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HerbalEGram: Volume 7, Number 10, October 2010
Special Turmeric Curcumin Formulation Relieves Osteoarthritis Symptoms
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Turmeric ( Curcuma longa)
rhizomes and tubers contain curcumin. This yellow pigment has been extensively
researched to assess its efficacy in the treatment of chronic diseases, and especially
inflammation, in over 2,500 preclinical investigations. There are several
challenges with curcumin pharmacokinetics, including instability at
physiological pH values, poor oral absorption, and quick elimination. However,
some researchers believe, and some research demonstrates, that these challenges
can be improved by complexing curcumin with phospholipids, specifically
phosphatidylcholine (PC). The resulting non-covalent adducts are named
Phytosomes® (a group of patented phytomedicinal formulations made by
Indena SpA of Milan, Italy). The authors of a recent research article state
that this proprietary, patented combination improves curcumin’s utilization in
the human body by a combination of higher hydrolytic stability and better
intestinal absorption.1
Osteoarthritis could potentially benefit from curcumin’s
anti-inflammatory properties. Meriva-SR® Curcumin Phytosome formula,
a curcumin and PC combination (1:2 ratio), was studied in a 3-month trial of 50
patients with X-ray diagnosed osteoarthritis in one or both knees to assess the
effects on their inflammation symptoms. The 50 patients were selected from the
Vascular Screening Project at the Chieti-Pescara University in San Valentino,
Italy, and sorted out into 2 groups. Patients from group A took only their
prescribed medication, while those from group B took their prescribed
medication along with 1.0 gram of Meriva capsules per day, corresponding to 200
mg of unformulated curcumin. (Meriva® is produced by Indena SpA;
this formulation is produced and marketed to healthcare professionals by Thorne
Research Inc., Dover, Idaho.)
The Western Ontario and McMaster Universities Arthritis
Index (WOMAC) questionnaire was utilized to rate the patients’ osteoarthritis
symptoms. The questionnaire scores were evaluated at inclusion and at the
conclusion of the 3-month study. A treadmill walking test at 3 km/h with a 10%
incline was also employed to assess mobility and walking distance before knee
joint pain occurred, at inclusion and at 3 months. Edema was evaluated and
found to exist in 88% of the 50 patients at inclusion. C-reactive protein (CRP)
plasma levels were measured to evaluate the inflammation status of the
patients. CRP levels were assessed with the use of laser nephelometry at
inclusion, 8 weeks, and 3 months. A healthy level of CRP, a marker for
inflammation, is lower than 10 mg/L.
The results showed a significant decrease of the WOMAC
median score for pain, stiffness, and physical function in patients from the
Meriva group, where this score changed from 83.4 at inclusion to 34.8 by the
end of the 3-month trial. In the control group, this score decreased from only
80.6 to 78.8. Walking ability increased from 76 m to 332 m (>400%
improvement) in the Meriva group versus a 30.8% improvement in the control
group at 3 months. Edema in both groups was reduced. Group A (control) began
the study with an edema score of 2.76 (Standard Deviation 0.4) and in Group B
(Meriva) their average score was 2.81 (0.33). At 3 months, Group B had edema
reduction with a mean decrease of 65% to 1.2 (0.3). Group A completed the trial
with a mean decrease of 5.0% and an edema score of 2.13 with P<0.05 between
the groups.
A sub-population of 23 patients had elevated CRP levels, and
was separated into 2 groups, Meriva (mean age 43.3; 8 females) and control
(mean age 44.2; 6 females), to assess the effects of Meriva on CRP levels.
Meriva patients experienced a significant decrease in CRP from 168 mg/L at
inclusion to a final level of 13.1 mg/L at 3 months, with a significant
improvement detected after 2 months. The control group began the trial at 175
mg/L, and at the end of the trial had decreased to only 112 mg/L. The Meriva
patients had a significantly greater reduction in CRP levels, which were almost
normalized by the end of the trial, while the control group’s CRP levels
remained elevated (P<0.05).
Several other measures were considered as secondary
end-points, including emotional well-being, decrease in pharmaceutical
medication consumption, and digestive disturbances. Emotional well-being
improved significantly in the Meriva group (from 34.9 to 10.5 [P<0.05]),
while it remained constant in the control group. The decrease in digestive
problems was 38% in Meriva and 15% in the control group. Analgesic medication (non-steroid
anti-inflammatory drugs, or NSAIDs) consumption decreased 63% in the Meriva
group compared to 12% in the control group (P<0.05).
Previous research has indicated that the proprietary
curcumin-phosphatidylcholine complex had a superior bioavailability to curcumin
alone, with an over 20-fold improvement of plasma curcuminoid concentration.2
The overall results from this new clinical study suggest that Meriva, when
integrated with conventional medication, improves the general quality of life
of osteoarthritis patients, by decreasing the painful symptoms associated with
the disease, improving joint functionality, and reducing the consumption of
NSAIDs.
This trial did not investigate whether Meriva affects the
levels of other inflammatory cytokines, such as TNF-alpha. Such information
would have been constructive, as TNF-alpha blocker medications have been
approved for this disease. Furthermore, a potential weakness of this study is
the lack of a control group taking a non-formulated curcumin extract alone to
compare with Meriva. Such direct comparison could help determine the possible
superiority of Meriva over a more conventional curcumin extract. The dosage of
curcumin in Meriva used in the study (200 mg) was significantly lower than
those of unformulated curcumin preparations found clinically active in the
treatment of inflammatory diseases (over 1 g).3
—Erin Miner
and Mark Blumenthal Photo Caption:
1) Sliced turmeric (Curcuma longa). ©2010 Jasmine Oberste. www.chineseherbgarden.com.
References
1. Belcaro G,
Cesarone M, Dugall M, et al. Product-evaluation registry of Meriva®, a
curcumin-phosphatidylcholine complex, for the complementary management of
osteoarthritis. Panminerva Med.
2010;52(2):1-8.
2. Marczylo TH, Vershoyle RD, Cooke DN, Morazzoni P, Steward
WP, Gesher AJ. Comparison of systematic availability of curcumin with that of
curcumin formulated with phosphatidylcholine. Cancer Chemother Pharmacol. 2007;60:171-177.
3. Surenka JS. Anti-inflammatory properties of curcumin, a
major constituent of Curcuma longa: A review of preclinical and clinical
research. Altern. Med. Rev.
2009;14:141-153.
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