Open Source Apothecary At Home / Digestion

Indigestion without an ulcer (functional dyspepsia)

A German combination of nine herbs has the largest trial base of any herbal preparation in this handbook.

remedy

Functional dyspepsia is pain or discomfort in the upper abdomen with no ulcer, no reflux explaining it, and no other structural cause. It is common, it is genuinely unpleasant, and it is one of the rare conditions where a herbal preparation has a substantial trial literature.

STW 5 (Iberogast) is a fixed combination of nine plant extracts — bitter candytuft, chamomile, milk thistle, celandine, liquorice, lemon balm, angelica, caraway and peppermint. It has been tested in multiple randomised trials and pooled analyses, and the trials are of better quality than the norm in this field because the product is standardised and commercially funded. That funding is a genuine caveat about the literature, not about the trials' internal validity: these are double-blind randomised trials with a defined extract, which is more than can be said for most of what is sold as a digestive aid.

Peppermint and caraway together have their own trials in dyspepsia and in functional gastrointestinal disorders generally, and caraway is the aromatic that gives the traditional after-dinner preparation its character. Carvone, its principal monoterpene, has antispasmodic activity.

Bitters are a different mechanism and worth knowing. Artichoke leaf and other bitter plants work by stimulating bitter taste receptors in the mouth and gut, which triggers digestive secretion. That is why a bitter preparation is taken before a meal and why tasting it is the point — a bitter in a capsule with no taste is missing the mechanism.

The limits. Dyspepsia is a symptom, and the most common dangerous cause is an ulcer or gastric cancer. New dyspepsia over the age of 55, or with weight loss, vomiting, difficulty swallowing, or anaemia, is not a case for a tea. H. pylori testing and treatment is the standard first step and a herbal preparation is not a substitute for it.

What the studies found

Preparation

Caraway and fennel tea (the household version)

• 1-2 g crushed caraway or fennel seed to 250 mL water, just off the boil
• Cover and steep 5-10 minutes; crush the seed first to release the oil
• After meals, up to 3 cups a day

Peppermint and caraway

• Equal parts dried peppermint leaf and crushed caraway seed
• 1-2 g of the blend per 250 mL, covered, 5-10 minutes

Artichoke leaf as a bitter

• 1-2 g dried artichoke leaf (or a standardised extract per the product's label)
• Take 15-30 minutes before a meal as a tea, so the bitter taste reaches the receptors
• Do not take it if you have gallstones or a bile duct obstruction

STW 5

• A licensed combination product; use as labelled, usually 20 drops or one tablet three times daily before meals
• Do not attempt to make an equivalent at home. The trials are on a standardised product, and a home blend is a different preparation with no trial behind it.

Cautions and interactions

• Liquorice is one of the nine components of STW 5. Anyone with hypertension, heart failure or on a diuretic should check the formulation and their blood pressure.
• Artichoke leaf can worsen gallstone or bile duct pain. Avoid in obstruction.
• Bitters and reflux: stimulating acid secretion is unhelpful if you have reflux disease.

When this is not a self-care problem — get help

• New indigestion over 55, difficulty swallowing, vomiting blood, black stool, weight loss, or persistent vomiting — endoscopy, not a tea.
• Sudden severe upper abdominal pain radiating to the back — emergency care.

Related

• Peppermint oil and peppermint tea for IBS and indigestion
• Reflux and heartburn
• Stomach ulcers and Helicobacter pylori
• Nausea and vomiting, including morning sickness

Sources

1. Menthacarin, a Proprietary Peppermint Oil and Caraway Oil Combination, Improves Multiple Complaints in Patients with Functional Gastrointestinal Disorders: A Systematic Review and Meta-Analysis. Digestive diseases (Basel, Switzerland) 2023; doi:10.1159/000528553 PubMed 36502789
2. Non-Chinese herbal medicines for functional dyspepsia. The Cochrane database of systematic reviews 2023; doi:10.1038/ajg.2016.499 PubMed 37323050
3. Effectiveness of Menthacarin on symptoms of irritable bowel syndrome. Wiener medizinische Wochenschrift (1946) 2019; doi:10.1111/j.1365-2125.1984.tb02519.x PubMed 29728848
4. A randomized placebo-controlled trial on the effects of Menthacarin, a proprietary peppermint- and caraway-oil-preparation, on symptoms and quality of life in patients with functional dyspepsia. Neurogastroenterology and motility 2017; doi:10.1111/nmo.13132 PubMed 28695660
5. The effect of ginger (Zingiber officinalis) and artichoke (Cynara cardunculus) extract supplementation on gastric motility: a pilot randomized study in healthy volunteers. European review for medical and pharmacological sciences 2016; PubMed 26813467