1. Plant Compounds Used to Treat the Digestive System

2. Irritable Bowel Syndrome (IBS) Mentha X piperita – peppermint Traditional ethnomedical uses: – digestive problems – intestinal spasms – irritable bowel syndrome

3. Irritable Bowel Syndrome (IBS) The active compound in peppermint is peppermint oil: contains high concentration of menthol, also some menthone Numerous double-blind placebo controlled human clinical trials have demonstrated the effectiveness of peppermint oil in treating IBS – Cappello, G.; et al. (2007). Peppermint oil (Mintoil) in the treatment of irritable bowel syndrome: A prospective double blind placebo-controlled randomized trial. Digestive and Liver Disease 39 (6): 530–536. – 75% of patients who took peppermint oil capsules for four weeks had a significant reduction in IBS

4. after dinner mints Peppermint oil also relaxes the gastro- esophageal sphincter, which promotes burping

5. Constipation Plantago afra, P. ovata – psillium Traditional ethnomedical uses: seeds and seed husks used as a laxative to treat constipation Active components: whole seed preparation Mechanism: seeds add bulk to soften stools (takes 1-3 days)

6. Constipation Senna alexandria – senna seeds traditionally used to treat constipation sennosides A & B are the active compounds

7. Constipation Pharmaceutical derivative of sennosides is danthron a stimulant laxative that causes muscle contractions of the intestinal wall now considered carcinogenic, so only used in terminally ill patients (e.g., for opiate-related constipation)

8. Constipation Rhamnus spp. – cascara sagrada, buckthorn, bear berry Active components – anthraquinone derivatives R. purshiana (cascara sagrada) was used by indigenous people of CA and the Pacific NW, also early settlers Stimulant laxative Common ingredient in over- the-counter laxatives until it was banned by the FDA in May, 2002.

9. Constipation Ricinus communis – castor oil seed oil is used in low dosage as a laxative, in high dosage as a cathartic in low dose, caster oil acts directly on the intestinal mucosa to change water/electrolyte balance (osmotic laxative)

10. Diarrhea Papaver somniferum – opium poppy In its native range, Hmong and many other cultural groups used opium fruit capsule latex to treat diarrhea

11. Diarrhea Traditional active opium preparations for treatment of diarrhea: – morphine (single compound) – opium tincture – paregoric of opium (opium, camphor oil, anise oil, & benzoic acid) Synthetic opiate treatments: – loperamide (Imodium) – diphenoxylate in Lomotil (also contains atropine)

12. Diarrhea Opiates reduce diarrhea by: reducing propulsive contractions in the large and small intestine reducing gastric secretions this occurs through agonism of opioid recepters in the gut

13. Diarrhea Atropa belladona – belladona Anticholinergic effects of atropine at muscarinic receptors in intestine tissues reduce intestinal motility (mimic sympathetic response) Hyoscyamus niger or Madragora officinarum in the Solanaceae can also be taken as intestinal antispasmodics (hyoscyamine = active compound)

14. Diarrhea Croton lechleri – sangre de drago Native to western Amazon basin, S. America Traditional ethnomedical uses: – diarrhea – ulcers – herpes skin infections – wound healing – tuberculosis – pneumonia

15. Diarrhea Sangre de drago’s anti- diarrhea action is due to a proanthocyanidin compound acts through inhibition of cAMP-mediated fluid and chloride secretion in the villi of the small intestine useful in treating secretory diarrheas (e.g., travelers’ diarrhea, HIV-associated diarrhea)

16. Diarrhea Berberis spp. – barberry (Europe), Oregon grape (W. US) Active compound: berberine Mechanism: berberine directly inhibits ion transport across the intestinal endothelium Useful for secretory diarrheas & dysentery

17. Nausea / Motion Sickness Zingiber officinale – ginger clinical trials (and long use in Chinese traditional medicine & Ayurveda) indicate ginger is an effective antiemetic – S. Phillips, R. Ruggier, & S. E. Hutchinson. 1993. Zingiber officinale (Ginger)–an antiemetic for day case surgery. Anesthesia 48(8): 715-717.

19. Anti-helminthic Plants Anti-helminthics are drugs that expel intestinal worms from the body, either by stunning (aka vermifuges) or killing (aka vermicides) the worms It is estimated that ¼ of the world’s population is infected with intestinal helminths Children are particularly susceptible to helminthic infection, which is associated with poor immune response, malnutrition, anemia, and stunted/slowed physical and intellectual development

20. Anti-helminthic Plants Many plants contain compounds that are toxic to insects (herbivores) - some of these compounds are effective in combating intestinal worms

21. Anti-helminthic plant compounds Nicotiana tabacum, N. rustica - tobacco Nicotine is an effective insect neurotoxin, and tobacco was traditionally used as an anti-helminthic N. tabacum is the variety of tobacco commonly grown for smoking – N. rustica has a much higher (3x) nicotine content in its leaves, and is now grown as a source of nicotine for organic pesticides

22. Anti-helminthic plant compounds Dryopteris filix-mas – Male Fern, Worm Fern Very common fern throughout N. temperate areas of the world Until recent times, the rhizome was used to expel tapeworms The only fern to have appeared in the USP

23. Anti-helminthic plant compounds Artemisia maritima, A. cina, A. absinthum, Artemisia spp. – wormwood, wormseed Traditionally used as antihelminthics (for roundworms) Active compound: santonin No longer used, as it had potentially fatal side effects (convulsions, seizures…) Also altered color vision (xanthopsia)

24. Anti-helminthic plant compounds Tanacetum vulgare – Tansy Related to wormwood (also in the Asteraceae) Contains compounds toxic to insects, including thujone (like wormwood) and possibly santonin Long used as an insect repellent, preservative, and worm treatment

25. Anti-helminthic plant compounds Punica granatum – pomegranate peel of fruit high in tannins, traditionally used as a treatment for intestinal worms in Ayurvedic and Chinese medicine

26. Anti-helminthic plant compounds Agrimonia pilosa – agrimony native to China traditionally used for a variety of purposes, including anti-infective and haemostatic source of compound agrimophol, which is an antihelminthic

27. Anti-helminthic plant compounds Areca catechu – areca palm (areca nut) source of alkaloid compound arecoline arecoline is a nicotinic and muscarinic receptor agonist also acts as an antihelminthic, and is used to treat worms

28. Anti-helminthic plant compounds Peganum harmala – Harmal Native from Eastern Mediterranean to India Active compound in harmal seeds is harmaline – a CNS stimulant and reversible MAO-A inhibitor Seeds traditionally ground and used as an anti- helminthic Ancient Greks used harmala seeds to get rid of tapeworms

29. Anti-helminthic plant compounds Digenea simplex a marine red algae native to Eastern Pacific (Philippines, Japan) used as an antihelminthic (round worms) in Eastern medicine source of kainic acid (active compound)

30. Anti-helminthic plant compounds Kainic acid is an agonist of glutamate (stimulatory) receptors in the brain In higher concentrations, it is a potent CNS stimulant and neurodegenerative agent – used in neuroscience research to model epilepsy and Alzheimer’s

31. Anti-helminthic plant compounds Quisqualis indica – Rangoon creeper Native to SE Asia Fruit/seeds used to kill intestinal worms

32. Anti-helminthic plant compounds Source of quisqualic acid, an agonist of AMPA (glutamate) receptors in the brain Like kainic acid, quisqualic acid is also used in neurological research due to its excitotoxicity in the neurons of the brain and spinal cord