Studies about the resin of Chios continue to show that …

Mastic Heals
What is known, who knew it, and when did they
know it? Mastic on trial before a jury of peers …

By Will Block

Science is the father of knowledge,
but opinion breeds ignorance.

— Hippocrates

C itizens of Athens … Mastic is said to fight ulcers; suppress induced intestinal damage; calm indigestion distress; balance dangerous humors;* combat heavy blood; help treat inflammatory bowels;§ battle various tumors;** act as an anti-allergenic; protect the liver, among many other curative wonders. But it is also alleged to do harm.

* Once the theory of humors was discarded, and replaced by the germ theory of disease, control the growth of microbes such as the bacterium H. pylori and harmful fungi.

✝ Probably dyslipidemia.

§ Possibly Crohn’s disease.

** From what we now know: includes prostate, colorectal, leukemia, and lung carcinoma.

Of the earliest forerunners of modern jury systems there are those of ancient Greece, and in particular the city-state of Athens, where records of jury courts date back to 500 BC. These post-Draconian (unforgiving rules or laws of the 7th century BC) juries voted by secret ballot and were eventually even granted the power to dissolve unconstitutional laws, thus introducing judicial review, meaning that they could pass on the validity of the law (the ancient precursor to the Fully Informed Jury Association’s advocacies).

What say ye, jury of medicinal peers, about the damage to health and bodily essence that the medicine mastic may have caused to innocent users in violation of the oath by which we are bound: first do no harm?

[With a little help from the deus ex machina (god from the machine) of “time travel,” the jury of medicinal peers is comprised not only of ancient Greeks, but ancient Romans as well, mostly from different circa, but all of whom knew about mastic.]

Hippocrates [the “father” of Western medicine, c. 460–370 BC]: I have long observed and pointed out that mastic is good for myriad ailments. Remember that the oath “Do no harm” is attributed to me.

Herodotus [the “father” of history, c. 484–425 BC]: We know that the chewing of mastic (mastication) has proven beneficial to the oral cavity and the stomach and that ancient Egyptians used it to spread over the sheets covering embalmed corpses in order to preserve them.

Dioscorides [physician, pharmacologist and botanist, the author of De Materia Medica—a 5-volume encyclopedia about herbal medicine and related medicinal substances (a pharmacopeia), c. 40–90 AD]: In my writings there are many extended references to mastic, by attributing to schinin, as I have called it, numerous therapeutic properties: beneficial for blood coagulation, for healing chronic cough, for stomach aches; also useful for cleaning the teeth, odoring the mouth when chewed and giving glow to the face when used as an ointment. In my work De Materia Medica, it is mentioned as “mastichinon elaion (oleum),” a preparation received by mixing mastic with olive oil and lauded for its warming, astringent, and emollient properties, as well as its effect on inflammations of the stomach and on abdominal and intestinal disorders.

Furthermore, I have strongly emphasized that the best “mastichinon elaion” is produced in Chios. However, it can be adulterated when combined with pine resin or frankincense, and that may be the cause of harm, but it is not mastic per se.

Galen [physician, surgeon, and philosopher and arguably the most accomplished of all medical researchers of antiquity, c. 129–200 AD]: I share the belief that mastic is an important healing factor. Often have I mentioned its properties and recommended its use. Superior is “white mastic,” which is produced only in Chios, and to it there are attributed properties as emollient and styptic, which make it suitable for inflammations of the stomach, the abdomen and the liver. Frequently, I prescribe it for healing stomachaches and I even recommend it as an antidote for snakebites.

Plinius [author, naturalist, and natural philosopher, and author of an encyclopedic work, Naturalis Historia, which became a model for all such works written thereafter, 23 AD – 79 AD]: Among my Roman colleagues, I was forceful to emphasize the use of mastic for its superiority to other resins. In fact, I reported on the unique cultivation of the mastic tree in the southern part of Chios, as well as its use as an additive to grape must.

