NMT150 BOT Wk11 GERD (1) PDF

GASTROESOPHAGEAL REFLUX DISEASE (GERD) YEAR 1 - HERBAL MEDICINE Dr. Matt Gowan, ND email: [email protected] LEARNING OBJECTIVES Define the main herbal actions used to treat GERD Identify commonly used herbs for GERD Remember both common names and latin binomials for the herbs discussed Explain...

GASTROESOPHAGEAL REFLUX DISEASE (GERD) YEAR 1 - HERBAL MEDICINE Dr. Matt Gowan, ND email: [email protected] LEARNING OBJECTIVES Define the main herbal actions used to treat GERD Identify commonly used herbs for GERD Remember both common names and latin binomials for the herbs discussed Explain the main indications and actions for the herbs Understand what classes of phytochemicals are responsible for the medicinal effects Evaluate the safety issues and contraindications of the herbs Provide a summary of the leading research on the herbs used to treat GERD  A NATUROPATHIC APPROACH TO GERD Remove food sensitivities (IgG testing, Elimination diet) Stimulate digestion (Bitters) Soothe mucous membranes (Demulcents) Increase fiber (Bulk laxative) Avoid sugar, fatty foods, over-eating Avoid spicy foods (Carminatives) HERBAL ACTIONS GERD HERBAL ACTIONS FOR GERD Bitter tonic - “tonifies" the digestive organs to increase appetite and stimulate digestive function. Bitter tonics usually possess the following actions: Sialogogue - increase salivation Stomachic - tones the stomach and helps increase appetite & support digestion Choleretic - stimulates bile formation in the liver Cholagogues - stimulates bile secretion from the gallbladder Hepatic - aids liver function Laxative (mild) - promotes bowel movements Demulcent - Soothes irritated mucous membranes by creating a protective coating. Antiacid - decreases the acidity in the stomach. Peppermint tea increases the risk of GERD. Other carminatives (fennel, anise, oregano, cumin, ginger, etc) likely do this as well MATERIA MEDICA GENTIAN Latin: Gentiana lutea Family: Gentianaceae Part: Root Drug: Gentianae radix Optional: Click here to read a monograph online GENTIAN MAIN INDICATIONS Indigestion Gastroesophageal reflux disorder (GERD) Cholestasis leading to gallstones Liver disease and jaundice ACTIONS Bitter tonic (Sialogogue, Stomachic, Cholagogue, Choleretic, Hepatic) Hepatoprotective Antimicrobial Photo courtesy of Matt Gowan GENTIAN German Commission E (Approved) The Commission E approved the internal use of gentian root for digestive disorders, such as loss of appetite, fullness, and flatulence. King's American Dispensatory, 1898 A powerful tonic, improves the appetite, strengthens digestion, gives more force to the circulation, and slightly elevates the heat of the body. "Sense of depression referred to epigastric region, and associated with sense of physical and mental weariness" (Scudder, List of Specific Indications). The British Herbal Compendium “The British Herbal Compendium approves gentian for lack of appetite, anorexia, atonic dyspepsia, gastrointestinal atony, and as a tonic and anti-emetic. GENTIAN PHYTOCHEMICALS Seco-iridoid derivative (amarogentin) Phenolics SAFETY Caution: Heartburn & GERD Contra-Indications: Gastritis, heartburn & stomach ulcers, obstructed gallbladder Side-Effects: May cause GI irritation leading to nausea, vomiting and diarrhea. Pregnancy: Caution. May be harmful. RESEARCH Four gentian decoctions demonstrated their good ability to stimulate acid-, enzyme- and mucin-forming functions of the stomach attributed to mostly by iridoids and flavonoids CENTAURY Latin: Centaurium erythraea Family: Gentianaceae Part: Root Drug: Centaurii herba Optional: Click here to read a monograph online CENTAURY MAIN INDICATIONS Indigestion Cholestasis leading to gallstones Gastroesophageal reflux disorder (GERD) Liver disease and jaundice ACTIONS Bitter tonic (Sialogogue, Stomachic, Cholagogue, Choleretic, Hepatic) Hepatoprotective Anticancer (stomach, liver) Antimicrobial Photo courtesy of Matt Gowan CENTAURY German Commission E (Approved) Loss of