Dozens of hepatitis cases linked to turmeric supplement consumption, ANSES warns

08 Jul 2022 --- Used for centuries in food and medicine for its health benefits, over 100 reports have been received on adverse effects of turmeric in Italy and France. In Italy, 20 cases of hepatitis have been recorded involving people consuming turmeric supplements, and 15 cases in France are potentially connected to curcumin or turmeric supplements, the French National Food Safety Agency (ANSES) flags.

“Cases reported in our vigilance system and experimental animal data suggest that turmeric can be a direct cause of hepatitis. Furthermore, the Italian authorities conducted analyses of the food supplements whose consumption caused hepatitis,” Fanny Huret, coordinator of the expert appraisal at Anses, tells NutritionInsight.

“In none of the samples analyzed was the presence of contaminants (heavy metals, hepatotoxic synthetic colorant, drugs etc.) detected,” says Huret.

Safe ingredient?ANSES provides data for linkage between turmeric consumption and hepatitis, but industry members disagree.
Responding to the report, Arjuna Natural, stresses turmeric is a safe ingredient.

“Turmeric has a recorded history of thousands of years in Asia, especially in the Indian sub-continent where it forms a part of food and medicine in significant quantities. If turmeric were to be toxic and cause hepatitis, there would be a clear indication long ago,”  Dr. Benny Antony, joint managing director at Arjuna Natural, tells NutritionInsight.

“Turmeric is bioavailable and safe. As a producer of natural curcumin, our experience has been that 100% turmeric is safe, and this has also been clinically studied.” 

Adverse effects
Turmeric is a flowering plant originating from Curcuma longa, known for its many health benefits such as digestive, antioxidant and anti-inflammatory properties.

Huret adds that frequently reported adverse events from turmeric consumption are headache, dizziness and digestive disorders, such as diarrhea or nausea. She also emphasizes the importance of correct dosage.

“Indeed, low doses have an antioxidant effect (hepatoprotective) and high doses would have a pro-oxidant effect (hepatotoxic),” she adds.

“Moreover, curcumin interacts with certain medications such as anticoagulants, cancer drugs and immunosuppressants. This interaction can make them less safe or less effective. Therefore, the Agency advises individuals taking these medications not to consume food supplements containing curcuma without seeking medical advice.”

Antony explains that turmeric “has been a leading ingredient in herbal nutraceutical ingredients” and is backed by scientific and historical evidence. “Curcumin has been one of the most researched ingredients in recent times. Many studies attest to its benefits and safety under scientifically validated conditions.”

Dosage and bioavailabilityThere is a need for increased information on daily dosage to prevent poisoning. 
Antony highlights that all curcumin supplements in the market do not contain 100% turmeric, therefore he stresses the lack of studies on supplements, safety and consumer awareness. He adds that increased efforts are needed to guide consumers to choose studied and safe ingredients in supplements overall.

“The scientific data available on this subject are scarce. Further studies are needed to understand this toxicity better. The opposite effects on oxidative stress could be explained by the amount of curcumin bioavailable in the human body,” says Huret.

However, even though both industry and the agency emphasize the lack of studies in the field, a link has been found between health risks and turmeric, stressing the need for further research in supplements.

“ANSES’ work has led to the proposed hypothesis to explain the role of turmeric or curcumin – the active molecule in turmeric – in the triggering of hepatitis. The dose of turmeric or curcumin is an essential parameter,” Huret says.

Formulations enhancing effects
The European Food Safety Authority set the daily acceptable intake of 180 mg, based on a person weighing 60 kg. ANSES recommends the daily dosage to remain below 153 mg for 60 kg adults, as exposure to turmeric in the French diet reaches 27 mg for turmeric-heavy diets. 

Although this dosage is set for “classic form of curcumin” consumption, the agency notes the growing use of formulations that increase the bioavailability and, therefore, the effects of curcumin in food supplements when mixed with other ingredients.

“Curcumin has very low bioavailability, i.e., it is poorly absorbed into the bloodstream and rapidly eliminated by the body. Manufacturers have developed various formulations to increase this bioavailability and thereby enhance the effects of curcumin,” explains Huret.

Bioavailability is also stressed by the agency to be transparent to consumers and set an explicit limitation of daily dosage to avoid cases of poisoning.

“Not all curcumins are the same”Historical and scientific evidence for the health benefits of turmeric, although further studies are required to ensure its safety.
The industry for supplements has recently received criticism due to lack of transparency and regulations, as well as who should be the driver for change. However, the lack of scientific research is a recurring issue.

“As responsible players in the nutraceutical space, we consider safety the most serious concern. While it is easy to generalize, we understand that all curcumins are not the same. 100% Turmeric has a long history of use and is considered safe. However, one must go with clinically documented studies. The benefits of curcumin are noted in countless studies,” Antony says.

ANSES noted the growing use of formulations that increase the bioavailability and, therefore, the effects of curcumin in food supplements. For example, those that combine curcumin with other ingredients such as piperine. 

The agency advises companies marketing food supplements to provide detailed data on the bioavailability of their products so that a specific maximum daily intake level may be defined. 

Other supplements than turmeric have previously received attention for their adverse effects, such as vitamin D, vitamin E and beta carotene. Additionally, researchers have claimed that vitamin supplements are a waste of money, as it does not contribute to the stated health effects. However, exceptions are made for people with vitamin deficiency or other health conditions.

By Beatrice Wihlander