‡ This was confirmed by archeological findings of the 6th century BC in Italy, where FT-IR analysis of the residue in wine vessels revealed the presence of mastic. Then, analysis of an ointment found in a small ceramic bottle in an Etrurian tomb of the 2nd c. BC in Chiusi, Italy, revealed mastic as one of the compounds. This is probably the oldest cosmetic containing mastic yet discovered.

Of course, this trial never took place, but if it had, would the jury still be out? However, we are now living in an age in which the scientific method is more significant than ever before, so let’s progress forward in time and gather momentum as we move thorough various epochs of mastic appreciation and study of it, up to the present.

Byzantine Mastic Prosperity

During the Byzantine era (451-843 AD), the trade and use of mastic became very profitable for Constantinople.1 Its uses for stomach aches, mouth hygiene, facial creams, production of soap, tooth paste and even as a panacea (especially for pathological cases with no confirmed cause) were mentioned by many authors of that period.2

Expansion of Trade to the Islamic World

After the occupation of the island of Chios by the Genovese (1346-1566 AD), exploitation of mastic passed first to the house of the Zaccaria and later to that of Giustiniani. The prosperity of the production encouraged the expansion of mastic’s trade to the Islamic world, where mastic was already popular for chewing and odoring the mouth, and also as an additive in bread, due to a recommendation for its use by Mohammed himself in the Quran. During the Giustiniani period, mastic was exported all over Europe, but the price paid by the population of Chios for this expansion was exhausting (with high taxes and slavish working conditions). So when the Ottoman Turks took over, this was seen as positive for the fortunes of mastic.

Mastic and the Sultan’s Harem

With Ottoman rule, most of the production of mastic was devoted to the Sultan’s harem, and taxes were lowered for Chios’ inhabitants, starting in 1567. Unfortunately, this period was also characterized by unlimited political power and violence, with the ultimate destruction of Chios by the Ottomans in 1822. From this devastation of the island, which included total annihilation of mastic production, many decades were required for recovery.

Numerous European authors of the Ottoman period mentioned applications of mastic, such as its addition in wine and alcoholic preparations, its use in healing ointments, its addition to bread, its use as a heart stimulating agent, its positive effect on stomachaches and vomiting, as well as the chewing of mastic in order to assist digestion, teeth whitening, improvement of mouth odor, and the use of mastic tooth-picks for strengthening the teeth.

Into the Pharmacopoeias

Mastic was also written about in many European pharmacopoeias of the 19th century, mentioned for numerous prescriptions of ointments and pills. Then there were British pharmacopeias, wherein it was prescribed for its disinfectant, stimulating, and sweetening properties. In a Belgian pharmacopeia, mastic was referenced in numerous preparations against catarrh (phlegm) and diarrhea and also the base for a formula known as the Spiritus Mastiches Compositus. French pharmacopoeias of that period mentioned mastic as a compound of several preparations, against dyspepsia, and skin injuries, as well as an analgesic for teeth extraction. Numerous German pharmacopoeias referred to mastic and its uses, usually as an analgesic, in dentistry and for plasters, especially for military applications. Also, in Italian pharmacopoeias, mastic was preferred as a diuretic and as a compound for use as a temporary tooth sealing.3

Modern Times

After its liberation by Greece in 1912, Chios sought to reclaim its once famous mastic production and distribution. It was then that the Chios Gum Mastic Growers’ Association was created, becoming the sole agency for collecting, packaging and trading the mastic sold to it by the growers. While this was superior to what had been, it was far from ideal. Nevertheless, this organization helped mastic production growth, fortified the growers’ income, and gave the opportunity for a coordinated promotion of mastic on an international level, together with gaining the co-operation of academic researchers who helped reveal and substantiate mastic’s therapeutic properties.

