September 2013 Issue

Natural Remedies for Tummy Troubles — Research Shows Herbs Can Relieve Symptoms in Patients With GI Diseases
By Melinda Lund, MS, RD
Today’s Dietitian
Vol. 15 No. 9 P. 18

All illnesses that affect the gastrointestinal tract (GI) are classified as digestive diseases, including those of the esophagus, stomach, duodenum, jejunum, ileum, ileocecal complex, large intestine (ascending, transverse, and descending), sigmoid colon, and rectum.

According to the National Digestive Diseases Information Clearinghouse (NDDIC), digestive diseases affect 60 to 70 million people. They lead to 105 million ambulatory care visits and 13.5 million hospitalizations annually, amounting to $141.8 billion in costs.

People who suffer from digestive diseases, such as ulcerative colitis, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and gastroesophageal reflux disease (GERD), often seek conventional medications for much-needed relief. However, for various reasons, some people prefer to use alternative medicine instead. Research has found that herbal remedies can help relieve symptoms of these diseases, which can benefit those who prefer a more natural route to health and wellness.

This article will discuss the most common digestive diseases and the herbal remedies that research shows can help treat and manage them.

GERD
To be diagnosed with GERD, which affects 20% of the population, an individual must experience acid reflux symptoms more than twice per week.1

According to the National Institute of Diabetes and Digestive and Kidney Diseases, GERD is a more serious form of gastroesophageal reflux (GER), which is common among Americans. GER occurs when the lower esophageal sphincter opens spontaneously at various times or doesn’t close properly, causing stomach contents to rise up into the esophagus in a process known as acid reflux.

When acid reflux occurs, individuals can taste food or stomach acid in the back of the mouth. When the stomach acid touches the lining of the esophagus, it can cause heartburn or acid indigestion.

Occasional GER is common and doesn’t necessarily mean a person has GERD. However, persistent reflux or GERD eventually can lead to more serious health problems, such as erosive esophagitis, stricture of the esophagus, and Barrett’s esophagus, a condition in which the tissue lining the esophagus is replaced by tissue that’s similar to the intestinal lining, increasing the risk of a rare cancer type called esophageal adenocarcinoma.

Conventional treatment for GERD includes over-the-counter antacids and other medications that treat the disease’s symptoms in various ways. Antacids such as Mylanta, Maalox, and Alka-Seltzer neutralize stomach acid; proton pump inhibitors such as Prilosec, Prevacid, and Protonix aim to heal the lining of the esophagus and relieve symptoms; and H2 blockers such as Zantac, Pepcid, and Tagamet decrease acid production. While many of these treatments can be effective, they can cause side effects such as constipation, diarrhea, and fatigue.

Stress has been known to exacerbate GERD symptoms, so incorporating stress-relieving techniques and supplements, such as valerian root, vitamin B complex, and folic acid, can go a long way toward healing. “One of the best natural remedies I’ve found for GERD is to decrease stress,” says Kathy Mankofsky, RD, LD, a dietitian at Mercy Hospital in St Louis. “In high-stress states, the body can produce more acid.” Practicing mind-body techniques, including meditation and yoga, also can help relieve stress.

For more natural remedies to relieve symptoms, dietitians can recommend the following herbal medicines:

Anti-Inflammatories/Antispasmodics
Chamomile (Chamaemelum nobile): A member of the Asteraceae family, the medicinal part of the chamomile plant is the flower head, which is gathered just before blooming and then dried. It contains flavonoids and volatile oils that have anti-inflammatory (alpha-bisabolol and matricine), antispasmodic (alpha-bisabolol oxides A and B), and muscle-relaxing properties. German chamomile specifically is used to treat GERD; inflammation, irritation, and spasms of the GI tract; indigestion; IBS; IBD; gastritis; and other illnesses.2

Mucoprotective
Licorice (Glycyrrhiza glabra): A shrub in the Fabaceae family, licorice holds its medicinal properties in the rhizome. The glycyrrhizic acid within its triterpenoid constituent may increase gastric mucosal blood flow and stimulate gastric mucosa repair, which soothes irritated mucous membranes associated with IBS, gastritis, and other GI diseases.3,4 Suggest clients and patients buy deglycyrrhizinated licorice, which means the glycyrrhizin has been removed and won’t produce the side effects associated with licorice, such as hypertension, hypokalemia, and edema.

Slippery elm (Ulmus rubra): A traditional Native American remedy, this herb comes from the inner bark of a deciduous tree native to eastern Canada and the eastern and central parts of the United States. Slippery elm is dried and produced in the form of capsules, teas, and tinctures and is used to protect, soothe, and heal irritated mucous membrane tissue in the esophagus, stomach, and intestinal membranes.5,6

IBD
According to the Mayo Clinic, IBD involves chronic inflammation of all or part of the digestive tract. Primarily, IBD includes ulcerative colitis and Crohn’s disease. Ulcerative colitis causes long-lasting inflammation in part of the digestive tract. Crohn’s disease causes inflammation anywhere along the lining of the digestive tract and often spreads deep into affected tissues.

