The Everything Guide to Herbal Remedies: An easy-to-use reference for natural health care

CHAPTER 11

Improving Digestion

Around 400 B.c., Hippocrates—the Father of Medicine—reportedly gave us some words to live by: “Let food be thy medicine and medicine be thy food.” The traditional schools of medicine in China, Europe, and India also stress digestion—and the use of nutritious and medicinal herbs—as a cornerstone of health. Herbal gastrointestinal aids and remedies work gently to support digestion and restore healthy functioning. Most produce no side effects and can be used safely in combination with other herbs as well as conventional medical treatments.

The Details of Digestion

Your digestive system converts everything you eat and drink into the fuel you need to function—and survive.

The digestive tract, also known as the gastrointestinal (GI) tract, transports and processes your meals, delivering essentials to your bloodstream and eliminating the rest. Its components include, in sequential order: mouth, esophagus, stomach, small intestine, and large intestine (colon). The system also includes the liver, which produces digestive juices, processes nutrients, and eliminates toxins.

Your GI tract includes about thirty feet of hollow tubes—including your stomach, which holds less than a quarter-cup when empty and more than eight cups after a big buffet, and your small intestine, which contains millions of tiny villi that collectively make your intestinal surface area about 200 times bigger than that of your skin.

First, you chew your food and swallow it, propelling it into your esophagus. It’s passed along through a series of involuntary smooth muscle movements into the stomach, where it’s churned together with digestive juices and sent into the small intestine. Once there, it’s combined with other juices, some from the intestine and others from the liver and pancreas.

In the small intestine, essential nutrients are absorbed into the bloodstream, and what’s left—now considered waste—moves into the large intestine, where much of the remaining fluid is removed. It’s then sent to the rectum, where it’s eliminated.

Acid Indigestion and Heartburn

Acid indigestion, or dyspepsia, is a type of chronic or recurrent discomfort in the upper abdomen that’s often accompanied by gas, bloating, and heartburn (a painful, burning sensation in your throat or chest).

Heartburn is the most common symptom of gastroesophageal reflux (GER), also known as acid reflux, a condition in which stomach acid backs up into your esophagus. Recurrent acid reflux is called gastroesophageal reflux disease, or GERD.

Heartburn and acid reflux, two of the most common digestive issues in the United States, can be triggered by many pharmaceuticals, including cardiac medications and drugs used to treat osteoporosis, insomnia, and anxiety. Both prescription and nonprescription pain medications have also been implicated, as have some oral contraceptives.

Heartburn and acid indigestion often run in families, but they can also be caused by lifestyle factors (smoking, obesity, drinking alcohol or caffeinated drinks, and eating foods that are very acidic or fatty). And while heartburn is most often only an annoyance, it can lead to more serious problems, including ulcers and precancerous cell changes.

Chronic heartburn can also be a symptom of serious conditions, including erosion of the esophagus and cancer.

Conventional Treatments

Dyspepsia, heartburn, acid reflux, and GERD are typically treated with these drugs:


• Antacids. Over-the-counter (OTC) remedies like sodium bicarbonate (Alka-Seltzer) neutralize acid and provide rapid heartburn relief; antacids can cause side effects like headaches, nausea, constipation, and diarrhea.

• Acid Blockers. Acid blockers like famotidine (Pepcid) and ranitidine (Zantac) reduce the amount of acid your stomach makes. They also can cause headaches, nausea, constipation, and other problems.

• Bismuth Subsalicylate. Bismuth subsalicylate (Pepto-Bismol, Kaopectate) balances the fluids in your GI tract. It can cause reactions in people who are allergic to aspirin and other salicylates and can make an ulcer or other bleeding problem worse. It can also interact with other drugs (including those prescribed to treat heart disease, arthritis, and diabetes, as well as nonprescription pain relievers and cold medicines).

