Native Americans cherished and used the bark of slippery elm for thousands of years in traditional medicine. It was taken to relieve sore throats, stomach and bowel inflammation, to heal wounds, urinary tract infections, and even cancer. Read on to find out if you should be using slippery elm, especially if you have IBS or IBD, and what health benefits are supported by science.

What is Slippery Elm?

Ulmus rubra, commonly known as Slippery Elm or Moose Elm, is a deciduous red tree native to North America and Canada. The tree can grow up to 25 m and its inner bark has a reddish-yellow or reddish-brown color [R].

Slippery elm got its name because its inner bark feels slippery when chewed or mixed with water. The inner bark contains mucilage, a slime-like substance that turns into a gel when it comes in contact with water. Mucilage is a mix of polysaccharides with many medicinal properties [R, R].

Slippery elm was used by the Native Americans for many purposes, including building canoes and making fire, but also for promoting health. Traditionally, the inner bark of slippery elm has been used as a natural remedy for [R, R, R, R]:

  • Diarrhea
  • Constipation
  • Urinary tract infections
  • Skin injuries and diseases
  • Sore throat & throat infections
  • Stomach and bowel inflammation
  • Cancer

The potential benefits of slippery elm are difficult to fully assess, given the lack of clinical studies. However, limited evidence suggests that slippery elm can help with irritable bowel syndrome (IBS), skin conditions, and inflammation [R, R, R].

Active Components

The mucilage of slippery elm contains polysaccharides (l-rhamnose, d-galactose, 3-O-methyl-d-galactose, d-galacturonic acid, pectin). After the mucilage comes in contact with water, these polysaccharides break down to sugars (galactose, glucose, and fructose) [R, R, R, R].

The bark of slippery elm also contains [R, R, R]:

  • Simple sugars (hexoses, pentoses)
  • Fatty acids (oleic and palmitic acid)
  • Phytochemicals and sterols (oleanolic acid, ursolic acid, beta-carotene, beta-Sitosterol, citrostadienol)
  • Starch
  • Tannins

Mechanism of Action

Slippery elm contains mucilage. Mucilage is a substance made from polysaccharides. When mucilage comes in contact with water, it swells up and becomes a gel. This gel can soothe dry or inflamed skin, such as in psoriasis. Mucilage can also heal injuries and wounds, soothe a dry throat and reduce throat inflammation [R, R, R, R]

Slippery elm may help with digestive health problems, as:

  • Mucilage can soothe an inflamed gut, act as a laxative, and relieve constipation [R, R, R]
  • Other components can block harmful gut bacteria (such as Citrobacter freundii and Klebsiella pneumoniae) and increase good gut bacteria (such as Bifidobacterium, Lactobacillus, and Bacteroides species) [R, R, R].

Slippery elm may fight inflammation and cancer by:

  • Blocking the release of oxygen radicals (superoxide, peroxyl) involved in inflammation, blood vessel damage, DNA damage, and cancer [R, R, R, R].
  • Decreasing the production of interleukin 8 (IL-8), a cytokine that can cause inflammation and cancer [R, R].

Slippery Elm Health Benefits & Uses

1) Slippery Elm May Improve IBS

Irritable bowel syndrome (IBS) is a chronic disorder that impacts the stomach and intestines. Symptoms include diarrhea or constipation (usually one will be dominant), straining, stomach pains, and bloating [R, R, R].

Slippery elm is a better option for people with constipation IBS, as it can increase bowel movements. In people with diarrhea IBS, it may reduce some symptoms but may worsen the diarrhea.

Constipation IBS

In a clinical trial on 10 people with constipation IBS, 14 g/day of slippery elm together with other anti-constipation herbs (lactulose, oat bran, and licorice root) for 5 weeks [R]:

  • Increased stool frequency by 20%
  • Improved stool consistency by 29%
  • Reduced straining by 65 %
  • Relieved stomach pain and bloating by ~13%

Diarrhea IBS

In a clinical trial on 21 people with diarrhea IBS, 9 g/day of slippery elm for 5 weeks together with other herbs (dried bilberries, cinnamon, and agrimony) [R]:

  • Reduced straining and stomach pain by ~20%
  • Decreased bloating by 28%
  • Reduced gas and flatulence by 18%.

