Ulcerative colitis (UC) is a chronic and ambiguous disease afflicting the rectum as well as sometimes, the entire colon.
While the root cause of the disease is not clearly understood, it likely is a result of an alteration of the immune response to the normal, healthy bacteria residing in the lower region of the intestine. This process may be enhanced by genetic, as well as environmental factors.
While synthetic pharmaceutical medicine is the mainstay of treatment, the use of herbal medicines to combat this ailment is on the upswing, to include traditional Chinese medicine.
There are a variety of medicinal herbs that have shown promise in the treatment of ulcerative colitis and it appears that the common trait found linking many of the herbs are innate anti-inflammatory properties.
In recent years there have conducted multiple pre-clinical and clinical trials in order to evaluate the safety and efficacy of various herbal remedies for ulcerative colitis.
Natural Herbs with the Most Promising Supportive
Information for Ulcerative Colitis
Almond Mushroom (Agaricus subrufescens)
This mushroom grows indigenously in the Brazilian rainforest and has been used in traditional Brazilian medicine for decades (described as early as 1893) for the prevention and treatment of a host of diseases, including cancer, allergies, and infection.
In an attempt to unravel the workings of this special mushroom, Geir Hetland, MD, Ph.D., at the Department of Cellular Therapy at Oslo University Hospital, et al (the scholarly abbreviation of the Latin phrase “et alia”, which means “and others”) developed a number of working hypotheses.
In the course of this particular research, it was found that almond mushroom was able to modify the body’s immune system, as well as possess anti-cancer, anti-infective, anti-allergic and anti-inflammatory effects. These anti-inflammatory effects were further developed in models of inflammatory bowel disease patients.
D.T. Førland, MD, and associates (Department of Gastrointestinal Surgery) also at Oslo University Hospital, investigated the impact of a commercial extract of Agaricus subrufescens.
Subjects with ulcerative colitis were administered the extract product daily for 12 days. Patient blood samples were collected both before and after treatment to test for effects on markers of inflammation (cytokines) associated with the development of UC.
After treatment, reductions were observed in all of the 17 pathogenic cytokines evaluated, suggesting that almond mushroom may have a beneficial effect in the pathogenesis (the mechanism that causes the disease) of UC.
Fabio Firenzouli, Ph.D., et al, at the Center for Natural Medicine at Giuseppe Hospital in Italy, authored a review article examining the usage and safety of the almond mushroom.
They state that the consumption of these mushrooms was generally safe.
Further to that, they cite a preclinical study (Kuroiwa, et al: Food Chem Toxicol 2005; 43:1047–53) where rats received an extract of Agaricus subrufescens for 90 days as well as a 16 week human clinical study (Inuzuka, et al. Jpn Pharmacol Ther 2002; 30:103–7).
No untoward signs of toxicity were observed in either study. On rare occasions, liver damage was observed in subjects using the mushroom for cancer therapy. As a result, it should be avoided in patients with existing liver disorders.
Although most of the clinical research conducted used commercially available or experimental extract products, fresh almond mushrooms can be found in a variety of specialty and general grocery stores.
Doses for the commercial formulations would be specific to the product, and the correct therapeutic doses for the raw mushroom as an herbal remedy for ulcerative colitis are not readily available.
There is, apparently, no published information describing the impact of almond mushrooms on pregnancy and breastfeeding. As a result, users should err on the side of caution, and not use the herb if pregnant, trying to become pregnant or breastfeeding.
Aloe (Aloe vera)
There have been reports that Aloe vera gel could be an effective herbal remedy for the treatment of ulcerative colitis.
Aloe vera gel should not be confused with Aloe vera extract or juice: although Aloe vera gel is generally considered safe, Aloe vera extract and juice contain anthraquinones which have powerful laxative properties and may also be toxic. The gel contains only minimal amounts of these substances.
Louise Langmead, MD, and colleagues at the Centre for Gastroenterology, of the Queen Mary School of Medicine and Dentistry in London, set out to determine the efficiency of Aloe vera in the treatment of UC by randomly assigning 44 patients to receive either 100 mL of Aloe vera gel or placebo treatment for a period of 4 weeks.
