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Mastic

Scientific Name(s): Pistacia lentiscus L.
Common Name(s): Lentisk, Mastic, Mastich, Mastick (tree), Mastix

Clinical Overview

Use

The purported uses of mastic are diverse. The resin has been used in cancer, infection, surgical wound adhesion, and benign gastric ulcers. Other traditional uses include as an antioxidant and as an insecticide, and for treatment of high cholesterol, Crohn disease, diabetes, and hypertension. However, clinical trials are lacking to support these uses.

Dosing

Mastic resin at a dosage of 1 g daily has been studied for the treatment of duodenal ulcer. Various commercial products are available to help eliminate H. pylori bacterium in the stomach (implicated in a number of GI complaints), including Mastika, which contains mastic gum 250 mg in capsule form. Manufacturer dosage guidelines recommend 4 capsules orally before bed for 2 weeks, followed by a maintenance dosage of 2 capsules daily.

Contraindications

Avoid use in individuals with hypersensitivity to pollen or to any of the ingredients of mastic gum.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

Most adverse reactions are associated with hypersensitivity to the plant species or with allergic reactions.

Toxicology

Most toxic effects involve allergic reactions.

Botany

Mastic is a gum or resin collected from an evergreen, dioecious shrub, which can grow to approximately 3 m in height. The shrub is native to the Mediterranean region, primarily the Greek island of Chios. Its leaves are green, leathery, and oval. Its small flowers grow in clusters and are reddish to green. The fruit is an orange-red drupe that ripens to black.

Mastic is tapped from June to August via numerous, longitudinal gouges made in the tree bark. An oleoresin exudes and hardens into a teardrop shape that is approximately the size of a pea (3 mm). The transparent, yellow-green resin is collected every 15 days. If chewed, the resin becomes plastic-like, with a balsamic/turpentine-like odor and taste.Chevalier 1996, Evans 1996, Lawless 1995, Windholz 1989, Youngken 1950

Mastic resembles the resin sanderach (obtained from Tetraclinis articulata), although sanderach does not have the chewable qualities of mastic.Evans 1996, Lawless 1995 A related species is Pistacia vera, the pistachio nut.

History

Mastic resin was used in ancient Egypt as incense and to embalm the dead.Chevalier 1996 It has also been used as a breath sweetener and is chewed to preserve the teeth and gums. Mastic resin has been used as a flavoring in puddings, sweets, and cakes, and as the basis of a Greek liqueur called 'mastiche.'Pistacia 2017

Commercial applications of mastic resin include as an adherent for protecting luster in glass, porcelain, bone, wood, and metal. Mastic resin is used in alcoholic and nonalcoholic beverages, in some cosmetic mixtures and perfumes, in dentistry as an ingredient in filling material, and in toothpaste. The resin has been used traditionally as a chewing gum and for protection against lip dryness.Duru 2003

Chemistry

Mastic is an oleoresin containing approximately 2% volatile oil.Evans 1996, Windholz 1989 The resin contains alpha- and beta-masticoresins, masticin, mastic acid, masticoresene, and tannins.Chevalier 1996 Mastic is a complex mixture of tri-, tetra-, and pentacyclic triterpene acids and alcohols.Marner 1991 Reports of certain fractions from the plant include polymer fraction isolation/characterizationSanz 1992, van den Berg 1998 and acidic triterpenic fractions of mastic gum.Papageorgiou 1997

The essential oil component in mastic contains more than 70 compounds, some of the primary constituents being alpha-pinene, myrcene, caryophyllene, beta-pinene, linalool, and germacrene D.Calabro 1974, Calabro 1974, Magiatis 1999, Papageorgiou 1991, Papageorgiou 1981 Another report lists certain percentages of essential oils from galls and aerial parts of the plant, such as sesquiterpene hydrocarbons (47%), beta-caryophyllene (13%), and cadinene (8%).Fernandez 2000 Essential oil composition in the species P. lentiscus differs from region to region. Reports from the areas of Chios,Katsiotis 1984 Egypt,De Pooter 1991 and CorsicaCastola 1996 are available. The chemical composition of the essential oil in mastic also changes with solidification and storage,Papanicolaou 1995 as well as with the time of year in which samples are taken.Medina 1979 Chemical composition of various parts of the plant has been discussed, including of the leaves, fruits, and aerial parts.Boelens 1991, Bonsignore 1998, Fleisher 1992, Wyllie 1990 Lipids in the bark of P. lentiscus have been examined.Diamantoglou 1979

