Essential Oils & Herbs: Treatment of Intestinal Dysbiosis By Michelle Morgan The human gut is the natural habitat for a large, diverse and dynamic population of microorganisms, mainly bacteria. The intestinal habitat of a human adult contains 300–500 different species of bacteria. Thirty to 40 species comprise up to 99% of the population. Some of the bacteria are pathogens or potential pathogens when the integrity of the mucosal barrier is functionally breached.1 Major functions of the intestinal microflora include:1 metabolic activities that result in salvage of energy and absorbable nutrients protection against invasion by alien microbes (a barrier effect) trophic effects on intestinal epithelia (eg the control of the proliferation and differentiation of epithelial cells) and on immune structure and function (eg assisting in the development and homoeostasis of the immune system such as via intestinal lymph tissue) Dysbiosis is an imbalance of the intestinal ecosystem,2 usually a breakdown in the balance between “protective” and “harmful” intestinal bacteria.3 Changes in the composition or metabolic functions of intestinal flora may be associated with pathological conditions, including inflammatory bowel diseases and colon cancer.1 There are several types of dysbiosis, more than one of which can co-exist in an individual and cause poor health: Helicobacter pylori presence in the stomach (although some argue it is a commensal) can lead to peptic ulcer and stomach cancer small intestinal bacterial overgrowth colonic flora imbalance – can include abnormal presence of parasites (protozoa) or yeasts (Candida) infections, spasmodic cough, tuberculosis and asthma. It stimulates digestion and is effective for relieving intestinal gas and for killing intestinal parasites.8,9 Essential oil of Origanum vulgare is used in traditional Chinese medicine (TCM) to treat dysentery and enteritis.10 Oregano oil has demonstrated growth inhibitory activity towards human intestinal pathogens including Candida albicans when tested in vitro. The phenolic compounds, carvacrol and thymol are important for the activity.11-13 Oral administration of Oregano oil for 30 days successfully treated 80% of mice with systemic candidiasis.13 Clinical Trial The antiparasitic effect of Oregano oil has been demonstrated in an uncontrolled trial in the United States involving 14 adults whose stools tested positive for enteric parasites (protozoa): Blastocystis hominis, Entamoeba hartmanni and Endolimax nana. For six weeks patients took emulsified oil of Origanum vulgare (200 mg, three times per day) with meals. Thirteen of the 14 patients completed the treatment and submitted follow-up stool samples. Parasites could no longer be detected in 10 patients, seven of these patients reported a reduction of symptoms. Parasite scores decreased for the other three patients.14 Anise Oil Anise (also known as Aniseed) essential oil is obtained by steam distillation of the fruit of Pimpinella anisum. The main constituent of Anise essential oil is trans-anethole.15 excessive antibiotics or a diet low in soluble fibre may create a deficiency of healthy flora (linked to food intolerance and irritable bowel syndrome) Aniseed fruit is traditionally used as an expectorant, spasmolytic and carminative, for bronchitis, tracheitis and flatulent colic.16 A decoction of Aniseed fruit is traditionally used as a vermifuge by the people of rural northern Argentina.17 Aniseed fruit is recorded in the monastic scriptures of Cyprus written during the Ottoman period (1571–1878). It reveals that, in addition to the many familiar traditional applications (dyspepsia, to promote lactation, cough), Aniseed was also recommended for prophylaxis of cholera and plague.18 abnormal responses to normal flora or excessive presence of pathogenic flora lead to deranged immune function (leading to autoimmune disease or chronic skin disorders) Anise oil has been used traditionally for colic, indigestion, coughs, bronchitis,19 and as an antibacterial in cough mixtures and lozenges.4 putrefaction due to high fat and meat and low fibre diets (linked to colon and breast cancer) carbohydrate intolerance due to excess fermentation by normal bacteria in overgrowth or excessive yeasts (Candida) Oregano Oil Many species of plant with the common name ‘oregano’ are used throughout the world as condiments or medicines. Most common is European Oregano (Origanum vulgare) and Mexican Oregano (Lippia graveolens).4,5 The composition of the essential oil of European Oregano can vary. All widely used varieties show a high content (>90%) of four major constituents: carvacrol, gamma-terpinene, p-cymene and thymol.6,7 Oral administration of the essential oil of Oregano (Origanum vulgare) is used in herbal medicine particularly in France and Germany. It is a strong antimicrobial, useful in respiratory Anise oil has demonstrated growth inhibitory activity towards human intestinal pathogens including Candida albicans when tested in vitro. Anethole has been found to be responsible for the antifungal activity of Anise oil.20-22 Pau d’Arco The bark of Pau d’Arco (Tabebuia avellanedae, T. impetiginosa) is used in traditional South American medicine for dysentery, fever, sore throat, intestinal inflammation, snake bites and carcinomas.23 It is also regarded as a tonic.24 The naphthoquinones (including lapachol and beta-lapachone) are key active constituents.25 Results Tabebuia impetiginosa bark extracts exhibited growth inhibition of the human intestinal pathogenic bacteria Clostridium perfringens and C. paraputrificum