Ulcerative Colitis Patients Find New Hope in Herbal Medicine, Meta-Analysis Suggests

For the millions worldwide suffering from ulcerative colitis, finding safe and effective treatments can be a daunting task. While conventional medications remain the mainstay of therapy, a growing number of patients are turning to herbal medicines for additional support. Now, a new systematic review and meta-analysis has shed light on which botanical treatments hold the most promise for managing active disease.

Ulcerative colitis (UC), a chronic inflammatory bowel disease affecting the colon, poses significant challenges for patients and healthcare providers alike. While standard treatments such as aminosalicylates, corticosteroids, and biologics can be effective, they are not always tolerated and may have significant side effects.¹ As a result, many patients seek out complementary and alternative therapies, including herbal medicines, to help manage their symptoms.² However, the evidence for these treatments has been limited and sometimes conflicting.

Aiming to clarify the role of herbal medicines in treating active UC, researchers from the United States conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating these interventions.³ The study, published in the journal Nutrients, included 28 RCTs evaluating 18 different herbs.

The researchers, led by Preetha Iyengar of the Johns Hopkins University School of Medicine, searched multiple databases to identify relevant trials. To be included, studies had to be RCTs comparing an herbal medicine to placebo, standard therapy, or another active treatment in patients with active UC. The primary outcomes of interest were clinical response, clinical remission, endoscopic response, and endoscopic remission. Safety data were also collected.

After screening over 2,000 articles, 28 RCTs met the inclusion criteria. The most commonly studied herbs were Curcuma longa (turmeric), Andrographis paniculata, and Indigo naturalis. Pooled analyses revealed some significant findings.

Compared to placebo, Indigo naturalis demonstrated significantly higher rates of clinical response (RR 3.70, 95% CI 1.97-6.95), but not remission. Curcuma longa, on the other hand, did not show a statistically significant benefit for clinical response (RR 1.60, 95% CI 0.99-2.58), but did have significantly higher rates of clinical remission (RR 2.58, 95% CI 1.18-5.63), endoscopic response (RR 1.56, 95% CI 1.08-2.26), and endoscopic remission (RR 19.37, 95% CI 2.71-138.42). Andrographis paniculata did not demonstrate significant benefits for either clinical response or remission compared to placebo.

The dosages of the herbal treatments varied among the studies. For Curcuma longa, daily doses ranged from 450 mg to 3 g of curcumin, the active constituent. Indigo naturalis studies used either 0.5 g or 2 g per day of the powdered herb. Andrographis paniculata doses ranged from 1200 mg to 1800 mg per day of the extract.

Adverse events were generally mild across the studies, with no significant differences seen between the herbal treatments and placebo in most cases. However, the authors note that larger and longer-term studies are needed to fully assess safety.

While these results are promising, particularly for Curcuma longa, the authors caution that the overall quality of evidence was low to very low for most outcomes, largely due to the small size and methodological limitations of many of the included studies. They call for larger, well-designed RCTs to confirm these findings and better establish the optimal dosing and formulation of these herbal medicines.

This study adds to the growing literature on the potential of natural therapies for managing inflammatory bowel diseases like UC. The GreenMedInfo database, a repository of scientific research on natural medicines, lists over 170 substances that have been studied in the context of UC.⁴ Some of the top researched natural interventions include:

1. Curcumin: The active compound in turmeric, curcumin has well-established anti-inflammatory and antioxidant properties.⁵ Multiple studies have found it effective for inducing and maintaining remission in UC.^6,7

2. Probiotics: Dysbiosis, or imbalance of gut bacteria, is a key feature of UC. Probiotics can help restore a healthy microbiome and reduce inflammation.⁸ Specific strains like _Escherichia coli_ Nissle 1917 and VSL#3 have shown benefit in UC trials.^9,10

3. Omega-3 Fatty Acids: These anti-inflammatory fats, found in fish oil and flaxseed oil, can reduce disease activity and help maintain remission in UC.^11,12

4. Aloe Vera: The gel from this common plant has anti-inflammatory effects in the gut and has been found to improve symptoms and induce remission in UC patients.^13,14

5. Boswellia: Also known as Indian frankincense, boswellia extracts have potent anti-inflammatory actions and have shown promise in several UC studies.^15,16

6. Green Tea: The polyphenols in green tea, particularly epigallocatechin-3-gallate (EGCG), can reduce inflammation and oxidative stress in the colon.¹⁷ Clinical trials have found green tea enemas and oral supplements effective for UC.^18,19

7. Ginger: This common spice has anti-inflammatory and antioxidant effects that may benefit UC. Animal studies have found it effective for reducing colitis severity.^20,21

8. Vitamin D: Low vitamin D levels are common in UC patients and are associated with more active disease.²² Supplementation can reduce inflammation and improve quality of life.^23,24

9. Andrographis Paniculata: While the current meta-analysis did not find a significant benefit, other studies have suggested this herb can reduce disease activity and rectal bleeding in UC.^25,26

10. Wheatgrass: The juice of this young grass is rich in antioxidants and has been found to reduce disease activity and rectal bleeding in UC patients in several small studies.^27,28

As always, patients should consult with their healthcare provider before starting any new treatment, as herbal medicines can interact with other medications and may not be appropriate for everyone. However, with guidance from a knowledgeable practitioner, integrative approaches incorporating both conventional and evidence-based complementary therapies may offer new hope for better managing this challenging condition.

Source: Ulcerative Colitis Patients Find New Hope in Herbal Medicine, Meta-Analysis Suggests