Diarrhoea and bacterial

dysbiosis
Ann Walker PhD MCPP MNIMH
 Case: IBS

Patient First visit Advice/ Outcome

details 24 June 2005 Treatment 5 August 2005
LP female Loose stool Diet: Problem cleared in
62 yrs 3-4 x day for 3 yr • ↑F&Veg when able 8 days!
BMI 27 Occ anal leakage Completely back to
Generally in Flatulence, Supplements: normal
good health bloating • None
Going without fear
Diet: PMH Herbal medicine to the theatre:
low in F&V Rx1 “Wonderful - can’t
and dairy OA (hands) • Hebe remember lasts
Stress in past • Tarax rad time I had a
Drugs: Hyper- • ‘Bowel’ mix normal stool”
cholesterolaemia Rx2
Atorvastatin Constipation in • Rasp leaf/mint Signed off
past 15g as inf
Rx3
• Slippery elm tabs 4 bid
Case study IBS in long-term Px
Patient Returned Px June Advice/ 10 days later
details 2008 Treatment
RW 85 yr IBS started suddenly Diet: IBS cleared
woman 1 mo ago with • ↓seeds oils completely – no
Long-term flatulence and (omega-6) further
patient loose stools prescription was
originally Supplements: necessary
consulting PMH • multi vit/min
2000 for Skin problems much • Vit C Support for
skin rash better • Ca+Mg general and
Diabetes controlled • Flax seed oil (EPA) cardiovascular
Diet : by diet • Algal DHA health continues
vegetarian History of
low in Angina & Herbal medicine
omega-3, Osteoporosis Hawthorn
dairy Shoulder pain Red yeast rice
Drugs: Wormwood complex
Aspirin Tablets 2, three
Disoprolol times a day for 10
Lisinopril days
 Case: Fatigue (with IBS)
Patient First visit Advice/ Outcome
details 27 Jul ‘08 Treatment 1 Aug ‘08
KH female Low vitality, Diet: IBS symptoms much
40 yrs ‘foggy’ head, • ↑F&Veg worse
BMI 21 cries easily, • ↓seeds oils(omega-6)
Stressed anxious, • ↑oily fish • Wormwood
mother of 2 IBS for 18 yrs Supplements: complex 2 tds for
and (diarrhoea, • multi vit/min↑ 10 days
teaching indigestion, • Vit C
assistant bloating) • Ca+Mg “Follow-up Digestive”
Restless legs • Mg Mix:
Diet : low in palpitations, • Hebe
• Omega-3/ 2 g
dairy, F&V PMS-A,D,H, • Potentilla
Herbal medicine
and oily fish Premenstrual: • Dioscorea
‘Vitality Mix’:
mastalgia/ • Elettaria
Eleuthero
severe 10 ml bid
Rehmannia
headaches/
Glycyrrhiza
obsessive
Withania
thoughts
Cimicifuga
KH outcome a five weeks later
 No indigestion, no bloatedness – absolutely
normal GI tract for one whole week
 “Miracle – can’t believe it”
 Normal cycle – much less PMS, energy good and
not a single headache. No ‘fog’ in head. Feels
more relaxed and confident. No obsessive
thoughts.
 “I feel like the easy-going person before I started the
family”
 Treatment continued with the “Vitality Mix” for one
more month and then signed off
 Wormwood complex*
 Herbs:
 Wormwood (Artemisia absinthium) ≡ dry herb100 mg

Stemona (S. sessilifolia) ≡ dry root 1.0 g
 Black Walnut (Juglans nigra) ≡ dry fruit hull 100 mg
 Clove essential oil 20 mg
 Actions: anthelmintic, carminative and
digestive
 Indications: Traditionally these herbs have
therapeutic activity useful in the elimination of
harmful parasites from the gut and to ease
symptoms of flatulence and colic
*Mediherb
 Wormwood Indications:
 Anthelmintic - used since ancient times
and is currently utilized in many countries
throughout the world
 Experimental evidence confirms this property
 Appetite loss, disturbed digestion,
flatulence and disordered bile flow

Clinical trials have demonstrated the ability of
wormwood to increase the flow of gastric
enzymes, pancreatic enzymes and bile
 Research on Wormwood

 Steroid-sparing effect: Omer B et al Phytomedicine. 2007;14:87

 40 Crohn’s patients on steroids given wormwood (3

x 500 mg/day) or placebo for 10 weeks and

steroids tapered off to zero by week 10
 From week 8-20 remission recorded in 65%

patients on wormwood but none on placebo

 Anti-inflammatory effect: Lee HG et al. Ann N Y Acad Sci.
2004;1030:555

Wormwood flavonoid (p7F) reduces pro-
inflammatory mediators: COX-2, PGE,, iNOS/NO,
TNF-alpha
 Low toxicity: Muto T, et al J Toxicol Sci. 2003;28:471

