Alternative Medicines or Natural Remedies

& Inflammatory Bowel Disease (IBD)

KEY POINTS:

The first medicines were derived from plants. There has been an interest among the public over the years in using herbal medicines for a variety of health problems including IBD.
The amount of research on alternative medicines for the treatment of IBD is small when compared to the amount of research on conventional (prescription) medications. Therefore, conclusions about alternative medicines including herbal medicines are more uncertain.
As with other medicines, herbal medicines must be taken in the right amount or dose to be effective. If you use one of these medicines, be sure to check carefully what dose would work for you. Too high a dose may cause health problems.
Herbal medicines can interact with other commonly used medicines and may have side effects, so it important to let your doctor and pharmacist know if you are taking a herbal medicine along with other medicines (prescriptions or herbal ones).
The strength or potency of herbal medicines may vary depending on the brand and the batch. One reason for this may be the method used to extract the active ingredient from the plant. To make sure that you receive a product with the recommended potency and without unhealthy contaminants, purchase from a supplier and manufacturer with a good reputation. Your pharmacy may be able to provide advice about the most reliable products.
Products without a clear list of ingredients or with a language you don’t understand have more risk of containing unhealthy substances. Some of these products would not have been tested by health authorities for safety.
In most countries herbal medicines do not have to provide proof that they have the effects they claim to have.

Specific Substances

This section lists herbal medicines for which there have been published controlled clinical trials to test their efficacy (see the material on probiotics for a review of that topic).

Curcumin

This is bright yellow chemical produced by some plants. It is present in a spice used in cooking - turmeric, which is a member of the ginger family. This substance has also been used as a food flavouring or colouring agent and in cosmetics.
3 studies have assessed the use of curcumin in managing ulcerative colitis.
In one well-designed study of maintenance of remission in ulcerative colitis, all of the patients received sulfasalazine (a medicine used for ulcerative colitis), half received curcumin and half received a placebo (an inert substance). Fewer patients receiving sulfasalazine and curcumin had relapses than those receiving sulfasalazine and placebo.
In another study curcumin enema combined with oral 5ASA (a prescription medicine for IBD) was compared to placebo enema combined with oral 5ASA in active ulcerative colitis. At 8 weeks there was a suggestion of benefit for the curcumin enema group but the results were not conclusive.
In a third study patients with active ulcerative colitis received curcumin or placebo. There was overwhelming benefit seen in those receiving curcumin. The differences were so great between curcumin and placebo (compared to other research) that it raised questions about whether the study was reliable.
There was one study comparing curcumin to placebo in persons with Crohn’s disease who underwent surgery (as postoperative agent to prevent recurrence). All participants also got daily azathioprine. There was no difference in outcomes between the curcumin and placebo groups for clinical or endoscopic recurrence at 6 months. Hence, curcumin was not useful as an adjunct to azathioprine in preventing postoperative Crohn’s disease.
The research to this point suggest that this herbal medicine MAY be helpful but more research is needed before we can be confident that it is helpful.

Boswellia serrata (Indian frankensense)

One 8 week study in active Crohn’s disease found no difference compared to 5ASA (a medicine used for IBD treatment).
Another 12 month study in Crohn’s disease in remission found no difference compared to placebo (an inert substance) in reducing the chance of a return of symptoms.
Hence, there is not strong evidence for using this agent in IBD.

Artemisia absinthium (wormwood)

One well-controlled study suggested some benefit for this agent in treating active Crohn’s disease when added to standard treatment.
It has not been assessed as a treatment on its own (without other medicines). There is not yet strong evidence for using this agent in IBD.

Andrographis paniculata (Indian Echinacea, HMPL-004)

One well-controlled study in active ulcerative colitis compared this agent to 5ASA (a prescription medication) and by 8 weeks revealed no differences in benefits (meaning that this compound could be as effective as 5ASA).
Another well-controlled study in active ulcerative colitis compared this medicine to placebo (an inert substance) and by 8 weeks found that this agent was better at inducing an improvement in symptoms but not better at inducing a remission (where symptoms are much improved).
These findings suggest that this herbal medicine has some promise but more research is necessary.

