ONE WILD WORLD — NEWSLETTER

Issue #024  |  Things Companies  |  May 2026

In 2024, consumers around the world spent more than ten billion dollars on supplements marketed as anti-inflammatory. Turmeric capsules. Fish oil softgels. Krill oil. Ginger extract. Resveratrol. Quercetin. Boswellia. The marketing told a simple story: chronic inflammation is the silent driver of disease, and these products will reduce it. Both halves of that story have problems. The first half is a definition that quietly drifted away from what medicine actually means by the word. The second half is a category of products that, in healthy adults, mostly fail to do the one thing they are sold to do. The gap between the marketing and the science is where the industry lives.

BY THE NUMBERS

For most of the twentieth century, when a doctor said anti-inflammatory, they meant something specific. They meant a class of drugs — non-steroidal anti-inflammatories like ibuprofen and naproxen, corticosteroids like prednisone, and a newer generation of biologics like Humira and Enbrel — that reduce acute inflammation. The kind you can see and measure. Swelling. Redness. Heat. Pain. The four classical signs of inflammation written down by Aulus Cornelius Celsus in the first century AD, which have been the working definition of the word ever since.

That category of drugs is a major chapter in modern medicine. The global anti-inflammatory drug market — the actual pharmaceutical category — is worth about $122 billion a year. It treats rheumatoid arthritis, inflammatory bowel disease, asthma, lupus, psoriasis, and dozens of other conditions where the inflammation is measurable, the target is known, and the drugs have to clear a clinical trial before they reach a pharmacy.

Somewhere around the year 2000, a different word started doing the rounds. Chronic, low-grade, systemic inflammation. The idea — perfectly respectable in its original form — was that the body could be running a slightly elevated inflammatory state at all times, below the level of any visible symptom, and that this state was implicated in heart disease, diabetes, depression, and the general process of ageing. There was real science behind it. The trouble started when the wellness industry noticed.

Chronic low-grade inflammation had three features that made it commercially perfect. It was invisible, so nobody could tell whether they had it. It was implicated in almost everything, so anything could be sold as a treatment for it. And it had no agreed clinical biomarker, so nobody could ever prove that a product wasn't working. The medical use of anti-inflammatory required a measurable disease and a measurable response. The wellness use of anti-inflammatory required neither. Over twenty years, the second meaning quietly absorbed the first.

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Acute inflammation has clear biomarkers, clear treatments, and a clear research literature. Chronic low-grade inflammation, in the wellness sense, has none of these things. Which is precisely why the wellness industry adopted it.

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Turmeric is the poster child of the anti-inflammatory supplement industry. The active compound, curcumin, has been the subject of thousands of peer-reviewed papers, most of them testing its effect on inflammatory markers, cancer pathways, and a long list of other biological systems in petri dishes and rodents. The global turmeric supplement market was worth about $1.6 billion in 2024 and is growing at over 8% a year.

There is a single, awkward fact about curcumin that the marketing has spent two decades politely declining to mention. It does not get into your blood. Curcumin has a water solubility of roughly 11 ng/mL, which is so low that researchers describe it as practically insoluble. When you swallow it, your intestine and liver rapidly metabolise it into conjugated forms — glucuronides and sulfates — which are then excreted in urine and faeces. The whole process takes hours. The fraction of free, bioactive curcumin that reaches systemic circulation, in the standard 95%-extract form sold in capsules, is generally measured at less than one percent. Most studies struggle to detect it at all.

To understand how extreme this is: in a Phase II clinical trial of advanced pancreatic cancer patients, researchers administered eight grams of curcumin per day — a dose so large it sits near the upper limit of human tolerability — and the resulting plasma concentrations were 22 to 41 nanograms per millilitre. Nanograms. A separate study gave colorectal cancer patients between 450 and 3,600 mg of curcumin daily for a week before they underwent surgery for liver metastases. When the surgeons examined the liver tissue, they could detect no curcumin in it at all. The supplement had passed through.

