Dyspepsia

Dyspepsia is a catchall term that includes a variety of digestive problems such as stomach discomfort, gas, bloating, belching, appetite loss, and nausea. Although many serious medical conditions can cause digestive distress, the term dyspepsia is most often used when no identifiable medical cause can be detected. In this way, dyspepsia is like a stomach version of the symptoms in the intestines and colon called irritable bowel syndrome.
The standard medical approach to dyspepsia involves looking for a treatable cause and addressing it if one can be identified. Failing that, various treatments are often suggested on a trial-and-error basis, including medications that reduce stomach acid as well as those that decrease spasm in the digestive tract. The drugs cisapride (Propulsid) and metoclopramide (Reglan) increase stomach emptying, and have also been tried for dyspepsia. However, cisapride has been taken off the market, and metoclopramide causes many side effects.
Its thought that stress plays a role in dyspepsia, as it does with irritable bowel syndrome. Interestingly, one study of 30 people with dyspepsia found that after 8 weeks of treatment with placebo, 80% reported their symptoms had improved. This unusually high placebo response emphasizes the emotional aspect of this condition.

Proposed Treatments for Dyspepsia:

In Europe, dyspepsia is commonly attributed to inadequate bile flow from the gallbladder. While there is little real proof that gallbladder dysfunction is truly the cause of dyspepsia, many herbal remedies that stimulate gallbladder function have a long history of use for dyspepsia, and some may be effective.

The herb cayenne has also shown promise as a treatment for dyspepsia. The essential oils of various herbs may be helpful as well.

Turmeric

The spice turmeric contains a substance, curcumin, that stimulates gallbladder contractions.There is some evidence that curcumin might be effective for dyspepsia.

A double-blind, placebo-controlled study including 106 people compared the effects of 500 mg of curcumin 4 times daily against placebo (as well as against a locally popular over-the-counter treatment). After 7 days, 87% percent of the curcumin group experienced full or partial symptom relief from dyspepsia as compared to 53% of the placebo group.

For more information, including dosage and safety issues, see the full turmeric article.

Combination Herbal Treatments

Other herbs beside turmeric are thought to stimulate the gallbladder, including artichoke leaf, boldo, and celandine. Combinations of these herbs are frequently used in Germany for the treatment of dyspepsia.

A double-blind trial of 60 individuals given either an artichoke leaf/boldo/celandine combination or placebo found improvements in symptoms of indigestion after 14 days of treatment. Similarly positive effects were seen in a double-blind trial of 76 individuals given a combination treatment containing turmeric and celandine. However, reports have raised concerns that celandine can damage the liver. In addition, boldo is dangerous for use by pregnant women, or individuals with liver or kidney disease.

Essential Oils of Carminative Herbs

Herbs believed to assist in the passing of gas are traditionally called "carminatives." Classic carminatives include caraway, chamomile, dill, fennel, peppermint, spearmint, and turmeric. Essential oils made from some of these herbs have been studied for the treatment of dyspepsia.

For example, a double-blind, placebo-controlled study including 39 individuals found that an enteric-coated peppermint-caraway oil combination taken 3 times daily for 4 weeks significantly reduced dyspepsia pain as compared to placebo. Of the treatment group, 63.2% was pain free after 4 weeks, compared to 25% of the placebo group.

Results from a double-blind comparative study including 118 individuals suggest that the combination of peppermint and caraway oil is comparably effective to the no-longer-available standard drug cisapride. After 4 weeks, the herbal combination reduced dyspepsia pain by 69.7%, whereas the conventional treatment reduced pain by 70.2%.

A preparation of peppermint, caraway, fennel, and wormwood oils was compared to metoclopramide in another double-blind study enrolling 60 individuals. After 7 days, 43.3% of the treatment group was pain free compared to 13.3% of the metoclopramide group.

Note: Essential oils of herbs can present health risks. In particular, wormwood (the herb is absinthe) is dangerous when taken long term. Physician supervision is strongly recommended.

Cayenne

Preliminary evidence suggests that oral use of the herb cayenne can reduce the pain of dyspepsia. This may seem like an odd use of the herb; intuitively, it seems that hot peppers should be hard on the stomach. However, contrary to popular belief, hot peppers don’t actually inflame the tissues they contact; in fact, hot peppers aren’t even harmful for ulcers! Rather, they merely produce sensations similar to those caused by actual damage.

Here’s how it works: All hot peppers contain a substance called capsaicin. When applied to tissues, capsaicin causes release of a chemical called “substance P.” Substance P is ordinarily released when tissues are damaged; it is part of the system the body uses to detect injury. When hot peppers artificially release substance P, they trick the nervous system into thinking that an injury has occurred. The result: a sensation of burning pain.

When capsaicin is applied regularly to a part of the body, substance P becomes depleted in that location. This is why individuals who consume a lot of hot peppers gradually build up a tolerance.

It’s also the basis for a number of medical uses of capsaicin. When levels of substance P are reduced in an area, all pain in that area is somewhat reduced. Because of this effect, capsaicin cream is widely used for the treatment of painful conditions such as shingles, arthritis, and diabetic neuropathy.

Oral use of capsaicin also appears to reduce discomfort in the stomach. In a double-blind study, 30 individuals with dyspepsia were given either 2.5 grams daily of red pepper powder (divided up and taken prior to meals) or placebo for 5 weeks. By the third week of treatment, individuals taking red pepper were experiencing significant improvements in pain, bloating, and nausea as compared to placebo, and these relative improvement lasted through the end of the study.

For more information, including dosage and safety issues, see the full cayenne article.

Other Herbs and Supplements

A controlled (but not blinded) study of 46 people suggests that banana powder, a traditional Indian food, may help treat dyspepsia. After 8 weeks of treatment, 75% of the people taking banana powder reported complete or partial symptom relief compared to 20% of those who received no treatment.

Herbs with a reputation for relaxing a nervous stomach, such as chamomile, valerian, and lemon balm, are also sometimes recommended for dyspepsia. Numerous other herbs that have been recommended for dyspepsia include angelica root, anise seed, bitter orange peel, blessed thistle, cardamom, centaury, chicory, dandelion root, cinnamon, cloves, coriander, devils claw, dill, gentian, ginger, horehound, juniper, milk thistle, radish, rosemary, sage, St. Johns wort, star anise, and yarrow.

Digestive enzymes are often recommended for indigestion; however, one placebo-controlled crossover study enrolling 37 individuals found no significant difference between the effects of enzymes and placebo on dyspepsia symptoms.

A tea made from the "fruits" or seeds of parsley is a traditional remedy for colic, indigestion, and intestinal gas.