Natural Remedies for Digestive Disorders

February 2014 Issue

Natural Remedies for Digestive Disorders
By Sherry Coleman Collins, MS, RDN, LD
Today’s Dietitian
Vol. 16 No. 2 P. 30

Learn what the research says about the most popular herbal remedies clients may be using

Thirty weeks into her pregnancy, Stephanie began to feel an intense burning sensation in her throat shortly after eating meals. Friends told her she was experiencing heartburn, which she never had before. She avoided taking over-the-counter medications for fear they might harm her baby.

At her next prenatal appointment with her midwife, Stephanie mentioned the heartburn and asked whether there were any natural remedies she could take to treat it. She left the office with a recommendation to take slippery elm lozenges and went on to become mostly heartburn free for the rest of her pregnancy.

Like Stephanie, more clients and patients are looking for ways to treat their digestive disorders with natural medicines sold over the counter. According to a 2007 National Institutes of Health–funded survey on the use of complementary and alternative medicines in the United States, roughly 38% of adults use natural remedies, such as diet-based therapies (eg, gluten-free diets) and herbs, among others.1 Also in 2007, it was estimated that nearly $34 billion was spent on complementary and alternative medicines, including about $15 billion on “nonvitamin, nonmineral, natural products.” Remarkably, this is equivalent to about one-third of out-of-pocket dollars spent on prescription drugs.

Despite the fact that many alternative treatments have been poorly studied and are loosely regulated, their popularity continues to grow. According to a market overview report by Natural Foods Merchandiser, total natural product industry sales for 2012 were nearly $81 billion, almost a 10% increase over 2011.2 With expected increases in drug and health care costs and ongoing issues concerning uninsured or underinsured Americans, using alternative treatments sold over the counter is expected to become even more attractive to clients and patients.

Healing Herbs and Spices
For centuries, various herbs and spices have been promoted as healers for the body. For instance, in Chinese and Ayurvedic medicine, both herbs and spices comprise the majority of treatments. Through thousands of years of use, medicinal substances have been identified and categorized to treat digestive and other common disorders. Despite the fact that many prescription drugs are fashioned after naturally occurring herbs, limited research has been done on their efficacy and safety when used alone or in combination for specific digestive problems.

Unlike prescription medications, natural remedies aren’t regulated by the FDA and therefore are more at risk of being adulterated or contaminated during processing. When clients ask about herbal and other natural therapies, it’s best to educate them about the ones that have been scientifically studied, caution them about those that don’t have much science behind them, and suggest they use them under the supervision of their primary care physicians, especially if they’re taking prescription drugs for other health issues.

The following is a review of the most common natural remedies clients may be using to treat digestive disorders and advice on how to counsel them.

Ginger
Ginger (Zingiber officinale) has a distinct and pungent flavor, and is known for relieving nausea. Denine Rogers, RD, LD, president of HEPSA Living Healthy, recommends raw ginger or ginger tea to clients as a natural remedy. “I’ve had multiple clients with cancer who have benefited from chewing raw ginger or drinking ginger tea during their treatments,” she says.

A study published in the May 2013 issue of Neurogastroenterology & Motility supported the use of ginger to alleviate nausea in cancer patients receiving chemotherapy3; however, the National Center for Complementary and Alternative Medicine (NCCAM) reports that research is mixed on ginger’s effectiveness in this area.

A meta-analysis published in the January 2006 issue of the American Journal of Obstetrics & Gynecology showed that ginger was effective for preventing and reducing postoperative nausea and vomiting.4

Kate Scarlata, RDN, a Boston-based dietitian and author of The Complete Idiot’s Guide to Eating Well With IBS and coauthor of 21-Day Tummy, recommends ginger for nausea and gastric emptying. She suggests patients take 1- to 1.2-g capsules to boost the frequency of antral contractions and accelerate gastric emptying to reduce nausea and symptoms of gastroparesis.5 “My clients who have ongoing nausea or gastroparesis have noted a benefit from ginger tea in that it quells their symptoms—perhaps taking a break from a hectic day with a warm cup of nurturing tea provides additional GI-calming benefits,” Scarlata says.

