Herbal Successes in Treating Ulcerative Colitis: Review

A newly published analysis of 1,227 studies concludes non-invasive herbal treatments could be a game-changer for people enduring ulcerative colitis.

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Air, water, food, sleep, and warmth are a human’s basic physiological needs. When one or more of those needs is not met, we fail to thrive.

Just as we eat and drink multiple times a day, we must also rest and digest. Likewise, we suffer when one of our bodily systems is not able to process or respond to those basic needs. In the case of ulcerative colitis, the troubled system is the digestive tract, which can affect one’s entire life.

Common recommendations to help alleviate symptoms include lifestyle and nutritional changes, such as the removal of dairy products from the diet, eating smaller portions, and stress management.

Mostly, however, the disease is treated with anti-inflammatory drugs and immunosuppressants. In the worst cases, doctors might opt for a proctocolectomy, an invasive surgery to remove parts or all of the colon and rectum.

New Developments in Plant-Derived Medicine

Epoch Times health reporter Terri Ward recently wrote an essential guide to ulcerative colitis, explaining its “symptoms, causes, treatments, and natural approaches.”

Here, we will deep-dive into the last on that list, as a systematic review, published in March in the journal Nutrients, offers exactly that perspective. The assessment considers phytopharmaceuticals (plant-derived compounds with medicinal qualities) as remedies for ulcerative colitis.

Researchers investigated 1,227 studies and concluded that the herbal armamentarium available to modern practitioners shows promising results. They suggest it is “imperative that healthcare providers are educated on how to guide their patients in safe herbal medicine use.”

Non-invasive herbal treatment could be a game-changer for those with ulcerative colitis.

18 Investigated Herbal Remedies

The meta-analysis examined 18 herbs, some of which have been used for centuries in herbal treatments outside of the United States. This article will cover the top four studied herbs, their usage, their benefits regarding ulcerative colitis, and how they compare with conventional drugs.

1. Turmeric

One of the most studied and readily available herbal compounds is Curcuma longa, also known as curcumin or turmeric. This member of the ginger plant family showed promising results in a 2021 analysis.

Some drawbacks of the analysis were that the study sizes were usually small and the dosage of the golden spice varied therein. Hence, finding an exact formulation that could be observed in clinical trials was challenging.

Nevertheless, the new 2024 review showed “improved rates of clinical remission, endoscopic response, and endoscopic remission” with curcumin ingestion.

Modern technology plays a major role in transporting turmeric to sites of severe inflammation in the bowel. Scientists utilize novel nanovesicles (carrier systems that move the active component to the location of usage) to bring curcumin to their target site.

This oral administration of turmeric-derived nano-size spheroids “exhibited superior anti-inflammatory activity” in both in vitro and in vivo trials, according to a 2022 study.

Even dietary turmeric is a powerful stimulant of our bodies’ healing mechanisms. However, consumers must be aware of its naturally low bio-availability, which can be improved by adding black pepper—as outlined in a recent Epoch Times article.

2. Indigo Naturalis

Indigo naturalis is well known in traditional Chinese medicine (TCM). Though ingesting indigo can generate side effects, its use as a topical treatment, specifically in left-sided distal ulcerative colitis, has been promoted.

Furthermore, active ingredients in indigo “can promote mucosal healing” of the intestine, according to a review published in Immunological Medicine.

A promising small “prospective uncontrolled open-label study” investigated the efficacy of indigo in 33 UC patients. People experiencing moderate to severe symptoms were given two grams per day of indigo naturalis for one year. During the trial, doctors observed their health condition at zero, four, and 52 weeks.

Although 17 patients had adverse reactions, only three experienced active colitis. The mucosal tissue healed for 48 percent of participants at the four-week mark. The rate climbed to 70 percent at 52 weeks. “The rates of clinical remission at weeks four, eight, and 52 were 67 percent, 76 percent, and 73 percent, respectively,” according to the study.

3. Baikal Skullcap

Known as Huang Qin in traditional Chinese medicine, Baikal skullcap has been the subject of several studies in recent years, most of which examined its efficacy regarding the intestinal microbiome, its mucosal barrier, and amino acid metabolism.

As early as A.D. 220, Chinese physician and pharmacologist Zhang Zhongjing noted the ameliorating qualities of Baikal skullcap in gastrointestinal disorders in his famous medicinal treatise “Shang Han Lun.”

