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Medicinal Foods for Functional GI Disorders

  • Neurogastrointerology and Motility Disorders of the Gastrointestinal Tract (S Rao, Section Editor)
  • Published:
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Abstract

Purpose of Review

Over the past 10 years, there has been a dramatic increase in basic and clinical research involving functional gastrointestinal disorders (FGIDs). New diagnostic and biomarker procedures are helping to identify physiologic disruptions associated with FGIDs on cellular and molecular levels. Simultaneously, clinicians are using new approaches to help manage patients with FGIDs. Among these, an important component of care has been the use of medical foods. These include probiotics, prebiotics, synbiotics, peppermint oil, caraway oil, curcumin, bovine immunoglobulin and many others.

Recent Findings

The putative effects of different medical foods make these therapies attractive for the management of FGIDs. These include effects on several pathophysiological mechanisms such as anti-inflammatory, smooth muscle relaxation, analgesia, mitigation of gut barrier dysfunction, and stimulation or inhibition of gastrointestinal receptors. Recent research has also demonstrated the efficacy of medical food products such as peppermint oil and serum-derived bovine immunoglobulin for the management of irritable bowel syndrome. Older data supports the probiotic VSL#3 and Bifidobacterium species. For functional dyspepsia, positive effects have been observed with the combination of caraway seed oil and peppermint oil as well as with STW-5, a botanical combination preparation, although robust RCTs are lacking.

Summary

With advancing knowledge regarding the pathogenesis of FGIDs, it is likely that the compounds available in the medical food category will increase dramatically, and they could play an important role in the management of several common and bothersome gastrointestinal conditions in the future.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Weng W, Chen J. The eastern perspective on functional foods based on traditional Chinese medicine. Nutr Rev. 1996;54:S11–6.

    Article  CAS  PubMed  Google Scholar 

  2. Kamboj V. Herbal medicine. Curr Sci. 2000;78:35–9.

    Google Scholar 

  3. Zhou S, Zhang S, Shen H, Chen W, Xu H, Chen X, et al. Curcumin inhibits cancer progression through regulating expression of microRNAs. Tumor Biol. 2017;39:1–12.

    Google Scholar 

  4. Jiang S, Han J, Li T, Xin Z, Ma Z, Di W, et al. Curcumin as a potential protective compound against cardiac diseases. Pharmacol Res. 2017;119:373–83.

    Article  CAS  PubMed  Google Scholar 

  5. Pavan AR, Silva GD, Jornada DH, Chiba DE, Fernandes DF, Man Chin C, et al. Unraveling the anticancer effect of curcumin and resveratrol. Nutrients. 2016;8(11):628. https://doi.org/10.3390/nu8110628

  6. Yang CS, Jin H, Guan F, Chen YK, Wang H. Cancer preventive activities of tea polyphenols. Molecules. 2016;21:1–19.

    Google Scholar 

  7. Lee EA, Angka L, Rota SG, Hanlon T, Mitchell A, Hurren R, et al. Targeting mitochondria with avocatin B induces selective leukemia cell death. Cancer Res. 2015;75:2478–88.

    Article  CAS  PubMed  Google Scholar 

  8. •• Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV. Gastroenterology. 2016;150(6):1262–79. Updated clinical criteria and evidence review of the various functional gastrointestinal disorders. Key reading for a fuller understanding of the current approach to the diagnosis and management of these disorders.

    Article  Google Scholar 

  9. Talley NJ. Functional gastrointestinal disorders as a public health problem. Neurogastroenterol Motil. 2008;20(s1):121–9.

    Article  PubMed  Google Scholar 

  10. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10(7):712–21.

    Article  PubMed  Google Scholar 

  11. Mahadeva S, Ford AC. Clinical and epidemiological differences in functional dyspepsia between the East and the West. Neurogastroenterol Motil. 2016;28:167–74.

    Article  CAS  PubMed  Google Scholar 

  12. •• Burnett BP, Levy RM. Proposed industry nest practices in development and marketing of medical foods for the management of chronic conditions and diseases while awaiting regulation. Food Drug Law J. 2017;72:53–77. Excellent position paper on the current landscape of regulatory issues surrounding medical foods and the history of this class of therapies.

    PubMed  Google Scholar 

  13. 5(b)(3) of the Orphan Drug Act (21 U.S.C. 360ee(b)(3)). https://www.fda.gov/RegulatoryInformation/Legislation/SignificantAmendmentstotheFDCAct/OrphanDrugAct/default.htm. Retrieved 28 Jan 2017.

  14. U.S. Department of Health and Human Services Food and Drug Administration Center for Food Safety and Applied Nutrition. Frequently asked questions about medical foods. Guidance for industry. 2nd ed. May 2016.

