Herbs and Supplements for GI Disorders

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Herbs and Supplements for GI Disorders

• Kathi J. Kemper, MD
• Caryl J Guth Chair for Holistic and Integrative
  Medicine
• Professor, Pediatrics, Public Health Sciences,
  Family Medicine WFUSM
• Instructor, Harvard Medical School
• Author, The Holistic Pediatrician

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Objectives (by the end of this session, you will
be able to)

• Define prebiotic
• List the herbs commonly used to treat colic
• Describe two ways of using ginger for nausea
• Recommend peppermint for IBS
• Describe the herbs and supplements most commonly
  used to treat constipation
• Identify reliable resources

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Probiotic case

• You have just recommended probiotics for one of
  your patients, based on Dr. Pietzaks lecture.
• The patients mother asks if theres anything she
  can do to help the probiotics work better.
• Is there?

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YES- Prebiotics

• Prebiotics are non-digestible food ingredients,
  such as non-digested short chain sugars and fiber
  that promote the growth of healthy bacteria in
  the intestines
• Examples beta glucan, arabinoxylan,
  oligosaccharides (galacto- and fructo-oligosacchar
  ides, FOS/GOS, inulin)

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Prebiotics - Benefits

• Increased numbers of healthy bacteria
  (Lactobacillus, Bifidobacter)
• Increased short chain fatty acids such as
  butyrate, which suppresses growth of unhealthy
  gut bacteriaand provide energy to gut muscoal
  cells
• Increased absorption of calcium and magnesium
• Decreased gut inflammation
• Mixed results on glucose, cholesterol,
  triglycerides

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Prebiotics Sources, Side effects

• Sources breastmilk, barley, bran and whole
  grains, legumes, such as beans vegetables such
  as leeks, onions, asparagus, greens such as
  chicory, spinach, burdock, fruits such as
  bananas, berries
• Doses 1 2 grams daily (adults)
• Side effects flatulence, diarrhea, allergies

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Colic

• The mother of a newborn infant asks you about
  natural remedies for her babys colic. The baby
  is crying 4 hours a day. Theyve tried car rides,
  bouncy seats, etc.
• The grandmother has recommended Gripe Water, star
  anise, and fennel tea
• What are these things and are they safe?

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Gripe Water

• Traditionally dill extract bicarbonate
  (Woodards), alcohol
• Dill, fennel and caraway are spasmolytics
• Some include ginger, fennel (Babys Bliss),
  chamomile, cinnamon and other herbs (Wellements)
• Some contain homeopathic remedies and activated
  charcoal (eg. Colic Calm)
• GRAS allergies possible small RCTs suggest
  benefits

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Star Anise for Colic

• Illicium verum used in Caribbean and Latino
  populations and China
• Adulteration with Japanese star anise (Illicium
  anisatum) leads to malaise, jitteriness,
  hyperexcitability, nystagmus, vomiting,
  hypertonia, seizures
• Concerns about adulteration have led to product
  recalls in Spain, Japan, Scotland, China, Japan,
  Netherlands
• Avoid unless youre sure of what you have!

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Colic herbs in J Pediatrics

• 1993 publication of randomized, prospective,
  double-blind, placebo-controlled trial
• Product Calme Bebi brand
• Extracts of fennel, German chamomile (Matricaria
  chamomilla), vervain (Verbena officinalis),
  licorice root
• Dose up to 150 mL TID for 7 days
• Eliminated colic in 57 of infants compared with
  26 in placebo (Plt0.01)
• NO adverse effects noted

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Nausea

• A teenager suffering from nausea associated with
  chemotherapy asks you if there are any natural
  remedies for nausea.
• She is tired of taking pills.
• She has already starting using SeaBands.
• Can you advise her?

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Ginger for Nausea

• Numerous RCTs suggest benefits of ginger in
  preventing and treating nausea

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Ginger Dosing

• Capsules 500 mg used in RCTs because easy to
  blind
• Dried/candied
• Tea
• 1 quart of water
• 1-2 inch slice of ginger root, cut up
• Boil simmer 15 minutes cool, sweeten
  peppermint?
• Gingerale? Depends on brand. Most commercial
  brands have no ginger, just artificial flavoring

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Irritable bowel syndrome (IBS)

• A 17 year old with a diagnosed by your partner as
  having irritable bowel syndrome says he read on
  the Internet that peppermint might help him.
  Should he eat more candy?
• Whats the evidence?