The clarification of the herb’s mechanism was the goal of a 2022 study published in Phytomedicine. Its results revealed the plant’s capability of activating the “mTOR signaling pathway”—meaning the stimulation of a signaling network that centrally regulates “cell metabolism, growth, proliferation and survival.”

Baikal skullcap was also able to normalize the gut microbiota, which act as a powerful modulator of autoimmune responses in the body. It also helped control the uptake of amino acids and guard the gut’s mucosal barrier.

A 2021 animal study, published in the International Journal of Biological Macromolecules, found that Baikal skullcap might be a candidate for innovative medicine against ulcerative colitis. Specifically, researchers isolated same-type glycosyl units called SP2-1 from Scutellaria baicalensis Georgi.

Not only did treatment with SP2-1 significantly increase beneficial gut bacteria such as Bifidobacterium and Lactobacillus, but also, it reciprocally inhibited “levels of Bacteroides, Proteobacteria and Staphylococcus.”

SP2-1 also repressed cytokine inflammation, which consequently has positive effects on the immune system and blood health.

In 2022, another study focused on the use of the TCM Huangqin decoction (HQD) in ulcerative colitis. Researchers “combined bioinformatics analysis, network pharmacology, and molecular docking to reveal the mechanisms.”

The results were promising: “161 active components with 486 effective targets of HQD were screened. 1,542 ulcerative colitis effective targets were obtained.”

The herb’s active components work through multiple pathways to heal a variety of targets in ulcerative colitis.

TCM classifies Baikal skullcap as a phytopharmaceutical that clears heat, drains dampness, and resolves toxicity—an herbal all-rounder in the digestive tract.

4. Licorice

A pre-released study features another herb that has its roots in traditional Chinese medicine, sometimes referred to as the single most important herb to treat ulcerative colitis—licorice.

The preview confirmed licorice’s healing effect on the disease, as the herb promotes mitophagy—meaning damaged organelles are eliminated properly to prevent their accumulation, future cell death, and toxic overload.

Licorice is also anti-inflammatory and features protective properties for the digestive system.

Licorice extract was the focus of a 2022 systematic review, which demonstrated its efficient role in preclinical studies.

As with Baikal skullcap, researchers employed network pharmacology, a novel system of methods used to understand more about the mechanisms of medicinal herbs.

In the above-mentioned meta-analysis, the technique indicated “that anti-inflammation, anti-oxidative stress, immunomodulatory effect, and microbiota homeostasis were the predominant therapeutic mechanisms of licorice extract and its active compounds treating UC.”

In a 2023 animal study, mice with UC treated with the licorice compound showed improvement through decreased inflammation, reduced oxidative stress, and increased mitochondrial autophagy.

The number of studies regarding licorice’s efficacy in ulcerative colitis cases has increased in recent years.

The Herbalist Perspective

As I am a community herbalist, a few additional herbs that assist with the healing of ulcerative colitis come to mind. These medicinals were not analyzed in the large system review above. However, I find them worthy of an honorable mention for their mild character and powerful properties.

1. Slippery Elm

Sometimes called an “all-purpose herbal medicine” for any type of irritation and “-itis” (inflammation in the body), slippery elm is a demulcent, anti-inflammatory, and vulnerary agent.

Its mucilaginous nature nourishes and soothes the entire digestive tract. The herb is also rich in mineral salts, which neutralize excess secretion of stomach acid. It strengthens atrophic gut mucosa and supports normal digestive function.

2. Marshmallow

Marshmallow is another mucilaginous herb that is an anti-inflammatory immunostimulant. Marshmallow moistens and soothes inflamed tissue and is an additional remedy for “-itises” of all manner, including ulcerative colitis.

3. Chickweed

Chickweed is a mild, mineral-rich, and mucilaginous herb with excellent anti-inflammatory and vulnerary qualities. It is often used for a wide range of ulcerated conditions and can be used as a nutritive strengthener and tissue healer for UC.

Medicinal Teas and Juice Recommendations

Slippery elm and marshmallow can be taken as medicinal tea. For either, add 1 teaspoon of the herb to 8 ounces of cold water, bring to low heat, and allow to steep for 15–20 minutes (mucilaginous herbs do not like much heat). Drink 3–4 cups per day.

However, slippery elm is best prepared as a cold infusion—use the same ratio of herb to water and steep for several hours.

