If you follow this blog on a regular basis, you must be aware of turmeric’s bioavailability problem. If you take turmeric by itself then most it is unabsorbed in the body.
Turmeric and curcumin (turmeric’s active ingredient) is insoluble in water and is poorly absorbed in the body. This reduces its therapeutic efficacy.
That is why we suggest that you should consume The Golden Paste. The Golden Paste incorporates both oil and black pepper which increase absorption and bioavailability of curcumin in the body.
Now black pepper is known as a bioavailability enhancer- it enhances absorption various compounds. So is it likely to cause drug interactions when included in diet?
Does Black pepper In Golden Paste Cause Drug Interactions?
Piper nigrum or black pepper is a commonly used spice. Its pungency is imparted by the active constituent- piperine.
Piperine constitutes 5-9% of black pepper. BioPerine is a standardized extract of black pepper that contains 95% piperine which is a natural bioavailability enhancer.
Black pepper and its pungent principle piperine are proven to stimulate gastric secretion and salivary secretion. Orally administered piperine is found to increase bile secretion in liver.
It is important to note that studies which show that piperine increases the level of digestive and pancreatic enzymes have used piperine at approximately 5 times the average amount included in human diet.
How does black pepper/piperine increase bioavailability of compounds?
Piperine increases bioavailability of compounds in the following ways :
• It inhibits the activity of various enzymes that metabolize drugs.
• It stimulates the activity of receptors in the intestine that absorb nutrients and other compounds.
• It inhibits the activity of P-gp, a protein that detoxifies compounds and pumps out drugs from cells.
• It decreases the production of certain metabolising agents such as glucuronic acid which metabolize and eliminate drugs before absorption.
Bano et. al report that 20mg piperine in combination with propranolol ( a drug used to treat hypertension) and theophylline ( a drug used to treat respiratory disorders) increases their concentration in blood and delays their elimination.
However it just enhances bioavailability and does not affect the activity the drug.
Sama et al report the increase in bioavailability of an anti-hyperglycaemic drug by piperineand this increased concentration potentiates it anti-hyperglycaemic activity without causing any side effects.
In Ayurveda, traditional Indian medicine, black pepper is used to increase bioavailability of herbal drugs. The first evidence dates back to 1928 in Pharmacopoeia Indica, where it is mentioned that long pepper was used to increase anti-asthmatic effect of vasaka leaves.
What is black pepper/piperine’s effect on curcumin’s bioavailability?
Shobha et al. have reported that 20mg piperine when given in combination with curcumin enhances bioavailability by 2000%. This is why black pepper and turmeric combination is always recommended for oral use. (Read Health Benefits of Turmeric and Black pepper, How to increase bioavailabilty of turmeric)
What is important to note that all these studies have made use of piperine and not dietary black pepper. So would it be appropriate to say that achieve the amount of piperine used in the studies we would have to eat quite a bit of black pepper?
What is the average consumption of black pepper?
Keith Singletary in his paper ‘Black Pepper: Overview Of Health Benefits’ writes that consumption of black pepper in India is 300mg/ day which is similar to the consumption pattern of Americans.
Piperine used in clinical trials is somewhere in the range of 10-20mg per dose. If piperine constitutes 5-9% of black pepper, that would mean consuming more than 200 to 400mg of black pepper per dose or ¼ tsp with every dose.
Considering you need a minimum of two doses a day that would add up to more than daily consumption.
What amount of black pepper is included in Golden Paste?
The Golden Paste recipe utilises 3.5g for ½ cup of turmeric powder; we consume not more than 1-2 teaspoon of the recipe so the amount of black pepper consumed is far less to cause drug interaction in comparison to the amount used in clinical trials.
Suresh et. al report that 44-63% of the piperine administered is not absorbed by the intestine and only 7-12% reaches the blood; however piperine is absorbed in larger amount than curcumin as per their study results.
Both dietary turmeric and black pepper interact with drug metabolizing enzymes an
Can dietary black pepper interact with your medicine?
The only study that would answer this query is ‘Piperine in food: interference in the pharmacokinetics of phenytoin’ by Velpandian et. al. This study had three parts.
In the first part animals were administered phenytoin, an anti-epileptic drug with or without piperine 0.6mg.
In the second part, six healthy volunteers were given phenytoin 300mg 30 minutes after consuming a soup that contained black pepper. In the third part, phenytoin was administered to animals via injections with or without administering piperine (10mg) orally.
We will focus on the human study. 6 volunteers were asked to fast overnight and then given a breakfast with or without black pepper (1gram). 30 minutes later they were given 3 tablets of phenytoin of 100mg each. This was below the therapeutic value.
2 weeks later similar settings were prepared but this time a breakfast lacking piperine was served. Blood samples were collected both the times.
Piperine content of the test soup provided for breakfast was 44mg (higher than regular dose). With the piperine the absorption constant was 1.78 times higher than that without piperine.
This rise in phenytoin levels could be due to inhibition of metabolism at intestines and liver. However the rise in concentration was below therapeutic range to cause anti-convulsive effect.
According to the researchers, with reference to epileptic patients who have a steady concentration of phenytoin in blood, pepper consumption could lead to increased concentrations of the drug and this may predispose patients to drug toxicity at therapeutic levels of phenytoin.
Not to miss this point, the researchers do mention that the amount of piperine is slightly more than normal consumption.
All in all dietary black pepper taken at a dose of 1g per serving ( higher than normal consumption) can increase concentration of certain drugs in the blood.
What does this mean?
Dietary black pepper is likely to work as a bioavailability enhancer but that is dependant on the amount you consume. Studies that show that black pepper and its active constituent piperine cause drug interactions use amounts higher than that taken in regular diet.
The amount of black pepper you would get from 1 teaspoon of Golden Paste would be far less than what is used in clinical trials and most of it is either not absorbed by intestine and whatever is absorbed works towards boosting curcumin’s bioavailability.
The black pepper in Golden Paste may increase the therapeutic effect of a drug consumed right after it. It would be best to avoid taking drugs at least at a 2-4 hour interval from when you consume Golden Paste.
The amount of black pepper in The Golden Paste is unlikely to cause any drug interaction; but dietary black pepper can still enhance bioavailability of concomitantly consumed drugs.
Its best to avoid consuming any drugs immediately or at least till a 2-4 hour gap since you consumed the Golden Paste.