In a review from the NCCAM, ginger is considered safe and causes few side effects in most people; however, in large doses, it can cause stomach upset.6

Turmeric
Another herb used to treat common digestive disorders is turmeric (Curcuma longa). The active component in turmeric is curcumin, the substance that gives turmeric its yellow color. Turmeric frequently is used in Chinese and Ayurvedic medicine to aid digestion and liver function, along with a host of other nondigestive ailments.7 The World Health Organization supports the use of curcumin to treat acid reflux, flatulence, or atonic dyspepsia.8

Research has shown that turmeric has anti-inflammatory effects, which may explain its effectiveness in preventing relapses of ulcerative colitis. In one randomized controlled trial, fewer patients experienced relapse when taking turmeric with conventional treatment.9 However, there was no difference between the groups after one year. Researchers are in the process of examining ways to overcome turmeric’s reduced bioavailability after consumption.10

Like the researchers in the study, Scarlata recommends taking 2 g of turmeric to treat ulcerative colitis. “I encourage my clients to use turmeric for its potential anti-inflammation and GI-calming impact in their recipes. Widely used in Indian cuisine, turmeric adds a bright yellow color and a nice earthy taste to rice dishes, soups, and stews,” she says.

But while turmeric may be an effective treatment for some, it may not be safe for everyone. For example, turmeric may worsen gallbladder issues; it may cause stomach upset and exacerbate gastroesophageal reflux disease (GERD) symptoms in some people. It’s recommended that those scheduled for surgery discontinue using turmeric at least two weeks in advance, as it may slow blood clotting.

Milk Thistle
Native to Europe, milk thistle (Silybum marianum) has long been used as food and medicine.11 Currently, it’s used to treat alcoholic hepatitis, liver cirrhosis, liver poisoning, and viral hepatitis and to protect the liver from the damaging effects of toxins.11

Cristina Caro, MBA, RD, LD, a consultant dietitian and adjunct faculty member at Chattahoochee Technical College in Atlanta, recommends milk thistle to clients who experience sluggish digestion and metabolism and to keep liver cells healthy. She suggests patients take a 175- to 200-mg capsule of milk thistle per day for 60 days (standardized to contain 70% to 80% silymarin) to support the regeneration of liver cells. However, it’s important to know that while milk thistle has been shown to protect the liver from toxins in animal studies, human studies haven’t demonstrated this, according to NYU Langone Medical Center.11

In general, milk thistle is well tolerated, although GI side effects have been noted as well as its tendency to lower blood sugar, so caution should be used for anyone at risk of hypoglycemia.12

Slippery Elm
As the name suggests, slippery elm (Ulmus rubra) contains a gel-like substance called mucilage that coats the esophagus. It’s this substance that may make slippery elm an effective natural treatment for GERD. The herb is available as a lozenge, capsule, tincture, or tea to treat digestive distress.

According to the University of Maryland Medical Center, the doses health care practitioners may recommend to clients will vary based on the preparation. Typical doses may include 4 g of powdered bark dissolved in 2 cups of hot water three times per day or 400 to 500 mg in capsule form three to four times per day for four to eight weeks.13

Although slippery elm appears to have no serious side effects, its coating effect may reduce the absorption of certain medications, so it’s important to tell clients to take it separately from medications they may take for other illnesses. As with all herbal remedies, pregnant or breast-feeding women should discuss the use of slippery elm with their health care provider. The efficacy of slippery elm is widely reported, though no clinical trials have been found to support its use.

Pineapple Extract
“As a teen, I worked in a health food store and learned about eating pineapple to manage an upset stomach, and it’s worked for me since then,” says Cindy Culver, MS, RD, LD, a school nutrition professional in Smyrna, Georgia.