Chickweed is better taken as a juice than a brew (up to 3 shots daily)—although tea is possible—use 2 teaspoons of the herb and steep in 8 ounces of hot (not boiling) water for one hour (3 cups daily).

Conventional Treatments, Drugs, and Their Side Effects

Research on the efficacies of herbal remedies is infrequent, but it seems that research regarding conventional treatments is no better.

A 2019 literature review published in the World Journal of Gastroenterology noted the scarcity of “high-quality evidence assessing conventional therapy in MS-IBD [moderate to severe inflammatory bowel disease] treatment." 

According to the study, conventional therapies were considered to be corticosteroids (prednisone, hydrocortisone, budesonide, prednisolone, dexamethasone), 5-aminosalicylic acid derivatives (mesalazine and sulfasalazine), and immunosuppressants (azathioprine, methotrexate, mycophenolate, cyclosporine, tacrolimus, 6-mercaptopurine).

Unfortunately, these come with a multitude of side effects.

Anti-Inflammatories

1. 5-Aminosalicylates

Oral 5-aminosalicylates seem to provoke similar symptoms to the ones they are trying to remediate.

A review including 44 separate studies regarding conventional administration of these medications lists commonly reported adverse reactions such as “flatulence, abdominal pain, nausea, diarrhea, headache, dyspepsia (indigestion), and nasopharyngitis (inflammation of the nasal passages).”

2. Corticosteroids

Prescribed corticosteroids, which find usage in moderate to severe cases of the disease and a plethora of other health conditions across medical specialties, work by suppressing the immune system.

Corticosteroids consist of “hormone mediators produced by the cortex of adrenal glands that further categorize into glucocorticoids, mineralocorticoids, and androgenic sex hormones.”

An article updated in 2023 offers grim warnings, as long-term use of corticosteroids can lead to several dangerous adverse reactions that may not be reversible, including weight gain, sleep disturbances, leg edema, depression, and hypertension.

Immunosuppressants

Most studies support the use of immunosuppressants only in Crohn’s Disease. Although there is a lack of evidence-based efficacy, these drugs are still a mainstay of therapy in ulcerative colitis, according to a publication in the journal Gut.

1. Azathioprine and Mercaptopurine

The minor side effects of azathioprine and mercaptopurine manifest as flu-like symptoms, nausea, or vomiting. A potential and more serious side effect is an increased risk for a type of cancer—lymphoma. A meta-analysis combined the data of six studies that examined the treatment of UC with the immunomodulators azathioprine and 6-mercaptopurine. The risk of lymphoma increased fourfold. Researchers do not know whether this was because of an underlying disease pattern, the medication, or a combination.

These drugs also pose a heightened risk to the liver and pancreas, so patients’ blood should be monitored regularly.

2. Cyclosporine

Cyclosporine has been known to increase total cholesterol. In a study published in the Scandinavian Journal of Gastroenterology, 52 out of 72 patients developed adverse reactions to nine months of medication.

3. ‘Small Molecule’ Medications

Small molecule drugs use a variety of “novel pharmacological pathways,” which include disease-modifying agents, modulators, and inhibitors.

In 2021, after a safety clinical trial, the U.S. Food and Drug Administration warned of severe adverse drug reactions, including “serious heart-related problems and cancer.” In 2022, the agency placed a black box warning on this type of medication. The tested drugs included Xeljanz and Xeljanz XR (active ingredient tofacitinib).

Yet, according to the Mayo Clinic, “These medications may be effective when other therapies don’t work.”

Biologics

Researchers do not know the exact cause of UC but think that an abnormal immune response might be the trigger. Biologic therapy targets and neutralizes exactly these proteins in the immune system. Medications such as Infliximab, adalimumab, or golimumab are called TNFs—tumor necrosis factor inhibitors.

In a book listed in the National Library of Medicine, researchers examine the development of cancer malignancies, congestive heart failure, demyelinating disorder, and drug-induced lupus. Patients have reported neurological problems and skin lesions.

“Serious liver‐function abnormalities can be observed in association with infliximab therapy,” a study reads.

“After all, it is not any more justifiable to withhold these potent therapies in patients with moderate and severe forms of IBD.”

Other drugs commonly used in the treatment of ulcerative colitis include painkillers, anti-spasmodics, anti-diarrheals, and iron supplements.

Patients should be well educated about phytopharmaceuticals and conventional treatments—only then can they choose what they think will make their digestive system thrive.