• Proton Pump Inhibitors (PPIs). People with GERD are often prescribed drugs called proton pump inhibitors, or PPIs, which stop your body’s production of gastric acid. They include omeprazole (Prilosec), lansoprazole (Prevacid), and esomeprazole (Nexium). Prilosec OTC is a nonprescription option. Nearly 40 percent of the people who take them daily still experience symptoms—and must use additional drugs. PPIs can also cause abdominal pain and headaches, and they’ve been linked with increased risk of infection and pneumonia.

Herbal Answers

Many herbs have a long history of use in treating dyspepsia and reflux, including:


• Artichoke (Cynara cardunculus, C. scolymus)

Artichoke leaf extracts have been shown to significantly reduce dyspepsia symptoms, including heartburn and nausea.

• Chamomile (Matricaria recutita)

Chamomile is a traditional remedy for all kinds of GI problems, and research shows it can relieve spasms and reduce inflammation in gastro-intestinal tissues.

• Turmeric (Curcuma longa)

This is a classic Ayurvedic remedy for digestive disorders—and studies show it can reduce the release of acid in the stomach.


Ulcers

An ulcer is an open sore caused by infection, poor circulation, or disease (people with diabetes often develop ulcers on their lower extremities). Within the digestive system, ulcers can occur in the esophagus, stomach, and small intestine; other ulcers can appear in the colon. Ulcers in the GI tract are generally known as peptic ulcers (peptin is an enzyme produced in the stomach).

While the classic image of someone with an ulcer is a red-faced, stressed-out, middle-aged man eating a spicy meal and washing it down with a stiff drink, scientists now know that ulcers aren’t caused by stress, foods, or alcohol. Ulcers can strike anyone—about one in ten people will develop one at some point—and are almost always caused by Helicobacter pylori bacteria, which thrive in a highly acidic environment (as many as 80 percent of peptic ulcers are caused by H. pylori infection).

The GI system’s natural defenses include microbes, known as gut flora, which can get a boost from probiotics (things that contain beneficial bacteria) or prebiotics (things that foster their growth). Many plants—including almonds (Prunus dulcis), garlic (Allium sativum), oats (Avena sativa), and wheat (Triticum aestivum)—contain prebiotics, which also might help prevent infections (including foodborne illness), ulcers, and cancer.

Symptoms of a peptic ulcer include abdominal pain (a gnawing or burning pain that comes on two or three hours after a meal or in the middle of the night) and bloating. Having a history of heartburn and GERD makes you more susceptible, as does taking certain pharmaceuticals, including NSAIDs and glucorticoids, which are steroids used to treat inflammation.

Treatment Options

If you’ve got a peptic ulcer, see your doctor right away. Left untreated, ulcers can cause potentially life-threatening internal bleeding. Conventional medicine generally treats peptic ulcers with antibiotics to kill the H. pyloriinfection (if it’s present) and suppress stomach acid production. The drugs used to accomplish that are acid blockers and PPIs (see above).

Herbal remedies, which can be used in conjunction with conventional treatment, include these:


• Aloe (Aloe vera)

Studies show that oral doses of aloe gel kill ulcer-causing bacteria, reduce inflammation, and promote healing of GI tissues.

• Chamomile (Matricaria recutita)

This herb is famous for its soothing effects on the digestive tract. But it also has a tough side: Studies show it’s lethal against ulcer-causing H. Pylori bacteria.

• Gotu kola (Centella asiatica)

This Ayurvedic herb is valued for its wound-healing abilities. Extracts have been shown effective in treating peptic ulcers and helping to protect the stomach and GI tissues against them.

• Marshmallow (Althaea officinalis)

Marshmallow leaves are a traditional European and Asian remedy for all sorts of GI inflammation, including peptic ulcers. Marshmallow contains polysaccharides, which form a gelatinous layer that helps promote healing.

• Neem (Azadirachta indica)

This is a classic digestive and immunity-enhancing herb in Ayurvedic medicine, and modern research shows it can inhibit acid production and promote ulcer healing in the stomach.


