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Curcuma: Case Study -- Turmeric and NSAID withdrawal

by Jill Hoppe

Medical Herbalism 11(4):6-9

African American Female, 300 lbs, 6’2” tall, 35 years old. Diagnosed with Systemic Lupus Erythematosus in 1991. Suffers from chronic joint inflammation and pain, especially in knees, elbows, hands. Always exhausted. Currently under the care of a Veteran’s M.D. She consulted me in an effort to decrease medications, lose weight and increase energy.

 Medications (upon initial consultation)

10 mg. Prednisone 1x daily: Corticosteroid (anti-inflammatory)

10 mg. Methotrexate weekly: Anti-rheumatic.

25 mg. Indomethacin 3x daily: Nonsteroidal anti-inflammatory (NSAID).

30 mg. Lansoprazole 1x daily: Acid pump inhibitor, anti-ulcerative. Blocks enzymes in the parietal cell of the gastric mucosa thereby inhibiting gastric secretion. Prescribed in response to Indomethacin.

200 mg. Plaquenil 2x daily: Anti-malarial. Used to decrease Prednisone dose.

Vicodin: Narcotic-analgesic (pain reliever) combination. Taken during flares.

1000 mg. Tylenol: Non-narcotic analgesic. For pain during menses.

Supplements (upon initial consultation)

12 mg BetaTene (beta-carotene,alpha-carotene, cryptoxanthin, zeaxanthin, lutein, lycopene), 20,000 IU vitamin A, 100 IU vitamin D3, 100 mcg selenium, 400 IU vitamin E, 10 mg zinc, 200 mg vitamin C, vitamin B complex, 1 mg folic acid, 325 mg ferrous sulfate, 25 mg DHEA

History

Military service 1989-1991. Multiple innoculations during this period. Lupus onset 1991 with butterfly-shaped rash across cheeks and nose, red spots all over neck, chest, back, arms and legs with high fever, six months following birth control pill usage. Initial birth control dose decreased due to bleeding, anemia (anemic as a child also). Currently anemic. Taken 10-60 mg. Prednisone for seven years and has been unable to drop below 10 mg. After initial 60 mg. prescribed Prednisone, she was unable to sleep, relax. Sleeping pills prescribed. Diagnosed Sjogren’s Syndrome (chronic, systemic inflammatory disorder characterized by dryness of mouth, eyes, mucus membranes) after a few years on Prednisone, all except three teeth fell out, currently wears dentures (she said Lupus patients are now warned of this with Prednisone use). A few years after initial symptoms, Prozac (selective serotonin reuptake inhibitor) was prescribed for depression. She was having marital problems, “no man could put up with what I was going through.”  Experienced increased depression and apathy on Prozac. Eventually divorced, without emotion, which she attributed to Prozac. Apathetic towards disciplining her son on Prozac. Overwhelming exhaustion. She said M.D. prescribed speed, which she didn’t take. Currently unable to decrease medications without resultant flares. Recently started a detox diet after reading a book (fruit, brown rice, steamed vegetables for 1 week.), then attempted an herbal colon cleanse, which triggered a flare requiring hospitalization. She had difficulty breathing, M.D. said herbs stimulated her overactive immune system. Flares once or twice monthly, especially during menses or when “I eat something that doesn’t agree with me.” Flares resolve in a few of days.  Increasing Prednisone dose usually required. Hospitalized yearly after Christmas, occasional cane required due to painful walking.

Diet

 High in processed foods, lacking in nutrients. Not enough fluids. At work, lunch is typically fast food hamburgers, fries and a soda. Average 10 cups coffee daily. Craves chocolate, sugar and eats daily. Frequent sodas.

Client Overview

Antibiotic Use: Urinary infections as teenager, Bronchitis, 1990 antibiotics for rash (1991 diagnosed as Lupus).

Surgeries/Biopsies: C-section for birth of son, kidney and bone marrow biopsy.

Exercise: Walks 10 minutes daily, occasional aerobics for 15 min. Profuse sweating, fatigue, green phlegm result.

Allergies: Potatoes, tomatoes cause joint soreness, inflammation. Diarrhea with milk, orange roughy.

Hair: Increased loss with Methotrexate, wears a wig.

Nails: Curved with humps, indentations.

Head: Headaches with flares, caffeine withdrawal.

Eyes: Blurred vision with flares and headaches.

Nose and sinuses: Very dry mucus membranes. Diagnosed Sjogren’s Syndrome.

Cardiovascular: Normal blood pressure. Occasional chest pain with shortness of breath. Chest x-rays didn’t display abnormalities. White spots on hands that don’t go away when rubbed (Raynaud’s). Increased dizziness within past year.

