Mastic Can Be Your Stomach's Best Friend
Mastic for a Healthy, Happy Stomach
Modern medicine rediscovers a natural remedy with a long history

iscovery - finding something new and exciting - has always been one of mankind's greatest achievements. The desire to explore new territory has taken us from the depths of the ocean to the surface of the moon and beyond, from splitting the atom to sequencing the human genome. We owe a long line of adventurers, explorers, and scientists a great debt for enriching our knowledge of the world. Where would we be, for example, without the bold seafarers who sought a shorter passage to the Spice Islands (now known as the East Indies) and found the New World instead?

Five hundred years ago, Christopher Columbus thought he might be able to reach the Spice Islands more quickly by sailing west than by sailing east. Like all educated people, he knew the earth was a sphere (the idea that people in those days thought it was flat is a myth), but he was not sure of its size. His motive was commercial: he wanted to reach his destination as quickly as possible so as to maximize the profits he might obtain in trade with the natives. We all know where Columbus wound up, but he went to his grave convinced that the Caribbean Islands he had discovered were part of the East Indies. Surely he was one of history's greatest "failures."

Among the items that Columbus was interested in acquiring on his voyages were gold, silk, a variety of spices, and a prized commodity known as mastic. What is that, and why was it so desirable that one would seek it in the far corners of the earth? Medical texts dating back to the first century A.D. suggested that mastic had a wide range of curative properties, including the ability to alleviate inflammation of the stomach, intestines, and liver and to soothe aches in the digestive and urinary systems. It was also used for cleaning the teeth.

Mastic Is Rediscovered

Mastic is a gum resin derived from the mastic tree, Pistacia lentiscus, which grows almost exclusively on the Greek island of Chios in the north Aegean Sea, off the coast of Turkey.* About 2 million mastic trees are currently cultivated on Chios and yield about 200,000 kilograms (440,000 pounds) of the resin every year. Over the centuries, mastic gum has had a variety of uses, including shipbuilding, painting, making masks, flavoring foods, and healing the sick.


*We know this now, but Columbus didn't. Needless to say, he never found any mastic trees in the Caribbean, but he did find a similar tree that had him fooled for a while into believing that he had found the real thing.


With respect to health, mastic has long been reputed to relieve gastrointestinal distress. In fact, references to its health benefits can be found in the classical works of Dioscorides and Galen. Inexplicably, references to mastic faded from the medical literature through the Middle Ages. Fortunately, however, knowledge of this natural herbal remedy was passed on through the traditions of folkloric medicine, especially in the Middle East.

Recently, scientific interest in mastic was reawakened, and it is now the subject of much research focusing on gastrointestinal health and peptic ulcers.

Peptic Ulcers Are Common

One of the primary ailments of the digestive system is peptic ulcer, a generic term that includes both gastric (stomach) and duodenal ulcers. The latter attack the duodenum, the first segment of the small intestine; they are the most common type of ulcer and occur most frequently in men. Gastric ulcers occur with one-quarter the frequency of duodenal ulcers and are equally distributed between men and women.

Peptic ulcers are common in the United States. In fact, physicians diagnose 500,000 to 850,000 new cases each year.1 Duodenal ulcers are most common in younger individuals (aged 20-50), while gastric ulcers are more prevalent in older individuals (aged 50-70).2 The clinical symptoms of gastric and duodenal ulcers are similar: pain is generally intermittent and is located in the upper abdomen. Temporary relief is generally brought about by eating food or taking an antacid. As you will see below, long-term relief is almost always associated with eradication of the infectious bacterium Helicobacter pylori from the digestive tract.

H. pylori Is a Major Factor in Peptic Ulcers

The digestive tract from the esophagus to the intestine is lined with a thick layer of mucus and mucosal cells designed to protect it from the corrosive action of stomach acid (mainly hydrochloric acid). If this protective layer is breached, the acid can attack the sensitive underlying cells and damage blood vessels, creating a peptic ulcer.

Peptic ulcers are commonly associated with the frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, but the one factor that is almost always present is infection with H. pylori.2 To shield themselves from attack by stomach acid, H. pylori bacteria secrete an enzyme that releases ammonia. The ammonia neutralizes the acid around the bacteria, creating a protective chemical "envelope" that allows them to survive in this hostile environment. It is toxic to the mucosal cells that line the stomach, however, and the helix-shaped bacteria "corkscrew" themselves into this layer and proceed to destroy it, causing an ulcer.

Eradicating H. pylori Decreases Ulcer Recurrence

Because H. pylori infection is a major cause of peptic ulcers - it is present in 60-80% of gastric ulcers and 95-100% of duodenal ulcers2 - one would expect that eliminating this bacterium from the digestive tract would reduce the risk and the recurrence of ulcers.

Do You Have an Ulcer?
Stomach distress can be caused by a variety of conditions, including indigestion, dyspepsia, heartburn, bloating, and gastritis - and ulcers. Precise diagnosis is often difficult, because symptoms can be deceptive. Lab tests are not warranted unless something unusual is suspected, and treatment is generally with medications alone, to see whether the symptoms will remit.

The definitive diagnostic tool for ulcers is endoscopy, in which a flexible fiber-optic probe is inserted into the stomach and duodenum to allow the physician to examine them visually. Being a somewhat invasive and expensive procedure, it is rarely done when medications provide symptomatic relief from stomach distress. So we save some money, but we may not be certain whether we have an ulcer or not.

