One of the presentations was from Jason Hawrelak during which we ‘went back to school’ (as in old-school Materia Medica-based teaching – unsurprisingly I love this stuff!) and we (?re)-learned all about the herb Black Pepper and its active constituent piperine. It was brilliant and really challenged a LOT of uninformed thoughts I had about how to use this herbal medicine. It is now officially my herb of the month😆 But seriously, prior to this, I would have thought of this as being a great adjuvant and circ stim but primarily a gut irritant. Wrong. While it is contraindicated (CI) in ulcers or very active gastritis here are some GIT actions that might just surprise you as much as they did me (please remember, the below only applies to liquid (ethanol) herbal extracts at the ratio of 1:2):
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- Major carminative & antispasmodic for the GIT
- It SLOWS transit time (TT) and hence its major indication, across different herbal medicine traditions, as anti-diarrhoeal
- Coupled with very powerful stimulation of both digestive enzymes and absorption
- Capable of increasing secretion of both saliva and HCl
- I was most wowed by its documented positive effect on improved nutrient absorption via the saliva, HCl promotion, the slowed TT and increased villi length (true!!), increased bile flow, increased pancreatic (up to 90%) and intestinal lipase and amylase etc etc so massive increases in Ca uptake most notably along with phytonutrients (think curcumin as just one illustration of this) and, though much smaller, still improved uptake of Fe/Zn etc etc
- In fact when Jason then created a profile of who he would think of Black Pepper for the one that really jumped out to me and related to this mentoring case was: the person who is eating good food but is surprisingly low in nutrient levels – esp if confirmed low pancreatic elastase. There is also evidence to support it as an effective strategy in both early and ongoing coeliac disease as well – which we still have as a differential in this patient
- It is a UGT & SULT inhibitor & esp of p-glycoprotein efflux transporters however, so we need to use extreme caution in patients taking pharmaceuticals because there are loads of potential drug interactions, however, this is not an issue for this patient
- Drop doses of a 1:2 liquid herbal extract of course – not pleasant to taste but not as bad as berberine (in my personal opinion!!)