Herbal Medicine 3

Disturbed intestinal permeability
• The role of the gut wall is to allow for selective
absorption of nutrients while providing vital protection
against intrusion into the body tissues of harmful
substances from the lumen
• NSAID treatment has adverse effects on enterocyte
mitochondria which may predispose the mucosa to
absorption of bacterial and other large molecules that
provoke a local inflammatory response.
• A similar mechanism may operate in patients with
untreated Crohn's disease, who show abnormally high
permeability.

Intestinal flora
• In humans there is a moderately predictable sequence of
colonization after birth and through to adulthood
• There are clear benefits of a healthy bacterial population in
the gut
• Anaerobic bacteria in particular are known to be responsible
for considerable secondary digestion and to decrease
intestinal transit time.

• The intestinal flora also contributes to non-specific defences
against immunological challenge from dietary antigens by
helping to reduce their uptake across the mucosal barrier.
• Antibiotic use is probably the most widespread impact on
bacterial populations in the gut with an adverse effect on
normal gut flora well established
• Particularly if the antibiotics are poorly absorbed from the gut
or if they are active against anaerobes

• A particularly revealing insight into the relationship is
seen in the case of bowel cancer.
– There are three known endogenous components that affect
development of colorectal cancer
• colonic bacteria
• the mucus layer
• bile acids

• The mucus layer covering the surface acts as a barrier but
its composition changes in pre-malignant and malignant
colon tissue.
– The secretion of protective mucus is elevated by plant cell wall
components in the diet.
– Mucus has some hydrophobic properties and its presence may
alter the effect of bile components and bacterial metabolites on
the gut wall.

• It was concluded that intestinal microflora raise oestrogen levels by
deconjugating bound oestrogens that appear in the bile, thereby
permitting the free hormones to be reabsorbed
• The beneficial effects of a high-fibre diet are likely to be the dominant
factor in women susceptible to breast cancer, especially as there is
evidence that bacterial flora actually enhance some of its wider
benefits.

• As herbalists we can combine the benefits of these dietary
changes with improved hepatic and biliary function and bitter
or aromatic digestive herbs so that food matter is well
prepared in the upper digestive tract
• The value of direct agents on disruptive bowel flora is likely to
be upheld
– Wormwood

• They are widely distributed in plants such as
– Onions
– Asparagus
– Wheat
– Globe artichoke
– Slippery Elm

• In clinical studies, improvement of faecal microflora was observed on oral
administration of fructooligosaccharides at 8 g and 12.5 g per day; the
population of Bifidobacteria in faeces increased substantially compared
with before the administration.

• IBS is not related to inflammatory bowel diseases, such as
Crohn’s disease or ulcerative colitis
• Typical symptoms include abdominal bloating and soreness,
gas, and alternating diarhoea and constipation.
• People with IBS are more likely than others to have backache,
fatigue, and several other seemingly unrelated problems.

• Though no prescription medications specifically treat irritable
bowel syndrome, antidepressant and anti-anxiety drugs may
be used for people with mental depression or chronic pain, or
for people who have symptoms that worsen during periods of
stress.
• The anticholinergic drug (Levsin®, Levbid®) may be used to
treat colon muscle spasms and abdominal soreness.

Serotonin: A Mediator of the Brain–Gut Connection?
• Kim & Camilleri (2000:2698) reviewed the current information
on Serotonin as a Brain-Gut mediator. They state:-
– ‘It has been estimated that about 95% of serotonin is found
in the GI tract’.

• ‘In irritable bowel syndrome (IBS), serotonergic
antidepressants have been used in clinical practice,
but they also modulate central cholinergic,
adrenergic, or dopaminergic systems’.
• ‘Selective serotonin agonists and antagonists are
being proposed for treatment of gut disorders,
primarily because of their direct effects on the gut
rather than any central effects’.

Dietary changes that may help
• Several trials report that food sensitivities occur in only a
small percentage of people with IBS.
• Researchers have found that standard blood tests used to
evaluate allergies may not uncover food sensitivities
associated with IBS, because IBS food sensitivities may
not be true allergies.
• The only practical way to evaluate which foods might
trigger IBS symptoms is to avoid the foods and then
reintroduce them.

• Hepatorestoratives & choleretics to improve liver
function
– Silybum
– Chionanthus
– Schisandra
• Mucilage-containing herbs
– Ulmus, especially if there is constipation.

Cholecystitis & Gall Stones
• Gallstones are hardened formations, composed primarily of
cholesterol, that develop in the gallbladder.
• The incidence of gallstones increases with age, with family history
being an important risk factor

• Choleretic herbs improve bile flow
– Chelidonium majus
– Cynara scolymus
– Taraxacum officinalis
– Silybum marianum

• Spasmolytic herbs can help to relieve gallbladder
pain
– Viburnum opulus
– Matricaria recutita
– Mentha piperita

Postcholecystectomy Syndrome
• Abdominal symptoms after removal of the GALLBLADDER.
• The common postoperative symptoms are often the same as
those present before the operation, such as COLIC, bloating,
NAUSEA, and VOMITING.
• There is pain on palpation of the right upper quadrant and
sometimes JAUNDICE.
• The term is often used, inaccurately, to describe such
postoperative symptoms not due to gallbladder removal

• When pancreatic insufficiency is severe, malabsorption
may result, leading to deficiencies of essential nutrients
and the occurrence of steatorrhea and diabetes.
• Chronic Pancreatitis is a slow, silent process that
gradually destroys the pancreas and is most often caused
by excessive alcohol consumption (80%).

• The resulting pain is classically epigastric, constant,
radiating through to the back, and relieved by bending
forwards; this is often associated with profuse Vomiting
(Sanders &Kingsnorth 2007:295).

• Combination therapy with selenium, beta-carotene,
methionine, and vitamins C and E was shown to improve
symptoms of chronic and recurrent pancreatitis (Uden etal
1990:357).
• Bagchi etal (1997:179) demonstrated that that Grape seed
extract is a more potent scavenger of oxygen free radicals
than vitamin C and vitamin E.