Digestive bitters are a great way to jump-start your digestion. Once much more common in our diet, bitters have been replaced by sweeter-tasting foods over time. While sugars might satisfy your taste buds, bitters stimulate your digestive juices, soothe gut inflammation, and increase nutrient absorption. Keep reading to find out what bitters can do for your digestive health.
What Are Digestive Bitters?
Digestive bitters broadly include all herbs or supplements with a bitter taste. Their bitterness stimulates digestive juices to help the body overcome gut problems such as indigestion, bloating, heartburn, nausea, and more. A number of bitters have been used for hundreds of years across the world to promote digestive health.
Digestive enzymes and bile acid supplements became more popular over the years, slowly pushing bitters out of the picture. Digestive enzymes are presented as more advanced targeted products, while bile supplements are regarded as more potent. While both can certainly improve digestion by making up for a physiological lack of gut enzymes and bile acids, they are only a temporary solution. Neither will stimulate your gut to re-establish healthy digestion.
Over time, you may even get into a state of constantly requiring bile and digestive enzymes to properly digest food. You may be happy enough that anything at all is working to improve your digestion but you’re probably also aware that you haven’t arrived at an ideal solution. Long-term, the goal of natural remedies should be to bring you back into a state of health and balance, not to keep you dependent on numerous supplements.
That’s where bitters come in and many cultures have known this for a long time. These herbs are gentle and beneficial in the long run. By incorporating bitters into your diet or supplement regime, you are telling your gut (and brain!) to gradually produce more digestive juices. Often times, this crucial difference between digestive enzymes and bile supplements, on one hand, and herbal bitters, on the other, goes unnoticed.
Of course, you will need to take into account many other factors if you want to get to the bottom of your indigestion issues. These will often also involve adapting your diet, working on food sensitivities, avoiding lectins, reducing inflammation, stress, circadian rhythm disruptions, and others. Learning how to use bitters can be one additional step in the right direction.
How Are Bitters Used?
Extracts of bitter herbs can be used in various ways: added to food, poured into drinks such as tea or alcoholic beverages, or taken alone in their pure form. Several herbs are traditionally combined into digestive elixirs, the most well-known ones being Swedish bitters and Iberogast. Bitters are typically used before a meal to stimulate digestive juices.
More recently, some manufacturers have formulated pills with herbal extracts that mask the bitter taste. Although this may sound appealing, it doesn’t work as well. Bitters need to activate specific bitter taste receptors (TAS2Rs) in the body (especially those on the tongue), which means you will not get the full effects by bypassing their somewhat unpleasant flavor [R+].
Snapshot of Bitters
- Safely improve digestion and support gut health
- Stimulate the release of stomach acid, digestive enzymes, and bile
- Increase the absorption of nutrients
- Versatile, easy to find and incorporate into a daily routine
- Many bitters with varying effects exist
- Not all traditional health benefits have been scientifically validated
- Some people find the bitter taste intolerable
Mechanism of Action
Despite their historic use, the digestion-promoting mechanism of action of bitters is still somewhat unclear. Bitters probably act by stimulating the vagus nerve and bitter receptors as well as by increasing blood flow to the gut. As a result, bitters increase stomach acid, digestive enzymes, and bile, which helps break down food and absorb nutrients.
Vagus nerve stimulation
According to the most supported theory, when bitter compounds turn on bitter taste receptors, a signal is sent through the cranial nerve in the tongue (glossopharyngeal) to the brain (cerebral cortex). This allows the brain to “sense” bitterness, which activates the vagus nerve. The vagus nerve sends the message back down to the mouth and stomach to aid digestion by increasing saliva, stomach acid, and bile [R+].
Bitterness Receptors in the Gut
According to this theory, bitters promote digestion without getting the brain involved.
Research has identified active bitter receptors in the gut. Bitter compounds can turn on these receptors, which stimulates digestion directly in the gut by triggering the release of digestive juices [R+, R, R, R+].
