Why we don’t use Black Pepper

TURMERIC AND BLACK PEPPER – MAYBE IT’S NOT ALL IT’S CRACKED UP TO BE!

We often get asked why we don’t use Black Pepper or the Black Pepper extract Piperine in our formulas.

“But it is 2000% more absorbed, so it must be better” is the most common statement out there.

Unfortunately the study (1) were they are referring has had its wording marketed and re-marketed several times to now have misleading “alternative facts” derived from it. It actually states that “the increase in bioavailability was 2000%”, not the absorption. This bioavailability is due to a couple of key physiological processes that cause irritation in the small intestine, create more inflammation throughout the body, stop normal liver detoxification pathways and lead to more substances crossing the intestinal lumen (similar to leaky gut syndrome) putting the immune system under more pressure (1,2,3,4,5,6,7,8,9).

Regrettably what also isn’t publicized in the comments and by the marketing people of the “2000%” is that the study they refer to also states several of these issues in the text.

Unfortunately the majority of people taking these Turmeric/Curcumin + Piperine supplements are taking them to help combat those very same issues!

With these effects is the Black Pepper now causing a symptomatic feedback loop, where the perceived cure is causing part of the ongoing physiological symptoms, prolonging the usage or requiring higher doses overtime to have an effect that was originally felt?

Since there is a clarification that needs to be addressed, let’s look at what actually is difference between absorption and bioavailability?

Absorption is defined as the movement of a substance across the outer mucosal membranes of the GI tract, while bioavailability is defined as availability of substance into systemic circulation or site of pharmacological actions.

So is adding Black Pepper/Piperine to Turmeric/Curcumin really useful to increase the absorption?

The simple answer is yes. But is it beneficial for you against the possible effects it causes?

What the numbers do tell us in the original 2000% study is that they used 20mg Piperine with 2g Curcumin in 8 healthy male participants, 20-26 years of age, weighing between 50-75kg and were fasting from 10pm the night before (there was 10, 2 dropped out due to non-medical issues). This is not a wide range of participants, and not typically the range of people or those seeking these supplements for their health issues. Also to note here is the fasting protocol, it doesn’t measure the typical usage of Curcumin supplementation when it is taken day-to-day or with food and how the processing of the Curcumin is actually influenced by other substances in the small intestine at the time or being processed by the liver and subsequent elimination from the body.

Typically supplement design today carries 5mg Piperine per dose, and 500-1000mg Curcumin standardized extract (standardized to contain 95% Curcuminoids) this is a 75% decrease in Piperine used to garner the highly publicized 2000% claim that gets thrown around without being questioned by many supplement companies marketing divisions, unqualified social media health aficionados and/or self-proclaimed “health influencers”.

As specific figures are measured from specific dosages, you cannot really expect to get the same results by taking 25% of the dose. Do you know of any drug or substance that you can take 25% of and get the same results as the scientifically validated dose recommendation?

As there have been many studies on this specific subject over the last 24 years, and vast improvements in physiological studies, testing and formulations to avoid these issues, why is it that people always refer back to this particular study? Basically its sensationalism on a massive number, 2000% – a marketers dream!

As mentioned there have been many other studies that have had different varying outcomes, one study in 2006 (3) demonstrated only a doubling of Curcumin absorption in the plasma using 5mg Piperine & 2g Curcumin. But was noted that this was a measure of “total Curcumin”  which is a combination of “free Curcumin” in its active form and the “conjugated form” or the Curcumin that has been processed by the body and ready for elimination. This is something the 2000% study doesn’t address and could also be one of the factors for such a rise and sudden decrease in Curcumin levels seen in Figure 2 of this study (1) between 30 – 60 minutes post consumption. More studies will need to be performed to address this issue on just how much “free or active” Curcumin is actually bioavailable.

How Piperine increases absorption and bioavailability of Curcumin

Piperine is a direct inhibitor of liver and intestinal detoxification pathways. Piperine also directly damages the intestinal wall and increases intestinal permeability (1,2,4,6,7,8,9).

These main 2 pathways, block drug and other normal hormonal and metabolic toxin pathways of detoxification and can lead to excess and delayed excretion of toxic metabolites and prolong the effects of other drugs and substances in your body.

