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Slippery Elm

Medically reviewed by Drugs.com. Last updated on Jan 1, 2019.

Scientific Name(s): Ulmus rubra Muhl.
Common Name(s): Indian elm, Moose elm, Red elm, Slippery elm, Sweet elm

Clinical Overview

Use

The mucilaginous property of slippery elm has been used in traditional medicine to treat multiple conditions; however, no clinical studies exist to support these applications. Although limited studies have investigated the antioxidant and anti-inflammatory potential of slippery elm, the information from these studies does not provide any recommendations for use.

Dosing

No clinical studies exist to support dosage guidelines. Traditional use suggests a dosage of 1 to 3 tsp of slippery elm powder in 240 mL of water, up to 3 times a day.

Contraindications

Contraindications have not been identified.

Pregnancy/Lactation

Avoid use in pregnancy. Abortifacient effects have been described, although they may be related to vaginal use of whole bark pieces to induce abortion. Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented. Because the mucilaginous property of slippery elm may decrease absorption rates of other medicines, it may be beneficial to separate slippery elm doses from those of other medicines by 2 to 3 hours.

Adverse Reactions

Oleoresins from several Ulmus species have been reported to cause contact dermatitis, and the pollen of slippery elm is a known allergen.

Toxicology

Research regarding the toxicity of slippery elm is limited.

Scientific Family

  • Ulmaceae (Elm)

Botany

The genus Ulmus contains 18 species of deciduous shrubs and trees.Hocking 1997 The slippery elm tree is native to eastern Canada and to the eastern and central United States, where it is found most commonly in the Appalachian Mountains. The tree’s rough bark has vertical ridges and is reddish-brown on the trunk and gray-white on the branches. The slippery elm can grow up to 18 to 20 m in height.Chevallier 1996 In the spring, dark brown buds appear at the branch tips and open into small, clustered flowers.Reader's Digest 1986, USDA 2006 White elm (U. americana) is a related species and has been used for similar medicinal purposes.Chevallier 1996 A synonym is Ulmus fulva Michx.

History

American Indians and early North American settlers used the inner bark of the slippery elm not only as a material for constructing canoes, shelters, and baskets, but also as a poultice and as an ingredient in a soothing drink.Chevallier 1996, Duke 2002, Tyler 1994 Upon contact with water, the inner bark yields a thick mucilage or demulcent that was used as an ointment or salve to treat urinary tract inflammation. It was also applied topically for cold sores and boils. A decoction of the leaves was used as a poultice to remove discoloration around blackened or bruised eyes. During the American Revolution, surgeons treated gunshot wounds with a similar poultice.Reader's Digest 1986 Early North American settlers boiled bear fat with the bark to prevent rancidity.Duke 2002, Hocking 1997 In the late 19th century, a preparation of elm mucilage was officially recognized in the United States Pharmacopoeia. Other traditional uses of the plant as a demulcent, emollient, and antitussive have been reported.Lewis 1977

Chemistry

Slippery elm contains carbohydrates, including starches, with mucilage being the major constituent,Duke 1992 as well as hexoses, pentoses, and polyuronides.Chevallier 1996, Newall 1996 Other constituents include sesquiterpenes, calcium oxalate, cholesterol (and other phytosterols), and tannins.Chevallier 1996, Lewis 1977, Newall 1996

Uses and Pharmacology

Antioxidant

Animal data

Screening studies have revealed peroxynitrite scavenging activity in the constituents of slippery elm,Choi 2002 as well as evidence of superoxide scavenging in colorectal tissue obtained from patients with inflammatory bowel disease who were treated with slippery elm.Langmead 2002 Another screening study described weak tumoricidal effects for slippery elm.Mazzio 2009

Clinical data

No clinical data exist regarding the use of slippery elm as an antioxidant. Slippery elm is one of several ingredients in the dietary supplements Essiac and Flor Essence, for which antioxidant activity has been attributed,Leonard 2006, Saleem 2009 but the US Food and Drug Administration (FDA) has not approved either product to treat cancer or any other medical condition.NIH 2015

Anti-inflammatory

Animal data

No animal data exist regarding the anti-inflammatory activity of slippery elm.

Clinical data

One open-label study evaluated slippery elm, in combination with other natural products, for the treatment of symptoms of irritable bowel syndrome (IBS).Hawrelak 2010 A small study of patients with either constipation- or diarrhea-predominant IBS investigated slippery elm mucilage combined with another polyanionic saccharide (sucrose octasulfate); clinically relevant symptom reduction occurred within approximately 48 hours.McCullough 2013 A study evaluating 5 cases of psoriasis found that daily consumption of slippery elm, in combination with saffron tea, may result in improved psoriasis severity scores.Brown 2004

Mucilage

Animal data

No animal data exist regarding indications for slippery elm as a mucilage.