appetite, peptic discomfort. King's American Dispensatory, 1898 A bitter tonic CENTAURY PHYTOCHEMICALS Seco-iridoid derivative (amarogentin) Phenolics SAFETY Caution: Heartburn & GERD Contra-Indications: Gastritis, heartburn & stomach ulcers, obstructed gallbladder Side-Effects: May cause GI irritation leading to nausea, vomiting and diarrhea. Pregnancy: Caution. May be harmful. RESEARCH No research ARTICHOKE Globe Artichoke Latin: Cynara scolymus Family: Asteraceae Part: Leaf Drug: Cynarae folium Optional: Click here to read a monograph online ARTICHOKE MAIN INDICATIONS Indigestion Gallbladder disease and stones Cardiovascular disease Gout ACTIONS Bitter Hepatoprotective Hypolipidemic Anti-inflammatory Antioxidant Photo courtesy of Matt Gowan ARTICHOKE German Commission E (Approved) The Commission E approved artichoke leaf for dyspeptic problems. King's American Dispensatory, 1898 Diuretic and alterative. Reputed very beneficial in dropsies, and has been efficient in rheumatism, gout, jaundice, tic-douloureux, etc. ARTICHOKE PHYTOCHEMICALS Flavonoids (Apigenin & luteolin) Sesquiterpene lactones (cynaropicrin) Phenylpropanoids (caffeic acid) Phytosterols (taraxasterol) SAFETY Side-Effects: Generally recognized as safe. Contra-Indications: Gastritis & stomach ulcers, obstructed gallbladder Pregnancy: Unsure. Probably safe? Risk asteraceae allergy: contains sesquiterpene lactones Apigenin RESEARCH There was a significant reduction of all dyspeptic symptoms, with an average reduction of 40% in global dyspepsia score. RESEARCH This report supports previous findings that ALE ameliorates symptoms of IBS, plus improves health-related QOL MARSHMALLOW Latin: Althaea officinalis Family: Malvaceae Root: Root & Leaf Drug: Althaeae radix & Althaeae folium Optional: Click here to read a monograph online MARSHMALLOW MAIN INDICATIONS Protect and soothe irritated mucous membranes Heartburn (GERD esophagitis and gastritis) Dry cough Diarrhea ACTIONS Demulcent Photo courtesy of Matt Gowan MARSHMALLOW German Commission E (Approved) The Commission E approved the internal use of marshmallow root for irritation of the oral and pharyngeal mucosa and associated dry cough, and for mild inflammation of the gastric mucosa. King's American Dispensatory, 1898 They will be found valuable, in the form of decoction, in diseases of the mucous tissues, as hoarseness, catarrh, pneumonia, gonorrhoea, vesical catarrh, renal irritation, acute dysentery, and diarrhoea. In strangury, inflammation of the bladder, hematuria, retention of urine, some forms of gravel, and indeed in nearly every affection of the kidney and bladder, their use will be found advantageous. Much use is made of them combined with equal parts of spearmint, in urinary derangements. They are likewise efficacious in gastro-intestinal irritation and inflammation. MARSHMALLOW PHYTOCHEMICALS Mucilage Flavonoids SAFETY Side-Effects: None known. Very safe. Pregnancy: No restrictions known. Drugs: May delay absorption. MARSHMALLOW In vitro: Gastroprotective effects SLIPPERY ELM Latin: Ulmus rubra Synonyms: Ulmus fulva Family: Ulmaceae Part: Bark Drug: Ulmi cortex Optional: Click here to read a monograph online SLIPPERY ELM MAIN INDICATIONS Inflammation and irritation of the gastrointestinal tract (esophagitis, heartburn, colitis) Constipation Diarrhea Topically: poultice for boils, absence Cough ACTIONS Demulcent Bulk laxative Nutritive Photo courtesy of Matt Gowan SLIPPERY ELM King's American Dispensatory, 1898 In mucous inflammations of the lungs, bowels, stomach, bladder, or kidneys, used freely in the form of a mucilaginous drink (1 ounce of the powdered bark to 1 pint of water), it is highly beneficial, as well as in diarrhoea, dysentery, coughs, pleurisy, strangury, and sore throat, in all of which it tends powerfully to allay the inflammation. German Commission E Not included SLIPPERY ELM PHYTOCHEMICALS Mucilage Tannins SAFETY Side-Effects: None known. Very safe. Pregnancy: No restrictions known. Drugs: