Mastic Gum Helps Kill the Ulcer-Causing Bacterium, Helicobacter pylori

Goodbye Pylori
An Herb for Gastrointestinal Support 
By Will Block
Mastic Resin Sap
Mastic resin sap

n often repeated Napoleonic maxim states that "an army travels on its stomach." This is true in more ways than one. An army must be wisely fed in order to provide it with the energy it needs to be alert, to endure the strain and the stress of the trek into battle, and for the urgency of combat. But rations must also be gentle on the stomach, to prevent gastrointestinal upset and distress. Gastric distress - a.k.a. dyspepsia - is an illness characterized by persistent and recurring abdominal pain or discomfort centered in the upper abdomen. A battalion suffering from dyspepsia is weakened, and that can place the outcome of the battle in jeopardy.

On his deathbed, the greatest military commander of antiquity suffered the anguish of abdominal pain caused by gastric distress. Alexander the Great's deep pangs are believed to have been directly connected to a perforated gastric or duodenal ulcer or small-bowel disease.1 Although the best study of Alexander's death concluded that malaria was the principal cause, in all likelihood the same swamp or similar waters that harbored the mosquito that bit Alexander also provided the bacteria that produced his ulcer. Alexander the Great's ulcer, also instrumental in his death, was probably caused by the gastrointestinal bacterium Helicobacter pylori, or H. pylori (pronounced pie lor´eye)


Alexander the Great's ulcer,
also instrumental in his death,
was probably caused by the
gastrointestinal bacterium
Helicobacter pylori, or H. pylori
(pronounced pie lor´eye).

In the Hellenic and Roman world that followed Alexander's "battlefield" death, military leaders were frequently accompanied into battle by their doctors. The Greek battlefield physician Dioscorides, who served the Roman army, wrote about the preparation and use of medicinal herbs, balms, and treatments in his influential Greek work, De Materia Medica (About Medicinal Substances). Written in the 1st century A.D. and not equaled for 1,500 years, until the Renaissance, De Materia Medica was based upon only about 500 substances. Despite Christian opposition to the dissemination of most written material, Dioscorides' work survived, laying the basis for modern pharmacology. It also memorialized some of the medical substances of value for gastric distress and dyspepsia. The most valuable of these substances, mastic gum, a resin produced by the tree Pistacia lentiscus, has been buried in antiquity . . . until now.


The most valuable herbal substance for gastric
distressand dyspepsia is mastic gum,
buried in antiquity ...
until now.

 
Hellenic physician Dioscorides, in the employ of the Roman army, gathers botanicals for his pharmacopoeia, De Materia Medica.
There was (and is) only one significant source for mastic gum (hereafter mastic), and that was the Greek island of Chios, the birthplace of Hippocrates. Called by many the "first physician," Hippocrates wrote many medical books, including one about ulcers. Ulcers, as we shall learn, are increasingly believed to be causally connected to dyspepsia.2 Although there are no references to mastic in the surviving work of Hippocrates, it is likely that he knew of its reputation and probable that he used it on his patients. We also know that Galen, the great 2nd century physician and successor to Hippocrates, remarked favorably on the therapeutic properties of mastic.

Another resident of Chios was Homer, the greatest poet of ancient times, who, according to legend, created parts of the epic tales The Iliad and The Odyssey while living on Chios. Homer was no stranger to medical science, and he describes in fine detail the fighting and many wounds inflicted upon the soldiers in the Trojan War; they are part and parcel of his epic poems. From The Iliad: "A physician is worth more than several other men put together, for he can cut out arrows and spread healing herbs." It is difficult to believe that he did not know of mastic, its use on Chios predating him by several hundred years. Had Homer written about its use in The Iliad, the world would be different today. As the world of Arabic medicine was later to learn from the writings of the physician Ibn Al-Baytar, mastic was found to be successful for upper abdominal pain and heartburn as well as for gastric and intestinal ulcers.3,4


Although there are no references to mastic
in the surviving work of Hippocrates,
it is likely that he knew of its
reputation and probable that he
used it on his patients.