Their results showed that clinical remission was obtained in 30% of patients receiving Aloe vera, and in 7% of patients receiving placebo.
Further to that, an activity index and microscopic scores of the ulcerative colitis lesions decreased significantly in the Aloe vera-treated patients, but not in those who received placebo. Adverse side effects were minor and similar in both groups.
The authors concluded that oral Aloe vera gel was more effective than placebo in treating UC, and appeared to be safe.
Indian Frankincense (Boswellia serrata)
Boswellia serrata is a tree indigenous to the Middle East, Northern Africa, and India.
The bark of the tree can be peeled away to yield a gummy resin. In order to collect the resin, a thin strip of bark is cut off of the tree, and a tap is inserted into the cut section, like the approach used to harvest maple syrup.
This tapping process usually occurs between the months of November and May.
An extract can then be made from the resin that has been used as a traditional herbal medicine in the Ayurvedic system. Its main use is to combat arthritis, as a stimulant, astringent and antiseptic.
As much as 16% of the resin can be fractionated as oil. It is thought that the active ingredients are volatile oils, terpenoids, and sugars. It appears that ß-boswellic acid is a major constituent.
Test tube studies of boswellic acid extracted from the gum resin suggest it is able to block multiple pro-inflammatory products that are known to be associated with UC.
I. Gupta, MD and colleagues at the Department of Medicine, Government Medical College in Jammu, India explored the value of Boswellia serrata (Sallai guggal) gum resin in the treatment of ulcerative colitis.
A total of 350 mg of Boswellia serrata gum resin was given to UC patients three times daily for 6 weeks. Patients in a control group received standard of care, sulfasalazine.
By the end of the prescribed treatment period, patients who received Boswellia serrata gum resin showed improvement in stool properties, microscopic examination of rectal tissue and various clinical chemistry values.
In summary, 82% of patients who received Boswellia serrata gum resin went into remission, compared to 75% of patients in the sulfasalazine control group.
In a follow-up study, these initial results were confirmed. In this experiment, thirty patients were randomized, such that 20 received 300 mg of Boswellia serrata gum resin three times daily, for 6 weeks, while another 10 subjects were administered 1 gram of sulfasalazine three times daily for 6 weeks.
Out of the 20 patients who received Boswellia serrata gum resin, 18 showed at least some improvement, while 14 went into remission. In the control group, some effect was enjoyed by 6 of 10 patients, with a complete remission rate of 40%.
The authors concluded that Boswellia serrata gum resin has the potential to be an effective treatment for UC.
The scientific literature seems to indicate that the appropriate dose of Boswellia serrata gum resin as a medicinal herb for the treatment of ulcerative colitis is 300 – 350 mg, three times daily.
Most of the available literature sources document the use of commercially procured Boswellia serrata gum resin, although enterprising individuals could likely grow and tap their own trees to produce preparation.
Boswellia serrata gum resin is likely to be safe and well tolerated in most adult patients with UC. It does not typically cause serious side effects, although stomach pain, nausea, and diarrhea have been reported on occasion.
Not enough is known about the safety of using frankincense during pregnancy or breastfeeding. As a result, expectant or breastfeeding mothers should likely avoid the use of this herb.
Turmeric (Curcuma longa)
In a recent review article by M.S. Baliga, et al, with the Department of Research and Development at the Father Muller Medical College in India, it is stated that the use of curcumin, a principal component in the Indian spice turmeric, is viable as a treatment for ulcerative colitis.
The authors state that the common conventional pharmaceutical treatments are burdened by undue side effects that ultimately limit their efficacy.
As a result, they cite the need for novel, non-toxic preparations. Curcumin may be well positioned to play such a role in therapy as it functions as an antioxidant and inhibits multiple signaling pathways crucial to the pathology of UC.
H. Hanai and colleagues from the Department of Endoscopic and Photodynamic Medicine, Hamamatsu University School of Medicine in Japan, enrolled 89 patients with ulcerative colitis in a trial to evaluate the efficacy of curcumin as a maintenance therapy in patients with UC.
Approximately half of the patients received 1 gram of curcumin, and the other half received placebo. All treatments were in addition to sulfasalazine or mesalamine, and administered after the morning and evening meal, for 6 months of treatment.