Gastrointestinal: Gas, bloating, fatigue, stomach distention after meals. Burning in stomach without food, dissipates after eating (M.D. prescribed Lanzoprazole, but it hasn’t assisted). Extreme fatigue after meals, difficult to stay awake at work. Pain when palpating stomach, more pronounced in upper left and right quadrant. “It feels like a plank.” Two bowel movements daily, up to four. Occasional diarrhea, no constipation. Dark, heavy stools (test for stool blood turned out negative). With fat intake, stools are lighter, more frequent (i.e., four or more movements with pizza). Doesn’t digest protein well but eats a high animal protein diet.

Urinary: Urinary tract infections often as a teenager. Nocturia.

Renal: Impaired function. 1991 kidney biopsy revealed Glomerulonephritis (kidney inflammation characterized by protein and blood in urine).

Reproductive: Four - six day cycle with painful cramps, headaches. Night sweats increased during menses, around 1:30 - 2:00 a.m.

Skin: Clear, dry. Particularly dry on feet, lower extremities. Hot over aching joints during flares.

Musculoskeletal: Joint and neck pain, increases with flares.

Neurological: Occasional numbness, tingling in legs, ankles, increases after sugar intake or when decreasing Methotrexate. Occasional headaches.

Endocrine: M.D. suspects low thyroid, said long-term lupus patients may develop hypothyroidism. Dry skin, dislikes cold. Edema in ankles, lower legs. Night sweats, increased during menses.

Psychological: Terrified of the dark since childhood, inside only. Sleeps with lights on nightly. Vivid dreams previously, no recall now (she attributes to medications). No memories prior to age five, sister remembers clearly, they shared rooms. Doesn’t recall any traumatic experiences. She looks in the mirror and doesn’t believe she is who she sees. Difficulty establishing relationships, doesn’t date, too tired.

Treatment Summary

The following treatment was applied over a ten month period. Starting slow and tracking symptoms was imperative.  M.D. should be informed of any added herb or supplement.  Many symptoms were potential side effects of medications.  Education topics included nutrition, food allergies, NSAIDs and leaky gut, Raynaud’s, cosmetic ingredients to avoid, liver congestion, dehydration, EFAs, breath work, pineal gland and light sensitivity, anemia and low hydrochloric acid, hypothyroidism, power of thoughts.

Food Suggestions

Eliminate all gluten (wheat, oat, rye, barley), dairy, nightshade vegetables from diet.  A gluten allergen was confirmed by removal and rechallenge.

Ensure adequate fluid intake in the form of water, herbal teas and vegetable juices.

Increase antioxidant-rich fresh fruits and berries (rich in bioflavonoids that stabilize cell membranes of inflammatory cells and provide support for blood vessels, including glomeruli capillaries), and fresh vegetables.  Juice fresh vegetables such as beet, apple, celery, carrot, parsley, radish. Organic preferred.

Immune soup recipe with burdock root, reishi and shiitake mushrooms, dandelion root, ginger root, vegetables and millet.  Eat only when not flaring.

1 teaspoon each of fresh ground seeds daily: Linum usitatissimum (flax):  For protective effects on mucosa. Source of trace minerals, anti-oxidants, lignans, linolenic acid. Sesame seed:  Demulcent, source of calcium, trace minerals. Silybum marianum (milk thistle):  Source of trace minerals, flavonoids, essential fatty acids, glutathione. Demulcent, hepatoprotective, anti-hepatotoxic, anti-oxidant, cholagogue.

Decrease intake of simple carbohydrates, processed foods. Avoid chips, baked goods, cookies and other sources of bad oils and high sodium (Prednisone may cause body to retain sodium/water and water retention observed with long-term NSAID use).

Replace red meat with non-allergic fish.  Cold water, fatty fish (wild preferred) such as salmon, sardines, mackerel, eel, herring, tuna.  Fish provide a rich source of EPA and DHA, which compete with arachidonic acid for enzymes and provide precursors for anti-inflammatory prostaglandins.

Chew food thoroughly, each bite 25x.

Supplements

250 mg. probiotics daily.  Formula that includes bifidus for lower intestinal microflora support (i.e., Bifidobacterium breve, B. longum, B. bifidum, B infantis).  Assists in repopulating beneficial intestinal microflora, which aids in synthesis of B vitamins, promotes digestion.  Eat foods rich in prebiotic fructo-oligosaccharides:onions (also high in quercitin), asparagus, bananas, garlic.

Food grown multi vitamin/mineral complex or ½ teaspoon trace minerals daily.

High quality fish oil supplement daily.

800 mg. magnesium, 400 mg. calcium (in this ratio).  List of food sources provided.

Increase vitamin C to 1-3 grams daily.  Anti-inflammatory, anti-oxidant, promotes iron absorption. List of food sources provided.

Increase natural vitamin E to 800 IU daily.  Anti-inflammatory, anti-oxidant.  Inhibits production of pro-inflammatory chemicals from arachidonic acid.  List of food sources provided.

Herbs/Other

4 teaspoons (approximately 10,000 mg) Curcuma longa (turmeric) powder daily with 450 mg. Ananas sativas (bromelain) mixed in water throughout the day or equivalent encapsulated between meals. Anti- inflammatory and digestive support.

