Indian Gooseberry (Emblica) for Pancreatitis?

Indian Gooseberry pancreatitis

Indian Gooseberry (photo courtesy of Wikipedia)

In the ongoing search for an effective therapy for pancreatitis — conventional or alternative — Indian Gooseberry (otherwise known as phyllantus emblica, or emblica officinalis) comes up fairly frequently as a suggested herbal remedy.

The University of Maryland Medical Center is one of the few medical sites that suggests specific non-traditional remedies for pancreatitis.  They recommend “Indian gooseberry (Emblica officinalis) powder, 3 – 6 grams daily in favorite beverage for antioxidant support. Emblica is a traditional Ayurvedic medicinal plant used to treat pancreatic disorders. It is a powerful antioxidant and one of the richest natural sources of vitamin C. Animal studies suggest that this herb can be used to prevent pancreatitis.”  (Source: Pancreatitis — University of Maryland Medical Center.)  Non-scientific sites like the Wellness Times and Mother Earth Living echo this advice.

I was able to find only two relevant studies, both on animals.  One study in India induced acute pancreatitis in rats, and then gave them the herb; control groups received either no treatment or vitamin C (thought to be the key active ingredient in Indian Gooseberry).  The study concluded that “E. officinalis treatment was found to be beneficial for treating acute pancreatitis. Serum levels of lipase and interleukin-10 were significantly lower than in the arginine group. Nucleic acid content, rate of DNA synthesis, pancreatic proteins, and pancreatic amylase content were significantly improved. Histopathological examination showed significantly lower total scores in the Emblica group.”  This was true compared with both the non-treatment group and vitamin C group.  (See the abstract of the study here.)

A much older study (1995), also out of India, tested the herbal remedy with dogs.  It found that “acinar cell damage was less and the total inflammatory score was significantly lower in the E.o. treated group” than the control group, concluding that more research was warranted.  (Abstract here.)

The human studies that have been done have not been specific to pancreatitis, but seemed to demonstrate positive outcomes in preventing cell death in the liver and reducing oxidative stress and inflammation in diabetes.   If accurate, these at least seem to support the potential benefit for pancreatitis.

As with other promising alternative remedies, it seems clear that rigorous research involving human subjects with pancreatitis would be extremely informative.  In the meantime, it is hard to evaluate whether it would be helpful, and to know what formulations or dosages would be best.  If I am able to turn up any additional results (scientifically or anecdotally), I will report back.

A Great TED Talk on How to Game Yourself Back to Health

In this TED talk, Jane McGonical tells how creating a simple game helped her cope with traumatic brain injury, and how you can use the science underlying such benefits to extend your life (or at least your life expectancy).  Well worth 20 minutes.

She also developed a web site called SuperBetter (and an accompanying iPhone app) that teaches people the “gamification” process she used to cope with her own condition.  She claims this will “increase your personal resilience.”  Listen to her talk and you’ll be inclined to believe her.

Now the chronic pancreatitis community needs to come up with our own game — use your superpowers to vanquish flare-ups forever.

Turmeric (Curcumin) for Pancreatitis?

There is not a lot of credible information about vitamins or supplements that might help pancreatitis.  Nonetheless, given the lack of an effective treatment for most of us, the search continues for remedies that can make a difference…hopefully without harmful side effects or risks.

curcumin

One natural remedy mentioned often is turmeric — a spice with the main active ingredient of curcumin.  Turmeric is in the ginger family and is primarily produced (and used) in India and Pakistan.  It is used often in ayurvedic medicine, a holistic practice in India that emphasizes plant-based treatments (using spices we know well, like cinnamon).   Dr. Andrew Weil recommends turmeric for pancreatitis — though only in passing, along with ginger and traditional Chinese medicine.  Turmeric also shows up on patient discussion boards, at times from people who say their doctors have recommended it.

Research in PubMed, a repository of medical journals hosted by NIH (and my resource of choice) suggests that turmeric (a) can have anti–inflammatory effects for some conditions and (b) is generally harmless in reasonable doses.  (See abstracts of Curcumin in Inflammatory Diseases, published in Biofactors, and Therapeutic Roles of Curcumin, from MD Anderson Cancer Center.)

Interestingly for pancreatitis sufferers, studies on mice and rats seem to suggest that the spice can prevent or reverse acute pancreatitis, at least in rodents.  One study from Shandong University in China (see Preventive Action of Curcumin in Experimental Acute Pancreatitis in Mouse [sic]) concluded that “curcumin significantly decreased the pancreas injury and reversed the elevation of [relevant enzymes] in mice with acute pancreatitis.”  Another study out of Korea (much of the herb-related research seems to emanate from Asia and India) concluded that curcuma longa “plays a protective role in the development of [acute pancreatitis] and pancreatitis-associated lung injury,” again in mice.

The only human study I was able to find, out of India, examined markers of oxidative stress and pain levels when patients were given curcumin.  They concluded that the markers showed improvement but pain did not decrease.  (See the abstract.)

If curcumin is indeed harmless (refresher:  I am not a doctor, I am not giving medical advice, and I have no idea whether it is harmless or not), then these studies certainly warrant additional exploration into whether turmeric can help with pancreatitis.  In the meantime, I would be very interested to hear if others have had turmeric or curcumin suggested or prescribed, and what the results were.