  15. De Geest S, Sabaté E. Adherence to long-term therapies: evidence for action. Eur J Cardiovasc Nurs. 2003;2(4):323.

    Article  PubMed  Google Scholar 

  16. Aitken M, Kleinrock M, Lyle J Nass D, Caskey L. Medicines use and spending shifts: a review of the use of medicines in the US in 2014. IMS Inst Healthc Inf. 2015. http://www.imshealth.com/en/thought-leadership/ims-institute/reports/medicines-use-in-the-us-2014.

  17. Linnaeus C. Species Plantarum. Stockholm. 2:1762–3.

  18. Hawthorn M, Ferrante J, Luchowski E, Rutledge A, Wei XY, Triggle DJ. The actions of peppermint oil and menthol on calcium channel dependent processes in intestinal, neuronal and cardiac preparations. Aliment Pharmacol Ther. 1988;2:101–18.

    Article  CAS  PubMed  Google Scholar 

  19. Goerg KJ, Spilker T. Effect of peppermint oil and caraway oil on gastrointestinal motility in healthy volunteers: a pharmacodynamic study using simultaneous determination of gastric and gall-bladder emptying and orocaecal transit time. Aliment Pharmacol Ther. 2003;17:445–51.

    Article  CAS  PubMed  Google Scholar 

  20. Harries N, James KC, Pugh WK. Antifoaming and carminative actions of volatile oils. J Clin Pharm Ther. 1977;2:171–7.

    Article  Google Scholar 

  21. Galeotti N, Di Cesare ML, Mazzanti G, Bartolini A, Ghelardini C. Menthol: a natural analgesic compound. Neurosci Lett. 2002;322:145–8.

    Article  CAS  PubMed  Google Scholar 

  22. Hawrelak JA, Cattley T, Myers SP. Essential oils in the treatment of intestinal dysbiosis: a preliminary in vitro study. Altern Med Rev. 2009;14:380–4.

    PubMed  Google Scholar 

  23. Juergens UR, Stober M, Vetter H. The anti-inflammatory activity of L-menthol compared to mint oil in human monocytes in vitro: a novel perspective for its therapeutic use in inflammatory diseases. Eur J Med Res. 1998;3:539–45.

    CAS  PubMed  Google Scholar 

  24. Walstab J, Wohlfarth C, Hovius R, Schmitteckert S, Roth R, Lasitschka F, et al. Natural compounds boldine and menthol are antagonists of human 5-HT3 receptors: implications for treating gastrointestinal disorders. Neurogastroenterol Motil. 2014;26:810–20.

    Article  CAS  PubMed  Google Scholar 

  25. Khanna R, MacDonald JK, Levesque BG. Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. J Clin Gastroenterol. 2014;48:505–12.

    PubMed  Google Scholar 

  26. •• Cash BD, Epstein MS, Shah SM. A novel delivery system of peppermint oil is an effective therapy for irritable bowel syndrome symptoms. Dig Dis Sci. 2016;61:560–71. Important randomized controlled trial evaluating peppermint oil for IBS demonstrating improvements in multiple and global symptoms vs placebo.

    Article  CAS  PubMed  Google Scholar 

  27. Wilson D, Evans M, Weaver E, Shaw AL, Klein GL. Evaluation of serum-derived bovine immunoglobulin protein isolate in subjects with diarrhea-predominant irritable bowel syndrome. Clin Med Insights Gastroenterol. 2013;6:49–60.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Valentin N, Camilleri M, Carlson P, Harrington SC, Eckert D, O’Neill J, et al. Potential mechanisms of effects of serum-derived bovine immunoglobulin/protein isolate therapy in patients with diarrhea-predominant irritable bowel syndrome. Physiol Rep. 2017;5(5):e13170.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Brigidi P, Vitali B, Swennen E, Bazzocchi G, Matteuzzi D. Effects of probiotic administration upon the composition and enzymatic activity of human fecal microbiota in patients with irritable bowel syndrome of functional diarrhea. Res Microbiol. 2001;152:735–41.

    Article  CAS  PubMed  Google Scholar 

  30. Kim HJ, Camilleri M, McKinzie S, et al. A randomized control trial of a probiotic, VSL #3, on gut transit and symptoms in diarrhea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2003;17:895–904.

    Article  CAS  PubMed  Google Scholar 

  31. Kim HJ, Roque MI, Camilleri M, Lempke MB, Burton DD, Thomforde GM, et al. A randomized controlled trial of a probiotic combination VSL #3 and placebo in irritable bowel syndrome with bloating. Neurogastroenterol Motil. 2005;17:687–96.

    Article  CAS  PubMed  Google Scholar 

  32. Mennigen R, Nolte K, Rijcken E, Utech M, Loeffler B, Senninger N, et al. Probiotic mixture VSL #3 protects the epithelial barrier by maintaining tight junction protein expression and preventing apoptosis in a murine model of colitis. Am J Physiol Gatrointest Liver Physiol. 2009;296(5):G1140–9.