Because of their complex chemical structure, many herbs used traditionally to treat digestive and gastrointestinal problems actually address several problems at once. For example, licorice (Glycyrrhiza glabra) is a soothing demulcent, pain-killing analgesic, and antibacterial that can relieve the pain of ulcers, speed their healing, and prevent their return.

Gas and Flatulence

Everyone has gas—most of us generate between one and four pints a day (and pass some of it at least fourteen times). Gas is a natural by-product of the digestion process, and only causes problems when it’s produced in excess.

The gas in your intestinal tract comes from two places: the air you swallow and the bacteria in your large intestine, which create gas as they break down the food that’s passing through.

Some people have trouble digesting certain foods, and their bodies send partially digested food into the large intestine, where the bacteria produce extra gas as they “eat” it. For example, lactose, a sugar found in dairy products, can cause serious gas in people who don’t produce enough of the lactose-digesting enzyme lactase. Other people are sensitive to artificial sweeteners like sorbitol and mannitol, which are used in sugar-free gum and other “diet” foods. Overuse of antibiotics or laxatives can also cause problematic gas.

Aside from the social embarrassment, gas can cause abdominal pain when it gets out of hand. Frequent or severe episodes warrant a visit to the doctor, as they can be the sign of a more serious problem.

Herbal Remedies

Herbal remedies for gas include:


• Alfalfa (Medicago sativa)

Alfalfa contains chlorophyll, which is the green ingredient in many herbs and some types of algae. Taking supplemental chlorophyll—and its derivative, chlorophyllin—has been shown to reduce gas (and its odor).

• Caraway (Carum carvi)

Caraway contains carminative (antigas) and antispasmodic constituents. Research shows that it can relieve gas and stomach upset.

• Fennel (Foeniculum vulgare)

A classic digestive aid throughout the Mediterranean, fennel seeds and extracts can relax the smooth muscles in the GI tract and expel gas.


Constipation

Constipation is defined as having infrequent or difficult bowel movements or passing hard or dry stools. “Infrequent” generally means fewer than three in a week, although some people regularly have two or three a day and others can go two or three days without one.

People who frequently use conventional chemical laxatives are prone to lazy bowel syndrome, a condition in which the digestive system has essentially become addicted to the drugs—and can’t function properly without them. Overuse of laxatives can also damage your GI tract and interfere with your body’s ability to absorb the nutrients in your food.

Constipation is most often tied to intestinal slowdown, in which the undigested food is moving too slowly through the large intestine. This can be caused by diet (inadequate fluid or fiber intake) as well as lifestyle factors like physical inactivity. Stress and traveling can trigger it, as can many prescription drugs. Pregnant women and people over sixty-five, especially those with physical limitations, are more susceptible.

Most of the time, you can resolve a case of constipation with a few tweaks to your diet or a dose or two of a laxative (either conventional or herbal). But if your condition persists or you experience other symptoms, see your doctor. Unresolved constipation can lead to complications like hemorrhoids or anal tears (called abrasions or fissures). In extreme cases, you could develop impaction, in which a mass of stool obstructs the colon or rectum. Constipation can also by a symptom of a more serious condition (see below).

Treatment Options

In conventional medicine, constipation is generally treated with laxatives, which fall into one of three categories:


• Stool softeners include mineral oil and medications containing docusate (Colace) or magnesium hydroxide (Philip’s Milk of Magnesia), plus suppositories made with glycerine (Fleet Glycerin Suppositories).

• Bulk-forming laxatives create a more solid mass to keep things moving smoothly; they include methylcellulose (Citrucel, Docucal) and psyllium (Metamucil). Stool softeners and bulk-forming laxatives are generally free of side effects, but can cause abdominal pain and diarrhea in some people.

