Herbs for the UpperDigestive Tract

Lee W Carroll, B.Sc.

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Poor Digestive Function

Poor upper gastrointestinal function may be due to inefficient functioning of:

Salivary glandsStomachPancreasLiverGallbladder

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Symptoms

A prolonged sensation of fullness or stagnation after eating

Undigested food in stools Belching or flatulence Intolerance of fatty foods Nausea Eating disorders

e.g. anorexia

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Poor Digestive Function

May be largely asymptomatic, but can contribute to other conditions: Food intolerance or allergies Intestinal dysbiosis Constipation Nutrient deficiencies

Good upper digestive function is a prerequisite for a healthy digestive system

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The Five Tastes

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All regions of the tongue can detect the 5 basic tastes

Bitter         Salty         Sweet      Umami        Sour

Bitter Taste Receptors

Bitter taste receptors: TAS2R TAS1R are sweet receptors TAS2Rs are distinct from taste receptor

cells mediating responses to other taste qualities

Cells with these receptors appear to be wired to elicit aversive behaviour, probably because many toxic chemicals are bitter in taste

Meyerhof W, 2005, Elucidation of mammalian bitter taste.Rev Physiol Biochem Pharmacol. 2005;154:37-72. 6

Bitter Taste Receptors Amarogentin from Gentian stimulates 7

receptors: TAS2R1, 4, 39, 43, 46, 47 and 50 Absinthin from Wormwood stimulates 4

receptors : TAS2R10, 14, 46 and 47 Hop bitter acids (humulones) stimulates

TAS2R1, 14 and 40 Parthenolide from Feverfew stimulates 7

receptors : TAS2R1, 3, 8, 10, 14, 44 and 46 Bitter isothiocyanates from Brassicas tend to

mainly stimulate TAS2R38

Meyerhof W, Batram C, Kuhn C et al. Chem Senses 2010; 35(2): 157-1707

The Upper GITis a Tasting

Organ!

Valussi M. Functional foods with digestion-enhancing properties.Int J Food Sci Nutr 2012;63 (Suppl 1): 82-89 8

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Bitter Insights

Bitter herbs do NOT need to be tasted to favourably influence digestive function

In fact, clinical research on Gentian dating from 19981 supports this concept but now we understand why

This means that tablets or capsules containing bitter herbs are clinically active, although higher doses are probably necessary

1 Wegener T. Z Phytother 1998; 19: 163-164

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Bitters Can Help Regulate Metabolic Function

In epidemiological studies, functional variants in bitter taste receptors have been linked to alcohol dependency,1 adiposity (TAS2R38),2 eating behaviour disinhibition,3 body-mass index4 and colon cancer risk5

Variations in TAS2R9 have beenassociated with altered glucoseand insulin homeostasis6

1 Wang JC et al. Alcohol Clin Exp Res 2007; 31(2): 209-2152 Tepper BJ et al. Obesity (Silver Spring) 2008; 16(10): 2289-22953 Dotson CD, Shaw HL, Mitchell BD et al. Appetite 2010; 54(1): 93-994 Feeney E, O'Brien S, Scannell A et al. Proc Nutr Soc 2011; 70(1): 135-1435 Carrai M, Steinke V, Vodicka P et al. PLoS One 2011; 6(6): e204646 Dotson CD, Zhang L, Xu H et al. PLoS One 2008; 3(12): e3974

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Gentian Research

205 patients took on average five capsules per day, each containing 120 mg of a 5:1 dry extract of gentian root

All patients achieved rapid and dramatic relief of symptoms, including constipation, flatulence, appetite loss, vomiting, heartburn, abdominal pain and nausea

Wegener T. Z Phytother 1998; 19: 163-164

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Bitters Can Help Regulate Metabolic Function

Insulin resistance Can bitter herbs play a role in glucose homeostasis

and insulin resistance? 94 patients with prediabetes exhibited

improvements in BMI, glycemic control and body fatwhen given just 16 to 48 mg/day of isohumulones (hop bitter acids)as capsules in a double blind,placebo-controlled clinical trial1

1 Obara K, Mizutani M, Hitomi Y et al. Clin Nutr 2009; 28(3): 278-284

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Incretins

Incretins are gut derived hormones that stimulate insulin secretion from β cells after eating

Regulate glucose homoeostasis, gut motility, appetite and adiposity

GIP, glucose-dependent insulinotropic polypeptide

GLP-1, glucagon-like peptide-1

Diakogiannaki E, Gribble FM, Reimann F. Nutrient detection by incretin hormone secreting cells. Physiol Behav 2012; 106(3): 387–393

