February 2020

Natural Medicines for GI Symptoms

There are growing concerns regarding the safety of common GI medications. And recent headlines about a possible carcinogen in some prescription and OTC H2-blocker products (such as ranitidine) are raising additional questions about safety. These concerns are increasing interest in natural alternatives for managing GI symptoms – can any help? Which myths should you debunk?

There’s a lot of anecdotal evidence about apple cider vinegar for heartburn. Many online blogs and health websites claim that its acidic nature can help treat a wide variety of conditions. For heartburn specifically, the claim is that apple cider vinegar can help increase stomach acidity in people who don’t have enough stomach acid. The problem with these claims is that there’s no clinical evidence backing them up. For now, tell patients if they want to give it a shot there aren’t any major safety concerns when used short-term, but it’s unclear if it will actually help.

Patients might also ask about peppermint and caraway. Peppermint has been used since ancient Greek and Roman times for gastrointestinal disorders. And there’s some clinical evidence that it can help, but only in specific combination products – one containing both peppermint oil and caraway oil (Enteroplant), and another containing a long list of ingredients also including both peppermint and caraway oil (Iberogast). Enteroplant isn’t available in the US, but research shows that it reduces heartburn symptoms, including feelings of fullness, pain, and stomach spasms. Iberogast is available in the US. While it does seem to reduce symptoms such as acid reflux and stomach pain, it contains greater celandine. Due to concerns of liver toxicity, most experts recommend monitoring for liver injury and limiting use to 4 weeks or less. For this reason, this product might not be useful for people with chronic heartburn. It also contains licorice. There are concerns that licorice may cause problems in people with high blood pressure, but the amount of licorice in this product is unlikely to be a problem if people take it in recommended doses. There isn’t any clinical evidence showing that taking peppermint oil or caraway oil alone can help. In fact, peppermint oil taken alone can worsen heartburn in some patients and cause other side effects like nausea, vomiting, and belching.

There are some natural medicines that might be worth a shot. There’s supportive clinical evidence showing that taking Indian gooseberry fruit extract for 4 weeks helps to reduce the frequency and severity of heartburn in people with GERD. There also aren’t any major safety concerns. If your patients want to try it, tell them to stick to 1,000 mg twice daily. Anise also shows some promise. Research shows that taking anise powder 3 grams three times daily for 4 weeks reduces stomach discomfort, bloating, and pain in people who have indigestion after eating.

For more details on other natural medicines studied for GERD or dyspepsia, check out our Comparative Effectiveness chart.

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