A patient having heart problems, in particular a patient with cardiovascular disease who had recently received an angiogram and had a stent placed, could probably benefit greatly from taking oral liposomal curcumin, a concentrated highly absorbable form of the Indian spice turmeric.  The idea of doing so seems well supported in the current medical literature.

 

Screen Shot 2018-09-15 at 1.11.41 PM

Writing in 2010, Siu suggested that regulation of inflammatory processes in the body might limit progression of atherosclerosis.  Curcumin was one of several agents he suggested to target this process.[1]

 

A 2014 meta-analysis that combined data from six separate trials reported that curcumin effectively lowered c-reactive protein levels in the body, a measure of its anti-inflammatory actions. [2]

 

In another meta-analysis from 2014, the same author was unable to show that curcumin did anything to improve lipid profiles, though he did point out that his data was from older less absorbable forms of curcumin and that the newer products might prove to be effective yet.   [3]  This appears to be the case.  A 2017 paper reported that curcumin does indeed successfully modify lipid profiles though the patients in this trial were all diabetics.[4]   A new 2017 meta-analysis, combining data from 7 studies reported that curcumin may protect against CVD through improving serum lipid levels. So, the story seems to have changed [5]

the 3 of us

Curcumin is one of a short list of supplements that may fight against damage caused by Advanced Glycation End Products (AGEs) that are now considered the underlying culprit in atherosclerosis. [6]

Most important, curcumin helps an artery recover after stent placement [7]  and prevents restenosis of the artery, that is the stent clogging up with plaque. [8]

This being the case I was surprised to discover that cardiologists at Denver’s Kaiser Permanente have been telling patients not to take curcumin.  This idea comes from their pharmacists, who are concerned that curcumin might trigger excessive bleeding.  They quote a Natural Medicines Database: “Turmeric has antiplatelet effects. Turmeric might cause excessive bleeding if used perioperatively. Tell patients to discontinue turmeric at least 2 weeks before elective surgical procedures.”  These cautions apply during surgery.  Whether or not they are warranted for surgery is open for debate.  Kaiser’s cardiology department has extended these cautions to all patients taking blood thinners, fearful of some interaction.

 

I’ve been having patients copy the link to the abstract of a recent study and forward it along to their doctors.  The study published in August 2018 looked at patients taking the anticoagulant Plavix (clopidogrel), aspirin, and thyroid and then gave them liposomal curcumin (Meriva).  No changes in blood coagulability were seen after adding the curcumin. In other words, curcumin did not increase risk of bleeding.

 

Taking curcumin does not pose a risk for these patients.  More likely it will help them.

 

This new study does not come out of the blue.  A 2013 paper that looked at the effects of combining curcumin with various anticoagulants in rats reported that it “has no effect on anticoagulation or antiplatelet aggregation.”[9]

 

 

 

 

Here’s a link to the new study’s abstract:

https://www.ncbi.nlm.nih.gov/pubmed/30070343

Eur Rev Med Pharmacol Sci. 2018 Aug;22(15):5042-5046. doi: 10.26355/eurrev_201808_15647.

Interaction study between antiplatelet agents, anticoagulants, thyroid replacement therapy and a bioavailable formulation of curcumin (Meriva®).

Hu S, Belcaro G, Dugall M, Peterzan P, Hosoi M, Ledda A, Riva A, Giacomelli L, Togni S, Eggenhoffner R, Cotellese R.

Abstract

OBJECTIVE: The objective of this clinical study is to evaluate possible interactions between antiplatelet agents, anticoagulants, thyroid hormone replacement therapy and a formulation of curcumin (Meriva®) that resulted effective for the complementary treatment of osteoarthritis.

 

PATIENTS AND METHODS: Interaction between antiplatelet agents and Meriva® was evaluated by measuring anti-platelet activity with the in-vivo bleeding-time (BT) in patients assuming acetylsalicylic acid or ticlopidine or clopidogrel from at least 2 years. The BT was evaluated before and after 10 days of supplementation with Meriva®. The interaction between anticoagulants and Meriva® was evaluated in patients using warfarin or dabigatran for previous venous thrombosis. The INR level was evaluated before and after 10 days of supplementation with the curcumin formulation. Thyroid function tests in hypothyroid patients using LT4 replacement therapy (Eutirox®) were evaluated before and after 15 days of supplementation with Meriva®. Similarly, levels of glycemia and glycated hemoglobin were evaluated in diabetic patients in treatment with metformin, before and after 10 days of supplementation with the studied product.

 

RESULTS: After 10 days of supplementation with Meriva® the average BT value was not significantly different for patients assuming acetylsalicylic acid, ticlopidine or clopidogrel at standard dosages. Similarly, after 10 days of Meriva® treatment, the INR level in the two groups of patients assuming warfarin or dabigatran was not statistically different from that observed at baseline. In the analyzed patients assuming LT4 or metformin, no interactions between the therapy and Meriva® were observed.

 

CONCLUSIONS: Results from this non-interaction clinical study suggest that Meriva® does not interfere with the antiplatelet activity of the most common antiplatelet agents nor alters the INR values in stable patients assuming warfarin or dabigatran. Similarly, dosages of LT4 or metformin do not need to be adjusted in case of complementary treatment with Meriva®.

PMID: 30070343

 

 

 

 

kayak headshot 9-18

References:

 

  1. Siu D. A new way of targeting to treat coronary artery disease. J Cardiovasc Med (Hagerstown). 2010 Jan;11(1):1-6. doi: 10.2459/JCM.0b013e32832e0af3.
  2. Sahebkar A. Are curcuminoids effective C-reactive protein-lowering agents in clinical practice? Evidence from a meta-analysis. Phytother Res. 2014 May;28(5):633-42. doi: 10.1002/ptr.5045. Epub 2013 Aug 7.
  3. Sahebkar A. A systematic review and meta-analysis of randomized controlled trials investigating the effects of curcumin on blood lipid levels. Clin Nutr. 2014 Jun;33(3):406-14. doi: 10.1016/j.clnu.2013.09.012. Epub 2013 Sep 25.
  4. Panahi Y, Khalili N, Sahebi E, et al. Curcuminoids modify lipid profile in type 2 diabetes mellitus: A randomized controlled trial. Complement Ther Med. 2017 Aug;33:1-5. doi: 10.1016/j.ctim.2017.05.006. Epub 2017 May 29.
  5. Qin S, Huang L, Gong J. 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. Nutr J. 2017 Oct 11;16(1):68. doi: 10.1186/s12937-017-0293-y.
  6. Yamagishi SI, Matsui T, Ishibashi Y, et al. Phytochemicals Against Advanced Glycation End Products (AGEs) and the Receptor System. Curr Pharm Des. 2017;23(8):1135-1141. doi: 10.2174/1381612822666161021155502.
  7. Lu Q1, Ye F2, Yang X3, et al. Accelerated Recovery of Endothelium Function after Stent Implantation with the Use of a Novel Systemic Nanoparticle Curcumin. Biomed Res Int. 2015;2015:291871. doi: 10.1155/2015/291871. Epub 2015 Jun 8.
  8. Patel HJ, Su SH, Patterson C, Nguyen KT. A combined strategy to reduce restenosis for vascular tissue engineering applications. Biotechnol Prog. 2006 Jan-Feb;22(1):38-44.
  9. Planta Liu AC, Zhao LX, Lou HX. Curcumin alters the pharmacokinetics of warfarin and clopidogrel in Wistar rats but has no effect on anticoagulation or antiplatelet aggregation. Med. 2013 Jul;79(11):971-7. doi: 10.1055/s-0032-1328652. Epub 2013 Jun 27.

 

 

Advertisements