Kelp fronds (preferred) or tablet daily (follow dosage on bottle). Rich source of calcium, magnesium, iodine, potassium, iron, trace minerals.

Blue Green Algae (Spirulina) tablets daily, follow dose on bottle. Anti-oxidant, immune-enhancing, prebiotic, source of trace minerals, vitamins and essential fatty acids, chlorophyll.

Leaky Gut Tea - 4 cups daily

3 p Althea officinalis root (marshmallow). Assist with dry mucus membranes of the mouth and throat. Anti-inflammatory, demulcent, diuretic, emollient, expectorant.

1 p Matricaria recutita flower (chamomile). Anti-inflammatory, digestive antispasmodic, musculotropic, carminative, promotes wound-healing, hypnotic, nervine, antibacterial, antifungal in GI tract.

1 p Mentha piperita leaf (peppermint) Carminative, digestive antispasmodic, diaphoretic, anti-emetic, antiseptic, analgesic.

1 p Foeniculum vulgare seed (fennel). Anti-inflammatory, antispasmodic, antimicrobial, carminative, hepatic.

1/4 p Glycyrrhiza glabra root (licorice). Anti-inflammatory, antispasmodic, antihepatotoxic, anti-ulcer, demulcent, mineralocoricoid properties, immune stimulant. Note: This was removed due to corticosteroid contraindications (prolongs the biological half life of corticosteroids).

Signature: Pour 2 cups boiling water over 1 heaping tablespoon herb mixture. Let stand until cool. Strain and drink.

Other

Overnight infusion. 4 cups daily, 3 - 4 times weekly (can alternate with leaky gut tea).

3/4 cup spring-harvested (before budding) Urtica dioica leaf (nettle). Before budding required to avoid irritating kidneys. Source of calcium, magnesium, chlorophyll. Anti-inflammatory, anti-allergenic, antirheumatic, alterative, diuretic, expectorant, hemostat, lithotropic, rubefacient.

1/4 cup Althea officinalis root (marshmallow) Assist with dry mucus membranes of the mouth and throat. Anti-inflammatory, demulcent, diuretic, emollient, expectorant.

Signature: Pour 5 cups boiling water over herbs in tightly sealed container. Let stand overnight. Strain and drink.

Oil infused Hypericum perforatum (St. Johnswort) flowers to rub topically over painful joints. Anti-inflammatory.

Other

Mimilus Flower Essence for fear of darkness and a sensitive constitution.

Motivational tapes to assist with changing poor eating habits

Walk at least one-half hour daily.

Results

She was able to eliminate all drugs with exception of following: reduced Prednisone to 8 mg and still on 10 mg. Methotrexate.

Improved diet substantially. Decreased sugar, caffeine and attempts to avoid allergens. “I would have never believed that I could gain more control by being careful about what I eat. It’s good to know I’m not at the mercy of this disease.”

Rheumatoid specialist measured antinuclear antibodies and said reading was the closest to normal since lupus onset in 1991.

Lost 35 lbs.

Flares decreased.

Perceived increased health and energy for the first time in seven years “I’m no longer afraid of someone walking by my desk and finding me asleep!”

Family has commented on her renewed vibrancy. They are working on their own diets as a result.

Digestion improved. The “plank” she felt across her upper left/right quadrant is gone.

Not hospitalized after Christmas for the first time in years.

Joint pain decreased in the morning, ankles don’t swell as much at night.

Ankle edema decreased in general.

Previous curved humps on nails subsided.

Handles anxiety, fear better. “I don’t feel the anxiety in my stomach.”

Previous green phlegm during exercise changed to clear phlegm.

Comments

The intestinal wall is the barrier separating food proteins and bacteria in the intestine from the rest of the body and a thick mucosal lining, rich in healthy villi, is an important component. When the barrier becomes compromised through overuse of antibiotics, steroids, NSAIDs, birth control pills, poor diet, food allergies, increased exposure to environmental toxins, stress, etc. increased intestinal permeability (leaky gut syndrome) may result. A leaky gut allows partially digested foods, toxins and bacteria to be absorbed into the blood stream, prompting an immune response. If a partially digested food fragment resembles the same string of amino acids as a self protein, the body’s immune system will not only attack the invader but may attack ‘self’ tissues (molecular mimicry). Autoimmune diseases, including lupus, may be triggered by a leaky gut. NSAIDs may compromise the intestinal wall further. To assist healing a compromised gut, factors that contribute should be discontinued. In this case, daily ingestion of food allergens, inadequate nutrition, NSAIDs and other medications were suppressing her body’s healing mechanisms. Although she has much work ahead of her, eliminating food allergens and improving nutrition were challenging and important steps. I believe these steps enabled her to replace the NSAID and other drugs with safe herbal anti-inflammatories and cut-down on Prednisone.
 
Copyright 2001 Paul Bergner