Fordigestive healthThe role of nutrients, herbs, probiotics and enzymes in supporting the gastrointestinal system

Digestiv

e Health

F O R P RO F E S S I O N A L U S E O N LY

Glutathione Glutamine

Associated conditions Gastroesophageal reflux disease (GERD), nonerosive reflux disease (NERD), hiatus hernia, Barrett’s oesophagus.2

Oesophagus

Transports food from the mouth to the stomach and prevents reflux of gastric contents.1

Aid in the digestion of foods to prevent oesophageal reflux.

Aggravating factors Stress, food intolerances, inflammatory diet, spicy foods, fatty foods, caffeinated and carbonated drinks, alcohol, smoking.

Protect and facilitate the healing of damaged or inflamed oesophageal mucosa.

Zingiber officinale root

Taraxacum officinale root

Amylase

Protease Lipase Tilactase

Cellulase Bromelain

Treatment considerations

Associated conditions Achlorhydria, peptic and gastric ulcers, Helicobacter pylori (H. pylori) infection, gastritis.4, 5

Aggravating factorsBacterial infections, medications, smoking, alcohol.

Treatment considerations Support digestive function and promote migrating motor complex (MMC).

Protect and facilitate the healing of damaged, ulcerated or inflamed gastric mucosa.

Support microbial diversity to reduce symptoms of bloating and flatulence and promote neuroenteric modulation.

If H. pylori is present, consider broad spectrum antimicrobial support.

Associated conditions SIBO, coeliac disease, Crohn's disease, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), ulcers (peptic ulcer).

Aggravating factors Allergies, poor diet, inflammation, intestinal pathogens.

Treatment considerations If SIBO is present, consider antimicrobial support.

Provide a nutrient source for short chain fatty acid production (SCFA) production.

Reduce inflammation and promote healing of the GIT.

Balance microbiota to reduce symptoms of abdominal pain and bloating. 6-8, 17

Associated conditions IBS, diverticulitis, diverticulosis, colitis, IBD. 19

Aggravating factorsAntibiotics, stress, alcohol, low intake of fibre, dehydration.

Treatment considerations Reduce inflammation and promote healing of the GIT.

Modulate intestinal flora and increase levels of short chain fatty acid production (SCFA).

Support microbial diversity, reduce GIT symptoms and support neuroenteric modulation.

Detoxifies hormones and medications to reduce the risk of reabsorption of potentially toxic metabolites, and produces bile.13

Contains a complex microbiota consisting of hundreds of different bacterial species.18 Regulates the absorption of nutrients and water, minimises the absorption of toxins and transports a formed stool to the descending colon.19

Large IntestineSmall Intestine

Comprised of finger-like projections (villi) that contain absorptive cells and is therefore the primary site of digestion and absorption of nutrients, water, and ions. It consists of the duodenum, jejunum and ileum. 1

Stores bile produced from the liver; releases bile (when necessary) into the small intestine to assist with intestinal emulsification and absorption of fats from food. 11

Gall Bladder Associated conditionsGallstones.12

Aggravating factors Obesity, alcohol, poor diet including excessive consumption of fatty and fried foods.

Treatment considerations

Liver

The Gut Microbiome plays a key role in overall health, most notably digestion and immunity. It helps to reduce the chance of infection by enteric pathogens by competing for adhesion sites12, produces a variety of nutrients including SCFA, B vitamins, and vitamin K13, and can influence human metabolism through several cellular factors due to their effect on epithelial cell and subepithelial cell receptors.14

Associated conditions Non-alcoholic fatty liver disease, hepatitis (A, B, C, alcoholic).13-15

Aggravating factors Alcohol, high consumption of trans fats, poor dietary choices.

Treatment considerations

L. helveticus (R0052)

L. rhamnosus (R0011)

Broccoli sprouts Silybum marianum fruit

Glutathione

Choline Cysteine Glycine

GlutamineMethionine Taurine

Activated B-vitamins

Broccoli sprouts

Glutathione

Choline Cysteine Glycine

Glutamine

Methionine

Taurine

Activated B-vitamins

GlutamineZinc

DGL Licorice (GutGard®)

Aloe vera

Taraxacum officinale rootBroccoli sprouts Silybum marianum fruit

Choline Cysteine Glycine

Methionine Taurine Activated B-vitamins

Gut Pathogens such as Blastocystis hominis, Klebsiella pneumoniae, Escherichia coli (E. coli) can be transmitted through a variety of routes including contaminated food or water, the faecal oral route, and person-to-person. They compete with beneficial microflora for nutrients, interfere with nutrient absorption, and can negatively impact a healthy microbiome.9

Optimise liver function and the healthy production of bile.

Provide cholagogue support to assist with the timely release of bile.

Thyme oil Clove bud oil Allium sativum bulb

Phellodendron amurense stem bark Nigella sativa seed

Apple Pectin Arabinogalactan-larix (ResistAid™)

DGL Licorice (GutGard®) Aloe vera Vitamin A Vitamin D

GlutamineZinc S. boulardii

B. lactis (B94) B. infantis L. plantarum L. acidophilus

Amylase Protease

Lipase Tilactase Cellulase Bromelain

Curcuma longa rhizome DGL Licorice (GutGard®) Aloe vera

Glutamine Zinc

L. acidophilus B. lactis (B94) B.infantis 6-8

Thyme oil Clove bud oil Allium sativum bulb

Nigella sativa seed

Phellodendron amurense stem bark

Treatment considerations

Amylase

Provide enzymatic support to reduce the stress on the pancreas.