    Article  CAS  Google Scholar 

  33. Michail S, Kenche H. Gut microbiota is not modified by randomized, double-blind, placebo-controlled trial of VSL #3 in diarrhea-predominant irritable bowel syndrome. Probiotics Antimicrob Proteins. 2011;3(1):1–7.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Wong RK, Yang C, Song GH, Wong J, Ho KY. Melatonin regulation as a possible mechanism for probiotic (VSL #3) in irritable bowel syndrome: a randomized double-blinded placebo study. Dig Dis Sci. 2015;60:186–94.

    Article  CAS  PubMed  Google Scholar 

  35. Walker MM, Alasdair W, Ung C, Talley NJ. The role of eosinophils and mast cells in intestinal functional disease. Curr Gastroenterol Rep. 2011;13:323–30.

    Article  PubMed  Google Scholar 

  36. Talley NJ, Fodor AA. Bugs, stool, and the irritable bowel syndrome: too much is as bad as too little? Gastroenterology. 2011;141:1555–9.

    Article  PubMed  Google Scholar 

  37. Hod K, Ringel Y. Probiotics in functional bowel disorders. Best Pract Res Clin Gastroenterol. 2016;30(1):89–97.

    Article  CAS  PubMed  Google Scholar 

  38. Curro D, Ianiro G, Pecere S, Bibbò S, Cammarota G, et al. Probiotics, fibre and herbal medicinal products for functional and inflammatory bowel disorders. Br J Pharmacol. 2016;174(11):1426–49.

    Article  PubMed  Google Scholar 

  39. May B, Kohler S, Schneider B. Efficacy and tolerability of a fixed combination of peppermint oil and caraway oil in patients suffering from functional dyspepsia. Aliment Pharmacol Ther. 2000;14:1671–7.

    Article  CAS  PubMed  Google Scholar 

  40. Coon TJ, Ernest E. Systematic review: herbal medicinal products for non-ulcer dyspepsia. Aliment Pharmacol Ther. 2002;16:1689–99.

    Article  Google Scholar 

  41. Shams R, Oldfield EC, Copare J, Johnson DA. Peppermint oil: clinical uses in the treatment of gastrointestinal diseases. JSM Gastroenterol Hepatol. 2015;3(1):1035–46.

    Google Scholar 

  42. Chey WD, Lacy BE, Cash BD, Epstein M, Shah S. Efficacy of caraway oil/l-menthol plus usual care vs placebo plus usual care, in functional dyspepsia patients with post-prandial distress (PDS) or epigastric pain (EPS) syndromes: results from a US RCT. Gastroenterology. 2017;152(5):S307.

    Article  Google Scholar 

  43. Cremonini F. Standardized herbal treatments on functional bowel disorders: moving from putative mechanisms of action to controlled clinical trials. Neurogastroenterol Motil. 2014;26:893–900.

    Article  CAS  PubMed  Google Scholar 

  44. Sibaev A, Yuece B, Kelber O, Weiser D, Schirra J, Goke B, et al. STW5 (Iberogast) and its individual herbal components modulate intestinal electrophysiology of mice. Phytomedicine. 2006;13(Suppl 5):80–9.

    Article  CAS  PubMed  Google Scholar 

  45. •• von Arnim U, Peitz U, Vinson B, Gindermann KJ, Malfertheiner P. STW5, a phytopharmacon for patients with functional dyspepsia: results of a multicenter, placebo-controlled double-blind study. Am J Gastroenterol. 2007;102:1268–75. Large randomized controlled trial demonstrating efficacy for FD with STW-5 over 6 months compared to placebo.

    Article  Google Scholar 

  46. Ottillinger B, Storr M, Malfertheiner P, Allescher HD. STW 5 (Iberogast)—a safe and effective standard in the treatment of functional gastrointestinal disorders. Wien Med Wochenschr. 2013;163:65–72.

    Article  PubMed  Google Scholar 

  47. Braden B, Caspary W, Borner N, Vinson B, Schneider AR. Clinical effects of STW5 (Iberogast) are not based on acceleration of gastric emptying in patients with functional dyspepsia and gastroparesis. Neurogastroenterol Motil. 2009;21(6):632–8.

    Article  CAS  PubMed  Google Scholar 

  48. Madisch A, Holtmann G, Plein K, Holtz J. Treatment of irritable bowel syndrome with herbal preparations: results of a double-blind, randomized, placebo-controlled, multicenter trial. Aliment Pharmacol Ther. 2004;19:271–9.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Division of Gastroenterology, University of South Alabama School of Medicine, 6000 University Commons, 75 University Blvd., South, Mobile, AL, 36688, USA

    Brent W. Acker & Brooks D. Cash

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Correspondence to Brooks D. Cash.

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Brent Acker declares no conflict of interest. Brooks Cash reports receiving personal fees from IM Health Sciences.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Neurogastrointerology and Motility Disorders of the Gastrointestinal Tract

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Acker, B.W., Cash, B.D. Medicinal Foods for Functional GI Disorders. Curr Gastroenterol Rep 19, 62 (2017). https://doi.org/10.1007/s11894-017-0601-x

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