Finding the Science in Herbs and Roots
After a questionable encounter several years back, I have come to regard herbal remedies, naturopathy, and traditional Chinese medicine with a great deal of skepticism. My mother had brought me to see a well-known herbalist in Vancouver’s Chinatown for a persistent cough that I couldn’t quite get rid of. This man opened my mouth, flickered a penlight at the back of my throat for half a second, and then proceeded to inspect my palms for five minutes. I was confused as to whether my mother had brought me to seek the advice of someone who would cure my ailment or determine how many future grandchildren I was going to provide her with. Having to endure his prescription of a foul-tasting black sludge for a week only added to my distrust of the herbalists’ dubious practices.
Whatever my own personal experience may have been, for many others, herbal remedies and traditional Chinese medicine remain an important supplement to Western medical treatments or a last alternative when conventional pharmacological or surgical therapies fall short of their expected goals. Despite such widespread use, there are surprisingly few publications in the scientific literature that have thoroughly investigated the mechanisms of action of these alternative remedies or their efficacy, particularly with regards to inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). This lack of research may be due to the fact that there are hundreds of products being marketed towards gastrointestinal disease sufferers ranging from synthetic polymers, to herbal extracts, to probiotics (or the “beneficial” bacteria). Matters are further complicated as many of these products are sold as combination therapies or in kits. In an effort to sort through the myriad of formulations, there have been a handful of publications that have made a start in the study of the more commonly used alternative therapy agents indicated by manufacturers and traditional Chinese herbalists for IBD and IBS.
One such agent, marketed towards individuals with IBD is N-acetyl-glucosamine (Glu-NAc) which, according to manufacturer’s claims, acts to support a healthy intestinal lining. A pilot investigation by Salvatore et al.1 studied the effects of Glu-NAc in pediatric chronic IBD. The group proposed two mechanisms of action for Glu-NAc: the stimulation of intestinal tissue repair mechanisms, and the inhibition of intracellular pathways that lead to an inflammatory response. The researchers performed a non-controlled study of twenty children with treatment-resistant inflammatory bowel disease and obtained preliminary evidence suggesting a beneficial clinical effect when Glu-NAc was administered either orally or rectally. Histological comparison of pre and post treatment biopsies further implied that Glu-NAc stimulated a response that improved the structure and organization of the intestinal lining. Salvatore et al. cited the need for more formal investigation under controlled clinical trials but were hopeful that due to its non-toxic and cost-effective nature, Glu-NAc would prove to be an effective means of treating chronic IBD for all age groups.
The so-called “anti-oxidant” herbal remedies are another popular group of alternative therapy among IBD patients. A study by Langmead et al.2, investigated the antioxidant effects of various herbal therapies, including slippery elm and fenugreek. They proposed that these herbal preparations would be effective in lowering the concentrations of reactive oxygen metabolites (ROM) – species that are present in excess during inflammation and generally thought to have a role in the pathogenesis of IBD. Through the use of two “cell-free” experiments and a model testing the herbal compounds with inflamed intestinal biopsies, the researchers concluded that slippery elm and fenugreek were able to “scavenge” and “disable” ROM.
The investigators further suggested that both remedies were able to limit the production of ROM at their source, thus decreasing inflammation, as well as being able to enhance and maintain the protective mucosal barriers that are essential for intestinal health. However, due to the dynamic nature of the gastrointestinal system and the presence of various biologically active molecules in each herbal preparation, Langmead et al. recommended that additional in vivo experimentation and profiling be performed to determine if these remedies have a significant therapeutic effect in managing IBD.
In addition to IBD, there are also alternative medicine treatments specifically indicated for IBS. A well-publicized study by Bensoussan et al.3, attempted to demystify Chinese herbal medicine by conducting a rigorously controlled and randomized trial to compare standardized Chinese herbal formulas, individually tailored Chinese herbal regimens (assigned by certified Chinese herbalists), and placebo. The standardized formula contained 20 herbs that have traditionally been used in Chinese medicine to treat the symptoms associated with IBS, including Yin Chen, Bai Zhu, Dang Shen, Yi Yi Ren, and Wu Wei Zi. At the end of the 18-month trial, 76% of patients receiving the standard formula, 64% of patients receiving individualized regimens, and 33% of the patients receiving placebo reported that their IBS symptoms had improved during treatment. To corroborate, 78% of patients receiving the standard formula, 50% of patients receiving individualized regimens, and 30% of the patients receiving placebo were judged by their gastroenterologists as having improved during the trial. Interestingly, a follow-up assessment conducted 14 weeks post treatment reported that patients who received the standard formula and patients who received the individualized regimens, 63% and 75% respectively, still felt improvement in their IBS symptoms as compared to 32% of patients who received placebo. Bensoussan et al. concluded that Chinese herbal formulations appeared to offer improvements in managing the symptoms of IBS and, although by no means considered conclusive, the results warranted further investigation for Chinese herbal medicine as a viable treatment alternative.
As the use and popularity of herbal remedies, traditional Chinese medicine, and other non-prescription natural products continues to expand, so too should the scientific research to accompany these alternative treatments. Judging from the sparse number of controlled trials that have adhered to accepted protocols and statistical analyses, clearly this is not the case. Since no single conventional drug and/or surgical therapy currently available is reliably effective in ameliorating the symptoms of IBD and IBS, it is understandable that many gastrointestinal disease sufferers seek unconventional and, perhaps more importantly, unproven remedies. Hopefully with time, the scientific community will successfully catch up with the thousands of natural products coming to market and lend empirical support or deconstruct anecdotal claims for using alternative medicine in complement to standard IBD and IBS treatments. Until then, this skeptic will continue to have greater comfort under the care of his family physician than with the man in Chinatown offering palm readings and magical elixirs.