physiology. 2020;120(7):1531-1540. doi:10.1007/s00421-020-04385-7
  7. Kobayashi K, Tsugami Y, Suzuki N, Suzuki T, Nishimura T. Suppressive effects of curcumin on milk production without inflammatory responses in lactating mammary epithelial cells. Phytomedicine. 2021;80. doi:https://www-sciencedirect-com.libproxy.txstate.edu/science/article/pii/S0944711320301914
  8. Isaza A. Dietary Supplements for Osteoarthritis and Rheumatoid Arthritis as an Alternative to NSAIDs. View Point on the Available Research. Nutritional Perspectives: Journal of the Council on Nutrition. 2019;42(3):42-44. Accessed February 11, 2021. https://search-ebscohost-com.libproxy.txstate.edu/login.aspx?direct=true&db=ccm&AN=142103645&site=ehost-live&scope=site
  9. Elchert CR. Curcumin: The Golden Anti-inflammatory. Nutritional Perspectives: Journal of the Council on Nutrition. 2021;44(1):30. Accessed March 16, 2021. https://search-ebscohost-com.libproxy.txstate.edu/login.aspx?direct=true&db=ccm&AN=148679291&site=ehost-live&scope=site
  10. Li Cheng, Miao Xiao, Li FengSheng, et al. Curcuminoids: implication for inflammation and oxidative stress in cardiovascular diseases. Phytotherapy Research. 2019;33(5):1302-1317. doi:10.1002/ptr.6324
  11. Gobert, D. (2019, Spring).  Introduction to ECG.  Lecture presented at PT 7333:  CardioPulmonary in TXST Campus, Round Rock. 

Image:  https://www.inspiredtaste.net/48607/chicken-curry/