Of the patients who received curcumin, 4.65% relapsed at some point during the trial, while 20.5% of those receiving placebo suffered a relapse. The investigators concluded that curcumin has the potential as an herbal remedy to prevent relapses of UC.
Curcumin can be found at most any health food store as a standardized supplement, usually formulated in a capsule. The majority of sources suggest that a dose of 400-600 mg should be administered 2-3 times daily.
Curcumin is generally recognized as safe, although it has been found to cause an upset stomach if taken for long periods of time.
People with gallstones, bile obstruction, are pregnant or breastfeeding should avoid using curcumin.
Further, curcumin has the potential to interact with some medications, to include diabetes drugs, medicines designed to lower stomach acid and some blood thinners.
Like any herb or medicine, patients should discuss the use of curcumin with their health care provider prior to using it.
Barley (Hordeum vulgare)
Barley, a common cereal, is eaten as a staple food in many countries and is often used as an ingredient in baked products and soups. Barley malt is used in the making of beer and as a sweetener.
Recently, there has been an interest in the use of germinated barley foodstuff (GBF) as a medicinal herb for ulcerative colitis and variety of other diseases.
H. Hanai, MD, and investigators with the Department of Endoscopic and Photodynamic Medicine at Hamamatsu University School of Medicine in Japan enrolled 54 patients with UC in a state of remission, to determine the efficacy of germinated barley foodstuff at maintaining this state of remission.
Of these patients, 32 were randomized to the control group and received standard of care. An additional 22 patients received 20 grams of germinated barley foodstuff in addition to standard of care every day for 12 months.
Significantly better clinical outcomes were enjoyed by patients in the germinated barley foodstuff 3, 6 and 12 months after the start of treatment compared to the control group.
No adverse side effects were reported, and the investigators concluded that germinated barley foodstuff played an important role in maintenance therapy of ulcerative colitis.
T. Bamba, MD, et al, with the Department of Internal Medicine at the Shiga University of Medical Science in Japan, administered 20-30 grams of germinated barley foodstuff daily to patients with mild to moderate cases of UC for 4 weeks.
At the end of the treatment period, the investigators found a significant clinical and endoscopic improvement in these patients. The treatment was found to play a beneficial role in moderating gut bacteria as well as treating and maintaining the remission of UC.
It appears that a daily dose of 20-30 grams of germinated barley foodstuff may be effective in the treatment of UC.
The occurrence of adverse side effects appears unlikely based on the available literature.
Psyllium (Plantago ovata)
It is a fiber derived from this herb, most commonly found in India, which is used in herbal medicine. On each plant, up to 15,000 seeds can be found and covering these seeds is a husk, from which the fiber is derived.
When psyllium husks come into contact with water, they immediately swell and turn into a mass that can be used to assists in the transit of waste through the intestinal tract.
The soluble fiber contained in psyllium has a number of potential uses, with the most common role as a gentle, bulk-forming laxative. It is also used as an herbal remedy to lower cholesterol and treat intestinal problems such as ulcerative colitis.
C. Hallert, MD, et al, with the Department of Internal Medicine at the Central Hospital in Norrköping, Sweden, tested the potential of psyllium to maintain the remission of UC in 29 patients.
In this experiment, patients were randomized to receive either psyllium or placebo for a period of 4 months.
The investigators determined that patients who received psyllium had consistently superior symptom control, with a 69% rate of disease improvement, compared to 24% of patients who received placebo.
They concluded that psyllium can be helpful in maintaining ulcerative colitis in a state of remission.
A daily dose of 10 grams of psyllium per day, taken with at least 240 ml of water, may be an effective dose for the treatment of UC. Psyllium is relatively safe with few side effects reported other than occasional gas and cramping. Allergic reactions, although rare, can occur.
