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question about slippery elm

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Ulcerative Colitis
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Posted 9/30/2018 3:54 PM (GMT -5)
Hi all, I'm actually using slippery elm for a terrible case of acid reflux (ongoing since start of 2018). I had tried it without success but recently discovered that at a higher dosage it can actually work quite well.

Of course as a UC sufferer I always make sure any new thing I am taking isn't contraindicated for UC. So I was delighted to discover many, including on this very forum, find slippery elm actually HELPFUL for UC.

So here's the thing-- I am not sure I am one of those people. After a few days of this higher dose (which actually isn't all that high-- 4 400-mg capsules twice a day, which in grams is the same amount in 2 teaspoons-- people seem to have taken way more than that), I started having skinny little BMs and low back warmth-- things I associate with an unhappy colon. My BMs have actually been probably the best they've ever been since diagnosis (2005) for awhile now, so I really don't want to rock the boat. But why would slippery elm cause this?

One question I do have is: Doesn't it work by increasing mucus production? And I can see why that would be protective, both for GERD and UC, but isn't increased mucus also a problem sign for UC? My only other thought was that it was a high fiber food, like psyllium husk, and so I had simply increased the dose too quickly; as with all high fiber things, perhaps it just needs to be added slowly? Anyway, any experience anyone has with this supplement and UC would be great to know! Thanks...
Posted 9/30/2018 4:01 PM (GMT -5)
As I understand it, Slippery Elm acts as a physical barrier to coat the ulcers, in the same way that you'd apply gel to a mouth ulcer to aid healing. I'm not aware of Slippery Elm increasing mucus production.
Posted 9/30/2018 4:58 PM (GMT -5)
Yes, most descriptions of slippery elm's properties mention this about it (that it increases mucus). WebMD for example. I have even seen it said that one might not want to take it if one already has nasal congestion.
Posted 10/1/2018 9:03 AM (GMT -5)
Since most of the action of mesalamine (and some steroid formulations like Uceris) is topical, a question is whether the coating acts as a barrier. IF the medication is soluble in the slippery elm, then it gets into the coating and the topical action may be enhanced. But if the med is not soluble, then it acts as a barrier reducing the effectiveness of the med.

Also, much of the immune system's symbiotic interaction with commensal bacteria takes place in the mucous layer. IF the slippery elm does not alter the mucous layer (other than thickening) then it would not be an immune modulator. But, if some helpful bacteria do not do as well in a mucus layer partly composed of slippery elm, then it could change the autoimmune response for better or worse. this area is very understudied.

as for increasing mucus. This has been debated, and I cannot easily find any proof in the medical literature. Hersey medical center website mentions slippery-elm may effect "reflux stimulation of nerve endings in the gastrointestinal tract leading to increased mucus secretion" -- BUT, the only citation is to a University of Maryland herb webpage that no longer exists. Search of Web of Science does not provide any study about slippery-elm and "reflux stimulation". The only articles are about potential antioxidant effects. This may be a myth.

Post Edited (DBwithUC) : 10/1/2018 11:01:30 AM (GMT-6)

Posted 10/1/2018 9:23 AM (GMT -5)
Thank you, this is very helpful. I have to say that the S.E. really does seem to have a negative effect on my bowels, which is a shame given it is so helpful for my esophagus. But as to whether this is because it is interacting with the mesalamine (I do take Asacol), I am curious: I had thought that if you took them 1-2 hrs. apart, this wouldn't be an issue. But it sounds like you are saying it might be anyway (which makes sense, since presumably the barrier created is not itself of such short duration)?

Since you seem to be so well informed, might I ask you whether marshmallow root has the same issues? Since its mechanism appears similar, I would imagine so?
Posted 10/1/2018 12:06 PM (GMT -5)
it could be that taking the SE and mesalamine several hours apart resolves any conflict. it is not well studied. a key question is how long the effect of SE lasts.

I have looked for more info on SE than marshmallow root because I tried SE in the 1st years of my diagnosis. I read it is both anti-inflammatory and a protective coating, so it sounds promising - but I just don't know enough to say.
Posted 10/4/2018 9:47 PM (GMT -5)
Slippery elm is one of a handful of demulcent substances that likely won't receive proper study due to lack of profit and similarity to other herbs. You can however get a pretty good grasp by studying mucilage which is present in SE, marshmellow root and others. It seems to provide direct coating and a minor prebiotic effect but is short lived. I lean toward clove oil for mucus protection due to the sustainability,bacterial involvement and solid studies.
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