In the mouth, bitter compounds increase saliva production by turning on bitter receptors on the tongue. Based on this outlook, the bitterness signal doesn’t need to reach the brain at all [R+].
Increased gut blood flow
Another line of research suggests that activating the cranial nerve in the tongue by bitter receptors leads to increased blood flow to the gut. Increased gut circulation aids digestion by supporting stomach acid release, the passing of food, the absorption of nutrients, and the clearing of waste products [R+].
Some have proposed that the alcohol in tinctures is what promotes digestive health, but this is highly unlikely having in mind the small amounts of alcohol in typical doses of bitter tinctures [R+].
Ultimately, not all bitters work in the same way. Some may work by one mechanism, and others may work by a different mechanism or by a mixture of effects. Some bitters can be categorized based on their mechanism of action but more research is needed [R+].
Health Benefits of Bitters
1) Bitters Improve Indigestion
Most of the research and traditional use of bitters focuses on their benefits for improving digestion.
The popular multi-herbal product Iberogast (which contains bitters such as milk thistle, chamomile, and angelica) was effective at improving indigestion in an analysis of 6 clinical trials [R].
Black cumin is another powerful herb with bitter qualities. In one study with 88 patients, grounded black seed (Nigella sativa) helped eliminate ulcer-causing Helicobacter pylori infections and improved indigestion [R].
In multiple studies, artichoke leaf extracts (alone or with other herbs) improved indigestion. In a survey of patients with irritable bowel syndrome and indigestion, nearly all said that artichoke was at least as helpful as other past interventions. In a study of 311 patients, the herbal mixture Cinarepa (artichoke, dandelion, and turmeric) relieved indigestion [R, R, R, R, R, R].
Traditional Chinese Medicine Formulas
Chaihu Shugan powder is a popular Chinese multi-herbal formula used for many years to relieve indigestion. An analysis of 22 clinical trials with nearly 2,000 patients showed that modified Chaihu Shugan powder could be an effective option for improving indigestion [R].
The Xiaoyao pill is another bitter multi-herb formula used in traditional Chinese medicine. In a study of 180 depressed women with indigestion, it improved digestion by boosting the flow of food through the digestive system, and by increasing stomach acid and digestive proteins (by raising motilin and gastrin hormones) [R].
A multi-herbal bitter (Yukgunja-Tang) reduced symptoms of indigestion, bloating, nausea, vomiting, and stomach pain in a clinical trial with 96 people after 8 weeks. The participants took 5g of the powder 3 times per day [R+].
Another multi-herbal extract (Ban Xia Xie Xin) similarly reduced indigestion, bloating, and stomach pain in a clinical trial of 101 people after 4 weeks. The extract was given as a powder mixed in hot water twice a day. The benefits were maintained even 4 weeks after the extract was stopped, which supports the idea that a short course of bitters can improve digestion in the long term [R+].
2) Bitters Improve Acid Reflux and GERD
Although it may seem counterintuitive, stimulating the release of stomach acid and digestive enzymes can help people with acid reflux. While most conventional drugs for acid reflux work to only temporarily reduce stomach acid secretion or neutralize it (like Tums), bitters help to re-establish proper digestion and strengthen the esophagus in the long run.
In one observational study, 50 patients with acid reflux were given an Ayurvedic syrup called Acidinol for 4 weeks. This multi-herbal formula with bitters such as neem (Azadirachta indica), relieved symptoms of heartburn, stomach pain, bloating, nausea, indigestion, and loss of appetite in over 75% of patients [R].
Extract of the bitter fruit quince mildly reduced symptoms of GERD in a clinical trial with 80 children after 4 weeks [R].
Most people with acid reflux have a weakened valve that separates the esophagus tube from the stomach. In rats, red sage (Salvia miltiorrhiza) helped manage GERD by keeping the lower esophageal muscle contracted, which prevents acid from regurgitating out of the stomach [R].
In rats with GERD, Iberogast decreased inflammatory molecules and protected against damage to the esophagus [R].