Clinical data

The mucilaginous property of slippery elm has been used to treat multiple conditions; however, no clinical studies exist to support such applications.

Dosing

No clinical studies exist to support dosage guidelines. Traditional use suggests a dosage of 1 to 3 tsp of slippery elm powder in 240 mL of water, up to 3 times a day. Commercial preparations of liquid bark extract are available as are capsules containing 340 mg of slippery elm powder.Duke 2002

Pregnancy / Lactation

Avoid use in pregnancy. Abortifacient effects have been described, although they may be related to vaginal use of whole bark pieces to induce abortion.Duke 2002, Rotblatt 2002 Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented. Because the mucilaginous property of slippery elm may decrease absorption rates of other medicines, it may be beneficial to separate slippery elm doses from those of other medicines by 2 to 3 hours.

Adverse Reactions

Oleoresins from several Ulmus species have caused contact dermatitis, and the pollen of slippery elm is a known allergen.Duke 2002

Toxicology

Research regarding the toxicity of slippery elm is limited.

Index Terms

  • Ulmus americana
  • Ulmus fulva Michx.
  • White elm

References

Brown AC, Hairfield M, Richards DG, McMillin DL, Mein EA, Nelson CD. Medical nutrition therapy as a potential complementary treatment for psoriasis--five case reports. Altern Med Rev. 2004;9(3):297-307.15387720
Chevallier A. The Encyclopedia of Medicinal Plants: A Practical Reference Guide to Over 550 Key Herbs and Their Medicinal Uses. New York, NY: DK Publishing; 1996:144.
Choi HR, Choi JS, Han YN, Bae SJ, Chung HY. Peroxynitrite scavenging activity of herb extracts. Phytother Res. 2002;16(4):364-367.12112294
Duke J. Handbook of Biologically Active Phytochemicals and Their Activities. Boca Raton, FL: CRC Press; 1992.
Duke J, Bogenschutz-Godwin M, duCellier J, Duke P. Handbook of Medicinal Herbs. 2nd ed. Boca Raton, FL: CRC Press; 2002.
Hawrelak JA, Myers SP. Effects of two natural medicine formulations on irritable bowel syndrome symptoms: a pilot study. J Altern Complement Med. 2010;16(10):1065-1071.2095496210.1089/acm.2009.0090
Hocking G. A Dictionary of Natural Products. Medford, NJ: Plexus Publishing; 1997:826-827.
Langmead L, Dawson C, Hawkins C, Banna N, Loo S, Rampton DS. Antioxidant effects of herbal therapies used by patients with inflammatory bowel disease: an in vitro study. Aliment Pharmacol Ther. 2002;16(2):197-205.11860402
Leonard SS, Keil D, Mehlman T, Proper S, Shi X, Harris GK. Essiac tea: scavenging of reactive oxygen species and effects on DNA damage [published online October 13, 2005]. J Ethnopharmacol. 2006;103(2):288-296.16226859
Lewis WH, Elvin-Lewis MP. Medical Botany: Plants Affecting Man’s Health. New York, NY: J Wiley; 1977.
Magic and Medicine of Plants. Pleasantville, NY: Reader's Digest Association; 1986:385.
Mazzio EA, Soliman KF. In vitro screening for the tumoricidal properties of international medicinal herbs. Phytother Res. 2009;23(3):385-398.18844256
McCullough RW. Rapid (48–96 hour) symptom-sign relief of ROME III irritable bowel syndrome (IBS), functional heartburn (FH) & postprandial distress syndrome (PDS) using cross-linked polyanionic saccharides: an implication for pathophysiology. Gastroenterology. 2013;144(5 suppl 1): S-932–S-933.
National Cancer Institute. US National Institutes of Health. Essiac/Flor Essence (PDQ). Updated January 7, 2015. http://www.cancer.gov/about-cancer/treatment/cam/patient/essiac-pdq/#link/_29. Accessed November 20, 2015.
Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-Care Professionals. London, England: Pharmaceutical Press; 1996:248.
Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus; 2002.
Saleem A, Walshe-Roussel B, Harris C, et al. Characterisation of phenolics in Flor-Essence--a compound herbal product and its contributing herbs. Phytochem Anal. 2009;20(5):395-401.19609882
Tyler V. Herbs of Choice: The Therapeutic Use of Phytomedicinals. Binghamton, NY: Pharmaceutical Products Press; 1994:93,94.
Ulmus rubra Muhl. USDA, NRCS. The PLANTS Database. http://plants.usda.gov, 30 May 2006. National Plant Data Team, Greensboro, NC 27401-4901 USA. Accessed 2015.

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This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

Further information

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