Studies Of The Biological Activities Of Mastic & Mastic Oil

Mastic in the Treatment of Gastrointestinal Disorders

It may come as a surprise that the healing properties of mastic, especially those related with the gastrointestinal system, were preserved in the traditional therapeutics of the peoples of Eastern Mediterranean and Middle East. Among this population, the use of mastic is quite widespread and is still used in medical practice. Moreover, the therapeutic uses of mastic gave the initiative for the first studies on the activity of mastic against ulcer and gastritis in the middle 1980’s. As reported in this publication (see “Goodbye Pylori” in the March 1999 issue), the first clinical study to show results on patients with active symptoms of endoscopically-detected duodenal ulcer after mastic administration was that of Al Habal et al in 1984.4

According to this double-blind clinical trial, 80% of the patients receiving mastic reported relief from the symptoms, compared to 50% of those receiving placebo. These findings were enforced by endoscopic examination, showing healing in 70% of the study group, as opposed to only 22% of the placebo group. Each subject received 2 g of mastic per day for four weeks.

Shortly after, in another study, Al-Said et al showed that orally administered mastic reduced the degree of gastric mucosa damages considerably in mice suffering from gastric or duodenal ulcers.5 Following pathogenesis induction, the mice received one oral dose of 500 mg of mastic/kg of body weight (the equivalent of nearly 7 g for a 187 lb human), and after examination of their stomachs and duodenums, it was found that oral administration of mastic reduced the degree of gastric mucosa damages significantly. Also, an intense cytoprotective effect of mastic was revealed in those that had received 50% ethanol damage induction. The results suggested that the anti-ulcer effect of mastic could be attributed to its mild anti-secretive and local cytoprotective activities.

Together, these two studies gave the first measurable proof for mastic’s healing effect on duodenal ulcer for both human patients and mice. In a more recent study, mastic oil reduced the intestinal damages induced by the pain-relieving drug diclofenac and concomitant bacterial translocation in mice, a phenomenon caused by non-steroidal anti-inflammatory drugs (NSAIDS).6 After estimating all the parameters that are increased by diclofenac, it was found that they were all reduced by administration of 1.0 mg of mastic oil/kg of body weight. Then, in a recent study,7 Dabos et al showed that mastic given to patients suffering from functional indigestion for three weeks induced relief of symptoms for 77% of the patients, as opposed to 40% of those receiving placebo. This was the first study concerning the effect of mastic in functional indigestion.

Anti-H. pylori Activity

After Warren and Marshall discovered Helicobacter pylori in 19838 and correlated it with gastric diseases—for which they were awarded a Nobel Prize in 2005—the interest in determining the mechanism of action of mastic and mastic oil in these diseases was focused on the investigation of their anti-H. pylori properties. Many studies ensued, concerning both in vitro experiments and clinical trials in the context of revealing the effect of mastic in confronting H. pylori and the disorders caused by it. Accompanying this research was the hypothesis that drugs aimed at H. pylori would become resistant and that alternative non-antibiotic therapies for infectious diseases were needed.

Remarkably, the first study that mentioned the anti-H. pylori activity of mastic appeared in the well-regarded New England Journal of Medicine in 1998.9 It found that the bactericidal activity of mastic could decimate strains of H. pylori that that were drug resistant at very low concentrations in vitro. The results clearly showed the antibacterial activity of mastic against H. pylori, offering a possible explanation of its anti-ulcer effect. Other studies followed, assessing the antibacterial activity of mastic upon isolated clinical strains of H. pylori in a range of concentrations. In addition, microscopic observance of the morphology of the bacterium by electron emission revealed air bubble release, abnormalities in morphology, and segmentation of H. pylori cells.

In the studies that followed, the concentration required was found to be higher than that stated by Huwez et al in the New England Journal of Medicine study and the bactericidal activity was now extended to a larger number of strains, but a mastic concentration of 125 μg/ml was nevertheless found to kill 50% of the bacteria. In these studies, it was observed that the structural effects of mastic on H. pylori cells could offer some explanation on the mechanism of mastic’s anti-H. pylori activity.

Chew Mastic for Fast Relief
and to Prevent Reinfection

It has been suggested that chewing mastic gum could be considered as a potential nontoxic agent in the treatment of oral malodor and gum disease that is more suited perhaps for local application rather than rinsing.