The island of Chios has a series of fortified towns, known as the Mastic Villages, which evolved because of fear from constant military assaults. Every astute commander wanted a supply of mastic, the sap of Pistacia lentiscus, a tree related to the pistachio, for the production of which Chios was famous. Because mastic has traditionally been used for the relief of abdominal discomfort, gastralgia (stomach pain), dyspepsia, and even peptic ulcers,5 imaginative generals had rightly viewed it as a medicine with great battlefield potential - an insurance policy against gastrointestinal defeat. They could even have believed, to paraphrase Shakespeare's Richard III, "For want of mastic, my kingdom is lost."


Mastic has been chewed by people around
the Mediterranean for thousands of years for,
among other reasons, its effectiveness
in reducing oral malodors (bad breath).

The early Greeks chewed on mastic for its benefits, as did the ancient Jews, who, according to folklore, recommended chewing the resin. Mastic has been chewed by people around the Mediterranean for thousands of years for, among other reasons, its effectiveness in reducing oral malodors (bad breath). Chewing anything stimulates saliva, which ameliorates bad breath; chewing mastic has additional benefits - antibacterial benefits. Mastic is also used for other medicinal and semi-medicinal purposes. Mastic was mentioned in the book of Genesis (Chapter 37), where it is referred to as ladanum, one of the products carried by the caravan that took Joseph down to Egypt.

RESEARCH SUPPORTS HISTORICAL USE
In present times, several studies have been published on the use of mastic powder as it appears to have been continually used in the Mediterranean world and in the Mideast for at least 3000 years, probably even longer.


As the world of Arabic medicine was later to learn,
mastic was found to be successful for
upper abdominal pain and heartburn as well as
for gastric and intestinal ulcers.

A study with rats found that mastic powder produced a significant reduction in the intensity of gastric mucosal damage induced by many of the drugs used to treat ulcer pain and the gastric excesses associated with it.6 Among these drugs were aspirin (which can cause ulcers), phenylbutazone (an anti-inflammatory), and respirine (a vasodilator), all of which are contraindicated for peptic ulcers.


When endoscopically examined, 70% of those
taking mastic were proven to have significant
healing, versus only 22%
of the placebo takers.


Frontispiece of The Comprehensive Book on Materia Medica and Foodstuffs by Ibn Al-Baytar, which mentioned mastic in the 13th century for the treatment of gastrointestinal ulcers.
Mastic was found to reduce damage caused by cold stress and the surgical procedure known as pyloric ligation, in which a portion of the stomach is stapled or tied off. It also was found to significantly reduce acidity and to protect tissue against alcohol (ethanol) damage. The researchers concluded that mastic gum powder was effective because of its combined anti-acid qualities as well as its tissue-protective (cytoprotective) benefits. Their research supported the use of mastic for therapy of duodenal (upper-tract intestinal) ulcers. This was consistent with several of its historical uses.

DUODENAL ULCER HEALING
Another similar conclusion was reached in a double-blind, placebo-controlled trial involving 38 human subjects with duodenal ulcers.7 The subjects were chosen not only by their clinical symptoms but also because of their endoscopically proven duodenal ulcers. (An endoscope is a viewing probe that allows examiners to see the ulcer in the lining of the stomach.) One gram of mastic powder was given once per day before breakfast to 20 subjects for a period of two weeks, while a 1-gram lactose placebo was given to 18 subjects.


Endoscopic analysis found that five of the six subjects
 had completely new epithelial cell growth over the
 ulcer at the end of the four weeks; new tissue had
 covered  the location of the ulcer(s), which appeared
 advanced in the healing process.

A high level of symptomatic relief was reported in 80% (16 subjects) of the mastic subjects, compared to 50% (9 subjects) of those taking placebo. However, when examined endoscopically, 70% (14 subjects) taking mastic were proven to have significant healing, versus only 22% (4 subjects) of the placebo takers. Ulcer healing was reported when the site of the original ulcer was completely replaced by epithelial tissue (the cells that normally line the gastrointestinal tract) without any appearance of new ulcers. According to the authors, the differences attributed to mastic were highly significant. There were no side effects reported in this study.