Uses and Pharmacology

The purported uses of mastic are diverse; however, clinical studies are generally lacking to support specific therapeutic applications. Limited reviews of the available evidence have been published.Dimas 2012, Rauf 2017

Antimicrobial effects

Activity against several bacterial and fungal pathogens is documented in the scientific literature. Clinical trials document oral antiseptic activity for use in dentistry.

In vitro data

Monoterpenes are the primary chemical components contributing to the antibacterial activity of mastic oil against gram-positive and gram-negative strains.Koutsoudaki 2005, Tassou 1995 Activity against the following organisms is documented: Sarcina lutea, Staphylococcus aureus, Escherichia coli, and Bacillus subtilis.Iauk 1996

Mastic also exhibits antifungal activity. The growth of the fungi Candida albicans, Candida parapsilosis, Torulopsis glabrata, and Trichophyton spp. has been inhibited by mastic.Ali-Shtayeh 1999 Activity against the agricultural pathogens Rhizoctonia solaniDuru 2003 and Aspergillus flavusBarra 2007 has also been documented.

Clinical data

Antibacterial activity of mastic gum against oral pathogens, such as Streptococcus mutans and lactobacilli primarily associated with dental caries, has been documented. In a preliminary study of 25 periodontally healthy patients, mastic had antibacterial activity against S. mutans and mutans streptococci compared with placebo gum.Aksoy 2006 Another study reported similar inhibition of lactobacilli growth in the saliva of orthodontically treated patients with fixed appliances who were chewing mastic versus placebo gum.Aksoy 2007

Antioxidant effects

In vitro data

Antioxidant activity of P. lentiscus resin and essential oil against free radicals has been documented.Abdelwahed 2007, Assimopoulou 2005, Ljubuncic 2005, Longo 2007 Anthocyanins,Longo 2007 tannins (eg, gallic acid),Ljubuncic 2005 and tocopherol contentAbdel-Rahman 1976, Abdel-Rahman 1975, Cerrati 1992 all contribute to mastic's antioxidant activity.

Antiulcer activity

Mastic has demonstrated an ability to improve benign gastric ulcers.Huwez 1986 Triterpenic acids may be responsible for reducing Helicobacter pylori colonization in gastric inflammation and ulceration.Paraschos 2007

Animal and in vitro data

Microdilution assay revealed that mastic gum killed 50% of the isolates of H. pylori strains when tested at a concentration of 125 mcg/mL, and killed 90% at a concentration of 500 mcg/mL.Marone 2001

Results of a study in rats with induced gastric and duodenal ulcers suggested antisecretory and cytoprotective effects of mastic.Al-Said 1986 A study in which H. pylori SS1–infected mice were administered total mastic extract without polymer documented an approximately 30-fold reduction in H. pylori colonization; however, no attenuation in H. pylori-associated chronic inflammatory infiltration and activity of chronic gastritis was observed.Paraschos 2007 Another study of mice concluded that monotherapy with mastic was not effective in eradicating H. pylori infection.Loughlin 2003

Clinical data

In a double-blind, controlled clinical trial of 38 patients with duodenal ulcers, mastic 1 g given daily for 2 weeks exhibited ulcer healing effects, determined by endoscopy, compared with placebo.Al-Habbal 1984 A letter in the New England Journal of Medicine discusses this study, as well as others, and concludes that mastic 1 g daily for 2 weeks can rapidly cure peptic ulcers, and that mastic's antibacterial actions against H. pylori may partly explain these beneficial effects.Huwez 1998 However, in another clinical study of 8 patients, investigators concluded that mastic gum had no effect on eradicating H. pylori.Bebb 2003 Immunomodulatory effects of mastic gum have been observed in H. pylori–positive patients.Kottakis 2009

