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Western herbalism

Mastic gumPistacia lentiscus (var. chia)

Resin of a Greek island tree. 350 mg three times daily gave marked relief to 77% vs 40% in 148 people with dyspepsia; human H. pylori data are negative or mixed.

Botanical name
Pistacia lentiscus (var. chia)
Part used
resin (the hardened sap tapped from the trunk)
Also called
Mastic, Mastiha, Chios mastic gum, Mastix, Rumi mastagi (Unani)
Used in
Western herbalism
Taken for
Indigestion, Antimicrobial use, The gut lining
Sold as
capsules, powder, fresh, tincture

What is meant by mastic gum

Mastic is the hardened resin of Pistacia lentiscus, a Mediterranean evergreen shrub related to the pistachio. The variety grown on the Greek island of Chios, Pistacia lentiscus var. chia, is the most familiar source. Cuts in the bark release a sap that dries into small pale tear-shaped pieces. Paraschos and colleagues note that the resin has been used for more than 2,500 years in traditional Greek medicine for stomach pain and ulcers and is mentioned by Herodotus, Dioscorides and Galen.

The resin is chewed as a gum, ground into powder, pressed into capsules, or distilled into an essential oil. Capsules and powders are the forms used in the human trials described here. A related Unani preparation, rumi mastagi, is the same resin.

Mastic gum is sold as a stomach-lining and H. pylori supplement, and the EU herbal committee has accepted it for mild dyspepsia. The trial record is mixed, with positive dyspepsia and ulcer results, a negative H. pylori eradication result, and small studies in bowel disease.

In the traditions

Western herbalism

Paraschos and colleagues describe mastic as used for more than 2,500 years in traditional Greek medicine for gastralgia and peptic ulcers, with references in the works of Herodotus, Dioscorides and Galen and by Roman, Byzantine, Arab and European authors. The EU herbal committee (HMPC) adopted a monograph on mastic by 23 of 27 votes, listing a traditional use in mild dyspeptic disorders and, for the skin, in minor inflammations and wound healing. Members from Austria, Denmark, Germany and Malta dissented on the grounds that the evidence for traditional use in the EU was insufficient.

What the plant contains

Mastic resin is rich in triterpenes and carries an essential oil. Miyamoto and colleagues identified 20 constituents in the oil by gas chromatography and found that alpha-terpineol and (E)-methyl isoeugenol inhibited four Helicobacter pylori strains, including drug-resistant ones. Marone and colleagues found that mastic killed 50 percent of H. pylori strains at 125 micrograms per ml and 90 percent at 500 micrograms per ml. Loughlin and colleagues measured a minimum inhibitory concentration of 7.80 mg/l and a bactericidal concentration of 31.25 mg/l. These are test-tube findings; the human results below are what matters for H. pylori.

What has been tested in people

Dyspepsia: Dabos and colleagues randomized 148 people with Rome II functional dyspepsia to Chios mastic gum 350 mg three times a day or placebo for 3 weeks. The symptom score on the Hong Kong dyspepsia index ended at 14.78 against 19.96 on placebo (P less than 0.05), and 77 percent of the mastic group had marked improvement against 40 percent on placebo (P less than 0.02), mainly for stomach pain, dull upper-abdominal ache and heartburn.

Ulcer: Al-Habbal and colleagues gave 1 g a day of mastic or placebo for 2 weeks to 38 people with endoscopically confirmed duodenal ulcer. Symptom relief was 80 percent against 50 percent, and endoscopic healing 70 percent against 22 percent (P less than 0.01). We found no larger replication of this 1984 trial.

H. pylori: Bebb and colleagues gave 1 g four times a day for 14 days to nine infected people and found no change in breath-test status in any of eight who completed. Loughlin and colleagues likewise failed to clear infection in 18 mice. Tulsian and colleagues added mastic to bismuth quadruple therapy in 64 adults: eradication was 85 percent against 67 percent, which did not reach significance (P=0.19), although dyspepsia scores improved more with mastic.

Bowel disease: in 10 people with active Crohn’s disease taking 2.2 g a day for 4 weeks, disease activity fell from 222.9 to 136.3 (P=0.05) with no control group. In a trial of 60 people with inflammatory bowel disease, 2.8 g a day for 3 months improved the quality-of-life score within the mastic group and lowered fecal lysozyme.

A large placebo-controlled trial of mastic alone for H. pylori has not turned up in our search.

