Curcumin is yellow curry powder, also called turmeric, Indian saffron, “Haldi,” or “curry powder.” It is a yellow pigment present in turmeric and constitutes 2%–5% of turmeric. Curcumin is the same spice that led Vasco de Gama to discover India and Christopher Columbus to discover the Americas in the 15th century. It was first isolated by Vogel in 1842, its structure was identified as diferuloylmethane by Milobedzka in 1910; and it was synthesized by Lampe in 1918.
The first paper ever to be published on curcumin was in Nature in 1949, where it was described as an antibacterial agent.[1] Two decades later, it was described as a cholesterol-lowering agent (in 1970),[2] as a blood-sugar-lowering agent in diabetic subjects (in 1972),[2] and as a nonsteroidal anti-inflammatory agent (in 1973).[3]
HOW IS CURCUMIN CURRENTLY USED?
Practitioners of the ancient science of Ayurveda (which, translated from Sanskrit, means “the science of long life”) have used curcumin for thousands of years, not only in food preparation, cosmetics and skin care, and textile manufacture, but also for a variety of medicinal purposes. Among these medicinal uses of “the golden spice” are treatment of infection and proinflammatory diseases, promotion of bone and wound healing, promotion of good digestion and a healthy weight, prevention of diabetes, and maintenance of good health overall. It is often sold as a 500-mg capsule.
There is a growing body of research assessing the health benefits of ingesting curcumin. Almost 40 clinical trials of curcumin have been completed and another 40 are currently ongoing. Most of these studies are small pilot trials. Various online links for curcumin are described and more detailed information can be found at www.curcuminresearch.org.[6]
WHAT IS THE EVIDENCE RELATED TO CURCUMIN AND CANCER?
Most of the evidence to date for health benefits of curcumin is based on preclinical research, with some early-phase clinical trials in humans. Curcumin has exhibited several properties consistent with many potential cancer applications. It has been shown to inhibit dozens of transcription factors (including NF-kB, activating protein-1, nuclear factor 2-related protein, Wnt/b-catenin, signal transducers and activators of transcription-3, NOTCH, hypoxia-inducible factor-1a, peroxisome proliferator-activated receptor-, etc.); downmodulate various inflammatory gene products (including tumor necrosis factor; interleukins 1, 6, and 8; and cyclooxygenase-2, 5-lipoxygenase); and downregulate adhesion molecules (eg, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, endothelial leucocyte adhesion molecule-1). It induces apoptosis through activation of both extrinsic and intrinsic pathways. More than 100 molecular targets have been identified that curcumin can modulate, and as many as 25 of these targets are modulated by direct binding to curcumin.[7]
Based on these properties, it is possible that curcumin may be helpful in preventing a broad array of cancers[8] and as an anticancer agent,[9,10] by directly impacting tumor cells and by sensitizing tumor cells to both radiation and chemotherapy.[11–13] In addition, anti-inflammatory effects of curcumin may make it useful in treating depression, neuropathic pain, and fatigue.[2,14]
These applications still need to be studied in definitive clinical trials. However, one of the challenges with curcumin is its bioavailability. It has poor solubility in water, a short biological half-life, and its bioavailability after oral adminsitration is low.[15] It is difficult to get biologically active quantities into humans through supplemental consumption. Curcumin may be more bioavailable when mixed with oils such as olive, corn, coconut, or turmeric oil, or liquids including milk and coconut milk; taking curcumin several times during the day may also improve its bioavailability.[16]
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
