Information & Resources for Dietitians

The CurQD® Compounds

Curcumin is the active compound extracted from the turmeric rhizome. The polyphenic is rich in anti-inflammatory and antioxidant properties and has been found in a large number of studies to induce remission in IBD patients and promote long-lasting remission maintenance. 

Curcumin targets inflammation through several mechanisms. The compound inhibits pro-inflammatory cytokines by blocking NF-kB signaling pathways (Olivera, Int Immunopharmacol. 2012), which when activated, can cause harmful immune dysregulation, severe inflammation, and tissue damage.  Curcumin suppresses the activity of interleukin-1 and TNFα, and prevents IL-1β-induced disruption of the organization of tight junction proteins, improving intestinal barrier function (Vounotrypidis, Autoimmun Highlights. 2013).  

Additionally, Curcumin has been found to neutralize the activity of reactive oxygen species (ROS), inhibiting ROS-generating enzymes such as LOX, COX, and xanthine oxidase (Sharifi-Rad, Front Pharmacol. 2020). Curcumin also boosts Glutathione (GSH) levels and can inhibit lipid peroxidation (Quiles, Arterioscler Thromb Vasc Biol. 2002).    

Curcumin has been found to exert a direct, regulatory effect on gut microbiota, and appears to be able to shift the composition of healthy and pathogenic bacteria. A review of the literature found that patients taking curcumin had less pro-inflammatory bacteria (e.g. prevotellaceae, coriobacteriaceae, enterobacteria, and enterococci) and higher levels of the anti-inflammatory bifidobacteria and lactobacilli (Zam, J Nutr Metab. 2018).

 

Qing Dai contains potent anti-inflammatory, antioxidant, antibacterial, antiviral, and immunomodulatory properties, showing “good clinical effect” on psoriasis, leukemia, and ulcerative colitis.  

A recent study found that Indirubin, an active component of Qing Dai, “markedly inhibits” NF-κB signals, resulting in the relief of severe inflammation in UC cases (Qi, Oncotarget. 2017). Qing Dai also activates the AhR pathway, further suppressing the production of proinflammatory cytokines such as TNF-α, IL-1, and IL-6, to name a few (Gu, Sci Rep. 2020).

Qing Dai also reduces serum MCP-1 levels and inhibits myeloperoxidase (MPO) activity, which is involved in oxidative stress that leads to chronic inflammation. Qing Dai additionally contains ligands for the aryl hydrocarbon receptor and induces the production of interleukin 22,  promoting the regeneration of the mucosa (Naganuma, Gastroenterology. 2018).

 

Guidelines

• The recommended dosing of CurQD® is individualized and determined by SCCAI/HBI validated activity scores filled by the patient on the Evinature website assessment page.
• Blood test for liver enzymes 4-8 weeks after starting QD1 is recommended. In a minority of patients, mild elevation of transaminases of up to X5 of ULN can occur, which resolve spontaneously when QD1 is continued at the same dose, or at lower doses. Rarely, QD1 may need to be discontinued because of elevated liver enzymes above X10 ULN. As this is generally unrelated to curcumin (Cura), the Cura component can usually be continued alone.
• Mild headache can occur in 5-10{f51dd843bf7d50e2c2524d7426524b60a5d6ed576877678000413abf86f76357} of patients starting QD1 and resolves usually within a few days either with continued dosing, reducing the dose for several days, or with temporary 2-3 days halting and resuming CurQD®.
• Rare reports from Japan have noted pulmonary hypertension in patients who consumed QD1 long-term, for over several months of therapy. The condition was reversible in all. Our uniquely-sourced QD was shown safe in the clinical trial and in our clinical experience with hundreds of patients without a single case of PAH. We therefore recommend adhering to our protocol of tapering QD1 and maintenance with Cura alone. If QD1 needs to be continued due to flare of disease, an echocardiogram may be warranted after 4-6 months to monitor for PAH. 
• As an ultimate caution, we advise against using QD1 in patients with a personal or family history of PAH, DVT, or severe cardiovascular, cerebrovascular, or liver disease.
• Drug interactions of curcumin are uncommon. Web-based interaction sources or our medical team can be consulted if in doubt. Drug interactions of QD1 have not hitherto been reported

Contraindicated during pregnancy 

In case of further questions please don’t hesitate to contact us at info@evinature.com. 

For the best results, we recommend the following dietary support for your IBD patients: 

Crohn’s Disease: Active – Mild- Severe Disease

The most evidence-based dietary treatment we have is Exclusive Enteral Nutrition (EEN). EEN is recommended by the European Crohn’s and Colitis (ECCO) and the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) as a first-line induction treatment for pediatric CD. Can be used in adults as well. Improves outcomes in CD via nutritional repletion, anti-inflammatory effects & influence on gut microbiota. EEN additionally reduces inflammation and leads to mucosal healing.   

Crohn’s Disease: Active – Mild to Moderate Disease 

Crohn’s Disease Exclusion Diet (CDED) is a combination of a whole foods diet together with 50% formula for induction of remission. CDED led to a reduction in inflammation in both children and adults in randomized control studies. In adult studies, endoscopic remission was reported as well. CDED is recommended as a treatment option by upcoming ESPEN guidelines. 

Specific Carbohydrate Diet (SCD) is shown in several small case series to be effective for induction and maintenance of remission in CD. 

Crohn’s Disease: Remission

Mediterranean Unprocessed Diet: Well-tolerated in patients with quiescent IBD, found to improve QoL and reduce disease activity in CD patients. 

Crohn’s Disease: Functional 

FODMAP might be helpful to control GI symptoms while in remission. Does not result in the reduction of inflammation, and is therefore only suitable for patients with inactive IBD suffering function symptoms. Should only be recommended for a short period of time, as FODMAP can negatively alter the microbiome.   

Ulcerative Colitis: Active disease

Unprocessed UC Diet. In cases of UC we are lacking evidence for one specific diet. Currently, we focus our recommendation to reduce exposure to foods found to be associated with UC and add food that might improve the microbiome. 

Ulcerative Colitis: Remission 

Mediterranean Unprocessed Diet: Well-tolerated in patients with quiescent IBD, and has been found to reduce symptom flare-ups, as well as potentially prevent the onset of dysbiosis. 

Ulcerative Colitis: Functional 

FODMAP: Might be helpful to control GI symptoms while on remission. Does not result in a reduction of inflammation, and is therefore only suitable for patients with inactive IBD suffering functional symptoms. Should only be recommended for a short period of time, as FODMAP can negatively alter the microbiome.