The following herbs may help relieve symptoms:

Aloe (Aloe vera): Aloe is a perennial succulent plant that’s native to Africa but grown throughout the world. The plant contains 99% water and yields both aloe gel and aloe latex, which have distinct properties with different uses. The aloe gel has been shown to help reduce inflammation in the GI tract in ulcerative colitis patients.7 It’s also been shown to reduce diarrhea in IBS and IBD patients.8

Boswellia (Boswellia serrata): A member of the Burseraceae family, the medicinal part of the boswellia tree is the gum resin that’s found in its bark. Boswellic acids reduce leukotriene formation, which slows the progression of inflammatory conditions. This action has been shown to reduce inflammation and increase remission rates in ulcerative colitis patients, and it’s been found to be as effective as sulfasalazine (Azulfidine), a sulfa drug used to treat ulcerative colitis and Crohn’s disease.9,10

IBS
According to the NDDIC, IBS is a functional GI disorder, meaning it’s a problem caused by changes in how the GI tract works. People with a functional GI disorder have frequent symptoms, but the GI tract doesn’t become damaged. Therefore, it isn’t a disease; it’s a group of symptoms that occur together that affects 15.3 million people in the United States.11

The most common symptoms of IBS are abdominal pain or discomfort, often reported as cramping, along with diarrhea and/or constipation.

Dietitians can recommend the following natural IBS remedies:

Probiotics: While past research has shown that probiotics have limited effectiveness in the treatment of IBS, recent studies have found that specific probiotics, such as Lactobacillus plantarum, L plantarum + Bifidobacterium breve, and Streptococcus faecium can decrease the severity and frequency of abdominal pain.12

There have been early, promising research results, but more research is needed regarding the effectiveness of probiotics in the treatment of IBS and other digestive diseases.

Peppermint oil (Mentha x piperita): A member of the mint family, the medicinal properties of peppermint are found in its dried state. Peppermint has more than 100 components currently identified, including volatile oils, flavonoids, and phenolic acids. It can be used as a smooth muscle relaxant.

In clinical trials using enteric-coated peppermint oil for IBS compared with placebo, peppermint oil showed statistical significance in alleviating general IBS symptoms.13

Putting It Into Practice
In addition to recommending herbal remedies, dietitians also should recommend dietary modifications to help decrease symptoms of digestive diseases. Many clients and patients living with digestive diseases eat foods that may exacerbate symptoms and cause preventable inflammation.

“A carefully planned diet can make a positive difference in individuals with digestive diseases,” says Lynn Langenberg, RD, LD, regional director of mercy service at Mercy Health System in Springfield, Missouri. “Individualization is a key word since a person’s response to fiber and lactose may vary as well as individual responses to stress and eating schedule. The benefit of symptom reduction and improved health is invaluable to our clients and to those of us who suffer from digestive disturbances.”

RDs should suggest clients and patients keep a food journal to identify food intolerances. In the journal, clients should write down the foods they eat and record the time and duration of symptoms or flare-ups.

To learn more about herbal remedies and GI diseases, research reputable resources from herbal experts that provide evidence-based information, such as Tieraona Low Dog, MD, who currently is a faculty member at the Arizona Center for Integrative Medicine at the University of Arizona; David Winston, RH (AHG), an herbalist and ethnobotanist with more than 40 years of training in Cherokee, Chinese, and Western herbal traditions; and the American Botanical Society. Depending on your role as a nutrition professional, you may be able to help teach future dietitians about the place natural remedies have in treating digestive disorders.

“In considering the first line of treatment for any disease, we work with our dietetics students to consider food and/or other natural remedies,” says Kristen Williams, MS, RD, LD, program director for the Cox College combined master’s in nutrition diagnostics/dietetic internship program in Springfield, Missouri. “Often we find that the drug treatment has led to more problems, which typically results in yet another drug to treat those symptoms or problems. If a significant change in the diet itself isn’t effective, we certainly want to look at the range of natural remedies as the next option.”

Remember to always consider drug and herbal interactions with patients. Find out from their physicians if the herb you’re recommending may hinder the patient’s treatment or cause negative side effects. Even though herbs are natural, they could be contraindicated for patients taking certain medications.

— Melinda Lund, MS, RD, is a freelance nutrition writer and a medical nutrition therapist at Mercy Integrative Medicine in Springfield, Missouri.

 

References
1. El-Serag HB, Petersen NJ, Carter J, et al. Gastroesophageal reflux among different racial groups in the United States. Gastroenterology. 2004;126(7):1692–1699.

2. Kuhn MA, Winston D. Herbal Therapy & Supplements: A Scientific and Traditional Approach. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2008:117.

3. Kuhn MA, Winston D. Herbal Therapy & Supplements: A Scientific and Traditional Approach. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2008:291.

4. Bone K, Mills S. Principles and Practice of Phytotherapy. Philadelphia, PA: Churchill Livingstone; 2000:465-478.

5. Rakel D. Integrative Medicine. 2nd ed. Philadelphia, PA: Saunders; 2007:42.

6. Bock S. Integrative medical treatment of inflammatory bowel disease. Int J Integr Med. 2000;2(5):21-29.

7. Langmead L, Feakins RM, Goldthorpe S, et al. Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Aliment Pharmacol Ther. 2004;19(7):739-747.

8. Davis K, Philpott S, Kumar D, Mendall M. Radomised double-blind placebo-controlled trial of aloe vera for irritable bowel syndrome. Int J Clin Pract. 2006;60(9):1080-1086.

9. Gupta I, Parihar A, Malhotra P, et al. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res. 1997;2(1):37-43.

10. Gupta I, Parihar A, Malhotra P, et al. Effects of gum resin of Boswellia serrata in patients with chronic colitis. Planta Med. 2001;67(5):391-395.

11. Sandler RS, Everhart JE, Donowitz M, et al. The burden of selected digestive diseases in the United States. Gastroenterology. 2002;122:1500-1511.

12. Kim YG, Moon JT, Lee KM, Chon NR, Park H. [The effects of probiotics on symptoms of irritable bowel syndrome]. Korean J Gastroenterol. 2006;47(6):413-419.

13. Grigoleit HG, Grigoleit P. Peppermint oil in irritable bowel syndrome. Phytomedicine. 2005;12(8):601-606.

 

ADVERTORIAL