Besides, symptomatic relief is not the same as cure, and the latter is the real goal. Since we know that H. pylori infection is strongly implicated in ulcers and that its eradication eliminates the problem (barring a subsequent recurrence of the infection), taking mastic to kill any H. pylori we may be harboring is a prudent step.

And one would be correct. A review of fourteen studies on this subject has shown that eradicating H. pylori from the digestive tract, using a standard type of drug regimen called triple therapy, dramatically reduces the recurrence of peptic ulcers.3 The combined data from these studies reveal that the rate of recurrence of duodenal ulcer is very high (67%) when H. pylori is not eradicated, but extremely low (6%) when it is eradicated. The rate of recurrence of gastric ulcers follows a similar pattern: it's 59% when H. pylori has not been eradicated, but only 4% when patients are cured of their infection.


Researchers in the Middle East
presented evidence that mastic was
far superior to placebo in healing
duodenal ulcers (70% versus 22%).

A paper recently published in the Journal of Clinical Gastroenterology supports these findings and also demonstrates that the eradication of H. pylori has lasting benefits.4 For example, in Japanese patients successfully treated with triple therapy for H. pylori infection, the recurrence rate over a five-year follow-up period for duodenal ulcers was a mere 1.7%; the rate for gastric ulcers over the same period was 5.3%. In patients whose H. pylori infection was not eradicated, the recurrence rates were significantly higher: 50% for duodenal ulcers and 25% for gastric ulcers.

Conventional Triple Therapy Is Overkill

The triple therapy mentioned above is called that because it entails three different drugs; the typical combination is two antibiotics and one drug that inhibits acid production. For example, in the Japanese study just described, patients received either of two treatments: (1) 400 mg of cimetidine (Tagamet HB®) twice a day, 300 mg of amoxicillin three times a day, and 250 mg of metronidazole three times a day, for 2 weeks;or (2) 20 mg of omeprazole (Prilosec®) once a day, 500 mg of amoxicillin three times a day, and 250 mg of metronidazole three times a day, plus 150 mg of roxithromycin twice a day, for 1 week.

These drug regimens are expensive, inconvenient, and aggressive. While they successfully kill H. pylori, they also eradicate many beneficial bacteria from the digestive tract. Furthermore, the liberal use of antibiotics contributes to the growing problem of antibiotic resistance in many strains of bacteria. Specifically, H. pylori is becoming resistant to metronidazole, which is commonly used in this type of therapy.

What Else Kills H. pylori? Mastic, Of Course!

Not only are antibiotics expensive, they often cause unpleasant side effects. An effective alternative that is both inexpensive and safe to use in cases of H. pylori infection is mastic. There is a rich medical tradition supporting the use of mastic to alleviate stomach discomfort. Until recently, however, the mechanism by which mastic improved gastrointestinal health was not clear. In the early 1980s, researchers in the Middle East (including Iraq) presented evidence that mastic was far superior to placebo in healing duodenal ulcers (70% versus 22%). Further experiments demonstrated that mastic acted by killing H. pylori.

Now working at the University of Nottingham in England, the lead researchers in this field have demonstrated in laboratory experiments that very small amounts of mastic gum can kill H. pylori in as many as seven different drug-resistant forms.5 Additional research has demonstrated that mastic significantly enhances immune-function activity against other strains of potentially harmful bacteria as well, including Staphylococcus aureus, Escherichia coli, and Sarcina lutea.6 Not surprisingly, these results have brought the use of mastic into the modern age, and it is gaining widespread medical recognition for its ability to manage peptic ulcers.

In addition to mastic, hyperforin from St. John's wort, as well as cinnamon and thyme likely help boost antibacterial resistance. Hyperforin is capable of destroying certain types of bacteria that become resistant to conventional antibiotics, such as penicillin, following repeated use. Cinnamon and thyme also possess antibacterial properties and can inhibit the growth of H. pylori.

Researchers recommend mastic gum to fight H. pylori in the digestive tract.

Mastic is a time-honored natural remedy. Although Columbus was unsuccessful in his attempt to discover a new source of this marvelous substance, you can now enjoy its benefits, thanks to its modern rediscovery in the medical literature.

References

  1. ASHP Commission on Therapeutics. ASHP therapeutic position statement on the identification and treatment of Helicobacter pylori-associated peptic ulcer disease in adults. Am J Health Syst Pharm 2001;58:331-7.
  2. Huether SE, McCance KL. Understanding Pathophysiology. Mosby, Inc., St. Louis, 2000, pp. 952-6.
  3. Hopkins RJ, Girardi LS, Turney EA. Relationship between Helicobacter pylori eradication and reduced duodenal and gastric ulcer recurrence: a review. Gastroenterology 1996;110:1244-52.
  4. Seo M, Okada M, Shirotani T, et al. Recurrence of Helicobacter pylori infection and the long-term outcome of peptic ulcer after successful eradication in Japan. J Clin Gastroenterol 2002:34:129-34.
  5. Huwez FU, Thirlwell D, Cockayne A, Ala'Aldeen DAA. Mastic gum kills Helicobacter pylori. N Engl J Med 1998;339:1046.
  6. Iauk L, Ragusa S, Rapisarda A, et al. In vitro antimicrobial activity of Pistacia lentiscus L. extracts: preliminary report. J Chemother 1996;8:207-9.

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