However, it didn’t help with diarrhea. On the contrary, it increased the frequency of bowel movements by 9%.

3) Slippery Elm May Relieve Sore Throat (Pharyngitis)

A sore throat (pharyngitis) is a common throat infection, usually caused by bacteria or viruses. It causes dryness, scratchiness, throat pain, and difficulty swallowing [R, R].

Throat Coat is a herbal medicine made from slippery elm, licorice root, and marshmallow root [R].

In a clinical trial with 60 people with a sore throat, Throat coat reduced overall pain and the pain of swallowing faster and better than the placebo [R, R].

4) Slippery Elm May Improve Psoriasis

Psoriasis is a chronic, inflammatory skin condition that causes red patches and scales over the skin [R].

Since slippery elm contains mucilage, it can soothe dry skin, heal wounds, and could be helpful for people with psoriasis [R, R].

In 5 people with psoriasis, slippery elm together with saffron tea and a special diet improved all psoriasis symptoms, such as redness, skin thickness, scaling, and the area of the affected skin [R].

5) Slippery Elm May Improve Acid Reflux/GERD

Gastroesophageal reflux disease (GERD) is a digestive disorder that causes stomach contents to return back up into the esophagus. Symptoms include heartburn and a sensation of bitter-tasting acid in the throat or mouth (acid regurgitation) [R, R, R].

In 3 people with GERD, slippery elm together with other herbs and lifestyle changes (smoking and alcohol cessation) decreased the intensity and frequency of GERD symptoms [R, R, R].

6) Slippery Elm May Reduce Migraines

Slippery elm together with multivitamins and a magnesium supplement reduced chronic migraines in a 23-year old female with GERD. Slippery elm may have helped more with acid reflux than with migraine, for which magnesium is known to be beneficial [R].

Further research on the benefits of slippery elm for migraines is needed to tease apart the effect.

7) Slippery Elm Is an Antioxidant

In cell studies, slippery elm blocked the release of free radicals involved in inflammation, DNA damage, and cancer [R, R, R, R].

Slippery elm can also block the production of interleukin 8 (IL-8), a cytokine that causes inflammation [R, R].

8) Slippery Elm May Reduce Weight and Blood Fats

In 49 healthy people, slippery elm together with antioxidant supplements and a vegan diet decreased weight, total and LDL cholesterol after 21 days [R].

9) Slippery Elm Balances the Gut Microbiome

Slippery elm can also reduce the harmful bacteria in the gut that can cause inflammation. These include bacteria that cause [R]:

  • Urinary tract infections (Citrobacter, Pseudocitrobacter, Enterococcus )
  • Urinary tract, respiratory, skin, and stomach infections (Enterobacter)

Moreover, slippery elm can increase gut bacteria that promote a healthy gut microbiome, such as Bifidobacterium, Lactobacillus, and Bacteroides species (which also protect against obesity) [R].

10) Slippery Elm May Fight Cancer

In rats with leukemia, slippery elm together with 3 other herbs (burdock root, sheep sorrel, and Chinese rhubarb) restored the number of total white blood cells, lymphatic white blood cells (lymphocytes), and bone marrow white cells (neutrophils) [R].

In mice cells, this herb mix also decreased the production of immature blood cells and blocked the production of S1P1 (Sphingosine-1-phosphate receptor 1) (S1P1), a protein involved in leukemia [R, R].

Slippery elm inner bark can also decrease the production of interleukin 8 (IL-8), a chemokine that can cause inflammation and cancer [R, R].

Essiac is a herbal mixture of slippery elm and burdock root, Indian rhubarb, and sheep sorrel. In cell studies, Essiac blocked the release of free radicals and reduced DNA damage. Essiac also blocked the growth of breast cancer cells [R, R].

However, no clinical studies investigated Essiac tea or slippery elm for their anti-cancer effects [R, R].