The bacterial soup that occcupies the oral cavity and especially the plaque where H. pylori is embedded and ready to recontaminate the stomach.
By “local application,” what is usually meant is the insertion (by a dentist) of an antibiotic biofilm directly into the diseased periodontal pockets around the teeth, where it can do the most good. At home, our best approximation to this ideal is to take the mastic in a form—such as a chewable wafer—that keeps it in the mouth for awhile and embeds it like antibiotic biofilm between your teeth so as to increase the chances that its biologically active constituents will penetrate those pernicious pockets.

It’s noteworthy that other research has shown mastic to be effective, not only against H. pylori, but against the bacterium Streptococcus mutans, which is the chief culprit in periodontal disease because of its dominant role in the formation of dental plaque (it also causes cavities). If it enters the bloodstream, S. mutans can infect the interior linings of the heart, causing endocarditis, a serious inflammatory disease. (For more on this, see “Chewing Mastic Gum Can Prevent Tooth Decay” in the March 2006 issue.)

There is another advantage to having mastic in direct contact with your teeth, and that is the liklihood that that we reinfect ourselves from H. pylori that ends up residing in the calculus (plaque) of our teeth. Chewing mastic may prevent such collusion.

Mastic’s Arabinogalactan-Protein Attribution

In a more recent study,10 the anti-H. pylori activity of mastic was attributed to the arabinogalactan-proteins (AGPs) isolated from mastic. The growth of H. pylori cells in the presence of mastic aqueous extracts containing AGPs showed that the viability of the bacterium was affected, by obstructing its growth. However, there were no indications whether AGPs were responsible for causing morphological abnormalities in H. pylori. Following this, Kottaki et al11 investigated the effect of AGPs, both in vitro and in vivo on the innate cellular immune effectors (neutrophils activations), comparing H. pylori-infected patients and healthy controls receiving 1 g of mastic daily for two months, under the presence of H. pylori neutrophil-activating protein. It was found that AGPs inhibit neutrophil activation in the presence of the neutrophil-activating protein.

Mastic Puzzle

Then in 2003, the same research groups questioned the capability of mastic to eradicate H. pylori from both mice12 and human patients.13 Mastic was administered, alternatively to a triple eradication scheme, to the subjects of each study for periods of 7 and 14 days respectively. In the mouse study, the susceptibility of H. pylori SS1 strain to mastic was assessed through the minimum inhibitory concentration and the minimum bacterial concentrations. Then, an H. pylori SS1 strain suspension was administered into the GI tract of the mice study group. Four weeks after infection, 1.72 mg of mastic daily [said to be the equivalent of 2 g for human subjects, but actually only 23 mg!(1.72*.081*75*2.2 for a 187 lb human)], or a triple therapeutic scheme consisting of metronidazole, clarithromycin and omeprazole (a proton pump inhibitor) was administered to mice twice daily for a seven-day period. It was found that the triple scheme eradicated the infection in 19 out of 20 mice, while mastic showed a complete failure (0 out of 18 mice). No statistically significant reduction of the bacterial load in mastic-treated mice was detected, either. The researchers arrived at the conclusion that mastic was not competent to eradicate H. pylori infection from mice by itself.

The study excluded neither the case of synergistic action of mastic with other factors nor the possibility of insufficient absorption and release of mastic and its compounds inside the stomach of mice, probably due to inherent differences between humans and mice in relation to the effect of mastic. One possible explanation given about the beneficial effects of mastic on humans is its cytoprotective and antisecretive activities, as mentioned by Al-Said et al.5

Conflicts of Interest?

