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Herbs for the Upper Digestive Tract Lee W Carroll, B.Sc.

Herbs for the Upper Digestive Tract Lee W Carroll, B.Sc. Poor Digestive Function. Poor upper gastrointestinal function may be due to inefficient functioning of: Salivary glands Stomach Pancreas Liver Gallbladder. Symptoms. A prolonged sensation of fullness or stagnation after eating

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Herbs for the Upper Digestive Tract Lee W Carroll, B.Sc.

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  1. Herbs for the UpperDigestive Tract Lee W Carroll, B.Sc.

  2. Poor Digestive Function Poor upper gastrointestinal function may be due to inefficient functioning of: • Salivary glands • Stomach • Pancreas • Liver • Gallbladder

  3. 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

  4. 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

  5. The Five Tastes All regions of the tongue can detect the 5 basic tastes Bitter         Salty         Sweet      Umami        Sour

  6. 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.

  7. 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): 157-170

  8. 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

  9. 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

  10. 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): 209-215 2 Tepper BJ et al. Obesity (Silver Spring) 2008; 16(10): 2289-2295 3 Dotson CD, Shaw HL, Mitchell BD et al. Appetite 2010; 54(1): 93-99 4 Feeney E, O'Brien S, Scannell A et al. Proc Nutr Soc 2011; 70(1): 135-143 5 Carrai M, Steinke V, Vodicka P et al. PLoS One 2011; 6(6): e20464 6 Dotson CD, Zhang L, Xu H et al. PLoS One 2008; 3(12): e3974

  11. 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

  12. 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

  13. 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

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

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

  16. 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 loss 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

  17. 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

  18. Gymnema therapy demonstratessimilar outcomes to exogenous GLP-1

  19. 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

  20. 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

  21. 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

  22. 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

  23. DiGest Dandelion root 4:1 extract 125 mgfrom Taraxacum officinale root 500 mg Chen Pi fruit peel 5:1 extract 100 mgfrom Citrus reticulata fruit peel 500 mg Milk Thistle fruit 70:1 extract 30 mgfrom Silybummarianum fruit 2.1 gContaining flavanolignans calc. as silybin 24 mg Ginger rhizome 5:1 extract 20 mgfrom Zingiberofficinale rhizome 100 mg Gentian root 5:1 extract 20 mgfrom Gentianalutea root 100 mg Chen Pi (Citrus reticulata) fruit peel oil 12.5 mg Chamomile (Matricariarecutita) flower ess oil 5 mg Dose: 1 tablet 15 to 30 minutes before each meal

  24. 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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