NOEL (no-effect-level) in rats was >1.27 g/kg/day
 Black Walnut Hulls
 Key Constituents

Naphthoquinones including juglone and
plumbagin
 Anthelmintic Activity
 In vitro studies show that plumbagin inhibits
the motility and hatching of nematodes
 Stemona – Bai Bu
S. japonica or S. sessilifolia or S tuberosa
 Actions:
 Respiratory relaxant: bronchodilator, expectorant,
antitussive, demulcent
 Anthelmintic and antiparasitic
 Insecticidal
 Anti-infective: antibacterial, antifungal
 Indications

Bronchitis, dry cough, whooping cough, croup,
lung TB

intestinal parasites, ringworm, pinworm,
trichomoniasis, schistosomiasis, giardiasis,
cholera, dysentery, typhus, yeast/fungal infections
 Topically for parasites
Holmes, P Jade Remedies: a Chinese herbal reference for the West Vol 1
 Stemona
 Active compounds:-
 Alkaloids:
• Tuberostemonine, protostemonine, stemospironine,
maistemonine, sessilistemonamines A-C,
dihydrostemoninine
 Bibenzyls:
• stilbostemins M-O, stilbostemins B, D and G, 3,5-
dihydroxy-2'-methoxy bibenzyl, 3,5-dihydroxy bibenzyl

Dihydrostilbenes:
• stilbostemins H, I

Dihydrophenanthrenes:
• stemanthrene E, stemanthrenes A and C

Yang XZ et al. J Asian Nat Prod Res. 2007, 9: 261

Wang P et al. Chem Biodivers. 2007; 4 :523
 Stemona research
 Antitussive effects Yang XZ Planta Med. 2009;75:174
 The main alkaloidal constituents, showed

significant antitussive activity animal model

 Antibacterial effects Zhang T et al. J Asian Nat Prod Res. 2007, 9:479
 The ‘bibenzyls’ showed strong antibacterial

activities against Staphylococci

 Clove bud essential oil
 History of use: Cloves (Syzygium aromaticum) has long
been used in Ayurveda and Western herbal medicine as
a carminative and aromatic and more recently as an
antihelmintic
 Constituents: phenylpropanoids such as carvacrol,
thymol, eugenol and cinnamaldehyde
 Actions: antimicrobial, antioxidant, antifungal and
antiviral activity, antiinflammatory, cytotoxic, insect
repellent and anaesthetic
 Therapeutic indications in GI tract: nausea, flatulence,
dyspepsia, abdominal colic/ pain
 Research: effective against some parasites, pathogenic
bacteria, Herpes simplex, hepatitis C viruses as well as
drug-resistant Staphylococci

Chaieb K Phytother Res. 2007 Jun;21(6):501-6

 In vitro Research on Clove oil
 Antimicrobial activity:
Fu Y, et al Phytother Res. 2007;21:989
Both clove and rosemary eo’s showed antimicrobial
activity against Staphylococcus epidermidis,
Escherichia coli and Candida albicans but clove oil
was strongest
 Anti-protozoal (trypanosome) activity:
Santoro GF et al. Exp Parasitol. 2007;116:283
Clove oil more potent inhibitor of trypanosome growth
than basil or yarrow eo’s [Trypanosoma spp cause
Chagas disease and sleeping sickness]
 Synergy with antibiotics:
Betoni JE, et al. Mem Inst Oswaldo Cruz. 2006;101:387
 13 antibiotics ± 8 plant extracts including clove oil,
garlic, lemongrass, ginger and mint tested against
Staph aureus. Clove oil showed the greatest
synergism with antibiotics
 Development of understanding of
aetiology of IBS

1970s Low fibre diet

1980s (early) Food intolerance

1980s (late) Exclusion diets

1990 Not allergy

2000s Dysbiosis : large and small

intestine

after John Hunter

 Blastocystis spp
 “Blastocystis spp are parasites found
throughout the world. Little is known
about how they are transmitted to humans.
Some people who are infected have symptoms
and some do not. Treatment is available but is
not always effective.” (CDC)
 Sometimes called B. hominis, but actually comprises
several species which can infect humans, farm animals,
birds, rodents, reptiles, amphibians, fish, and even
cockroaches
 Infection with Blastocystis can produce the disease
Blastocystosis with symptoms of abdominal pain,
constipation, diarrhoea
 Blastocystis is notoriously difficult to eradicate:
treatments in combination and rotated may help
 Dientamoeba fragilis

A protozoal parasite found in the GI

tract of some people, which it
causes gastrointestinal upset in some
but not others
 Infection is can cause symptoms of
abdominal pain, diarrhoea, weight loss,
and fever
Hebe salicifolia (H. stricta) - Koromiko