StudyDoseWhat it found
Randomized placebo-controlled trial, 148 people with functional dyspepsia PMID 19961914350 mg three times daily for 3 weeksSymptom score 14.78 vs 19.96; marked improvement in 77% vs 40% (P<0.02)
Double-blind trial, 38 people with endoscopically confirmed duodenal ulcer PMID 63959941 g daily for 2 weeksSymptom relief 80% vs 50%; endoscopic healing 70% vs 22% (P<0.01)
Pilot, 9 people with H. pylori (8 completed), breath test before and after PMID 128885821 g four times daily for 14 daysNo change in H. pylori status in any patient
Randomized single-blind pilot, 64 adults, bismuth quadruple therapy with or without mastic PMID 41832367Added to a 2-week eradication regimenEradication 85% vs 67% (P=0.19, not significant); greater dyspepsia score improvement (P=0.001)
Pilot study, 10 people with active Crohn's disease and 8 healthy controls PMID 172781986 capsules a day (0.37 g each) for 4 weeksCrohn's Disease Activity Index 222.9 to 136.3 (P=0.05); IL-6 and CRP fell; no control group
Randomized placebo-controlled trial, 60 people with inflammatory bowel disease PMID 304506892.8 g a day for 3 monthsIBDQ score improved within the mastic group (P=0.004); fecal lysozyme fell (P=0.018)

Doses used in trials and traditional preparations

The EU monograph lists, for adults, 0.5 to 1 g twice daily (1 to 2 g a day) for mild dyspeptic disorders, and advises consulting a practitioner if symptoms last more than 2 weeks. Trials used 350 mg three times a day for 3 weeks (dyspepsia), 1 g a day for 2 weeks (ulcer), 1 g four times a day for 14 days (H. pylori, which did not work), 2.2 g a day for 4 weeks (Crohn’s) and 2.8 g a day for 3 months (inflammatory bowel disease). The traditional form is chewing the resin as gum.

Treat these figures as a record of what was studied. Whether any amount of mastic gum suits a particular person is a question for a clinician or pharmacist who knows their history.

Safety

The EU monograph lists no known adverse effects, no overdose cases, and hypersensitivity as the only contraindication. It states that use under 18 has not been established and that safety in pregnancy and breastfeeding has not been established, so use then is not advised in the absence of data. In Kaliora and colleagues’ pilot, no patient or control had side effects. The mastic tree is a relative of the pistachio, and contact dermatitis from gum mastic on the skin has been reported (Shaw and colleagues); we found no case series of reactions to swallowed mastic or of cross-reaction with pistachio or cashew.

Drug interactions

The EU monograph states no interactions with medicines are reported. We found no formal interaction study of mastic in people. In the Tulsian trial, mastic was given with a bismuth quadruple antibiotic regimen with no reported increase in adverse events, but that was a small pilot not designed to test interactions.

Prescriptions flagged alongside mastic gum

Published interaction references put these medicines next to this herb, and the quiz acts on them; a pharmacist is the person to confirm any of it:

Products in the catalog with mastic gum

These catalog entries list mastic gum or one of its preparations among their active ingredients. Each page shows the amount on the label, the trials behind it and what buyers report.

Jarrow Formulas Mastic Gum 1,000 mg 4.3 out of 5 from 3,171 ratings from Amazon · $1.07 a day Designs for Health GastroMend-HP 4.8 out of 5 from 58 ratings from iHerb · $112.99 for 120 capsules, about $3.77 a day at 4 capsules

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The questions that come up

Does mastic gum kill H. pylori in people?

In a pilot of nine infected people, 1 g four times a day for 14 days changed none of the breath tests. Added to a standard antibiotic regimen in 64 adults it gave 85 percent eradication against 67 percent, which was not statistically significant. It kills the bacterium in a dish at 125 to 500 micrograms per ml, and mice were not cleared.

Did mastic help dyspepsia in a trial?

In 148 people with functional dyspepsia, 350 mg three times a day for 3 weeks gave marked improvement in 77 percent against 40 percent on placebo. The EU lists mastic for mild dyspeptic disorders as a traditional use.

What did the ulcer trial find?

In a 1984 trial of 38 people with duodenal ulcer, 1 g a day for 2 weeks gave endoscopic healing in 70 percent against 22 percent on placebo. We found no larger replication.

Is the evidence for Crohn&rsquo;s or colitis solid?

No. A 10-person Crohn’s pilot with no control group showed disease activity falling from 222.9 to 136.3, and a 60-person trial found better quality-of-life scores and lower fecal lysozyme in inflammatory bowel disease. Both are small.

Does mastic have side effects?

The EU monograph lists none known, and the Crohn’s pilot reported none. Contact dermatitis from gum mastic on the skin has been reported, and safety in pregnancy and under 18 has not been established.

Sources