Evidence explainerTurmeric and curcumin

Turmeric With Black Pepper: Better Absorption, and a Liver Safety Question

Piperine from black pepper helps the body absorb curcumin. US investigators have also noted it in several products linked to liver injury.

By Kymata Health editorial teamPublished October 9, 2026Last reviewed October 9, 2026

Medical review pending. Written by our editorial team from the studies cited below; a credentialed clinician has not reviewed it yet. Educational only, not medical advice.

Key takeaways

  • Combining curcumin with piperine from black pepper is one way to improve its bioavailability [1].
  • NCCIH warns that liver damage has been reported in some people taking bioavailable curcumin formulations [1].
  • In 10 US liver-injury cases, 5 people were hospitalised and 1 died; 3 of 7 products tested also contained piperine [2].
  • LiverTox notes several dozen cases of clinically apparent acute liver injury linked to turmeric products [3].

The evidence, graded

Pulled from our monograph evidence tables. Grades follow our evidence-grading policy.

  • Grade BImprovedKnee joint pain and functionTurmeric and curcumin · Meta-analysis · n=1,009 · 2018 · PMID 29622343Curcuminoid formulations relieved knee pain and improved function more than placebo, with no difference in safety outcomes.
  • Grade CWorsenedPost-exercise muscle soreness and damage markersTurmeric and curcumin · Meta-analysis · n=349 · 2024 · PMID 39008500Curcumin reduced muscle soreness (MD -0.61) and creatine kinase (MD -137.32), lowered IL-6 and improved range of motion versus control.

Why black pepper is added

NCCIH describes formulations designed to increase how much curcumin the body absorbs, including combining it with piperine from black pepper [1]. Our sources give no head-to-head outcome trial of turmeric with and without piperine [1].

The liver reports

In a 2023 report of 10 turmeric-associated liver-injury cases from a US network, 5 people were hospitalised and 1 died, and onset was typically 1 to 4 months after starting [2]. Of 7 products tested, 3 also contained piperine, and the investigators suggested combination with black pepper may partly explain the rise in cases [2].

LiverTox notes several dozen cases of clinically apparent acute liver injury linked to turmeric products [3]. NCCIH says liver damage has been reported with bioavailable formulations [1].

Warning signs

NCCIH advises stopping turmeric or curcumin immediately and contacting a health care provider if fatigue, nausea, poor appetite, dark urine or yellowing of the skin or eyes appears [1]. It also says turmeric supplements may be unsafe in pregnancy [1].

For what the trials found on benefits, read turmeric and curcumin benefits.

Quick answers

Is turmeric with black pepper safe?

Most people tolerate turmeric, but liver injury has been reported, including with bioavailable formulations, and piperine appeared in 3 of 7 products tested in US cases [1][2].

How soon did liver problems appear?

In the US case series, onset was typically 1 to 4 months after starting [2].

What are common turmeric side effects?

NCCIH lists nausea, vomiting, acid reflux, stomach upset, diarrhea and constipation [1].

Keep reading

Full monographs

Related articles

Browse the full Supplement & Nutrient Encyclopedia or all supplement articles.

References

  1. [1]Turmeric: Usefulness and Safety (last updated April 2025). National Center for Complementary and Integrative Health, 2025.
  2. [2]Liver Injury Associated with Turmeric-A Growing Problem: Ten Cases from the Drug-Induced Liver Injury Network [DILIN]. Am J Med, 2023. PMID 36252717
  3. [3]Turmeric (LiverTox: Clinical and Research Information on Drug-Induced Liver Injury). National Institute of Diabetes and Digestive and Kidney Diseases (LiverTox), 2012. PMID 31643876

Turmeric and curcumin and other dietary supplements are not intended to diagnose, treat, cure or prevent any disease, and these statements have not been evaluated by the FDA. Talk to your clinician or pharmacist before starting a supplement, especially if you take prescription medicines. This page has no product or affiliate links.