 Renowned for its effectiveness in treating

diarrhoea
 Several of the growing tips are placed in the mouth,
chewed, the saliva swallowed and the leaves spat out
 Used in Christchurch hospital NZ during the
Spanish ‘flu epidemic
 New Zealand soldiers in the overseas 2nd World
War with dysentery sent home for Hebe leaves
which was said to be ‘very effective’
 Hebe: History of Use in NZ
 In 1895, it was listed in the UK Extra
Pharmacopoeia as an import from New Zealand,
“used there and in China, as a remedy for
chronic dysentery and diarrhoea” - it was deleted
from later editions
 Tincture 1: 5 - was kept in stock by the leading
druggists in the colony

Dose ½ to 1 drachm (≡ 2.5 – 5 ml)

The leaves were also chewed as a remedy for
diarrhoea
 An infusion or decoction was used for epidemic
infantile diarrhoea
 The plant was used by both settlers and Maori

http://www.herbdatanz.com/nz_botanic1.htm
 Hebe: constituents

 Hebe salicifolia
 hebeoside (2'-beta-xylopyranosyl-verbascoside)
 Hebe stricta
 Two phenylpropanoids derivatives have been isolated
from methanolic extracts
• forsythiaside, 3,4-dihydroxy-(3- phenethyl-0-a-L-
rhamnopyranosyl-(l->6)-4-0- caffeoyl-P-D-
glucopyranoside, and the uncommon
• 3-methyl-3-(6-O-caffeoyl-P-D-glucopyranosyloxy)-
pentan-5-olide
 Hebe salicifolia
 Actions:
 Astringent, antispasmodic, slows peristalsis
 Indications:
 GI tract: dysentery, "summer sickness", diarrhoea,
cholera, said to stimulate appetite and promote bile
flow
 External: as a poultice for skin diseases and ulcers, a
decoction for haemorrhoids, mouthwash, gargle,
bruises, varicose veins
 Pregnancy: infusion given to expectant mothers to
bring on an easy and rapid childbirth. Vaginal
application of leaves for heavy bleeding
 Other Uses: kidney and bladder problems
 Case: Px with metformin-induced IBS
Patient Follow-up Advice/ Outcome
details June 2006 Treatment
AW - Man Had IBS/ • ↑oily fish, dairy 14 Sept 2006
71 yrs ‘colitis’ • ↓alcohol Problem lessened but
BMI 28 induced by • ↓seeds oils not resolved
High CVD Metformin Rx1
risk factors 4-5 bowel Supplements: Agrimony + Mint tea
and type 2 movements a • multi vit/min 30 g as infusion/day
diabetes day, • Vit C, vit E Rx2
1st seen watery stool • Ca+Mg Slippery elm capsules
2004 • Omega-3 4, bid
Had various
Drugs tests and Herbal medicine 18 Sept 2006
Indapamide specialist ‘Diabetes control’ Desperate: unremitting
Ezetimibe appointments diarrhoea and mucosal
Cardiocor
Aspirin
but no answer Potentilla tr inflammation
Thyroxine 20 after each motion
Rosuvastatin 6-Weeks
Rasp leaf 30 g as WEED and FEED
infusion programme…….
WORKED!!!
 Weed and Feed Diet*
 Reducing starch, sugar and alcohol from
the diet diminishes the food source of the
pathogenic bacteria
 Increase the following foods:
 Meat, fish, beans, peas, nuts, vegetables,
salads, fruit
 Reduce the following starchy foods:
 Bread, potatoes, chips, rice, pasta, cereals,
cakes, biscuits

*Adapted from Kerry Bone’s modification of Hein Zeylstra’s protocol

 Weekend “WEED” days

Rx1 • Anti- microbial

• Uncaria (Cat’s claw)
• Tabebuia spp (Lapacho)
• Commiphora (Myrrh)
• Baptisia (Wild indigo)
• Berberis vulgaris (Barberry)
• aa / 10 ml bid
Rx2
• Garlic tablets - 2 bid
(pathogenic bacteria,
yeasts and protozoa)
• Garlic helps to restore
normal bowel flora by
inhibiting ‘pathogenic’
bacterial growth
 Weekdays “FEED” days

Rx1 • Slippery Elm contains mucilage

• Slippery elm (polysaccharides) which acts as
capsules 5 bid with a pre-biotic – supporting the
plenty of water growth of gut friendly organisms
such as pro-biotics
Rx2 • Grape Seed and Green Tea
• Vitanox tablets 2 inhibit the regrowth of
bid pathogenic bowel flora but do
not seem to inhibit healthy flora
Rx3 • Given to boost the strength of
• Grape seed extract the Vitanox tablets
(Colladeen) 1 bid
 Conclusion
 IBS can be caused by a wide range of micro-
organisms, which are difficult to characterise
 Herbs can stabilise the gut flora by inhibiting the
growth of:-
 Pathogenic/ commensal bacteria
 Yeasts
 Protozoa
 Not every herbal ‘regime’ will be successful in all
cases – this is why it is helpful to have several
alternatives