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Incretins

GIP is secreted from enteroendocrine K cells mostly located in the duodenum and upper jejunum1

GLP-1 is secreted from enteroendocrine L cells found along the length of the intestinal tract, from duodenum to colon2

1 Diakogiannaki E, Gribble FM, Reimann F. Nutrient detection by incretin hormone secreting cells. Physiol Behav 2012; 106(3): 387–393

2 Jang HJ, Kokrashvili Z, Theodorakis MJ et al. Gut-expressed gustducin and taste receptors regulate secretion of glucagon-like peptide-1. PNAS 2007; 104 (38): 15069–15074 16

Incretins Insulinotropic effect of GIP and GLP-1 combined,

accounts for up to 60 % of the insulin secreted after a meal in healthy humans and plays a crucial role in postprandial glucose homoeostasis

Patients with long-standing T2DM and poor glycaemic control have deficient GLP-1 secretion

Chia CW, and Egan JM. Role and development of GLP-1 receptor agonists in themanagement of diabetes. Diabetes Metab Syndr Obes 2009; 2: 37

GLP-1 Increases insulin secretion from beta cells Suppresses glucagon secretion from alpha cells

in the presence of hyperglycaemia but not hypoglycaemia

Delays gastric emptying and gut motility which in turns delays absorption of ingested nutrients and dampens postprandial glucose uptake

Increases the duration of postprandial satiety therefore suppressing appetite and decreasing food intake which eventually leads to weight lossChia CW, and Egan JM. Role and development of GLP-1 receptor agonists in the

management of diabetes. Diabetes Metab Syndr Obes 2009; 2: 37

GLP-1

GLP-1 (in-vivo) demonstrates significant trophic effects Increases islet size Regulates islet growth Enhances β cell proliferation Inhibits β cell apoptosis

Chia CW, and Egan JM. Role and development of GLP-1 receptor agonists in the management of diabetes. Diabetes Metab Syndr Obes 2009; 2: 37

Gymnema therapy demonstratessimilar outcomes to exogenous GLP-1

Grieve DJ, Cassidy RS, Green BD. Emerging cardiovascular actions of the incretin hormone glucagon-like peptide-1: potential therapeutic benefits beyond glycemic control? Br J Pharmacol 2009;157(8):1340-1351

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Metabolic Disease and Dysbiosis

L cell viability (and GLP-1) is negatively affected by dysbiosis

Cani PD et al. Pathol Biol 2008; 56(5): 305-309

Poor Digestive FunctionTherapeutic Strategy

Improve all aspects of upper digestive function with bitters such as Gentian

Improve saliva and gastric acid output with aromatic digestives such as Coleus and Chen Pi and pungent herbs, especially Ginger

Improve bile production by the liver with choleretic herbs, Dandelion Root, Milk Thistle and Globe Artichoke

Improve gallbladder function with cholagogue herbs, Fringe Tree and Bupleurum

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Poor Digestive Function

Core Support

DiGest (1 tablet 15 to 30 minutes before each meal)

Additional Support (as required) Livton Complex tablets (1 tablet 15 to 30 minutes

before each meal) if fat intolerance or other signs of liver stagnation are predominant

Silymarin tablets (2 to 3 per day) if there is evidence or a history of liver damage

Coleus Forte tablets (2 to 3 per day) if patients have coconmittmant metabolic syndrome, hypertension, hypothyroidism

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DiGestDandelion root 4:1 extract 125 mgfrom Taraxacum officinale root 500 mgChen Pi fruit peel 5:1 extract 100 mgfrom Citrus reticulata fruit peel 500 mgMilk Thistle fruit 70:1 extract 30 mgfrom Silybum marianum fruit 2.1 gContaining flavanolignans calc. as silybin 24 mgGinger rhizome 5:1 extract 20 mgfrom Zingiber officinale rhizome 100 mgGentian root 5:1 extract 20 mgfrom Gentiana lutea root 100 mgChen Pi (Citrus reticulata) fruit peel oil 12.5 mgChamomile (Matricaria recutita) flower ess oil 5 mg

Dose: 1 tablet 15 to 30 minutes before each meal 25

Digest: Indications

Sluggish digestion Poor appetite Dyspepsia Flatulence Constipation Inflammation of the digestive tract Cholecystitis, gallstones To improve tone of the digestive tract

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