3) Bitters Relieve Gut Inflammation and Ulcers
In addition to improving digestion and acid reflux, bitters have anti-inflammatory properties. This can be beneficial to those with chronic inflammatory disorders such as ulcerative colitis, a disease that can cause ulcers throughout the digestive tract.
In a study with 94 patients, Dong Quai (Angelica sinensis) injections helped improve ulcerative colitis (by blocking platelet activation). Chamomile, myrrh, and coffee charcoal stopped ulcerative colitis from coming back at the same rate as standard drugs in a clinical trial of almost 100 people [R, R].
Helicobacter pylori infections are the main cause of stomach and gut ulcers. In a clinical trial of 36 people with H. pylori, a combination of bitter herbs (burdock, angelica, gromwell, and sesame) lowered inflammation and healed ulcers [R].
Berberine was also effective at lowering gut inflammation (especially in the colon) in rodents. Dandelion could ease stomach inflammation in rats (by lowering TNF-alpha and stopping mast cells from reaching the stomach) [R, R, R, R, R, R].
Artichoke, chamomile, gentian, and burdock could all protect against or heal stomach ulcers from excessive alcohol intake in rodents. Burdock healed ulcers caused by other harmful substances as well [R, R, R, R, R, R, R, R, R].
4) Bitters Help with Diabetes
While bitters are mostly known for their ability to boost digestion, they may also help people with type 2 diabetes by lowering blood sugar levels and body weight.
A Chinese herbal bitter (TM81) lowered blood sugar levels, BMI, weight, waist size, and improved diabetes symptoms in a clinical trial with 480 overweight type 2 diabetic patients in early phases of the disease [R].
In clinical trials of over 122 people with type 2 diabetes, another Chinese herbal bitter, as well as berberine, reduced blood sugar levels to the same extent as metformin, the standard anti-diabetic drug. Berberine normalized blood sugar levels after and in between meals, while also reducing blood fats such as triglycerides [R, R].
Chamomile tea can also help with diabetes, probably due to a mix of bitter and antioxidant qualities. In a clinical trial with 64 people with type 2 diabetes, chamomile tea (3X day) significantly lowered cholesterol, insulin, sugar-bound hemoglobin (HbA1C), and fat (triglyceride) blood levels [R].
Bioactive Components in Bitters
Gentian contains a class of bitter compounds called iridoids, including one called gentiopicroside. Gentiopicroside helps with the normal flow of food through the gut, and iridoids are important for stomach acid production [R, R].
In chamomile, certain flavonoids (apigenin, quercetin, and patuletin) can decrease muscle spasms in the gut. The aromatic compound chamazulene found in chamomile has anti-inflammatory effects [R+, R].
Digestive bitters are a diverse group of herbs. The most common ones are generally safe. However, polyherbal combinations are common and being aware of any potential side effects or sensitivities to their components can help you avoid negative reactions.
Dandelion is considered generally safe to use and has few side effects. However, it lowered fertility in one on male rats. In one instance, the consumption of dandelion excessively lowered blood sugar in a 58-year-old woman with diabetes. Be sure to monitor your glucose closely if you have diabetes and are taking bitters [R+, R, R, R+].
In one study, artichoke leaf extracts caused a few patients (only ~1%) to feel weak, hungry and have gas. Megadoses of artichoke extract triggered DNA mutations in cells and mice. However, the dosage was so extremely high in mice (2g/kg, which would be about 200g of the extract for a person of ~220 lbs) that it would be almost impossible to achieve when supplementing [R+, R+].
Bitter orange extract is considered to be very safe [R].
Berberine is generally safe, although occasionally patients complain of constipation, diarrhea, nausea, and bloating [R+].
Extremely bitter bottle gourd juice can be quite dangerous, as 3 deaths and 26 hospital admissions due to stomach pain and vomiting have been reported [R].
Dandelion in higher amounts than those found in food is not recommended in children or women who are pregnant or breastfeeding [R+].