May delay absorption. SLIPPERY ELM No research PSYLLIUM Latin: Plantago ovata Synonyms: Plantago psyllium Family: Plantaginaceae Part: Seed husk Drug: Psyllii semen Optional: Click here to read a monograph online PSYLLIUM MAIN INDICATIONS Constipation Diarrhea GERD Blood sugar Cholesterol ACTIONS Bulk laxative Demulcent Photo courtesy of Matt Gowan PSYLLIUM German Commission E (None) The Commission E approved the use of blonde psyllium seed for chronic constipation and disorders in which easy bowel movements with a loose stool are desirable, e.g., for patients with anal fissures, hemorrhoids, following anal/rectal surgery, or during pregnancy. It was also approved as a secondary medication in the treatment of varying kinds of diarrhea and in the treatment of irritable bowel syndrome. King's American Dispensatory, 1898 Psyllium - They yield a mucilage, used in southern Europe as that of flaxseed, slippery elm, etc., is used in this country. The seeds, in tablespoonful doses, in a glass of water, before dinner, have been successfully employed to relieve chronic constipation. Ispaghula seeds are very mucilaginous and form a thick jelly with water. They are employed, either in substance or in decoction, in India, for the treatment of diarrhea and dysentery. In chronic diarrhea, they are often given whole PSYLLIUM PHYTOCHEMICALS Fiber: Mucilage SAFETY Side-Effects: Bloating and gas. It must be consumed with lots of water! Esophageal blockage & bowel obstruction- has occurred when taken with insufficient water. Acute constipation - may aggravate Pregnancy: No restrictions known. Drugs: May delay absorption. RESEARCH Clinical Trials: Fiber-enriched diet led to a significant increase of minimal lower esophageal sphincter resting pressure, a decrease of number of gastroesophageal refluxes, and a decrease of heartburn frequency per week ALOE VERA GEL Latin: Aloe barbadensis Synonyms: Aloe vera Family: Asphodeloideae Optional: Click here to read a monograph online ALOE VERA GEL MAIN INDICATIONS Gel - Burns, wounds, diarrhea Resin - Constipation ACTIONS Bulk laxative Demulcent Vulnerary Anti-inflammatory Photo courtesy of Matt Gowan ALOE VERA German Commission E (Approved) Constipation King's American Dispensatory, 1898 Atony of large intestine and rectum, mucoid discharges, prolapsus ani, pruritis ani, ascaris vermicularis. Difficulty in evacuating the lower bowel. ALOE VERA PHYTOCHEMICALS Resin = Anthraquinone glycosides (Emodin) Gel = Mucilage SAFETY ALOE GEL Side-Effects: None known. Drugs: May delay absorption. Pregnancy: Caution. It may be harmful. ALOE RESIN Side-effects: see Senna (similar phytochemicals) RESEARCH Clinical Trial: A. vera was safe and well tolerated and reduced the frequencies of all the assessed GERD symptoms LICORICE / LIQUORICE Latin: Glycyrrhiza glabra Synonyms: Liquiritia officinalis Family: Fabaceae Part: Root Drug: Liquiritiae radix Chinese Licorice Latin: Glycyrrhiza uralensis Family: Fabaceae Optional: Click here to read a monograph online LICORICE MAIN INDICATIONS Inflammation in the GI tract (Gastritis, ulcers) Hepatitis and cirrhosis of the liver Respiratory tract infections (cough, sore throat) Adrenal fatigue ACTIONS Demulcent (Indirect) Antiulcer Hepatoprotective Antiinflammatory Adrenal Tonic Phytoestrogen Antiviral Expectorant Photo courtesy of Matt Gowan LICORICE German Commission E (Approved) The Commission E approved the internal use of licorice root for catarrhs of the upper respiratory tract and gastric or duodenal ulcers. King's American Dispensatory, 1898 Liquorice root is emollient, demulcent, and nutritive. It acts upon mucous surfaces, lessening irritation, and is consequently useful in coughs, catarrhs, irritation of the urinary organs, and pain of the intestines in diarrhoea. The British Herbal Compendium The British Herbal Compendium indicates its use for bronchitis, peptic ulcer, chronic gastritis, rheumatism and arthritis, and adrenocorticoid insufficiency LICORICE PHYTOCHEMICALS