in vitro.26 Tabebuia avellanedae bark extracts demonstrated growth inhibitory activity towards methicillin-resistant Staphylococcus aureus strains in vitro. Several compounds in the ethanolic extract appeared to be acting synergistically.27 The effect of each compound on the microbial growth of the test organisms is outlined in Table 1 (below). A value of 0 means there were no colonies left after three hours. Values over 100 are possible because the organism may have grown faster over the three hour time period than the controls. The emulsifier used in the preparation of the essential oils made a small contribution to their antimicrobial effect. Lapachol has demonstrated activity against protozoa in vitro.28 Key findings were: Andrographis The aerial parts of Andrographis paniculata is used in many traditional systems, with an emphasis on enhancing immune function, treating fever and infections, including those of the gastrointestinal tract.29-31 In Ayurveda and Indonesian traditional medicine it is also regarded as a tonic.31,32 Key constituents of Andrographis include diterpenoid lactones, collectively referred to as andrographolides.33 Andrographis has been found to affect the cell surface hydrophobicity of E. coli strains in vitro and hence possibly interfere with this bacteria’s adhesion capability.34 Andrographis also reduced the E. coli enterotoxin secretory response in isolated intestinal tissue.35 However, with regard to infections and intestinal dysbiosis, its value is mainly as an immune-enhancing treatment and it is a useful part of any formulation on that basis.25 Pau d’Arco had a significant inhibitory effect on the growth of Candida albicans, C. glabrata and Enterococcus faecalis, with the greatest effect on the latter organism Synergistic Formulation These essential oils and herbs would complement each other in a very potent formulation with the following actions: A trial conducted in Thailand found that Andrographis decreased the frequency and amount of discharge in patients with acute diarrhoea and bacillary dysentery. In China, treatment with Andrographis preparations was found to be beneficial for bacillary dysentery and enteritis. Andrographolides were also of benefit in the treatment of bacillary dysentery, but other constituents may also be important for the therapeutic activity of Andrographis.33,36 The in vitro antimicrobial activity of Oregano and Anise essential oils and extracts of Pau d’Arco and Andrographis was assessed by an independent laboratory at Charles Sturt University in 2007. The test microorganisms included two yeasts (Candida albicans, Candida glabrata) and four bacteria (Enterococcus faecalis, Escherichia coli (E. coli), Klebsiella pneumonia, Salmonella spp. serotype Monschaui). All of these organisms are commonly found in the human intestinal flora. Anise essential oil significantly inhibited the growth of all organisms, with the effect on Candida albicans less than that for the other organisms which were almost completely inhibited With the exception of Enterococcus faecalis no significant antimicrobial effect was demonstrated for Andrographis, as might be expected (results not shown) Clinical Trials In vitro Antimicrobial Activity by Essential Oils & Herbs Oregano essential oil and the combination of all compounds completely inhibited the growth of all organisms antimicrobial, antiparasitic immune-enhancing It is advantageous to use more than one antimicrobial and antiparasitic agent to reduce the risk of organisms becoming resistant. It is also best to have the combination presented with enteric coating, to deliver the antimicrobial and antiparasitic agents directly to the intestine where their action is needed. The use of some essential oils by oral administration is part of the tradition of herbal medicine, particularly in Europe, as can be seen by their inclusion in old pharmacopoeial texts. These essential oils can be used safely when administered at the recommended dosage. Information from the British Pharmaceutical Codex 1934 allows the following oral dosages to be derived: Oregano essential oil (170–1150 mg/day), Aniseed essential oil (177–788 mg/day).37 Indications As part of a bowel flora protocol for intestinal dysbiosis Adjunctive treatment for diarrhoea and candidiasis Method The compounds were suitably prepared in broth to a concentration of 0.1 w/v (weight per volume). A combination containing equal amounts by weight of each of the compounds was also tested. Broth was tested as a control. The test organisms were prepared, added to a broth containing each compound and allowed to incubate for a period of three hours. Colony count was then performed after 48 hours for yeasts and 24 hours for bacteria. Assays were performed in triplicate. Microorganism Oregano (essential oil) Candida albicans 0 Candida glabrata 0 Enterococcus faecalis 0 Escherichia coli 0 Klebsiella pneumonia 0 Salmonella spp. (serotype: Monschaui) 0 Table 1. Colony count as a percentage of controls. References available at MediHerb’s Professional Library www.mediherb.co.uk Any health condition linked to intestinal dysbiosis such as autoimmune disease, gut disorders (such as irritable bowel syndrome, food sensitivities, gastrointestinal infections), chronic skin disorders, poor immunity, fatigue, breast and colon cancer Cautions and Contraindications Contraindicated in pregnancy and lactation. Mean Growth (%) Pau d’Arco stem bark Anise (essential oil) (powdered extract) 29 34 0 19 6 4 0 102 0.3 80 0 46 Combination 0 0 1 0 0 0 © Copyright 2009 MediHerb. MH/797 – 03/09