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Chios Mastiha: Prized by the Greeks Since Antiquity, and We Now Know Why

Research suggests Chios mastic gum may be a solution for difficult-to-treat gastrointestinal disease and metabolic syndrome

In the U.S., all too often, major players in the botanical world that are native to other countries and regions are easily overlooked. Not surprisingly, we tend to learn the most about botanicals that are right in front of our eyes: Oregon grape, dandelion, and American ginseng are well known among American herbalists, in part due to their prevalence on the landscape in which we live. Ashwagandha, an herb commonly used in Ayurvedic medicine, has been making a splash as we deal with the life stressors of 2020 and beyond,[1] but yet, there is a plethora of botanicals many of us do not know.

If one steps off a plane in Greece, they can’t ignore the influence that Chios mastic gum, the resinous exudate from the plant Pistacia lentiscus var. Chia, has on the culture. Liqueur made from mastic is commonly consumed as a digestive, second only to ouzo, and is found on every menu. But many in Greece know this plant beyond its use in the culinary and beverage industry: it is widely chewed as a gum for its oral health benefits,[2],[3] used topically for its anti-dermophyte activity and skin healing effects,[4],[5] and taken in capsule form for its digestive and metabolic effects.[6],[7]

In 2019, much recognition was given to Chios mastiha internationally, with publications like National Geographic,[8] The New York Times,[9] and CNN[10] highlighting the culture surrounding its traditional farming and some of the medicinal uses of the plant. In the last five to 10 years, substantial research has shown Chios mastic gum (CMG) may be of benefit for numerous gastrointestinal disorders as well as metabolic health. After reviewing the data, you just might want to give CMG a try as well.

Gastrointestinal healing and anti-H. pylori effects

First mentioned as a digestive by Hippocrates in the 5th century BCE, this use of Chios mastiha has carried through the ages. Although many find this benefit from consuming the liqueur as a digestif, CMG is used by medical practitioners and well supported by research showing that, indeed, it is effective in resolving digestive discomfort as well as damage of the gut lining.

Research as early as 1984 validated these historical observations, with a randomized, double-blind placebo-controlled trial (RDBPCT) showing that consumption of 1 g of CMG daily with breakfast for two weeks relieved digestive symptoms in 80% of individuals with a duodenal ulcer, compared to improvement in only 50% of those taking a placebo.[11] Not only were symptoms improved, it was also shown via endoscopy that the duodenal ulcers were healed in 70% of those taking CMG, while they only were resolved in 22% of the placebo group.

CMG has been shown to be an effective treatment for Helicobacter pylori, including antibiotic-resistant strains.

Hinted at by the improvement of duodenal ulcers in the 1984 study, CMG has been shown to be an effective treatment for Helicobacter pylori, including antibiotic-resistant strains.[12],[13] A multi-arm human study in 2010 showed that treatment with 350 or 1050 mg of CMG three times daily eradicated H. pylori in 30.8% and 38.5% of patients, respectively, compared to resolution of the infection in 76.92% of patients treated with the standard “triple therapy” (a combination of antibiotics with stomach acid-reducing medication).[14] Unpublished data, provided by the Chios Mastiha Growers Association (personal communication with Dr. Ilias Smyrnioudis, Director of Research and Development, October 25, 2019), found that treatment with 1 g of CMG daily for two weeks prior to the standard triple therapy improved elimination of H. pylori to 90% – even higher than the 80% eradication rate typically seen in regions where there isn’t antibiotic resistance.[15]

In 2009, CMG also was shown to improve symptoms in individuals diagnosed with functional dyspepsia. In this RDBPCT, treatment with 350 mg of CMG thrice daily significantly improved symptoms in 77% of the cases while only 40% of the placebo group experienced improvements.[6] Symptoms of heartburn, general and anxiety-related stomach pain, and dull ache in the upper abdomen were significantly improved with CMG treatment.

Also noteworthy is the improvements that multiple studies have shown in inflammatory bowel disease (IBD). Collectively, data from human and animal studies suggest that treatment with CMG improves may improve IBD symptomatically, biochemically, and histologically.[16],[17],[18]

In individuals with mild to moderate Crohn’s disease, supplementation with 2.2 g of Chios mastic gum daily was associated with significant improvements in the Crohn’s disease activity index, C-reactive protein, and interleukin-6.

In a small pilot study of humans with mild to moderate Crohn’s disease,[16] supplementation with 2.2 g of CMG daily for four weeks was associated with significant improvements in the Crohn’s disease activity index, C-reactive protein (CRP), and interleukin (IL)-6 compared with baseline. Noteworthy were the improvements in stool consistency and general well-being. In a follow-on RDBPCT of 60 patients with IBD, supplementation with 2.8 g of CMG daily for three months significantly improved Inflammatory Bowel Disease Questionnaire scores compared to baseline.[18] Fecal lactoferrin and calprotectin, two established markers of inflammation in IBD patients,[19] significantly worsened in the placebo group during the course of the study, while they did not in the CMG group.