In the second study,13 the goal was to find whether mastic gum could either suppress or eradicate H. pylori infection from humans. Nine H. pylori positive human subjects without any duodenal ulceration were subjected to treatment with 1 g of mastic four times daily for 14 days. Urea breath tests were carried out right before, on the 15th day and five weeks after the treatment. Mastic had no effect on H. pylori status for none of the eight subjects that completed the treatment. They were all found positive to the bacterium with the urea breath test to which they were submitted, both immediately after completion of the administration and five weeks later. The researchers regarded that even large doses of mastic had no significant clinical effect on H. pylori in humans, while they also questioned the validity of a previous study4 according to which mastic could be beneficial in ulcer treatment, since the credibility of the experiment was not sufficiently documented, according to Bebb et al.13

The study reached the conclusion that H. pylori-related ulcer therapy (remember that the subjects didn’t have any ulceration) should only be conducted by antisecretory drugs and eradication schemes, since they constitute the only possible way to cure ulcer and prevent relapse. It is quite interesting, however, to note that one of the researchers has participated in the past in clinical trials funded by the manufacturer of a known proton pump inhibitor, as stated under Conflicts of Interest.

Nevertheless, in 2007, the anti-H. pylori activity of mastic was justified by a study14 from the authors of the review155 that set the stage for this article. These researchers examined the extracts and pure major constituents of mastic gum for their potential activity against H. pylori. A total mastic extract without polymer (TMEWP) was prepared after removal of the contained insoluble polymer in order to ameliorate solubility and enhance in vivo activity.

Administration of TMEWP to mice infected by H. pylori SS1-strain over a period of 3 months with an average dose of 0.75 mg/day led to an approximately 30-fold reduction in the H. pylori colonization. No reductions were observed, however, in the H. pylori-associated chronic inflammatory infiltration and the activity of chronic gastritis.

Triterpenic Acids May Cause Anti-H. pylori Activity

In order to determine potential active mastic constituents, the TMEWP was fractionated into an acidic and a neutral fraction, following which the structures of the major components within each fraction were extensively characterized by spectroscopy. What they found is that the acidic fraction gave mainly the major triterpenic acids, while the neutral fraction gave several triterpenic alcohols and aldehydes. The two mastic fractions and isolated pure triterpenic acids were tested for in vitro activity against 11 H. pylori clinical strains. The most active extract was found to be the acidic fraction (MBC 0.139 mg/ml), the major compounds of which are masticadienonic (1a) and isomasticadienonic acids (1b), and the most active pure compound was isomasticadienolic acid (2, MBC 0.202 mg/ml, 0.443 mM). The results showed that administration of TMEWP may be effective in reducing H. pylori colonization and that the major triterpenic acids in the acidic fraction are possibly responsible for the antibacterial activity. This study could constitute an initiative for further investigation of the role of the acidic compounds of mastic in its anti-H. pylori activity.

The Smoking Gun?

In a 2009 study about the anti-H. pylori effect of mastic,16 mastic polymer was identified as the most active of its fragments, followed by the acidic fraction and mastic gum itself, whereas the neutral fraction was inactive. The increase in potency for both the polymer after oxidation, and the gum after chewing (mastication) was considerably high (100% and 50%, respectively). Following this, in a recent study by Dabos et al,7 different doses of mastic were administered to two groups of patients (A & B) with a detected H. pylori infection for 14 days, while a third group (C) received mastic and pantoprazole, and a fourth one (D) was given a triple therapeutic scheme of pantoprazole, amoxicillin and clarithromycin (triple therapy) for the same period. Breath urease test showed that the bacterium was eradicated in 4/13 patients in Group A, 5/13 in Group B, 0/13 in Group C and 10/13 in Group D. While the results were not statistically significant for Groups A and B, they showed a tendency for mastic to eradicate H. pylori. The paradox in the failure of mastic-pantoprazole combination could be due to the increase in the pH of stomach caused by proton pump inhibitors, which may lower the potency of mastic’s active ingredients, probably responsible for its anti-H. pylori activity.14

Mastic’s activities may result from
synergy between numerous or even
all of its components.