This is the technical fact the headline of this newsletter is built on. Curcumin is, for the typical consumer taking a standard turmeric capsule, a product whose primary biological journey is from mouth to toilet. The figure of 99% in the headline is, if anything, generous. The real figure is closer to 99.9%. What reaches a measurable level in your blood is dwarfed by what does not.

The industry has responded with bioavailability-enhanced formulations: piperine combinations (turmeric plus black pepper), liposomal curcumin, phytosome curcumin, nanoparticle formulations, lipid-based formulations. Some of these do increase plasma curcumin by factors of one hundred or more — which sounds impressive until you remember that one hundred times almost nothing is still almost nothing. And once you start measuring total curcumin (free plus the inactive conjugated forms), the bioavailability numbers in the marketing become almost meaningless as a measure of how much active drug actually reaches its supposed targets.

If curcumin is the poster child of the supplement-marketed-as-anti-inflammatory category, fish oil is its founding father. The global omega-3 supplement market was worth $7.68 billion in 2024 and is projected to reach $12.89 billion by 2030. Around 7.8% of US adults take an omega-3 supplement on a given day, according to the CDC. The product has been around for so long, and is so embedded in the language of healthy living, that the idea of questioning it now feels almost rude.

The supporting science came in two waves. The first wave was observational: populations who ate a lot of fatty fish — Greenland Inuit, coastal Japanese — had lower rates of heart disease. This produced the famous omega-3 hypothesis of the 1970s. The second wave was the early supplementation trials in the 1990s and 2000s, which suggested fish oil capsules reduced cardiovascular events in high-risk patients. The combined effect of these two waves was a cultural assumption that fish oil pills did, in some general way, reduce inflammation and reduce heart disease in everyone who took them.

The cultural assumption did not survive contact with large, well-controlled trials. The Muldoon trial at the University of Pittsburgh randomised 261 healthy adults to either 1,400 mg of EPA+DHA per day or a placebo for 18 weeks. Red blood cell levels of EPA+DHA rose by 64% in the supplement group — meaning the pills were doing what they were supposed to do in terms of getting omega-3s into the body. The effect on inflammation? Nothing. C-reactive protein: no change. Interleukin-6: no change. Four other pro-inflammatory cytokines measured ex vivo: no change. The authors concluded that 1,400 mg of EPA+DHA daily did not reduce common markers of systemic inflammation in healthy adults.

The VITAL trial, much larger and more recent, randomised 1,561 healthy older adults to fish oil, vitamin D, both, or placebo, and measured systemic inflammation over years. The result was the same: no reduction in inflammatory markers from the supplements. Steven Nissen, chief academic officer of the Cleveland Clinic Heart, Vascular and Thoracic Institute, has summarised the picture from the cardiovascular angle bluntly. In subsequent randomised controlled trials, he said, supplementation with omega-3 fatty acids has shown no benefits. Harvard Health Publishing, which is about as cautious an institutional voice as exists in American medicine, ran a piece in 2023 with the headline The False Promise of Fish Oil Supplements. Their own conclusion: there is no conclusive evidence that fish oil supplements reduce inflammation.

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Eating salmon is not the same as taking fish oil. The wellness industry has spent two decades selling you the second by quietly leaning on data from the first.

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Three structural features make this category remarkably resistant to consumer correction.

Unmeasurability. Acute inflammation has biomarkers — C-reactive protein, IL-6, fibrinogen, ESR — that a doctor can measure with a blood test. Chronic low-grade inflammation, as the wellness industry uses the term, has no agreed clinical biomarker. There is no test you can take after three months on turmeric capsules to confirm or deny that they are working. Every consumer is left with their own subjective sense of whether they feel better, which is a famously unreliable measure of anything.

The placebo effect on soft endpoints. The symptoms the supplements are marketed against — fatigue, brain fog, joint stiffness, low mood, general malaise — are all symptoms with large, well-documented placebo responses. People feel better on supplements. They also feel better on placebo pills. The difference, where it has been measured in controlled trials, is small and frequently statistically indistinguishable from zero. What you experience after starting a supplement is not necessarily what the supplement is doing.

