By Yuli Widiyastuti, et al*
Since the end of 2019, the world has been shaken by the emergence of a new disease caused by a virus of the Corona type. Later, the World Health Organization (WHO) named the virus SARS-Cov-2 and Covid-19 for the disease. The virus that first appeared in Wuhan, China then spread to various countries, and has been designated a pandemic by WHO.
The announcement of Covid-19 entering Indonesia on March 2, 2020, people began to seek health efforts by utilizing traditional herbs. People used herbal medicine, especially empon-empon to increase their immune system, especially turmeric, temulawak and ginger. These ingredients then became rare and pushed up prices due to minimal supply.
However, in mid-March, through an Instagram social media account, a scientist from the Faculty of Biology, Institut Teknologi Bandung stated that based on a study of an article published in a scientific journal, consuming turmeric and temulawak will increase the body's susceptibility to Covid-19. Curcumin in turmeric and temulawak rhizomes is said to be able to increase the expression of the ACE2 enzyme (Angiotensin-converting-enzyme2) which is a receptor for Covid-19.
Curcumin is a single compound belonging to the polyphenol group which is the result of isolation from the rhizome of empon-empon. As a single compound, of course, it cannot be equated with drinking boiled turmeric and temulawak. Boiled turmeric and temulawak still contain dozens or even hundreds of chemical compounds with very diverse effects, not only polyphenols and polysaccharides, there are also flavonoids and alkaloids. Since its discovery more than 200 years ago, curcumin has also been studied worldwide. Various studies have shown that curcumin has various properties ranging from antibacterial, antioxidant, anti-inflammatory, anticancer, lowering blood sugar and also as an immunomodulator.
In the renin-angiotensin enzyme system, ACE2 acts as a negative regulator so that it can maintain cardiovascular, kidney, lung, fertility, and intestinal functions. Research shows that the ACE2 enzyme is a receptor or entry point for SARS-Cov-2. This has worried users of cardiovascular drugs included in the ACE inhibitors (ACE inhibitors, ACEis) and angiotensin receptor blockers (ARBs) groups. The results of the study showed that the use of both types of drugs would cause an increase in ACE2 enzyme levels. Professional associations in various countries responded that the clinical evidence supporting the link between increased ACE2 and the COVID-19 pandemic was not yet strong enough, so that COVID-19 patients who were also treated with ACEis and ARBs did not need to stop using their drugs.
Similar things happen, with concerns about the use of turmeric and temulawak which contain the active compound curcumin. The results of research by Pang et al., 2015, showed that curcumin maintains liver function by inhibiting myocardial fibrosis through modulation of the renin-angiotensin enzyme system and increasing ACE2 expression in experimental mice and concluded that curcumin has the potential as a therapeutic compound that can treat heart failure patients due to fibrosis who are intolerant to ACEis drug therapy. As with the case of the use of ACEis and ARBS drugs in patients exposed to Covid-19, there is no strong enough clinical evidence to state that curcumin can also increase the risk of Covid-19 infection. Based on the results of research by Hoffmann et al., 2020, SARS-CoV-2 virus infection depends not only on the binding of the viral S protein to ACE2 but also on the S protein priming by the host cell protease, namely the serine protease TMPRSS2. The study also revealed important similarities between SARS-CoV-2 and SARS-CoV infections, and identified potential targets for antiviral intervention. The statement that curcumin causes an increase in Covid-19 receptors contradicts many studies related to the clinical benefits of turmeric and temulawak as ingredients that can increase immunity.
On the other hand, the results of Bioinformatics research released in March 2020 using the bioinformatics modeling method (molecular docking), curcumin is able to bind to the SARS-CoV 2 protein receptor, namely through binding to the protease domain (6Lu7) and spike glycoprotein. This bond has the potential to inhibit Covid-19 activity. In addition, curcumin is known to inhibit the release of body compounds that cause inflammation or pro-inflammatory cytokines such as interleukin-1, interleukin-6 and tumor necrosis factor-α. The release of large amounts of cytokines, called a cytokine storm, can accumulate in the lungs and then cause shortness of breath. By inhibiting the release of cytokines, there will be no cytokine storm which has an impact on respiratory disorders. This mechanism explains the role of curcumin in preventing cytokine storms in viral infections (Sordillo and Helson, 2015). Curcumin also has the effect of inhibiting the growth process of the virus, either directly by physically damaging the virus or by suppressing cellular signaling pathways that are important in the process of virus replication. (Mathieu and Hsu, 2018).
Curcumin is a polyphenol compound which is the main compound of turmeric and ginger rhizomes. Curcumin is also contained in the rhizomes of several Curcuma species from the Zingiberaceae family. Turmeric and ginger are medicinal plants that are very commonly known to the Indonesian people and are used as ingredients in health drinks in almost all regions of Indonesia. The results of the Medicinal Plant and Herbal Medicine Research carried out by the Ministry of Health in 2012, 2015 and 2017, turmeric and ginger are included in the 10 types of medicinal plants that are most widely used by traditional healers from various tribes in Indonesia. Turmeric and ginger have been scientifically studied both in vitro and in vivo at the pre-clinical stage and clinical research and have been proven to have many health benefits (Cundell and Wilkinson, 2014).
In the United States, turmeric has been recognized as Generally Recognized as Safe as a food additive by the FDA (US FDA, 2013). Serious adverse effects in humans using high doses of curcumin have not been reported. A single oral dose escalation trial of curcumin up to 12 g/day in 24 adults was safe, with adverse effects, including diarrhea, headache, rash, and yellow stools, not related to dose (Lao et al., 2006). In a phase I clinical trial in Taiwan, curcumin supplementation up to 8 g/day for three months was reported to be well tolerated in patients with precancerous conditions or noninvasive cancers (Cheng et al., 2001).
Another clinical trial in the UK found that curcumin supplementation ranging from 0,45 to 3,6 g/day for four months was generally well tolerated by people with advanced colorectal cancer, although diarrhea and nausea were reported in two participants (Sharma et al., 2004).
The use of curcumin as a single compound is certainly different from research on the use of turmeric or temulawak as herbal ingredients or herbal medicine. In herbal medicine scientification and at the Hortus Medicus Herbal Research House, Center for Research and Development of Medicinal Plants and Traditional Medicines Tawangmangu, temulawak, turmeric, and meniran are medicinal plants that can improve fitness.
In a pre-post clinical trial in 2017 with a herbal formula of temulawak, turmeric, and meniran, it was proven to help improve cardiovascular fitness, and improve the quality of life of subjects, especially for the dimensions of physical role and pain. The herbal formula of temulawak, turmeric, and meniran is safe for blood, liver, and kidney profiles.
Thus, it can be concluded that turmeric and temulawak will increase susceptibility to Covid-19 is not based on a comprehensive scientific study at all. The use of turmeric and temulawak in the preventive realm to prevent the spread of Covid-19 is very relevant based on several pre-clinical and clinical studies of curcumin which have been shown to have immunomodulatory effects. For this reason, the public can continue to consume boiled turmeric and temulawak to maintain health, as exemplified by the head of state, Mr. Joko Widodo, whose daily life is very familiar with this drink.
*Yuli Widyastuti is a researcher at the Tawangmangu Center for Research and Development of Medicinal Plants and Traditional Medicines.
References are with the author.
*Grammar editor : English