In another clinical study (N=148), mastic gum 350 mg taken 3 times daily for 3 weeks was effective in reducing pain associated with functional dyspepsia compared with placebo.Dabos 2010

Cancer

Animal and in vitro data

Despite several in vitro studies using human cancer cell lines that reported antiproliferative and proapoptotic effects, research reveals no clinical studies regarding the use of mastic in cancer.Balan 2007, He 2006, Loutrari 2006 Studies of rodents in the last 10 years are limited but report positive findings.Spyridopoulou 2017

Cholesterol effects

Animal and in vitro data

Animal studies have documented the beneficial effects of mastic on blood lipids.Andreadou 2016, Bomboi 1988 An in vitro study demonstrated antiatherogenic effects of P. lentiscus resin.Dedoussis 2004

Clinical data

In one study, patients receiving Chios mastic powder exhibited a decrease in serum total cholesterol, low-density lipoprotein, total cholesterol/high-density lipoprotein ratio, lipoprotein (a), apolipoprotein A-1, apolipoprotein B, liver enzymes, gamma-GT levels, and glucose levels.Triantafyllou 2007

Crohn disease

Animal data

In a study of rats with induced colitis, administration of mastic oil decreased inflammation and resulted in fewer intestinal tissue changes.Naouar 2016

Clinical data

A 4-week pilot study examined the efficacy of mastic in patients with mild to moderate active Crohn disease (N=18). Patients received mastic capsules (6 capsules per day [mastic 0.37 g per capsule]) (n=10) or control (n=8). Mastic was effective in regulating inflammatory mediators such as C-reactive protein, interleukin 6, tumor necrosis factor–alpha, and monocyte chemotactic protein-1 in plasma, as well as oxidative stress. Mastic therapy induced remission in 7 of the 10 patients, and nutritional status also improved in patients receiving mastic therapy.Kaliora 2007

Diabetes

Animal data

Older reports of antidiabetic effects in rodents exist in the literature.Eskander 1995

Hypertension

In vitro data

Older reports of hypotensive effects of P. lentiscus exist in the literature.Sanz 1992, Sanz 1993

Insecticide

In vitro data

According to older reports, mastic may possess insecticidal properties.Pascual-Villalobos 1998

Surgical wound adhesive

Clinical data

In a comparative study, mastic gum (Mastisol) adhesive plus surgical adhesive strips exhibited the strongest adhesion when compared with 4 other anchoring methods.Mikhail 1986, Mikhail 1989 Mastic gum adhesive has a lower incidence of postoperative contact dermatitis and skin discoloration,Lesesne 1992 and provides increased adhesiveness compared with compound tincture of benzoin.Yavuzer 2005

Dosing

Mastic resin at a dosage of 1 g daily has been studied for the treatment of duodenal ulcer.Al-Habbal 1984

Various commercial products are available to help eliminate H. pylori bacterium in the stomach (implicated in a number of GI complaints), including Mastika, which contains mastic gum 250 mg in capsule form. Manufacturer dosage guidelines recommend 4 capsules orally before bed for 2 weeks, followed by a maintenance dosage of 2 capsules daily.Mastic 2000

Pregnancy / Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

Most adverse reactions are associated with hypersensitivity to the plant species or with allergic reactions.

Toxicology

Most toxic effects related to mastic or P. lentiscus involve allergic reactions. The plant pollen is a major source of allergic reactions.Cvitanović 1994, Keynan 1987, Keynan 1997 The first report of immunological reactions to pollen extracts of the Pistacia genus occurred in 1987.Keynan 1987 A monographic review of mastic's chemistry, pharmacology, and toxicity is available.Ford 1992 Children ingesting mastic may develop diarrhea.Kang 2007

A 13-week toxicity study in rats documented changes in hematological parameters, including increased white blood cell and platelet counts. Increases in total proteins, albumin, and total cholesterol were also documented. Liver weights increased in a dose-dependent manner, and decreased body weight was documented at high doses.Janakat 2002 Some studies report hepatoprotective effectsLjubuncic 2005 of aqueous extracts of P. lentiscus, while others identify hepatotoxic effects.Janakat 2002

References

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