This cannot be recommended for people suffering from gastrointestinal disorders and chronic or systemic inflammation. Unfortunately these are some of the main reasons for consumer use.

What are the effects of taking Piperine that can cause higher inflammation internally?

• Increased intestinal permeability (think something like leaky gut syndrome)
• Damages intestinal wall membranes
• Blocks and inhibits of hepatic and intestinal detoxification pathways

Is it possible to increase the absorption and bioavailability of Curcumin without causing side effects like those seen with Piperine?

Yes, from a holistic or Naturopathic stand point, there are several goals that get taken into account when we design formulas;

• Increase the absorption of Curcumin into the bloodstream

• Reduce the conversion of Curcumin to low activity metabolites, this means keeping Curcumin in its active and free form

• Use natural ingredients and that do not increase intestinal permeability

• Increase the bioavailability with a source of fat such as avocado, animal fats, nuts and coconut oil etc

• More isn’t necessarily better. The body has a maximum absorptive capability for not only Curcumin but many other substances. As there has been thousands of years of empirical data for the use of Turmeric in SE Asia, dosages can be formulated around this data for maximum deliverability. Another factor here is waste and costs involved, those that create a product that has more than what is required not only show that they lack the skills and knowledge in herbal medicine, and have done so to only market a “stronger, better, you need more” mentality, creating expensive poo, less money in consumers’ pockets and also leading people to believe in things that aren’t beneficial to them. A study in 2006 (10) shows that 95% of pure Curcumin powder is not absorbed for doses up to 8g/day. Amongst the group of 26 participants only 2 had increases in blood Curcumin levels with doses at 10-12g/day, and this was at a level that would have no sufficient increase in health benefits to that of people taking traditional dosage levels. For a mental picture of how much you would need to consume to achieve this, that is the equivalent approximately of 240 grams of Turmeric root or at least 15 teaspoons of Turmeric powder!

References:

1. Shoba G., Joy D., Joseph T., Majeed M., Rajendran R., Srinivas P.S. Influence of piperine on the pharmacokinetics of curcumin in animals and human volunteers. Planta Med. 1998;64:353–356.
2. Salvo-Romero et al. Función barrera intestinal y su implicación en enfermedades digestivas. Rev Esp Enferm Dig. 2015 Vol. 107, Nº 11, 686-696.
3. Anand P, Kunnumakkara AB, Newman RA, Aggarwal BB. Bioavailability of curcumin: problems and promises. Mol Pharm. 2007 Nov-Dec;4(6):807-18.
4. Kesarwani K., Gupta R. Bioavailability enhancers of herbal origin: An overview. Asian Pac J Trop Biomed. 2013 Apr; 3(4): 253–266. 
5. Subash G.C., Patchva S., and Aggarwal B.B. Therapeutic Roles of Curcumin: Lessons Learned from Clinical Trials. AAPS J. 2013 Jan; 15(1): 195–218.
6. Prasad S., Tyagi A.K., Aggarwal B.B. Recent developments in delivery, bioavailability, absorption and metabolism of curcumin: the golden pigment from golden spice. Cancer Res Treat. 2014;46(1):2-18. doi:10.4143/crt.2014.46.1.2
7. Han HK. The effects of black pepper on the intestinal absorption and hepatic metabolism of drugs. Expert Opin Drug Metab Toxicol. 2011 Jun;7(6):721-9.
8. Hewlings SJ, Kalman DS. Curcumin: A Review of Its Effects on Human Health. Foods. 2017;6(10):92. Published 2017 Oct 22.
9. Singh J, Dubey RK, Atal CK. Piperine-mediated inhibition of glucuronidation activity in isolated epithelial cells of the guinea-pig small intestine: evidence that piperine lowers the endogeneous UDP-glucuronic acid content. J Pharmacol Exp Ther. 1986 Feb;236(2):488-93.
10. Lao CD, Ruffin MT 4th, Normolle D, Heath DD, Murray SI, Bailey JM, Boggs ME, Crowell J, Rock CL, Brenner DE. Dose escalation of a curcuminoid formulation. BMC Complement Altern Med. 2006 Mar 17;6:10.