From spice to spotlight: Turmeric's safety concerns and the need for herbal education and enhanced regulation

Several mass media reports have linked turmeric supplements with drug-induced liver injury bringing herbal supplement safety into the public eye. These reports raise important areas of consideration for pharmacists, including turmeric safety and efficacy, pharmacists' roles in ensuring safe supplement use, and pharmacist advocacy for improved supplement regulatory processes. Turmeric's main pharmacologically active form, curcumin, is reported to have antioxidant, antiviral, antibacterial, and anti-inflammatory properties. Turmeric supplements show generally positive, albeit weak, evidence in benefitting a variety of disease states such as arthritis, metabolic disorders, and depression. While turmeric's safety profile is largely benign, several cases of turmeric-induced liver injury have been reported with most patients having a successful dechallenge. Mechanisms of liver injury are considered idiopathic with a hepatocellular injury pattern. Few parallels exist regarding dosing, timing, or patient characteristics that may increase risk of turmeric-induced liver injury. However, pharmacists are uniquely qualified to assess medication safety and efficacy, which extends to dietary and herbal supplements. Pharmacists can use recent media headlines as a catalyst for reflection and education. Comprehensive professional development on common dietary and herbal supplements will aid pharmacists in providing public education regarding supplement safety and limitations in the supplement regulatory process. Enhanced knowledge and awareness may lead to increased advocacy for supplement regulatory reform to improve transparency, safety, and efficacy.