Bitters that increase bile production, such as artichoke, should not be taken by people with bile duct occlusion or gallstones [R+].
Because tinctures contain alcohol, higher amounts are not recommended for pregnant women and children.
In one study of 235 people, 1.3% had an allergic skin reaction to dandelion [R].
While there are no reports of skin allergies to oral artichoke, skin contact can cause rashes and inflammation in some cases [R+].
Talk to your doctor if you are taking prescription medications and want to supplement with bitters.
In healthy adults, milk thistle extract silymarin blocked the breakdown of the blood-pressure-lowering medicine Cozaar (Losartan). The degree of inhibition depended on the genotype of the CYP2C9 gene [R].
Chamomile, berberine (from Goldenseal), and dandelion block cytochrome P450 (CYP3A4 and CYP1A2), which break down drugs such as warfarin and cyclosporine. Taking them at the same time can increase blood concentrations of the drugs. In one instance, the combination of warfarin and chamomile led to internal bleeding in a 70-year-old woman [R+, R, R, R, R].
In healthy people and kidney transplant patients, berberine raises the bioavailability of Neoral (cyclosporin), likely by inhibiting CYP3A4. This can be good if monitored in people prone to poor cyclosporin bioavailability but can be dangerous if this drug’s blood levels get too high [R, R].
Dandelion might lower the effects of the antibiotic ciprofloxacin, and may, in theory, increase the risk of bleeding in combination with blood thinners (due to its coumarin content). Dandelion may also increase the side effects of Vitamin B3 (Niacin) such as stomach aches [R+].
The Genetics of Bitter Taste
Genetics play a role in how you perceive bitter taste, as different types of bitter receptors sense bitterness if different ways.
One study found that mutations (polymorphisms) in the TAS2R38 gene can lead to 3 main categories of bitter perception to bitter compounds. People with the AVI type of receptor have difficulty in tasting bitterness, while those with the PAV type are sensitive to bitter taste. The 3rd AAI type falls somewhere in between [R+].
These genetic predispositions can impact dietary choices. People who are sensitive to bitters have a lower preference towards certain vegetables like spinach, cabbage, kale, and others, and they also have a lower vegetable and fruit intake than those who are not sensitive. Additionally, people who are sensitive to bitters also have a decreased preference for alcohol [R+].
If you’re more sensitive to bitter taste, you will find bitters hard to tolerate. However, since these receptors also play a role in producing the effects of bitters by increasing digestive juices, you may need a smaller amount to get the benefits.
Being more sensitive to bitters can have additional health benefits. One study found that European Americans who are sensitive to bitters (PAV type) were less likely to be smokers. This might be because people who can taste bitters are more likely to be turned off by the bitter compounds in tobacco smoke. This relationship did not hold for African Americans, however [R].
These genetic predispositions can broadly affect your diet, lifestyle, and disease risk. Mutations in the TAS2R38 gene are associated with conditions such as thyroid dysfunction, obesity, and colon polyps [R+].
Forms of Supplementation
Bitters come in many different forms. Tinctures are very common and bottled as sprays that can be applied directly to the tongue or droppers to be taken straight or mixed with water.
Other common forms include pills and powders that need to be mixed with water.
Usually, several herbs are combined into a bitter elixir. The content of individual herbs will vary depending on the formulation and brand. The more well-known combinations include:
- Swedish bitters are a blend of many herbs including angelica root, senna leaf, rhubarb root, myrrh stem, valerian root, cinnamon bark, and more
- Angostura bitters are made in Trinidad and Tobago by the House of Angostura and are known for their tinctures with gentian
- The main component of black seed bitters is black cumin (Nigella sativa), and can also contain acai, honey, garlic, and ginger
- Lavender bitters have lavender, orange peel, and other herbs, and Peychaud’s bitters are based on gentian
- Iberogast, a German formulation with 9 herbs commonly found in pharmacies
How to Make Bitters
If you have the time, making your own bitter infusions can be a fun and easy process. You will need bitter herbs (such as artichoke leaf, burdock root, angelica root, dandelion root, etc.), alcohol (at least 100-proof), jars for storage, a strainer, a cutting board, and a knife. You can also mix in additional herbs and spices to add flavor.