Antimicrobial – Antifungal Activity

The discovery of the anti-H. pylori effect of mastic followed its already known antimicrobial properties, was mentioned in 1957 by Abdel-Ghaffar et al,17 in the first reference of the biological activities of the gum. The antimicrobial activity of mastic oil is described for the first time by Tassou & Nychas in 1995,18 as expressed during the process of food spoilage and against food-borne organisms. When mastic oil was added to broth cultures inoculated with the bacteria S. aureus and Lactobacillus plantarum along with bacteria Pseudomonas fragi and Salmonella enteridis, the inhibitory effect was greater on Gram positive bacteria (the first two) than on Gram negative (the second two). Another study19 attributed antifungal activity to the aqueous extract of mastic, reducing the growth of three species from 36% to 100%. Also, in a study20 examining the chemical composition of mastic oil together with that of the essential oils of the leaves and twigs of P. lentiscus var. chia, the researchers also examined the antimicrobial and antifungal activities of mastic oil, total mastic extract and acidic and neutral mastic fractions against six bacteria and three fungi with mastic oil proven to be the most active.

Then, in 2005, Koutsoudaki et al,21 while analyzing the chemical composition of mastic and mastic oil, also examined the antimicrobial activity of mastic oil and its major fractions and. Fragmentation of mastic oil, led to the identification of several trace components. Each of the minor compounds exhibited different grades of activity against different bacteria. This showed that the antimicrobial efficacy of mastic oil cannot be easily attributed to one or some of its compounds. Mastic’s activity should be considered as a result of synergy between numerous or even all of its components.

Antioxidant Activity

Mastic had been used for centuries as a preservative for fats and oils by various peoples. Such uses by Egyptian villagers triggered the first study on mastic’s antioxidant activity by Egyptian researchers in the 70’s. Abdel-Rahman et al22 showed that mastic possessed antioxidant activity similar to that of butylated hydroxyanisol (BHA), a powerful synthetic antioxidant.* In another study,23 the same group showed antioxidant activity of mastic for cottonseed oil and sunflower oil similar to that of BHA and Embanox B (another synthetic antioxidant). In 2003,24 the potential protective effect of several resins upon the copper-induced oxidation of human low-density lipoprotein (LDL) was tested, and the researchers rated the hydromethanolic extract of mastic as the most active. Several combinations of triterpenes, including mastic compounds such as oleanolic acid, showed considerable protective activity as well. In another study,25 mastic was studied together with other resins for their antioxidant activity in vitro, using lard, corn oil and sunflower oil as oily substrates. Mastic as well as mastic oil showed potent activity and the researchers thought that they could both be used as preservatives in pharmaceutical and cosmetic preparations, as well as for functional foods.

* Since 1947, BHA has been added to edible fats and fat-containing foods for its antioxidant properties as it prevents food from becoming rancid and developing objectionable odors.

Lowering Blood Lipids

Recently, two research groups examined the hypolipidemic activity of mastic. The first one26 studied the molecular mechanism through which a mastic extract inhibits the cytotoxic effect of oxidized LDL (oxLDL) on peripheral blood mononuclear cell (PBMC). Inhibition was observed when culturing cells with oxLDL and the mastic extract concurrently. The results showed that oxLDL decreased GSH (glutathione) levels and upregulated CD36 (a scavenger receptor involved in immunity) expression, while the mastic extract restored GSH levels and downregulated CD36 expression. When fractions were examined for their antioxidant effect on oxidatively-stressed PBMC, the triterpenoid fraction revealed remarkable increase in intracellular GSH. Conclusion: GSH restoration and downregulation of CD36 mRNA expression are the pathways by which mastic triterpenes exert their antioxidant/antiatherogenic effect.

Hepatoprotective/Cardioprotective Role for Mastic

In the second study,27 the effect of mastic on cardiologic and hepatic biochemical indices of humans was assessed. Of 133 participating subjects (>50 years) were randomly assigned to two groups, the first ingesting daily 5 g of mastic powder and the second receiving daily a mastic solution (low-dose group). After 18-month (first group) and 12-month (second group) follow-up period, the first (high-dose) group exhibited a decrease in serum total cholesterol, LDL, total cholesterol/HDL ratio, lipoprotein, apolipoprotein A-1, apolipoprotein B (apoB/apoA-1 ratio did not change), SGOT, SGPT (both indicative of liver stress) and gamma-GT levels. In the low-dose group, glucose levels decreased in male subjects. These results indicate that Chios mastic powder could have a hepatoprotective/cardioprotective role in vivo in humans.

