Chios Mastiha: Prized by the Greeks Since Antiquity, and We Now Know Why
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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[1] Schultz H. Nutraingredients-USA. US botanical sales top $8 billion, notch 8.5% growth, ABC report says [Internet]. Crawley (UK): William Reed Business Media Ltd.; 2018 [cited 2019 Nov 15]. Available from: https://www.nutraingredients-usa.com/Article/2018/09/12/US-botanical-sales-top-8-billion-notch-8.5-growth-ABC-report-says
[2] Biria M, et al. Effects of three mastic gums on the number of Mutans streptococci, Lactobacilli and pH of the saliva. J Dent (Tehran). 2014 Nov;11(6):672-9.
[3] Biria M, et al. Comparison of the effect of xylitol gum-and mastic chewing on the remineralization rate of caries-like lesions. J Dentistry Tehran Univ Med Sci. 2009:6-10.
[4] Ali-Shtayeh MS, et al. Antifungal activity of plant extracts against dermatophytes. Mycoses. 1999;42(11-12):665-72.
[5] Lesesne CB. The postoperative use of wound adhesives. Gum mastic versus benzoin, USP. J Dermatol Surg Oncol. 1992 Nov;18(11):990.
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[7] Kartalis A, et al. Effects of Chios mastic gum on cholesterol and glucose levels of healthy volunteers: a prospective, randomized, placebo-controlled, pilot study (CHIOS-MASTIHA). Eur J Prev Cardiol. 2016 May;23(7):722-9.
[8] Silver MG. This Healing Plant Grows on Only One Greek Island [Internet]. Washington (DC): National Geographic Society; 2019 [cited 2019 Nov 19]. Available from: https://www.nationalgeographic.com/travel/destinations/europe/greece/fascinating-chios-island-only-home-of-healing-plant/
[9] Bruni F. Can This Ancient Greek Medicine Cure Humanity? [Internet]. New York (NY): The New York Times; 2019 [cited 2019 Nov 19]. Available from: https://www.nytimes.com/2019/07/26/opinion/mastic-greek-medicine-chios.html
[10] Malathronas J. The Mysterious Healing Plant That Only Grows On Greece’s Chios Island [Internet]. Atlanta (GA): Cable News Network; 2019 [cited 2019 Nov 19]. Available from: https://www.cnn.com/travel/article/chios-island-mastiha/index.html
[11] Al-Habbal MJ, et al. A double-blind controlled clinical trial of mastic and placebo in the treatment of duodenal ulcer. Clin Exp Pharmacol Physiol. 1984 Sep-Oct;11(5):541-4.
[12] Huwez FU, et al. Mastic gum kills Helicobacter pylori. N Engl J Med. 1998 Dec 24;339(26):1946.
[13] Marone P, et al. Bactericidal activity of Pistacia lentiscus mastic gum against Helicobacter pylori. J Chemother. 2001 Dec;13(6):611-4.
[14] Dabos KJ, et al. The effect of mastic gum on Helicobacter pylori: a randomized pilot study. Phytomedicine. 2010 Mar;17(3-4):296-9.
[15] Chey WD, et al. ACG clinical guideline: treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2017 Feb;112(2):212-39.
[16] Kaliora AC, et al. Chios mastic treatment of patients with active Crohn’s disease. World J Gastroenterol. 2007 Feb 7;13(5):748-53.
[17] Gioxari A, et al. Pistacia lentiscus resin regulates intestinal damage and inflammation in trinitrobenzene sulfonic acid-induced colitis. J Med Food. 2011 Nov;14(11):1403-11.
[18] Papada E, et al. Regulation of faecal biomarkers in inflammatory bowel disease patients treated with oral mastiha (Pistacia lentiscus) supplement: a double‐blind and placebo‐controlled randomised trial. Phytotherapy Res. 2019 Feb;33(2):360-9.
[19] Angriman I, et al. Enzymes in feces: useful markers of chronic inflammatory bowel disease. Clin Chim Acta. 2007 May;381(1):63-8.
[20] Papalois A, et al. Chios mastic fractions in experimental colitis: implication of the nuclear factor κB pathway in cultured HT29 cells. J Med Food. 2012 Nov;15(11):974-83.
[21] Gabr KE. Influence of indomethacin-mastic combinations on dissolution, absorption and gastrointestinal mucosal damage in rats. Int J Pharmaceutics. 1997 Dec 8;158(2):137-45.
[22] Heo C. Protective effects of mastic in non-steroidal anti-inflammatory drug induced gut damage and bacterial translocation in a rat model. Korean J Medicine. 2006 Oct 1;71(4):354-61.
[23] Al-Said MS, et al. Evaluation of mastic, a crude drug obtained from Pistacia lentiscus for gastric and duodenal anti-ulcer activity. J Ethnopharmacol. 1986 Mar;15(3):271-8.
[24] van den Berg KJ, et al. Cis-1, 4-poly-β-myrcene; the structure of the polymeric fraction of mastic resin (Pistacia lentiscus L.) elucidated. Tetrahedron Letters. 1998 Apr 23;39(17):2645-8.
[25] Sharifi MS, et al. Bio-activity of natural polymers from the genus Pistacia: a validated model for their antimicrobial action. Glob J Health Sci. 2011 Dec 29;4(1):149-61.