• Stimulant (chemical) laxatives trigger movement in the smooth muscles and induce secretion of fluids from the mucous membranes in the large intestine. They include polyethylene glycol (MiraLAX) and bisacodyl (Dulcolax, Correctol). Stimulant laxatives can cause cramping, lightheadedness, diarrhea, and rebound constipation.

Herbalism has its own constipation cures:


• Flax (Linum usitatissimum)

Flaxseed is high in fiber (both the soluble and insoluble kind) and mucilage, which is a goopy substance known for its ability to sooth mucous membranes. Flaxseed works as an effective (and side effect-free) constipation remedy.

• Fenugreek (Trigonella foenum-graecum)

Fenugreek also contains lots of fiber, including pectin, a type of insoluble fiber that’s gelatinous when saturated with water (it’s the ingredient in jelly that makes it gel).

• Olive (Olea europa)

Olive oil acts as a gentle stool softener and laxative.

• Psyllium (Plantago ovata, P. psyllium)

Both the blond and black varieties are tried-and-true constipation remedies (P. ovata is the key ingredient in Metamucil). Research shows that psyllium is as effective as many harsh chemical laxatives.


Diarrhea

Like constipation, diarrhea is something everyone has experienced: loose, watery, voluminous stools, accompanied by abdominal cramping, and frequent trips to the bathroom. Diarrhea is usually acute, lasting only a few days, but in some cases can become chronic, lasting more than a few weeks and possibly signifying a more serious condition. Persistent diarrhea can also lead to dehydration and loss of important minerals (such as salt).

When your digestive system is running smoothly, the food you’ve consumed travels through the GI tract as a liquid, until it hits the colon, where most of the liquid is absorbed (leaving behind a semi-solid waste). But if something happens to make the food pass too quickly through the colon (or to hinder the colon’s ability to remove the liquid), you’ll have watery bowel movements.

Acute diarrhea caused by infection is called gastroenteritis, which quite often is a type of foodborne illness (a.k.a. “food poisoning”) that can usually be traced to a virus. It can also be caused by some diseases (including AIDS), exposure to toxins, and by taking certain medications—most often antibiotics, which destroy both beneficial and pathogenic bacteria in your digestive tract and can set the stage for infection. Blood pressure drugs and antacid medications containing magnesium can also trigger diarrhea.

Many people have food intolerances and sensitivities that bring on an acute bout of diarrhea whenever the offending food is consumed. Some of the most common examples are lactose (in milk and other dairy products), fructose (a type of sugar), and artificial sweeteners.

Chronic diarrhea, on the other hand, can be a sign of a serious condition. See a doctor if your diarrhea lasts longer than three days or if you become dehydrated (you’re feeling lightheaded and are passing dark urine), are running a fever that’s higher than 102°F, have bloody or black stools, or are in severe pain.

Treatment Options

Conventional medical practitioners typically recommend OTC antidiarrheal medications such as loperamide (Imodium) and bismuth subsalicylate (Kaopectate, Pepto-Bismol). Loperamide slows the transit of fluids through your GI tract, and bismuth subsalicylate balances the fluids in your intestinal tract. If your diarrhea is being caused by an infection, a doctor might prescribe antibiotics as well.

Pectin, a type of water-soluble fiber found in many fruits, vegetables, and herbs, can be used as a stand-alone treatment for diarrhea (it seems to increase the absorption of salt and water in the GI tract). To get it as nature intended, eat lots of apples (Malus domestica).

Loperamide can cause constipation and cramping. Bismuth subsalicylate can interact with other drugs and turn your tongue (and stools) temporarily black. Here are some herbal alternatives:


• Barberry (Berberis vulgaris)

Barberry is a traditional herbal remedy for diarrhea and other digestive problems. It contains a chemical called berberine, which has proven anti- spasmodic, antimicrobial, and anti-inflammatory power.

• Cinnamon (Cinnamomum verum, C. aromaticum)

Cinnamon can be used to treat diarrhea and other types of GI distress. It contains chemicals and essential oils that have been proven to relieve diarrhea, gas, and bloating.