Anti-Inflammatory Activity

Complementary to mastic’s hypolipidemic activity, are two recent studies of its anti-inflammatory capabilities. In 2009, Zhou et al28 showed that mastic inhibited the production of proinflammatory substances such as nitric oxide (NO) and prostaglandin in lipopolysaccharide activated mouse macrophage-like cells, leading to the decline of viable cell numbers. Mastic was thought to act by inhibiting the expression of inducible NO synthase and cyclooxygenase.

Mastic and its oil show considerable
activity and according to researchers
can both be used as preservatives in
pharmaceuticals and cosmetics, as
well as for functional foods.

In another study29 in 2009 researchers examined the anti-inflammatory activity of Mastic Neutral Fraction (MNF) in human aortic endothelial cells. Noting that he attachment of leukocytes to the vascular endothelium and the subsequent migration of cells into the vessel wall are early events in atherogenesis, a process that requires the expression of endothelial adhesion molecules, the effects of MNF on the expression of adhesion molecules and the attachment of monocytes in tumor necrosis factor-alpha (TNF-α) stimulated Human Aortic Endothelial Cells (HAEC) were studied. MNF significantly inhibited the adhesion process.

Another aspect of mastic’s anti-inflammatory potential was studied in 2007 by Kaliora et al,30 who evaluated the effectiveness of mastic administration on the clinical course and plasma inflammatory mediators of patients with active Crohn’s disease (CD). The result was a significant reduction of CD activity index, plasma interleukin-6 levels and C-reactive protein, while total antioxidant potential was increased and no signs of side effects were observed.

Mastic may be an important
immunity regulator in Crohn’s disease.

The same research group31 assessed the effects of mastic administration on cytokine production of circulating mononuclear cells of patients with active CD. TNF-α secretion was reduced, while there was also a significant increase in the macrophage migration inhibitory factor. This indicated that random migration and chemotaxis (movement toward or away from a chemical stimulus) of monocytes/macrophages was inhibited. In conclusion, mastic acted as an immunomodulator on peripheral blood mononuclear cells, providing strong evidence that it might be an important regulator of immunity in CD.

Anticancer Activity

Several studies suport the anticancer activity of mastic. Prostate and colorectal cancer are among the ones upon which the effect of mastic has been studied more extensively, as well as leukemia and lung carcinoma.

Activity Against Prostate Cancer

In 2006, He et al32 showed that mastic affects the function of prostate cells androgen receptors, by inhibiting in vitro the receptor’s expression both on the mRNA and the protein level, thus setting the bases for the hypothesis of mastic’s potential prostate anti-cancer activity. In 2007,33 the same research group studied the effect of mastic on the proliferation of androgen-independent prostate cancer PC-3 cells, and reached the conclusion that it inhibits the proliferation and blocks the cell cycle progression in PC-3 cells by suppressing NF-B activity and the NF-B signal pathway. As well, they studied whether mastic could regulate the expression of maspin, a prostate tumor suppressive protein of prostate cancer cells,34 finding that mastic induced the expression of maspin. The above studies indicate that mastic could help mount an important defense against prostate cancer.

Activity Against Colorectal Cancer

Balan et al35 showed in 2005 that a hexane extract of mastic induced apoptosis in HCT116 human colon cancer cells in vitro through a caspase-related mechanism. In a follow up study, Balan et al36 demonstrated that a 50% ethanol extract of mastic also inhibited proliferation and induced death of HCT116 human colon cancer cells in vitro, possibly through a caspase-related mechanism, which nevertheless remained unclear. When the in vivo activity of the hexane extract of mastic was tested against human colon tumour in immunodeficient mice by Dimas et al,37 it was found that mastic hexane extract administered at a dose of 200 mg/kg daily for 4 consecutive days (followed by 3 days without treatment) inhibited tumor growth by approximately 35% without of toxic side-effects after 35 days. The researchers concluded that mastic possesses antitumor activity against human colorectal cancer.

