The 2019 curcumin crisis in Italy: what we know so far, and early lessons

On May 10, 2019, the Italian Ministry of Health publicly announced that 4 cases of acute cholestatic non-viral hepatitis had been reported, and associated with the consumption of food supplements. Investigators suspected a causal association with curcumin obtained from turmeric (Curcuma longa L.). By July, 21 cases had been reported by health authorities, involving 22 different food supplements, mostly by Italian brands. A significant proportion of products also included piperine as ingredient; it has also been reported that several products were adulterated with synthetic curcumin, presented to consumers as natural. Few cases of acute non-viral hepatitis associated with curcumin had been reported in the US, Australia and, apparently, Japan. The aim of the presentation is to summarize available information on the case-series, and in the literature; to report on the risk assessment and risk management decisions in Italy, and being debated in other Member States; to reflect on early lessons, particularly in reference to adulteration. Surveillance bias may have contributed to the clustering of cases, but risks to individuals with liver or biliary disease or undergoing medicinal therapy could have been anticipated. Both authorities and industry have shown to be only partially prepared to investigate and address case-reports. While synthetic curcumin is not believed to be the cause of the case-series at this stage, its safety is untested, and its labeling not appropriate. In this case, authorities and industry have become aware of the challenge posed by adulteration, but struggle to respond in an effective and decisive manner.