The researchers noted that they had previously
documented another 14 cases of gastric ulcers
treated successfully with mastic, confirmed by
upper gastrointestinal endoscopy during a one-year
period of treatment and follow-up.

COMPLETE SYMPTOMATIC RELIEF FOR GASTRIC ULCERS
Five male patients and one female patient with benign gastric ulcers were endoscopically and histologically diagnosed.8 (Meaning: The linings of their stomachs were examined with a viewing probe, and cells taken from their stomach were studied under a microscope.) The female was a 70-year-old diabetic with ischemic heart disease (disease of heart vessels) and atrial fibrillation (abnormal heartbeat). She had not responded to standard ulcer-drug therapy. Aside from their gastric ulcers, the five men were without other discernible medical problems.

The subjects received no treatment for their ulcers for two months. The researchers then gave the subjects 2 g per day of mastic as a powder, 1 g in the morning before breakfast and 1 g at bedtime. The regimen continued for a total of four weeks, during which a series of laboratory tests were given. Endoscopic examinations were given at the end of the study, with the results videotaped.


In case you haven't heard, the cause of ulcers - duodenal,
 gastric, and peptic - has been found. There is now a standard
 treatment for H. pylori, the spiral-shaped bacterium that
 lives in the stomach and the section of intestine just
 below the stomach, the duodenum.

Complete symptomatic relief was found in each of the six subjects (100%), including one patient with a double gastric ulcer. Endoscopic analysis found that five of the six subjects had completely new epithelial cell growth over the ulcer at the end of the four weeks; new tissue had covered the location of the ulcer(s), which appeared advanced in the healing process. This was true for the diabetic woman as well as the male with a double ulcer. No side effects were reported. It is interesting to note that the amount of mastic used in this study did not exceed the quantities used by the Mediterranean general public chewing mastic gum. The researchers noted that they had previously documented another 14 cases of gastric ulcers treated successfully with mastic, confirmed by upper gastrointestinal endoscopy during a one-year period of treatment and follow-up.9

HELICOBACTER PYLORI CAUSES ULCERS
In case you haven't heard, the cause of ulcers - duodenal, gastric, and peptic - has been found. It's not really new news, because the first report that ulcers may be caused by a bacterium was reported in 1983 by Barry Marshall and Robin Warren of Perth, Western Australia. The name of the bug is Helicobacter pylori (H. pylori). About half the people in the world are infected, many of whom have no outward symptoms and are apparently healthy. Yet investigation has proved that they all have gastritis, an inflammation of the stomach lining. Gastritis underlies the development of many - if not most - ulcers and is also responsible for many digestive complaints, even perhaps stomach cancer. Gastritis may be accompanied by symptoms of stomach pain or discomfort, bloating, nausea, and others.


Nearly all persons with duodenal 
ulcers are infected with H. pylori.

 
Figure 1. H. pylori survives below mucous membranes
.
There is now a standard treatment for H. pylori, the spiral-shaped bacterium that lives in the stomach and the section of intestine just below the stomach, the duodenum. H. pylori burrows under the mucous lining of the stomach, where it resists the normal immune mechanisms of the gut to annihilate invading bacteria. Every day, the stomach produces nearly 1/2 gallon of gastric juice, which has digestive enzymes and acids for digesting and destroying microorganisms. But H. pylori manages to survive and fight stomach acid with a substance known as urase, which converts urea to bicarbonate and ammonia, both strong bases that neutralize stomach acid in its vicinity. (See Figure 1.)


Needless to say, although the prescription protocols
help knock out H. pylori in most instances of
those who do comply, there can be unacceptable
side effects for many people sensitive
to any of these drugs.

It is the frustration of the immune system that produces destructive compounds (superoxide radicals) that antagonize stomach cells. The result is gastritis followed by a peptic ulcer, if certain conditions are right. But it is the H. pylori, through its inflammation of the stomach lining, that produces the ulcer. H. pylori is probably transmitted by means of fecal matter through the ingestion of waste-tainted food or water. There is the possibility that H. pylori could be transmitted by oral contact with another person.


