Natural stomach remedies worth considering

If your stomach is upset, a number of products offer relief: over-the-counter antacids such as Maalox, Tums, or their store-brand versions. There are also various herbal stomach remedies you can try. But choosing among them can be confusing at best and harmful at worst.

For one thing, supplements come in many strengths and forms—herbs, pills, extracts, and teas. And unlike prescription drugs and most over-the-counter medications sold today, they don't have to be screened for safety and effectiveness by the Food and Drug Administration. While some have been used for thousands of years, few have been proved effective as stomach remedies. Still, there's enough evidence to consider some to be "possibly effective," according to Philip J. Gregory, Pharm.D., editor of the Natural Medicines Comprehensive Database (NMCD), which provides reliable information about the safety and effectiveness of dietary supplements.

One supplement that is possibly effective for easing an upset stomach is Iberogast, a product sold online. Its main active ingredient is thought to be clown's mustard plant, but the product also contains a number of other herbs, including angelica, caraway, celandine, German chamomile, lemon balm, licorice, milk thistle, and peppermint.

An analysis that combined the results of several prior studies suggests that taking 1 milliliter orally three times a day for four weeks significantly reduced the severity of acid reflux, cramping, nausea, stomach pain, and vomiting compared with a placebo. While generally safe, those herbs might have side effects, and some (especially celandine) may harm the liver or interfere with medications that you take.

• Artichoke leaf extract. Two forms, Cynara SL and Hepar SL forte, were found to combat a queasy stomach in a few studies. The extracts are generally safe but might cause an allergic reaction in people sensitive to ragweed and related plants.
• Ginger. It has been found to be "possibly effective" in treating morning sickness, postoperative nausea and vomiting, and vertigo. It's probably safe for most people, though pregnant women should talk with their doctor first.
• Papaya. Some people take extracts of the fruit to prevent and treat an upset stomach, but the NMCD says "there is insufficient reliable information" to rate its effectiveness. Avoid it if you are allergic to latex or take the blood-thinning drug warfarin (Coumadin and generic). Large doses have been found to be dangerous because they could cause small holes to form in the esophagus. Also, papaya supplements are possibly unsafe when used during pregnancy and while breastfeeding.
• Peppermint. While many people turn to this herb for stomach woes, the best evidence is for a product, not sold in this country, that combines specific amounts of it with caraway oil.

Supplements of these "good" bacteria, which live naturally in your gut, might help prevent or treat stomach upset caused by antibiotic-associated diarrhea, irritable bowel syndrome, or inflammation caused by Helicobacter pylori, a bacterium that can cause ulcers.

Choosing probiotic supplements is difficult since there are no standards for them. The NMCD recommends sticking to those, such as Culturelle (lactobacillus GG) and bifidobacterium, which have some evidence behind them as stomach remedies.

Eating yogurt that contains probiotics is an alternative. Yogurts that have the National Yogurt Association's "Live and Active Cultures" seal on the label contained viable bacteria at the time of manufacture.

Probiotic supplements need to be stored carefully, since they tend to lose their effectiveness over time. Check the label to see if a product should be refrigerated. If you're also taking antibiotic medications, probiotics are more likely to survive if you take them at least two hours before or after the antibiotic. Products containing bifidobacterium or lactobacillus are generally safe, though they can cause gas for a few days.

Herbal supplements can contain multiple ingredients, so it's hard to know which are the active ones. Moreover, analyses of dietary supplements sometimes find differences between labeled and actual ingredients. What can you do to help protect yourself? Follow this CRH advice:

• Look for the "USP Verified" mark. It indicates that the supplement manufacturer has voluntarily asked the U.S. Pharmacopeia (USP)—a nonprofit, independent, standards-setting authority—to verify the quality, purity, and potency of its raw ingredients or finished products. The USP maintains a list of verified products.
• Consult your doctor or pharmacist. Even helpful products can be harmful in some situations, such as when you're pregnant or nursing, have a chronic disease, or are about to undergo surgery. And some supplements interact dangerously with certain prescription and over-the-counter drugs. Your doctor or pharmacist can help steer you away from such problems if they know what supplements you're taking or plan to take.
• Consider waiting it out. If your stomach is upset after too much food or drink, time is on your side. Symptoms can subside within several hours, even if you take nothing at all.