Fish oil

A study from Italy published in 1996 suggested that fish oil could be an effective therapy in Crohn’s disease. However, 2 large clinical trials that studied persons with Crohn’s disease who either a) had their active disease treated with prednisone and achieved remission (or symptom free state) or b) had longstanding remission found that fish oil was no better than placebo in keeping persons with Crohn’s disease in remission.

Other herbal medicines

Each of Triticum aestivum (wheatgrass juice), Oenothera biennis evening primrose oil, aloe vera gel, silymarin, has been compared with placebo in studies in persons with ulcerative colitis
Each of plantago ovata (Desert Indian wheat), Myrrhinil intest (combination of myrrh, chamomile extract and coffee charcoal), and sophora (Japanese pagoda tree) has been compared with 5ASA or sulphasalazine in treatment of ulcerative colitis.
All of these studies except the evening primrose oil study showed some benefit of these agents. However, most of these studies had flaws in their design to make their interpretation difficult.
It is important that multiple studies be undertaken with any one agent to be certain that beneficial results can be repeated and trusted.

Final notes

There is insufficient evidence to recommend any of these therapies in the treatment of ulcerative colitis or Crohn’s disease.
Curcumin may have the most promise to be an effective agent in treating ulcerative colitis but more research is necessary before we can be confident about this.
Many more studies with the same rigorous study design required of new medications are needed to understand which of these herbal medicines are effective and safe in the treatment of IBD whether as primary treatments or when used in addition to established treatments.

References

Hilsden RJ, Verhoef MJ, Best A, et al. Complementary and alternative medicine use by Canadian patients with inflammatory bowel disease: results from a national survey. American Journal of Gastroenterology 2003; 98: 1563-8.

Lakatos PL, Czegledi Z, David G, et al. Association of adherence to therapy and complementary and alternative medicine use with demographic factors and disease phenotype in patients with inflammatory bowel disease. Journal of Crohn Colitis 2010;4:283-90.

Rawsthorne P, Clara I, Graff LA, Bernstein KI, Carr R, Walker JR, Ediger J, Rogala L, Miller N, Bernstein CN. The Manitoba IBD Cohort Study: A prospective longitudinal evaluation of the use of complementary and alternative medicine services and products. Gut 2012; 61:521-7.

Ng SC, Lam YT, Tsoi KK, et al. Systematic review: the efficacy of herbal therapy in inflammatory bowel disease. Alimentary Pharmacology and Therapeutics 2013; 38(8):854-63.

Lang A, Salomon N Wu J, et al. Curcumin in combination with 5-aminosalycilate induces remission in patients with mild to moderate ulcerative colitis in a randomized controlled trial. Clinical Gastroenterology and Hepatology 2015.

Langhorst J, Wulfert HR, Lauche R, Klose P, Cramer P, Dobos GJ, Korzenik J. Systematic Review of Complementary and Alternative Medicine Treatments in Inflammatory Bowel Diseases. Journal of Crohn's and Colitis, 2015, 86–106.

Bommelaer G, Laharie D, Nancey S, Hebuterne X, Roblin X, Nachury M, Peyrin-Biroulet L , Fumery M, Richard D, Pereira B, Goutte M, Buisson A, POPCUR study group. Oral Curcumin No More Effective Than Placebo in Preventing Recurrence of Crohn's Disease After Surgery in a Randomized Controlled Trial. Clinical Gastroenterology and Hepatology 2019; in press.

Last reviewed: March 2020

For more information and fact sheets about IBD and its treatment please visit: http://www.crohnsandcolitis.ca

Disclaimer: This information is provided for educational purposes only. Always consult a qualified health care professional for your specific care.

Source: This summary provides scientifically accurate information. It was prepared in a research review by researchers with the IBD Clinical and Research Centre, University of Manitoba with assistance from colleagues in Canada and internationally.

Acknowledgement: Preparation of this material was supported by funding from the Canadian Institutes of Health Research.

©2016 Charles N. Bernstein, John R. Walker on behalf of Manitoba IBD Clinical and Research Centre. This work is licensed under a Creative Commons Attribution-nonCommercial-NoDerivs 2.5 Canada License. You are free to copy and distribute this material in its entirety as long as: 1) this material is not used in any way that suggests we endorse you or your use of the material, 2) this material is not used for commercial purposes, 3) this material is not altered in any way (no derivative works). View full license at http://creativecommons.org/licenses/by-nc-nd/2.5/ca/.