We have found that mastic is active against
Helicobacter pylori, which could explain its
therapeutic effect in patients
with peptic ulcers.


Figure 2. Helicobacter pylori and associated
relationships with ulcers and gastric cancer.

In the U.S., H. pylori is quite prevalent, especially with the elderly. It is estimated that more than 50% of those over 50 are infected. And minorities of African and Latino descent are infected at even higher levels, regardless of their age. The infection is less common in more affluent Caucasians, but still one of five under 40 carries H. pylori.

Nearly all persons with duodenal ulcers are infected with H. pylori. The presence of H. pylori appears necessary in order to develop a duodenal ulcer. On the other hand, not all gastric (stomach) ulcers are H. pylori-caused, but the incidence is still about 70%. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) can cause gastric ulcers independently of H. pylori. However, gastric cancers, both adenocarcinomas and lymphomas, occur in persons who have H. pylori or who have had it in the past. (See Figure 2.)


Even low doses of mastic - 1 g per day for two weeks -
can cure peptic ulcers very rapidly, but the mechanism
 responsible has not been clear.

The conventional treatment for H. pylori is two-fisted: both an antisecretory compound, such as omeprazol, and an antibiotic, such as amoxicillin, are used for two weeks. There are various other multiple-drug (prescription) therapies for treating H. pylori. However, compliance is low due to the need to take multiple drugs, multiple times per day. Needless to say, although the prescription protocols help knock out H. pylori in most instances of those who do comply, there can be unacceptable side effects for many people sensitive to any of these drugs (see drug inserts or The Physicians' Desk Reference).


Mastic killed H. pylori by inducing structural 
changes in the organism, changes that
 prevented its survival.

H. PYLORI AND DYSPEPSIA
In a recent issue of The New England Journal of Medicine, two studies investigated the same subject: Can the eradication of H. pylori provide symptomatic relief from the symptoms of non-ulcer dyspepsia?10,11 Non-ulcer dyspepsia is a gastrointestinal syndrome with garden-variety complaints, quite widespread throughout modern life. It is defined as "a persistent or recurrent abdominal pain or discomfort centered in the upper abdomen in patients who have no structural or biochemical explanation for their symptoms (e.g., peptic ulcer disease, gastroesophageal reflux disease, or pancreaticobiliary disease)."12 Even though the two studies were similar in structure, the conclusions were nearly diametrical. One study (McColl et al.) showed that if H. pylori is eradicated, then the symptoms of dyspepsia diminish significantly; the other (Blum et al.) showed that there was no significant effect. Take your pick.

 In an accompanying editorial, the Journal took the position that the results were different for a number of reasons. One reason was that the negative study, which was too lenient with placebo-effect claims of benefits (Blum et al.), lessened the difference. Another reason was the decision to include patients with heartburn (McColl et al.), who were more likely to experience gastroesophageal reflux following antibiotic treatment, the relief of which is a primary benefit.13 The Journal did not think the case was clearly proven, but then, the syndrome of dyspepsia is many things to many people.


Mastic gum has no known side effects when used in
 the same amounts traditionally used in foods, 1-2 g/day.

MASTIC KILLS HELICOBACTER PYLORI
In the very same issue of the Journal, a letter to the editor appeared by one of the authors, Farhad U. Huwez, Ph.D., of two earlier-cited mastic articles, this time writing and researching from an English hospital.14 He reported that . . .

"Even low doses of mastic - 1 g per day for two weeks - can cure peptic ulcers very rapidly, but the mechanism responsible has not been clear. We have found that mastic is active against Helicobacter pylori, which could explain its therapeutic effect in patients with peptic ulcers."

In assessing the antibacterial properties of mastic against H. pylori, Dr. Huwez and his colleagues found that mastic killed seven strains of H. pylori, irrespective of the organism's level of susceptibility to nitroimidazoles. Certain strains of H. pylori are resistant to nitroimidazoles. Even at lower concentrations, mastic still inhibited bacterial growth significantly. Its effectiveness was equal to antibiotics and possibly even better, with a clear post-antibiotic effect even at the lowest concentrations. Mastic killed H. pylori by inducing structural changes in the organism, changes that prevented its survival.