Culver found eating pineapple (Ananas comosus) helpful because it contains digestive enzymes that have been touted as a treatment for heartburn and indigestion. Many alternative and complementary medicine specialists promote bromelain (extracted from pineapple), one of the digestive enzymes, as a treatment for various conditions, and there’s some support that it may be effective as an anti-inflammatory to treat arthritis and muscle soreness. However, little evidence exists to support its use for digestive disorders.14

Large doses of bromelain may cause stomach upset, and it’s recommended that individuals stop using it at least two weeks before surgery because it may increase the risk of bleeding.

Probiotics
Probiotics are heavily marketed as a way to help regulate digestion. They’re a well-known treatment for antibiotic-induced diarrhea, and the use of probiotics containing bacterial strains such as Saccharomyces boulardii and Lactobacillus rhamnosus GG are supported in the literature.15

It’s important to recognize that of the many different probiotics products available, not all bacterial strains they contain have been studied for efficacy. Clients must choose the right type of probiotic for them and concern themselves with whether the bacteria they ingest can withstand stomach acid and make it into the intestines alive to be of any benefit.

Tracy Smith, RD, LD, a bariatric dietetics specialist, recommends probiotics to treat both diarrhea and constipation to her clients. However, a recent meta-analysis considers their use for constipation investigational and not yet supported by research.16

Rather than supplements, Connie Crawley, MS, RD, a University of Georgia Cooperative Extension nutrition and health specialist, recommends kefir milk to treat GERD. “I use it because of the probiotics. It has 10 [strains of bacteria] vs. the normal two in yogurt,” she says. She suggests clients drink at least a 1/2 cup per day but says a 1/2 cup per meal is even better. To increase its palatability, she recommends mixing half of the kefir milk with nonfat milk or choosing a flavored variety.

Food First
Dietitians know that altering the diet using medical nutrition therapy and eating specific foods can help treat the symptoms of transient digestive discomfort and chronic disease. The following are a couple of additional foods dietitians can recommend to clients to treat common digestive disorders:

• Milk: Drinking a glass of milk has long been recognized as a home remedy to treat heartburn. In fact, Rogers recommends it and reports success with her clients who suffer from GERD. It’s believed that milk may serve as a temporary buffer for stomach acid. The fat in milk may cause additional discomfort, but clients can avoid this by drinking fat-free or low-fat varieties. Anecdotal reports support the use of milk to treat GERD but not much clinical evidence exists.

• Honey: In a 2002 BMJ letter, Indian researchers reported success using honey to treat heartburn, noting it’s commonly used in Ayurvedic medicine.17 It’s believed that the viscosity of honey coats the upper gastroesophageal tract, preventing the stomach acid from rising. There appears to be no significant support for this in the literature, yet the combination of milk and honey to treat heartburn remains popular.

No Silver Bullet
Many natural remedies for digestive disorders are relatively harmless, and some may provide simple, inexpensive treatment for transient conditions, but they’re no magic cure for the more serious digestive disorders. It’s important for dietitians to make recommendations with the research (or lack of research) in mind and inform clients of the evidence for or against such remedies.

In addition, RDs should rule out more severe disease by taking an interdisciplinary health care team approach to helping clients with chronic digestive discomfort.

Regardless of an individual’s digestive disorder, modifying his or her diet by eliminating offending foods and reducing overeating is key. Lifestyle changes such as increasing physical activity and stopping smoking also are essential since obesity, smoking, and stress are known to increase GI distress.

Helping a client develop a nutrient-rich diet and overall healthful lifestyle are important tasks for the dietitian, despite other therapies the patient may be using. According to Patsy Catsos, MS, RDN, LD, a consultant dietitian at Nutrition Works and the author of IBS — Free at Last! “A whole foods diet that’s well matched to the patient’s needs is the best natural remedy.”

— Sherry Coleman Collins, MS, RDN, LD, is an Atlanta-based nutrition consultant, writer, and dietitian in private practice, specializing in food allergies and digestive disorders.