Other medicinal herbs that may be useful to treat ulcerative colitis
- Black walnut – (Juglans nigra)
- Flaxseed Oil – (Linum usitatissimum)
- Gingko – (Ginkgo Biloba)
- Diesel Tree – (Copaifera langsdorffii)
- Devil’s Claw – (Harpagophytum procumbens)
- Fenugreek – (Trigonella foenum-graecum)
- The Guggul Tree – (Commiphora Mukul)
- Licorice – (Glycyrrhiza glabra)
- Mexican Yam – (Dioscorea mexicana)
- Slippery Elm – (Ulmus rubra)
- Tormentil – (Potentilla erecta)
- Wheatgrass – (Triticum aestivum)
- Ashwagandha – (Withania somnifera)
- Knotgrass – (Polygonum aviculare)
- Wood Avens – (Geum urbanum)
Supporting References
Ke F, Yadav PK, Ju LZ.: Herbal Medicine in the Treatment of Ulcerative Colitis. Saudi J Gastroenterol. 2012; 18:3-10
Hetland G, Johnson E, Lyberg T, et al. The Mushroom Agaricus blazei Murill Elicits Medicinal Effects on Tumor, Infection, Allergy, and Inflammation through Its Modulation of Innate Immunity and Amelioration of Th1/Th2 Imbalance and Inflammation. Advances in Pharmacological Sciences. 2011, doi:10.1155/2011/157015
Førland DT, Johnson E, Saetre L, et al. Effect of an extract based on the medicinal mushroom Agaricus blazei Murill on expression of cytokines and calprotectin in patients with ulcerative colitis and Crohn’s disease. Scand J Immunol. 2011;73: 66-7
Firenzuoli F, Gori L, Lombardo G. The medicinal mushroom agaricus blazei murrill: Review of literature and pharmaco-toxicological problems. eCAM. 2008; 5:3-15.
Mayo Clinic, 2012.
Langmead L, Feakins RM, Goldthorpe S, et al. Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Aliment Pharmacol Ther. 2004;19 :739-47.
Vogler BK, Ernst E. Aloe vera: a systematic review of its clinical effectiveness. British Journal of General Practice, 1999; 49:823-828
National Institutes of Health, 2012.
Michael Castleman. The new healing herbs: The essential guide to more than 125 of nature’s most potent herbal remedies. Emmaus, PA. Rodale, Inc. 2009.
Alternative Medicine Review, 2008: http://www.thorne.com/altmedrev/.fulltext/13/2/165.pdf
Gupta I, Parihar A, Malhotra P, et al. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res. 1997; 2:37-43.
Gupta I, Parihar A, Malhotra P, et al. Effects of gum resin of Boswellia serrata in patients with chronic colitis. Planta Med. 2001; 67:391-5.
WebMD, 2013: http://www.webmd.com/vitamins-supplements/ingredientmono-63-INDIAN%20FRANKINCENSE.aspx?activeIngredientId=63&activeIngredientName=INDIAN%20FRANKINCENSE
Baliga MS, Joseph N , Venkataranganna MV, et al. Curcumin, an active component of turmeric in the prevention and treatment of ulcerative colitis: preclinical and clinical observations. Food Funct. 2012; 3: 1109-1117.
Hanai H, Iida T, Takeuchi K, et al. Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial. Clin Gastroenterol Hepatol. 2006; 4:1502-6.
Livestrong, 2011: http://www.livestrong.com/article/443052-curcumin-for-colitis/
All nutrionals.com, 2004: http://allnutritionals.com/natural-products/barley-hdeum-vulgare-l-germinated-barley-foodstuff-gbf.php
Hanai H, Kanauchi O, Mitsuyama K, et al. Germinated barley foodstuff prolongs remission in patients with ulcerative colitis. Int J Mol Med. 2004; 13:643-7.
Bamba T, Kanauchi O, Andoh A, et al. A new prebiotic from germinated barley for nutraceutical treatment of ulcerative colitis. J Gastroenterol Hepatol. 2002; 17:818-24.
Hallert C, Kaldma M, Petersson BG. Ispaghula Husk May Relieve Gastrointestinal Symptoms in Ulcerative Colitis in Remission. Scan J Gastroentol. 1991; 26: 747-750.
WebMD, 2013: http://www.webmd.com/drugs/drug-92834-Natural+Psyllium+Oral.aspx?drugid=92834&drugname=Natural+Psyllium+Oral.
Thordur Sturluson
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