Mastic may be able to help you to maintain proper
stomach digestive function, free from the curse of the
feelings of dyspepsia and - who knows?
- maybe even gastrointestinal hell. 

These results, indicating definite antibacterial activity against H. pylori, provide a solid explanation for the anti-ulcer properties of mastic. The anti-dyspepsia research of McColl (cited above) shows that when H. pylori is eliminated, dyspeptic symptoms dissipate. If correct, these data may explain mastic's other gastrointestinal benefits, e.g., its historical use for dyspepsia.

Examination of the various constituents of mastic, which have been recently identified,13 may pinpoint the anti-H. pylori active ingredient. Nonetheless, exhorts Dr Huwez, "mastic is cheap and widely available in Third World countries; therefore, our data should have important implications for the management of peptic ulcers in developing countries." And why not developed countries as well, we ask?

MALEVOLENT BACTERIA GIVEN THE BOOT
Mastic gum has no known side effects when used in the same amounts traditionally used in foods, 1 to 2 g/day. At that level, it produces structural changes within the malevolent H. pylori bacterium that kill the bacterium and that threaten its ability to thrive at your expense under the lining of your stomach. Thus, mastic may be able to help you to maintain proper stomach digestive function, free from the curse of the feelings of dyspepsia and - who knows? - maybe even gastrointestinal hell. If the use of this food were more widespread, more of us might be singing a different tune.

References

  1. Oldach DW, Richard RE, Borza EN, Benitez RM. A mysterious death. N Engl J Med 1998 Jun 11;338(24):1764-9.
  2. McColl K, Murray L, El-Omar E, Dickson A, El-Nujumi A, Wirz A, Kelman A, Penny C, Knill-Jones R, Hilditch T. Symptomatic benefit from eradicating Helicobacter pylori infection in patients with non-ulcer dyspepsia. N Engl J Med 1998 Dec 24;339(26):1869-74.
  3. Ibn Al-Jazzar Al-Qayrawani: In diseases of the stomach (950 P.D) Revised by Salman Qataya. Dar Al-Rasheed Press, Baghdad, 1980, p 151 (Arabic).
  4. Ibn Al-Baytar Abdullah Ahmad Al-Andalusi: Materia Medica Vol. 3 Al-Muthana Press, Baghdad, 1948, p 158 (Arabic).
  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. 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.
  7. Huwez FU, Al-Habbal MJ. Mastic in treatment of benign gastric ulcers. Gastroenterol Japon 1986;21:273-4.
  8. Al Habbal MJ, et al. Upper G.I.T endoscopy in Arbil. Iraq Med J 1982;29:25.
  9. Blum AL, Talley NJ, O'Morain C, van Zanten SV, Labenz J, Stolte M, Louw JA, Stubberod A, Theodors A, Sundin M, Bolling-Sternevald E, Junghard O. Lack of effect of treating Helicobacter pylori infection in patients with non-ulcer dyspepsia. Omeprazole plus Clarithromycin and Amoxicillin Effect One Year after Treatment (OCAY) Study Group. N Engl J Med 1998 Dec 24;339(26):1875-81.
  10. Heading RD. Definitions of dyspepsia. Scand J Gastroenterol Suppl. 1991;182:1-6.
  11. Friedman LS. Helicobacter pylori and non-ulcer dyspepsia N Engl J Med 1998 Dec 24;339(26):1928-30.
  12. Huwez FU, Thirlwell D, Cockayne A, Ala'Aldeen DA. Mastic gum kills Helicobacter pylori. N Engl J Med 1998 Dec 24;339(26):1946.
  13. Papageorgiou VP, Bakola-Christianopoulou MN, Apazidou KK, Psarros EE. Gas chromatographic-mass spectroscopic analysis of the acidic triterpenic fraction of mastic gum. J Chromatogr 1997;769:263-73.
 

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