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IBS - Peppermint

• Peppermint (Mentha piperita) primary ingredient,
  29 - 48 menthol
• Uses many digestive complaints, including colic,
  flatulence, diarrhea, dyspepsia, indigestion,
  nausea and vomiting
• Relaxes smooth muscle and slows GI transit
• Approved by German Commission E

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Enteric coated peppermint oil

• Reduces spasms during upper GI, colonoscopy,
  barium enema
• Mixed, mostly positive results in adults and
  adolescents with IBS
• RCT in 110 adults with IBS, 79 had less pain
  with Colpermin versus 43 with placebo, Plt0.05
  (Liu, J Gastroenterol, 1997)
• RCT of 42 children with IBS, 75 improved with
  peppermint, Plt0.05 (Kline J Pediatr, 2001)

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Constipation

• The father of a 5 year old girl asks whether
  herbal laxatives hes seen in the pharmacy, such
  as Senokot, are safe.
• Are they?

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Fiber for constipation

• It depends (dried fruit anyone?)
• Fiber is safe if taken with sufficient water no
  intestinal obstruction no allergies
• Bran
• Psyllium (Plantago. ovata and P. psyllium)
• Flax seeds also contain lignans and omega three
  fatty acids
• Side effects flatulence, abdominal pain,
  diarrhea, dyspepsia, nausea

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Stimulant laxative herbs

• Cascara sagrada (Rhamni purshiana) and Senna
  (Senna folum) castor oil
• FDA approved for patients 2 years and older
• Use sparingly and briefly
• Chronic use can lead to dependence
• Side effects cramping, diarrhea, severe diaper
  rash

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Recurrent abdominal pain

• The mother of an 8 year old boy with benign
  chronic recurrent abdominal pain associated with
  the stress of starting a new school asks if there
  are natural remedies she can give him that might
  help.
• Are there?

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Herbal remedies for stress-related abdominal pain

• Chamomile (Matricaria recutita) recommended by
  Peter Rabbits mother
• Contains flavonoids, anti-inflammatories,
  spasmolytic compounds
• Listed on formularies of 25 countries
• Approved by German Commission E to treat
  abdominal spasms and inflammatory diseases of the
  GI tract
• May combine with fennel, peppermint, lemon balm
• Side effects allergies

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Lemon balm

• Iberogast, German remedy containing 8 herbs
  Iberis amara, Chelidonii, Cardui, Melissae
  folium, Carvi, Liquiritiae radix, Angelicae,
  Matricariae, Menthae piperitae
• Meta-analysis of studies in 595 adults shows
  positive effects on dyspepsia in adults (Melzer
  J, 2004)

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Licorice Glycyrrhiza glabra

• Contains glycyrrhizin, glycyrrhizic acid,
  polyphenols, and polysaccharides
• TCM ulcer remedy newer HepC?
• Inhibits 11 beta-hydroxysteroid dehydrogenase
  other enzymes involved in the metabolism of
  corticosteroids. ? increased cortisol levels
• Anti-inflammatory and mineralocorticoid effects
  (BP, edema)
• NOT ANISE

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Caveats with herbs

• Variable quality think of produce
• Contaminants or wrong herbs included
• Heavy metals in some imports from developing
  countries with lower manufacturing standards
• Pharmaceuticals, e.g TCM
• Use identifiable products OR those from countries
  with higher standards, eg. Canada, Germany,
  Switzerland check ConsumerLabs

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Resources

• Compare brands
• http//www.consumerlabs.com
• NLM
• http//www.nlm.nih.gov/medlineplus/druginfo/
• Natural Medicines Comprehensive Database
• Natural Standard
• http//www.naturalstandard.com/
• NIH NCCAM http//nccam.nih.gov/
• Contemporary Pediatrics
• NC NW AHEC on-line course on HDS
• https//northwestahec.wfubmc.edu/learn/herbs_ce/in
  dex.cfm

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The History of Medicine

• 2000 BC Here, eat this root.
• 1000 AD That root is heathen say this prayer.
• 1850 AD That prayer is superstition drink this
  potion.
• 1940 AD That potion is snake oil swallow this
  pill.
• 1985 AD That pill is ineffective take this
  antibiotic.
• 2000 AD That antibiotic is artificial eat this
  root.