• Ginger (Zingiber officinale)

This is a classic remedy for diarrhea that’s accompanied by nausea. In the lab, it has demonstrated anticramping properties—and the ability to kill foodborne Salmonella bacteria.

• Juniper (Juniperus communis)

A traditional Native American remedy for all sorts of digestive ills, including stomachaches and diarrhea, juniper contains several chemicals with antidiarrheal and antimicrobial properties.

• Psyllium (Plantago ovata, P. psyllium)

Psyllium, which is typically used to treat constipation (it works as a bulk-forming laxative), also fights diarrhea. Research shows it can be as effective as the drug loperamide.

• Sangre de grado (Croton lechleri)

Research shows that sap of this South American tree can be effective against diarrhea caused by many types of infection.

• Tea (Camellia sinensis)

Tea contains tannins and other polyphenols, which have been shown to relieve diarrhea as well as the drug loperamide.


Nausea and Vomiting

Nausea—defined as an upset stomach accompanied by the urge to vomit—can be a symptom of many conditions, some decidedly more worrisome than others. Vomiting can by a symptom of a serious problem like poisoning, head injury or brain tumor, infection (such as hepatitis), or another disease or condition (such as appendicitis, kidney failure, gallstones, or an ulcer).

Less scary causes include migraine headaches, pregnancy (morning sickness), and certain drugs. Many people become nauseated when they’re in a moving vehicle (motion sickness); most of us feel nauseated when we’ve had too much to drink.

Treatment Options

Most cases of nausea are self-limiting: When you get out of the moving car, metabolize the alcohol in your system, or deliver the baby, the nausea will go away. However, if you think you’ve got food poisoning (or another type of poisoning), if you’re experiencing severe abdominal pain or other pains (like a headache or stiff neck), are vomiting blood, or have been sick to your stomach for more than twenty-four hours, you should see a doctor right away.

Conventional medicine typically treats nausea and vomiting with antiemetic (antinausea) drugs. Motion sickness is treated prophylactically with antihistamines—OTC drugs like meclizine (Bonine), dimenhydrinate (Dramamine), or prescription drugs like scopolamine (Transderm Scop). If you’re already vomiting, you might take bismuth subsalicylate (Pepto-Bismol); see above. Antihistamines can cause drowsiness and, less often, headache, diarrhea or constipation, and irregular heartbeat; scopolamine can cause vision problems, dry mouth, and drowsiness. Here are some herbal alternatives:


•American ginseng (Panax quinquefolius)

American ginseng is known for its antiemetic properties. In the lab, it’s shown the ability to prevent nausea and vomiting before they start.

•Ginger (Zingiber officinale)

Ginger can fight almost any type of nausea you can think of, including morning sickness, postoperative nausea, motion sickness, migrainerelated nausea, and nausea caused by chemotherapy.

•Lavender (Lavandula angustifolia)

Lavender is a traditional remedy for stomach upset, nausea, and vomiting (it contains camphor, a chemical with known antiemetic properties). The scent of lavender can also quell the queasies.


Food Intolerances

Food intolerances are much more common than allergies, affecting about 10 percent of all Americans, and are the sign of a problem in the digestive system. You’re intolerant if a certain food irritates your stomach or intestines or if your body can’t digest it properly. The most common type is lactose intolerance, which occurs in people who lack the enzyme lactase. Other intolerances occur in people who are sensitive to a certain chemical: Food dyes, monosodium glutamate (or MSG, which is a flavor enhancer often used by Chinese restaurants), and sulfites (which occur naturally but are also added to foods to inhibit mold) are common culprits.

Food allergies can be triggered by a tiny amount of food—even residuals left over in a manufacturing facility—and occur every time you eat it, so experts advise people with food allergies to swear off that food completely. But food intolerances are often dose related, meaning you won’t experience any symptoms unless you eat a lot of the food.