Flavonoids (Licoflavone) Glycyrrhizin Triterpenoid saponin (Glycyrrhizin) SIDE-EFFECTS: Pregnancy: Caution. May be harmful. Hypertension: can raise blood pressure Electrolytes - can causes potassium loss. Caution with medications for the cardiovascular system. COMMENT: Deglycyrrhizinated Licorice (DGL) is safe Licoflavone in high blood pressure. RESEARCH In vivo: Antiulcer effect of licorice flavonoids. RESEARCH In vivo: Protects against ulcers from aspirin. MEADOWSWEET Latin: Filipendula ulmaria Synonyms: Spireae ulmaria Family: Rosaceae Part: Herb Drug: Spiraeae herba Note: The old Latin name was Spireae ulmaria, and was where aspirin got its name. Optional: Click here to read a monograph online MEADOWSWEET MAIN INDICATIONS Heartburn Stomach ulcers Fever Rheumatic diseases ACTIONS Antacid Anti-ulcer Astringent Anti-inflammatory Antipyretic Photo courtesy of Matt Gowan MEADOWSWEET German Commission E (Approved) The Commission E approved the internal use of meadowsweet as supportive therapy for colds. Common Plants and their Uses in Medicine., Hool, 1902 Meadow-sweet, when made into a strong tea and a small cupful given every two or three hours, will be highly beneficial in all cases of fever, no matter of what kind, and in cases of dyspepsia caused through inflammation of the mucous surfaces and glands of the stomach. It will also be found not only to relieve, but eventually cure all cases of sour belchings, sour eructions, nausea, sickness and vomiting, water-brash, swellings after meals or vomiting before meals, bile, or bilious attacks….Being an anti-acid, it allays and corrects the acids accumulating in the stomach far better than carbonate or bicarbonate of soda, magnesia, cream of tartar, tartaric acid, saleratus, and bicarbonate of potass. Meadow-sweet not only allays the symptoms, but prevents the recurrence. The British Herbal Compendium The British Herbal Compendium indicates its use for atonic and acid dyspepsia, gastritis, peptic ulceration, and rheumatic and arthritic pains MEADOWSWEET O PHYTOCHEMICALS Tannins OH OH Salicin (Salicylic acid glycoside) OH O Flavenoids HO O SIDE-EFFECTS: Salicylic acid Contra-Indicated - Salicylate sensitivities OH Caution: may potentiate blood thinners Pregnancy: Likely unsafe OH OH COMMENT: Salicin Bitters - ideally, should not be combined with antacids because they have opposing action on stomach acid. RESEARCH In vivo: Gastroprotective action in rats revealed their capacity to preserve mucosal integrity RESEARCH In vitro: Meadowsweet has antacid effects via inhibiting the enzyme histidine decarboxylase (HDC) that generates histamine. Stomach acid is stimulated by histamine release. RESEARCH SUMMARY RESEARCH SUMMARY HERB RESEARCH DETAILS Gentian In vivo Stimulates digestive juices Centaury None None Artichoke Clinical Trials Improves symptoms of dyspepsia Marshmallow In vivo Gastroprotective effects Slippery Elm None None Psyllium Clinical Trial Reduces GERD Aloe vera Clinical Trial Reduces GERD / Licorice In vivo Antiulcer Meadowsweet In vitro Antacid effects In vivo Gastroprotective REFERENCES REFERENCES - BOOKS Barnes J, Anderson LA, Phillipson JD. Herbal Medicines, 3rd ed. London: Pharmaceutical Press, 2007. Bundesinstitut für Arzneimittel und Medizinprodukte , The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines Editors Mark Blumenthal, Werner R. Busse, J Klein, American Botanical Council, R. Rister, T. Hall, C. Riggins, Joerg Gruenwald, Ph.D., Alicia Goldberg. Institute for Drugs and Medical Devices, Bundesinstitut f ur Arzneimittel und Medizinprodukte (Germany). Publisher: American Botanical Council, 1998 Bone K. Principles and Practice of Phytotherapy. Edinburgh: Churchill Livingstone, 2000. Felter HW, Lloyd JU. King's American Dispensatory. 1898. http://www.ibiblio.org/ herbmed/eclectic/kings/main.html. Accessed: Nov 19, 2022. Hoffman D. Medical Herbalism. Rochester, Vermont: Healing Arts Press, 2003. THANK YOU M AT T G O W A N , N D M G O W A N @ N D A S S I S T. C O M