The research literature is not as clean as it looks. A methodological review of 171 systematic reviews of curcumin published between 2003 and 2022 found that only 3.5% of them actually accounted for the variable bioavailability of the different formulations being tested. The wider literature is a mix of cell studies, rodent studies, small human trials, and industry-funded trials, with the strongest claims often resting on the weakest study designs. A consumer searching the internet for does curcumin reduce inflammation will find thousands of pages saying yes. A consumer searching for does oral curcumin reach the bloodstream will find a quieter and more sobering literature.

This is not health advice. We are not telling you what to eat or what to swallow. We are not saying inflammation is a fiction — chronic inflammation, in the medical sense, is a real and important phenomenon, and there are real things in life that affect it (smoking, sleep, exercise, body composition, dietary patterns over years). We are not even saying that no one ever benefits from any of these supplements: in specific clinical conditions, with specific high-dose formulations, under medical supervision, some of them have plausible effects.

What we are saying is narrower. We are saying that a multi-billion-dollar category of consumer products has been built on the gap between two things — a word whose medical meaning is precise, and a marketing meaning that is deliberately not — and that the everyday consumer experience of taking these capsules in the hope of reducing inflammation in their body is, in most cases, an experience of taking pills that their body promptly excretes. That is the trick. You can decide what to do with the information.

A multi-billion-dollar consumer category. A bioavailability problem the marketing prefers not to mention. Healthy-adult trials that show no reduction in inflammation markers. And a word that quietly changed meaning while everyone was busy reading the label on the back of the bottle.

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Anti-inflammatory used to mean a drug that reduced swelling. Now, most of the time, it means a supplement that reduced your bank balance.

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SOURCES

Nelson, K.M. et al. — “The Essential Medicinal Chemistry of Curcumin”, Journal of Medicinal Chemistry (2017) — landmark paper identifying curcumin as a PAINS/IMPS compound (Pan-Assay Interference & Improbable Metabolic Pathway)

Hewlings, S.J. & Kalman, D.S. — “Curcumin: A Review of Its Effects on Human Health”, Foods (2017)

Sharma, R.A. et al. — “Phase I clinical trial of oral curcumin: biomarkers of systemic activity and compliance”, Clinical Cancer Research (2004) — the original colorectal cancer / liver tissue study

Dhillon, N. et al. — “Phase II Trial of Curcumin in Patients with Advanced Pancreatic Cancer”, Clinical Cancer Research (2008) — the 8 g/day plasma concentration study

Jamwal, R. — “Bioavailable curcumin formulations: A review of pharmacokinetic studies in healthy volunteers”, Journal of Integrative Medicine (2018)

Stohs, S.J. et al. — “Comparative Pharmacokinetic Assessment of a Novel Highly Bioavailable Curcumin Formulation with 95% Curcumin”, Journal of the American College of Nutrition (2017)

Methodological review of 171 systematic reviews on curcumin bioavailability — Critical Reviews in Food Science and Nutrition (2023)

Muldoon, M.F. et al. — “Fish oil supplementation does not lower C-reactive protein or interleukin-6 levels in healthy adults”, Journal of Internal Medicine (2016)

Manson, J.E. et al. — VITAL trial reports on omega-3 fatty acids, vitamin D, and systemic inflammation, New England Journal of Medicine and JAMA (multiple papers, 2018–2020)

Harvard Health Publishing — “The false promise of fish oil supplements” (2023)

National Geographic — “Omega-3s are great for your health—but supplements may not be” (March 2025), quoting Steven Nissen (Cleveland Clinic)

Grand View Research — “Omega-3 Supplements Market Size & Share Report 2024”

Future Market Insights — “Curcumin Market Size, Growth & Trends 2025 to 2035”

Verified Market Research — “Turmeric Supplement Market Size, Share, Trends & Forecast 2025–2033”

CDC National Health Interview Survey — dietary supplement use data, 2017–2018

Centers for Disease Control and Prevention — chronic disease and inflammation data, 2023–2024 updates