Botanicals: Choleretic Herbs

Herbal medicine has been used to treat gallbladder disease and is a good option for patients with small stones and mildsymptoms. Choleretic herbs can stimulate bile production,flow, and solubility.14’39 Their effects can be enhanced bycombining them with terpenes (e. g., peppermint oil, discussed later) that can help with gallstone dissolution.

Milk Thistle (Silybum marianum)

The following list of choloretic herbs may be used individually, or an herbologist may mix a combination together in a tea. They can be combined with peppermint oil for synergistic effect.

¦ Dosage

Standardized 70% silymarin extract, starting at 150 mg twice daily and increasing to three times daily if needed

¦ Precautions

Milk thistle may have a laxative effect. It should be used with caution in patients allergic to plants in the Asteraceae/Compositae family (ragweed, daisies, marigolds).

Dandelion (Taraxacum officinalis)

The following list of choloretic herbs may be used individually, or an herbologist may mix a combination together in a tea. They can be combined with peppermint oil for synergistic effect.

¦ Dosage

Give 4 to 10 g of dried leaf or 2 to 8 g of dried root, three times/day. Tea is made by steeping the same amount in150 mL of boiling water for 10 to 15 minutes and thenstraining. One cup of tea should be consumed three times/day. The most convenient dosing is a 1:5 tincture, 5 to10 mL three times/day.

¦ Precautions

Dandelion can cause gastric hyperacidity. If used topically, it may cause contact dermatitis. Patients who are allergicto plants in Asteraceae/Compositae family (ragweed, daisies, marigolds) should be cautious. Dandelion also can havehypoglycemic effects.

Globe Artichoke (Cynara scolymus)

¦ Dosage

The dose is 1 to 4 g of the leaf, stem, or root three times/day. Do not confuse this plant with Jerusalem artichoke.

¦ Precautions

If used topically, may cause contact dermatitis. Again, caution in those allergic to Asteraceae/Compositae family (ragweed, daisies, marigold).

Turmeric (Curcuma longa)

An animal study demonstrated that mice fed a lithogenic diet had the incidence of gallstones reduced by 73% whenthese animals were supplemented with curcumin. Curcuminalso reduces biliary cholesterol concentration.40

¦ Dosage

The dose is 450 mg of curcumin capsule standardized extract or 3 g turmeric root daily in divided doses.

¦ Precautions

Turmeric has blood thinning effects, so patients should be careful if they are taking other blood thinning medications. Turmeric should be used with caution in patientsallergic to yellow food colorings or plants belonging to theZingiberaceae (ginger) family.

Botanicals: Gallstone-Dissolving Herbs

Monoterpenes are a class of hydrocarbon molecules found in the essential oils of many plants. These compoundshave choleretic properties and inhibit formation of cholesterol crystals.16 A combination of monoterpenes, mainlyconsisting of menthol and pinene, is effective for stone dis-solution.41 A double-blind study concluded that the additionof menthol to ursodeoxycholic acid (UDCA) improved outcomes compared with UDCA alone, and that menthol wasequally effective as the monoterpene combination.42

Peppermint Oil (Mentha Piperita)

¦ Dosage

One or two enteric-coated capsules (0.2 mL/capsule) three times/day between meals

¦ Precautions

Peppermint oil relaxes the lower esophageal sphincter, and this may lead to reflux or heartburn. (Enteric-coated capsules are used to avoid this effect.) It may also cause allergicreactions, flushing, and headache.

Pharmaceuticals

Treatment with bile acids can be used for gallstone dissolution. These acids work by inhibiting biliary secretion of cholesterol and increasing bile secretion from the liver. They may also improve gallbladder motility. They are most effective when used in patients with small stones, mild symptoms,and good gallbladder function. Patients with calcified or pigment stones are usually poor candidates for bile acid therapy.Incomplete dissolution and stone recurrence are both significant drawbacks to the therapy.

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