Antileukemic Activity

In 2006, Loutrari et al,38 showed that mastic oil (concentration and time dependently) exerted an antiproliferative and proapoptotic effect on human K562 leukemia cells and prevented K562 and B16 mouse melanoma cells from releasing vascular endothelial growth factor (VEGF). Furthermore, it inhibited endothelial cell proliferation without affecting cell survival and decreased significantly microvessel formation both in vitro and in vivo.

Activity Against Lung Carcinoma

In order to investigate molecular mechanisms potentially triggered by mastic oil, Moulos et al39 treated Lewis Lung Carcinoma cells with mastic oil or DMSO. Mastic oil caused a time-dependent alteration in the expression of 925 genes, many of which are associated with several biological processes and functions. Certain modifications, such as cell cycle/proliferation, survival and NF-κB cascade, indicated the anti-proliferative, proapoptotic and antiinflammatory effects of mastic oil. The expression profiles of certain genes were similarly altered by mastic oil in the majority of test cancer cell lines. From analyses on a model of mouse lung adenocarcinoma, it was found that mastic oil inhibited actions on tumor cell growth and survival. This constituted the first study addressing the mechanisms of action of mastic oil at genome-wide gene expression level and upon specific target molecules and pathways.


Altogether, mastic has been the subject of various studies, employing its extracts and compounds, with regard to their biological activities. The main target of most researchers has been the effect of mastic on gastrointestinal disorders and principally its anti-H. pylori. The results of this series of scientific studies show:

  1. The positive role of mastic in the treatment of ulcer and indigestion, and as well, the anti-H. pylori activities of some of its compounds (inhibition of the colonization of the bacterium by acidic fraction and isomasticadienolic acid).

  2. The obstruction of H. pylori growth by mastic’s arabinogalactan-proteins and mastic without polymer

  3. As a complement of its gastrointestinal activity, mastic has been proven to possess anti-Crohn’s disease properties, through its role as an anti-inflammatory agent by inhibiting the production of proinflammatory substances and its anti-inflammatory activity in human aortic endothelial cells, mainly focused on its neutral extract and the phytosterolic compound tirucallol.

  4. These activities, combined with its antioxidant and its hypolipidemic propertiescan potentially lead to the hypothesis for its cardioprotective activity.

  5. Furthermore, recent researches attributing anti-cancer potential to mastic, together with clinical studies confirming its anti-indigestion and antiulcer effects on human subjects, have established mastic as a valuable therapeutic agent.

The role of mastic as a natural source of biologically active compounds remains to be clarified further by additional studies, concerning mainly the acidic compounds, namely the triterpenic acids for their anti-H. pylori activity, and its neutral compounds of phytosterolic structure, such as tirucallol, as potential cardioprotective agents. All in all, mastic remains a sure bet as a low-toxic health product about which Hippopcrates said, “I have long observed and pointed out that mastic is good for myriad ailments.”


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  2. Perrikos G. The Mastic of Chios. Callimassia:Chios;1993
  3. Kokkinakis D. Chios mastic references found in Greek and European pharmacopeias of the 19th century. Chios;2003.
  4. Al-Habbal MJ, Al-Habbal Z, Huwez FU. A double-blind controlled clinical trial of mastic and placebo in the treatment of duodenal ulcer. J Clin Exp Pharm Physiol 1984;11:541-4.
  5. Al-Said MS, Ageel AM, Parmar NS, Tariq M. Evaluation of mastic, a crude drug obtained from Pistacia lentiscus for gastric and duodenal anti-ulcer activity. J Ethnopharmacol 1986;15:271-8.
  6. Heo C, Kim SW, Kim KJ, Kim DW, Kim HJ, Do JH, Chang SK. Protective effects of mastic in non-steroidal anti-inflammatory drug induced gut damage and bacterial translocation in a rat model. Korean J Med 2006;71(4):354-61.
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Will Block is the publisher and editorial director of Life Enhancement magazine.

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