- Cut your bitters into small pieces and place them inside a jar. Note: If you have multiple bitters, you can either mix them all together in one jar or keep everything in separate jars and mix them later. The disadvantage of mixing them in the beginning is that different bitters may infuse into the alcohol at different speeds.
- Add the high proof liquor, making sure that the bitters are fully submerged. Place the lid on the jar and store in a cool, dark place.
- Every day, shake each jar well for around 10 seconds.
- Since infusing speeds are different depending on the bitter, this can take anywhere from one day to a few weeks. You can test whether or not the alcohol has been infused by taking a few drops out and smelling or tasting it. Once the liquid smells or tastes bitter enough, the tincture is ready.
- Once it is ready, strain out the bitters (a cheesecloth works well) and you will be left with your own homemade tincture. From this point, you can combine different tinctures together, add a few drops to food, tea, other beverages, or use them to your preference. They can last for about a year and don’t need to be refrigerated.
Digestive Bitters vs. Alcoholic Bitters
Digestive bitters are used to aid with indigestion or other gut problems and can come in a variety of different forms such as tinctures, pills, powders, and even creams. Tinctures are among the most common forms that are very easy to add to alcoholic beverages. Adding bitters to alcohol is done mostly for flavor – to make the drink taste better.
Thus, digestive bitters are taken for health reasons while alcoholic bitters are savored for taste. That being said, you should still receive the health benefits that bitters provide if you add them to alcohol and consume in moderation.
For dandelion leaf, the British Herbal Pharmacopeia recommends 3 – 5 grams twice daily or 5 – 10 mL of leaf tinctures twice daily [R+].
The recommended dosages of other dandelion preparations in adults include [R+]:
- Dried root: 2 – 8 grams infused in a drink
- Leaf fluid extract: 4 – 8 mL of a 1:1 alcohol (25%) extract
- Root tincture: 5 – 10 mL of a 1:5 tincture in 45% alcohol
In one study, 1 gram per day of chamomile extract (one 500mg pill taken twice) was used to effectively reduce vomiting frequency [R].
Berberine doses typically range between 0.5 gram per day to 1.5 grams per day in different clinical trials. One trial used 20 mg for every kilogram for each person [R+].
For reducing inflammation, one clinical trial used 2 grams of burdock root in 150 mL of boiled water to prepare tea taken 3 times a day [R].
Daily consumption of either 320 or 640 mg of artichoke leaf extract reduced indigestion [R].
For ulcerative colitis, patients took one 140 mg tablet of silymarin once per day for 6 months [R].
Most people who took bitters had a positive experience. One user reported that their digestion had improved greatly after incorporating bitters into their daily routine. Another said that they have been taking bitters for over 6 years and cannot imagine life without them. Others find that daily use greatly improves digestion and bloating.
One pregnant user experienced heartburn relief from bitters, although there was an adjustment period. She also said that it helped with her children’s digestion.
Some people add bitters to green tea. One user mentioned improved digestion from doing this in the morning, before and after meals, even more so than when they were taking digestive enzymes.
One user takes bitter pills after meals, which helped with gas, acid reflux, burping, and bloating.
A couple of users did have mildly negative experiences. One person said that they took bitters seeking heartburn relief, but they actually made it worse. A few users complained about the taste, saying that it is so overwhelmingly bitter that they could not bring themselves to drink the elixirs.
Limitations and Caveats
Many of the studies examine mixtures of multiple herbs or drugs at once. Since some of these components are not bitter, it cannot be known for certain if the herbal bitters are the ones responsible for the beneficial effects in these studies.
Additionally, a lot of the studies were conducted in animals or cells. While these are helpful, more clinical trials would present stronger evidence for the benefits of bitters.