Reduce inflammatory cytokines to support the health of the pancreas.

Curcuma longa rhizome

Bromelain

Associated conditionsPancreatitis , Type 1 and 2 Diabetes, exocrine pancreatic insufficiency. 10

Aggravating factors Excessive alcohol intake, biliary obstruction, inflammatory cytokines.

Produces and secretes digestive enzymes (protease, lipase and amylase), ions and water into the intestines necessary for the breakdown and absorption of nutrients from food.9

Pancreas

Mucosal Layer is the innermost layer of the GIT and is made up of epithelial cells and goblet cells that line the stomach and intestinal walls. The mucosal layer is the first line of defence against bacteria.1, 2

DGL Licorice (GutGard®) Aloe vera Glutamine Zinc Vitamin A Vitamin D

S. boulardii Apple Pectin Arabinogalactan-larix (ResistAid™)

B. lactis (B94) B. infantis L. plantarum L. acidophilus 6-8, 17

Aids in the breakdown and digestion of food through muscle contraction and the secretion of hydrochloric acid, digestive enzymes and peptide hormones. It also provides a non-immunological defence against invading pathogens.3

Stomach

Modulate inflammation and pathogenesis in alcoholic liver disease. 16

Provide substrates required to promote phase 1 and phase 2 detoxification pathways such as methylation and glutathionation.

Optimise liver function and the healthy production of bile.

Silybum marianum fruit

Zingiber officinale root Taraxacum officinale root

Silybum marianum fruit

DGL Licorice (GutGard®)

Lipase Protease

Zingiber officinale rhizome

INGREDIENT DRUG CLASS POTENTIAL INTERACTION RECOMMENDATION

Allium sativum Anticoagulants May have additional anticoagulant effects. Monitor for increased bruising or bleeding at doses >2g/day. 20

BromelainAntibiotics (eg. Amoxicillin, Tetracycline antibiotic)

May increase levels of drug. Caution.

Broccoli sprout extract

Drugs metabolised by CYP1A2 liver enzyme

In vivo studies suggest Broccoli sprout extract may increase metabolism and reduce levels of drugs metabolised by CYP1A2. 22 Monitor.

Clove Oil Anticoagulants May have additional anticoagulant effects. Monitor INR closely, monitor for changes in bruising and bleeding. 23

Curcuma longa

AnticoagulantsCaution is advised when combining high-dose turmeric due to potential of anticoagulant effect. Monitor INR closely, monitor for changes in bruising and bleeding. 20

Immunosuppressants

(eg. Sulfasalazine)

In a human study, curcumin increases the absorption of sulfasalazine via inhibition of efflux transporter BCRP, leading to serum drug levels 3 times higher than normal- increased risk of toxicity. Avoid. 21

Nigella sativa

Ovulation Stimulants Contraindicated due to anti-fertility effects of herb. 20

Immunosuppressants

May counteract immunosuppressive effects of drug, though immunomodulatory effects have not been observed in humans. Close monitoring is required. Not recommended in organ and bone marrow transplant recipients, leukaemia, lymphoma and myeloma.20

Pectin All medication Pectin fibre might slow or reduce the absorption of some oral drugs. Separate doses by at least 2 hours. 26

Phellodendron amurense

Proton Pump Inhibitors (PPIs)

Bitter effect of herb may increase stomach acid production and reduce drug effect. Caution if drug is being used to treat gastric ulcers, severe gastritis or Barrett’s Oesophagitis. 20

Immunosuppressant

(eg. Cyclosporine)Berberine significantly increases serum levels of cyclosporine in humans, possibly via P-glycoprotein alterations. Increased risk of adverse effects and toxicity. Avoid. 24

Vitamin A

Immunosuppressants & Selective Estrogen Receptor Modulators (SERMS)

Theoretical risk of interaction between high dose vitamin A and other potentially hepatotoxic drugs leading to increased risk of liver disease.20 Monitor.

Vitamin B9 (Folate) Proton Pump Inhibitors (PPIs) May reduce folic acid absorption. Separate doses by 2-3 hours. 25

Vitamin B12 Proton Pump Inhibitors (PPIs)

PPIs suppress gastric acid which may lead to decreased vitamin B12 status. 25

Zingiber officinale AnticoagulantsCaution at doses ≥ 4g/day dried ginger due to additional antiplatelet effects. Doses <2g may be considered with close monitoring. 20

Drug-herb-nutrient interactions guide

The above is a guide only, please contact Integria Technical Support on 1300 654 336 if you would like more information on drug-herb-nutrient interactions.

Beneficial Caution Avoid

A note on DGL Licorice (GutGard®): The main active constituent of licorice (glycyrrhizic acid) is known to be responsible for many drug

interactions. As DGL Licorice (GutGard®) does not contain glycyrrhizic acid, these interactions may not apply. Please contact Integria Technical Support for

more information.

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