Botanicals in the Treatment of Crohn's Disease

Curcumin

TNF-alpha elevation is part of the inflammatory process involved in the pathogenesis of Crohn's Disease. Curcumin, a flavonoid from Curcuma longa (turmeric) is a known inhibitor of TNF-alpha. An in vitro study found TNF-alpha increased intestinal permeability and curcumin inhibited the NFkappaB- induced-TNF-alpha-stimulated increase in intestinal permeability.¹⁰⁹

An interesting text-mining experiment, a Medline search that uses a specific algorithm to make discoveries, was used to determine medical uses for Curcuma longa. The goal was to determine possible connections between substances and conditions warranting research, rather than to locate research already conducted. For instance, curcumin’s influence on TNF-alpha might be connected to the increased TNF-alpha associated with Crohn's Disease, providing possible mechanisms for its usefulness in that disease. Analysis of the "mining expedition" resulted in the suggestion of evidence for the beneficial role of curcumin in Crohn’s disease, as well as spinal cord and retinal diseases. Curcumin inhibits several of the cytokines and genes involved in the pathogenesis of Crohn's Disease.²⁵⁴ Clearly, clinical trials are necessary to confirm curcumin’s benefit in Crohn's Disease.

Boswellia serrata

Boswellia serrata is a botanical with significant anti-inflammatory activity. In vitro, this botanical inhibits the 5-lipoxygenase product LTB4, which has been implicated in Crohn's Disease.²⁵⁵ A randomized, double-blind, clinical trial examined the effect of a Boswellia extract (n=44) or mesalamine (n=39) in 102 Crohn's Disease patients. The primary outcome measured was change in CDAI between baseline and end of the study (article was in German; abstract only in English – which did not note length of study or dosages used). Patients treated with the Boswellia extract exhibited an average 90-point decrease in CDAI, while those on mesalamine averaged a 53-point decrease. ²⁵⁶ Although the difference between Boswellia and mesalamine was not considered statistically significant, Boswellia appeared to perform better than mesalamine. A larger study with more statistical power is warranted.

Berberine

The inflammatory cytokine IL-8 is increased in Crohn's Disease. An animal study of trinitrobenzenesulfonic acid-induced colitis (an experimental model for Crohn’s disease) found the alkaloid berberine (7.5-15 mg/kg/day), administered orally for one week, inhibited decreased colonic tissue damage measured histologically and macroscopically. Cultured tissue exposed to berberine also demonstrated inhibition of IL-8.²⁵⁷ Berberine is an active constituent of several botanicals, including goldenseal, Oregon grape, Coptis, and barberry.



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