To what can these gastrointestinal healing effects be attributed? Interestingly, in vitro and animal investigations showed that treatment with whole CMG was more effective than its isolated fractions in resolving experimental colitis[20] – pointing towards a synergistic effect of its component fractions. CMG also has been shown in multiple animal models to help protect the gastrointestinal barrier from damage associated with non-steroidal anti-inflammatory drug intake,[21],[22] however benefits were not seen when it was delivered intraperitoneally – suggesting protective effects occur due to local action on the gut epithelium.[23]

CMG also has been shown in multiple animal models to help protect the gastrointestinal barrier from damage associated with non-steroidal anti-inflammatory drug intake.

One of the possible fractions of CMG that may be responsible for these healing effects is the natural polymer found in it, poly-β-myrcene.[24] Not only does this polymer have cytoprotective properties, it also is responsible for some of the anti-H. pylori activity of CMG – which may in part even be enhanced by mastication of the gum.[25],[26] Many triterpenic acids found in CMG also have strong antimicrobial effects.[27],[28] The arabinogalactan compounds found in CMG additionally impede the growth of H. pylori[29] and inhibit neutrophil activation,[30],[31] a key factor in the pathogenesis of the gastritis associated with this infection.

Metabolic syndrome benefits

Clinical research has also shown CMG may improve multiple facets of metabolic syndrome including insulin resistance,[32] hypercholesterolemia,[33] and hypertension.[34] Spurred in part by demonstration of CMG’s antioxidant effect in the setting of food preservation,[35] researchers undertook additional studies to investigate the impact of CMG on these increasingly common 21st century problems.

Multiple clinical studies have shown that consumption of CMG improves metabolic dysregulation, even at the low dose of 330 mg thrice daily.[7] Specifically, at this dose, after eight weeks, consumption of CMG significantly reduced total cholesterol and fasting glucose, with an even greater effect in individuals having a BMI of 25 kg/m2 or greater. Interestingly, in this study it was shown again that CMG without the polymer fraction was not effective.

Clinical studies have shown that consumption of Chios mastic gum improves multiple facets of metabolic syndrome, including blood pressure, cholesterol balance, and fasting blood glucose.

Higher doses of 5 g of whole CMG, taken daily, have been observed in additional studies to reduce serum triglycerides, insulin, low density lipoprotein (LDL) cholesterol, liver enzymes, and multiple cardiovascular risk markers (lipoprotein[a] and apoprotein B) after consumption for six to 18 months.[33],[34] Animal models also suggest CMG may have hepatoprotective and metabolic balancing effects.[36],[37],[38] Finally, CMG has been shown in vitro and in healthy humans to inhibit LDL oxidation as well.[39],[40]

One additional facet of metabolic syndrome that CMG may improve is hypertension. In both animal and human studies, CMG was shown to reduce systolic and diastolic blood pressure acutely.[34],[41] In the hypertensive animals, consumption of CMG for two weeks also decreased levels of CRP and IL-6 and prevented histological and mechanical changes of the aorta and small myocardial vessels, reducing the damaging, end-organ effects of hypertension.

Again, there are multiple mechanisms via which CMG may exert these metabolic effects. In hypertension, these effects may be mediated by reduced renin secretion by the kidneys,[41] while many of the additional metabolic effects may be due to interactions of fractions of CMG with peroxisome proliferator-activated receptor (PPAR),[42] a nuclear receptor that plays a role in metabolic and other diseases. Oleanonic acid as well as other components of CMG act as PPAR-γ agonists,[43] a mechanism via which many anti-diabetic medications also improve blood sugar, hyperlipidemia, and additional metabolic complications.[44],[45]

 

In regions about the Mediterranean, near the island of Chios where Pistacia lentiscus var. Chia flourishes, infection with H. pylori is common (with more than 80% of adults in Egypt and Turkey testing positive for this bacteria),[46],[47]  while H. pylori antibiotic resistance continues to increase, providing great incentive for continued research on the effectivity of CMG in this setting. The treatment of metabolic syndrome and non-alcoholic fatty liver disease with CMG also is the subject of an ongoing larger, multi-center study.[48] Clearly, we are just at the beginning of understanding, clinically, the many medicinal benefits of this amazing plant that the Greeks have known for so many years.

Click here to see References
The Tradition of Chios Mastiha
The Multivitamin Debate

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