Food intolerance can produce nausea, diarrhea, cramping, gas and bloating, headaches, and irritability or nervousness. Here are some herbal remedies:


• Ginger (Zingiber officinale)

Ginger is a proven stomach settler that also appears to have an antihistamine-like effect against food allergies.

• Peppermint (Mentha x piperita)

Peppermint is a classic stomach soother that appears to “deactivate” the inflammatory response in laboratory tests. Research shows it can relieve dyspepsia, bloating, and cramping.

• Rooibos (Aspalathus linearis)

Rooibos tea, also known as red bush tea, is a South African remedy for nausea and vomiting that also quells the allergic response.


Chronic Digestive Disorders

Sometimes, things like diarrhea, constipation, and vomiting are symptoms of more serious digestive disorders, such as irritable bowel syndrome or inflammatory bowel disease. These are known as “functional” bowel disorders because they are related to bowel functioning, not anatomical or structural problems.

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS), also known as spastic colon, is a condition of unknown origin with no known cure. Symptoms are abdominal pain and either constipation or diarrhea (in most people, one is predominant, but many people alternate between the two); some patients also experience dyspepsia, nausea, and bloating.

IBS is treated in conventional medicine with antispasmodic drugs such as dicyclomine (Bentyl), which can cause blurred vision, dizziness, nausea, and weakness. Acid-reducing, antidiarrheal, and/or laxative drugs are also used (see above).

People with IBS can treat their symptoms with the herbal remedies discussed above, along with these:


• Agrimony (Agrimonia eupatoria)

This herb contains tannins, which are astringent, making it useful for people with diarrhea-predominant IBS.

• Artichoke (Cynara cardunculus, C. scolymus)

Artichoke extracts have been shown to help people with chronic digestive complaints, including IBS-related constipation and pain.

   

• Peppermint (Mentha x piperita)

Peppermint leaves contain antispasmodic chemicals that can help relax the muscles in your GI tract and ease the gas and diarrhea caused by IBS.


Inflammatory Bowel Disease

Inflammatory bowel disease, or IBD, is much less common than IBS, affecting about 1 million Americans. IBD is immune-mediated, meaning it involves an exaggerated immune response to certain triggers and appears to have genetic and environmental causes. Some experts categorize it as an autoimmune disease.

There are two different forms of IBD: Crohn’s disease and ulcerative colitis. Both are characterized by inflammation, abdominal pain, weight loss, and diarrhea. People with ulcerative colitis can also experience fever and blood in the stool. Crohn’s disease usually involves the small intestine, but it can affect any part of the GI tract. Ulcerative colitis usually involves just the colon. IBD symptoms usually follow in a pattern of relapse and remission, and patients can go for years without symptoms, then have an attack that lasts from several weeks to several months.

If you’ve got inflammatory bowel disease, avoid taking herbs with immune-enhancing effects, such as barberry (Berberis vulgaris), echinacea (Echinacea purpurea), and goldenseal (Hydrastis canadensis). Some experts think that the effects of these products might actually make IBD worse.

Conventional doctors generally treat IBD with antispasmodic drugs like Bentyl; anti-inflammatories such as sulfasalazine (Azulfidine) or a 5-ASA agent (Dipentum), which can cause nausea, heartburn, diarrhea, and headaches; or corticosteroids (see Chapter 8). Herbal remedies for diarrhea (see above) can be helpful, along with the following:


• Boswellia (Boswellia serrata)

Boswellia, a.k.a. Indian frankincense, contains natural anti-inflammatories. Preliminary research suggests that it can be effective against both Crohn’s disease and ulcerative colitis.

• Evening primrose (Oenothera biennis)

Evening primrose oil contains gamma-linolenic acid (GLA) and linoleic acid, omega-6 fatty acids with proven anti-inflammatory effects.

• Pineapple (Ananas comosus)

An enzyme from pineapples called bromelain is used to promote proper digestion. Research shows it may be helpful in treating ulcerative colitis and the diarrhea that comes with it.