Efficacy of Nature’s Medicines

Product	Used to Treat	Efficacy
Ginger	Nausea, gastric emptying	Research shows it’s safe and effective for most people.
Turmeric	Dyspepsia, ulcerative colitis	Research supports efficacy as anti-inflammatory, but questions remain about its bioavailability; not safe for those with gallbladder disease; stop taking two weeks before surgery.
Milk thistle	Sluggish digestion	Human studies don’t support its efficacy; appears to be safe but may cause hypoglycemia.
Slippery elm	Gastroesophageal reflux disease (GERD)	Research is lacking on efficacy and safety, though no serious side effects are reported; caution should be used for pregnant or breast-feeding women.
Bromelain	Stomach upset	Research is lacking regarding the treatment of digestive disorders; may cause stomach upset and should be discontinued two weeks before surgery.
Probiotics	Diarrhea, constipation	Research supports use for antibiotic-associated diarrhea but not constipation; appears to be safe.
Milk	GERD	Research is lacking; appears to be safe.
Honey	Heartburn	Research is lacking; safe for those older than the age of 1.

References
1. The use of complementary and alternative medicine in the United States. National Center for Complementary and Alternative Medicine website. http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm. December 2008. Accessed December 2, 2013.

2. Marshall L. Staying ahead. Natural Foods Merchandiser. 2013;34(6):3-7. http://images.info.newhope360.com/Web/NewHopeNaturalMedia/%7Bcafe79ac-f211-40ab-8b80-3e242639eb4e%7D_NFM-MOV13-Standalone-v04.pdf

3. Walstab J, Krüger D, Stark T, et al. Ginger and its pungent constituents non-competitively inhibit activation of human recombinant and native 5-HT3 receptors of enteric neurons. Neurogastroenterol Motil. 2013;25(5):439-447.

4. Chaiyakunapruk N, Kitikannakorn N, Nathisuwan S, Leeprakobboon K, Leelasettagool C. The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis. Am J Obstet Gynecol. 2006;194(1):95-99.

5. Hu ML, Rayner CK, Wu KL, et al. Effect of ginger on gastric motility and symptoms of functional dyspepsia. World J Gastroenterol. 2011;17(1):105-110.

6. Ginger. National Center for Complementary and Alternative Medicine website. http://nccam.nih.gov/health/ginger. Updated April 2012. Accessed December 2, 2013.

7. Chainani-Wu N. Safety and anti-inflammatory activity of curcumin: a component of turmeric (Curcuma longa). J Altern Complement Med. 2003;9(1):161-168.

8. World Health Organization. WHO Monographs on Selected Medicinal Plants — Volume 1. Geneva, Switzerland: World Health Organization; 1999.

9. Kumar S, Ahuja V, Sankar MJ, Kumar A, Moss AC. Curcumin for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 2012;10:CD008424. doi:10.1002/14651858.CD008424.pub2.

10. Rajasekaran SA. Therapeutic potential of curcumin in gastrointestinal diseases. World J Gastrointest Pathophysiol. 2011;2(1):1-14.

11. Milk thistle. NYU Langone Medical Center website. http://www.med.nyu.edu/content?ChunkIID=21817. Reviewed August 2013. Accessed December 2, 2013.

12. Milk thistle. National Center for Complementary and Alternative Medicine website. http://nccam.nih.gov/health/milkthistle/ataglance.htm?nav=gsa. Updated July 2012. Accessed December 2, 2013.

13. Slippery elm. University of Maryland Medical Center website. http://umm.edu/health/medical/altmed/herb/slippery-elm. Updated May 7, 2013. Accessed December 2, 2013.

14. Bromelain. Medline Plus website. http://www.nlm.nih.gov/medlineplus/druginfo/natural/895.html. Reviewed April 24, 2013. Accessed December 2, 2013.

15. McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol. 2006;101(4):812-822.

16. Chmielewska A, Szajewska H. Systematic review of randomised controlled trials: probiotics for functional constipation. World J Gastroenterol. 2010;16(1):69-75

17. Math MV, Balasubramaniam P. Oesophagus: heartburn and honey [Rapid Response]. BMJ. http://www.bmj.com/rapid-response/2011/10/28/oesophagus-heartburn-and-honey. January 5, 2002.