11) Slippery Elm May Help with IBD

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder that includes both ulcerative colitis and Crohn’s disease. Both cause diarrhea, weight loss, fatigue and severe stomach pain [R].

How can slippery elm help?

Slippery Elm may alter the gut microbiota in IBD

Altered gut microbiota can cause IBD [R].

People with IBD have lower levels of health-promoting Bacteroides bacteria in the gut. Moreover, Lactobacillus spp. and Bifidobacterium spp. are given as probiotics to people with ulcerative colitis or Crohn’s disease [R, R].

Slippery elm can fight harmful bacteria that worsen bowel and stomach inflammation, such as Enterobacter, while increasing health-promoting bacteria, such as Bifidobacterium spp., Lactobacillus spp., and Bacteroides spp [R].

Slippery Elm may fight inflammation in IBD

Free radicals worsen inflammation and gut damage in IBD [R, R, R].

In a cell study, slippery elm blocked the release of oxygen radicals involved in ulcerative colitis [R].

Slippery Elm For Pets

Slippery elm is a safe herbal supplement that can be given to cats and dogs for digestive problems such as constipation and bowel inflammation.

Slippery elm killed parasites in the stomach and reduced stomach problems, food poisoning, stopped diarrhea and promoted colon health in dogs, cats, and pigs [R].

Slippery elm together with psyllium husks reduced the symptoms of hairballs (vomiting, retching, or coughing) in cats [R].

Side Effects

No serious side effects have been reported from taking slippery elm. It is well tolerated but may cause a skin rash or allergy [R, R].

Pregnant or breastfeeding women should be cautious with slippery elm. Traditionally, it was believed to cause abortions or miscarriages. However, taking slippery elm as a powder or tea is probably not harmful. The risk comes only from using the bark vaginally [R, R].

Despite the lack of scientific evidence, pregnant women believed that they could trigger an abortion by inserting slippery elm into their cervix. Some cases of slippery elm in the bladders’ of pregnant women have been recorded, although none of them had a miscarriage [R, R].

Drug Interactions

Slippery elm contains mucilage, which can reduce the absorption of oral drugs and decrease their effectiveness. Therefore, you should take slippery elm at least one hour after taking an oral drug and consult your doctor or pharmacist about possible interactions with your prescription medication [R].

Genetics

In rats, slippery elm together with other herbs (burdock root, sheep’s sorrel, and Chinese rhubarb) blocked the release of S1P1 (Sphingosine-1-phosphate receptor 1), a protein encoded in the S1P1 gene involved in leukemia [R, R].

Forms of Supplementation and Dosage

Slippery elm, as a herbal supplement, is available in the form of tea, lozenges, capsules, and powder [R].

Many supplements are available and because none are standardized, the dosage recommendations greatly vary.

As a rule of thumb, please consider the following [R]:

  • For gruel: 1.5 – 3 gr of powder in 1 cup (240ml) of water
  • For tea: 4 grams of powder in 2 cups of water
  • For capsules: 200mg – 500mg up to three times a day
  • For lozenges: 1 lozenge daily

User Experiences

Most users were happy with slippery elm. They reported it reduced the symptoms and promoted healing in cases of:

  • Heartburn
  • Irritable bowel syndrome (IBS)
  • Inflammatory bowel disease (IBD)
  • Acid reflux/GERD
  • Diverticulosis
  • Stomach ulcer
  • Sore throat and dry mouth
  • Vaginal yeast infections

There are many supplements widely available but not standardized, so the time it takes for slippery elm to work varies greatly. However, users reported improvements after the first capsule or after the first powder dosage.

However, a few users experienced side effects and health disturbances, such as constipation, diarrhea, and skin allergies.

Limitations and Caveats

Studies about the benefits of the slippery elm are limited and many are reviews rather than clinical trials.
Furthermore, the few clinical trials that were carried out had a small number of participants, and some of their findings are debatable. In most of the clinical studies, slippery elm was only one component of the diet/therapy examined.

Further research on the benefits and side effects of slippery elm is needed.

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