Cannabis Sativa Flowers

Medical Marijuana for Pancreatitis

Update September 2015

While there is still a troubling lack of scientific studies on the effectiveness of medical marijuana for CP, anecdotal feedback among the pancreatitis patient community suggests that some people have found it helpful in coping with pain, nauseau, or sleep problems, as well as lessening the stress and anxiety associated with chronic pain.  Others do not find such relief or simply do not like the psychotropic effects of marijuana.  Also anecdotally, pancreatitis specialists seem more open to patients experimenting with marijuana, likely figuring that the risks are much less than prescription opiates.

The National Cancer Institute recently issued a report on cannabis and cannabinoids meant for health professionals.  (Cannabinoids are the active ingredients in marijuana, which can be isolated and administered in pill, liquid or other forms.)  The ultimate conclusion was that “At present, there is insufficient evidence to recommend inhaling Cannabis as a treatment for cancer-related symptoms or cancer treatment–related side effects.”  However, the report did include some points relevant to our inquiry (largely from animal or small-scale human studies):

  • Cannabinoids may protect against certain tumors:  “Cannabinoids appear to kill tumor cells but do not affect their nontransformed counterparts and may even protect them from cell death.”
  • A mouse study suggested that cannabinoids may protect against inflammation in the colon.
  • Smoking marijuana may help with pain:  “Two randomized controlled trials of inhaled Cannabis in patients with peripheral neuropathy or neuropathic pain of various [causes] found that pain was reduced in patients who received inhaled Cannabis, compared with those who received placebo.”
  • There is conflicting evidence about whether marijuana helps with nausea and vomiting — one study showed no effect and the other helped 25% of patients.
  •  In very small studies (one had five people), “patients administered THC had improved mood, improved sense of well-being, and less anxiety,” as well as improved sleep.
  • Marijuana won’t kill you.  In sharp contrast to opiates often prescribed for pain, “lethal overdoses from Cannabis and cannabinoids do not occur.”
  • Some consider marijuana addictive, but “their addictive potential is considerably lower than that of other prescribed agents or substances of abuse.”

These findings certainly suggest that the medical profession should give marijuana very serious consideration for treating pancreatitis — especially since there is virtually no risk of overdose and a relatively low risk of addiction…much less than pain medications of choice like oxycodone.

With more states legalizing marijuana for medical or recreational use, and with bipartisan bills pending in Congress to decriminalize marijuana on the federal level, hopefully scientific studies are on the way.  Certainly CP patients living in medical marijuana states might want to address the issue with their doctor.  (You can find a table of state medical marijuana laws here.)

Below is the original article from 2013:

One of the biggest challenges with pancreatitis is pain management.  Those who suffer from chronic pancreatitis are often prescribed strong pain medications such as hydrocodone and oxycodone.  Prescription painkillers are highly addictive and are responsible for over 15,000 deaths a year, amounting to a “public health epidemic” according to the Centers for Disease Control.  Concerns about overuse of painkillers are mounting, and the FDA and states are considering restrictions on their availability.   (CNN:  FDA Advisory Panel Votes to Tighten Restrictions on Hydrocodone)

Cannabis Sativa Flowers

Cannabis Sativa Flowers (source: Wikipedia)

Medical marijuana is obviously gaining in acceptability and availability around the U.S. While some disagree over the long-term health effects, by any measure marijuana is much less dangerous than prescription painkillers.  Recently, there have also been reports that cannabinoids (the principal active ingredients in marijuana) can not only help with pain management, but may be able to help with other symptoms (such as spasticity with multiple sclerosis) or even have the potential to stop tumor progression in certain cancers. (See an article by Dr. Sanjay Gupta supporting use of medical marijuana — “Why I Changed My Mind on Weed.”)

Whether medical marijuana can help people with pancreatitis is therefore of serious interest.  Unfortunately, few studies have been done and it is difficult to find a strong (informed) opinion either for or against.

There are, however, some studies that bear on the subject.  First, it seems that excessive marijuana use can cause acute pancreatitis.  Reports are rare but doctors seem confident in the cause.  

Second, there are some studies (mostly with mice) suggesting that certain cannabinoids can reduce inflammation in the pancreas:

Perhaps most relevant to those of us with chronic pancreatitis, a 2008 German study of isolated cells of patients with chronic pancreatitis found that introduction of cannabinoids can reduce inflammation and prevent fibrosis, or scarring According to the authors, the results suggested that “(re-)activation of the (endo-) cannabinoid system in chronic pancreatitis may be beneficial for suppressing disease progress” (parentheses are theirs).    Find it here:  Cannabinoids reduce markers of inflammation and fibrosis in pancreatic stellate cells

And just to confuse matters, one study found that cannabinoids make acute pancreatitis worse in the early stage and can help at later stages:  Dual, time-dependent deleterious and protective effect of anandamide on the course of cerulein-induced acute pancreatitis.

Clearly more research is needed.  If there is a better route than reliance on addictive, potentially deadly prescription painkillers, pancreatitis patients need to know it.

At least one politician endorses medical marijuana for pancreatitis…as an alibi:  Former House Minority Leader says marijuana is recognized as a treatment for his pancreas pain.

Update August 2013:

A report by the Controlled Substances and Tobacco Directorate at Health Canada found that studies on cannabinoids’ effect on pancreatitis were conflicting:

There are only a handful of reports on the effects of cannabinoids in experimental animal models of acute or chronic pancreatitis, and the findings from these reports are conflicting. Thus, the use of cannabinoids in the treatment of acute or chronic pancreatitis remains unclear.

The report concluded that “These contradictory findings may be due to differences in experimental methods, differences in timing of drug administration, differences in the types of agonists and antagonists that were used, differences in the route of administration, and differences in animal species.”

Time for a rigorous, controlled human study in a state where medical marijuana is legal (California?).