[26] Sharif Sharifi M, Hazell SL. Fractionation of mastic gum in relation to antimicrobial activity. Pharmaceuticals (Basel). 2009 Apr 1;2(1):2-10.
[27] Sharifi MS, Hazell SL. Isolation, analysis and antimicrobial activity of the acidic fractions of Mastic, Kurdica, Mutica and Cabolica gums from genus Pistacia. Glob J Health Sci. 2011 Dec 29;4(1):217-28.
[28] Paraschos S, et al. In vitro and in vivo activities of Chios mastic gum extracts and constituents against Helicobacter pylori. Antimicrob Agents Chemother. 2007 Feb;51(2):551-9.
[29] Kottakis F, et al. Arabino-galactan proteins from Pistacia lentiscus var. chia: isolation, characterization and biological function. Amino Acids. 2008 Apr;34(3):413-20.
[30] Kottakis F, et al. Effects of mastic gum Pistacia lentiscus var. Chia on innate cellular immune effectors. Eur J Gastroenterol Hepatol. 2009 Feb;21(2):143-9.
[31] Choli-Papadopoulou T, et al. Helicobacter pylori neutrophil activating protein as target for new drugs against H. pylori inflammation. World J Gastroenterol. 2011 Jun 7;17(21):2585-91.
[32] Fukazawa T, et al. Effects of Chios mastic gum and exercise on physical characteristics, blood lipid markers, insulin resistance, and hepatic function in healthy Japanese men. Food Sci Biotechnol. 2018 Jan 12;27(3):773-80.
[33] Triantafyllou A, et al. Chios mastic gum modulates serum biochemical parameters in a human population. J Ethnopharmacol. 2007 Apr 20;111(1):43-9.
[34] Kontogiannis C, et al. Chios mastic improves blood pressure haemodynamics in patients with arterial hypertension: implications for regulation of proteostatic pathways. European J Prev Cardiol. 2019 Feb;26(3):328-31.
[35] Abdel‐Rahman AH, et al. Mastich as an antioxidant. J Amer Oil Chemists’ Soc. 1975 Oct;52(10):423.
[36] Georgiadis I, et al. Evaluation of Chios mastic gum on lipid and glucose metabolism in diabetic mice. J Med Food. 2014 Mar;17(3):393-9.
[37] Rehman MS, et al. Anti-diabetic activity of crude Pistacia lentiscus in alloxan-induced diabetes in rats. Bangladesh J Pharmacol. 2015 Jul 1;10:543-7.
[38] Tzani A, et al. Investigation of Chios mastic gum effect on metabolic profile in streptozotocin-induced diabetic mice. Atherosclerosis. 2016 Sep 1;252:e95.
[39] Andrikopoulos NK, et al. Biological activity of some naturally occurring resins, gums and pigments against in vitro LDL oxidation. Phytother Res. 2003 May;17(5):501-7.
[40] Papada E, et al. Bioavailability of terpenes and postprandial effect on human antioxidant potential. An open-label study in healthy subjects. Mol Nutr Food Res. 2018 Feb;62(3):1700751.
[41] Tzani AI, et al. Chios mastic gum decreases renin levels and ameliorates vascular remodeling in renovascular hypertensive rats. Biomedicine & Pharmacotherapy. 2018 Sep 1;105:899-906.
[42] Georgiadis I, et al. Beneficial health effects of Chios Gum Mastic and peroxisome proliferator-activated receptors: indications of common mechanisms. J Med Food. 2015 Jan;18(1):1-10.
[43] Petersen RK, et al. Pharmacophore-driven identification of PPARγ agonists from natural sources. J Comput Aided Mol Des. 2011 Feb;25(2):107-16.
[44] Dumasia R, et al. Role of PPAR- gamma agonist thiazolidinediones in treatment of pre-diabetic and diabetic individuals: a cardiovascular perspective. Curr Drug Targets Cardiovasc Haematol Disord. 2005 Oct;5(5):377-86.
[45] Calkin AC, et al. PPAR-alpha and -gamma agonists attenuate diabetic kidney disease in the apolipoprotein E knockout mouse. Nephrol Dial Transplant. 2006 Sep;21(9):2399-405.
[46] Khedmat H, et al. Helicobacter pylori Infection in the general population: a Middle Eastern perspective. Caspian J Intern Med. 2013 Fall;4(4):745-53.
[47] Ozaydin N, et al. Prevalence and risk factors of Helicobacter pylori in Turkey: a nationally-representative, cross-sectional, screening with the ¹³C-Urea breath test. BMC Public Health. 2013 Dec 21;13:1215.
[48] Kaliora AC, Dedousis GV. Mastiha Treatment for Obese With NAFLD Diagnosis (MAST4HEALTH) [Internet]. Bethesda (MD): National Library of Medicine; 2018 [cited 2019 Nov 19]. Available from: https://clinicaltrials.gov/ct2/show/NCT03135873
The information provided is for educational purposes only. Consult your physician or healthcare provider if you have specific questions before instituting any changes in your daily lifestyle including changes in diet, exercise, and supplement use.
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Dr. Carrie Decker
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