Article published in Pathways Magazine Winter 2012-13 issue:

By Jim Duke and Helen Lowe Metzman

Jim’s Rant on Bitters:

Where once the green trees were kissed by the sunrise
There’s a highrise ‘tween the sunrise and the smog in your eyes.
All the other flow’rs got twisted by the herbicide squirt;
The last dandelion’s laughing, deserved bitter dessert. (HerbAlBum, 1985)

Perhaps one of the healthiest recommendations in the Bible is to “eat with bitter herbs,” anticipating by a couple millennia the tardy appeal by the National Institutes of Health (NIH) to eat your leafy veggies. Helen and I are going to make that suggestion also. The bitter herbs of the Bible have variously been interpreted to include chicory, dandelion, endive, lettuce, sheep sorrel, watercress, and possibly fenugreek. Some have even suggested rocket, which I find more bitter than the endive, lettuce, and watercress.

In the Green Farmacy Garden, we have a more exhaustive list of bitters—some weak, some strong, and many of them invasive weeds, but free to us for the harvesting. They are: air potato, alfalfa, aloe, American and Asian ginseng, angelica, artichoke, asparagus, baical skullcap, balmony, barberry, bayleaf, bearberry, blackberry lily, black cohosh, blessed thistle, blue cohosh, boneset, bottle gourd, burdock, cascara sagrada, chickweed, chicory, Chinese foxglove, corydalis, cranberry, creat, dandelion, dogwood, dong quai, Dutchman’s breeches, Echinacea, eclipta, eleuthero, ephedra, fennel, feverfew, forsythia, fo ti, fringetree, gotu kola, goldenseal, goldthread, hawthorn, hops, horehound, horseradish, horsetail, huang qi, Indian valerian, juniper, lesser periwinkle, licorice, magnolia vine, mate, mayapple, milkthistle, mugwort, nandina, neem, nettle, Oregon grape, pawpaw, phyllanthus, pot marigold, redroot sage, rhubarb, rose-of-Sharon, rue, saw palmetto, self-heal, shatavari, sida, skullcap, southernwood, sweet annie, tansy, tulip tree, tulsi, turmeric, vervain, watercress, wild yam, willow, wolfberry, woodruff, wormwood, yellow dock, yellowroot, yerbasanta, and yucca.

All of these bitter herbs contain many important nutraceuticals, which primitive and modern agriculture tend to select against, as seeds of more palatable variants are saved and more bitter ones discarded. In other words, modern agriculture selectively breeds to diminish the bitter nutraceuticals, making them less bitter and tastier, but thereby also reducing their medicinal value. I suspect that a half cup a day each of seven of these bitter herbs would lower the incidence of many diseases of modern man, some by as much as seven-fold. Instead of following the NIH directive, maybe you should strive for seven veggies a day, maybe even seven bitter herbs.

For example, among the many diseases for which the maligned dandelion is useful are some of the most advertised ailments of Americans. I will wager that if you have the much-touted acid-indigestion, dyspepsia, gastroesophageal reflux disease (GERD), and heartburn and/or indigestion, dandelion can help. But I will also wager that if you go to your doctor, he or she is more liable to prescribe such things as (alphabetically from A to Z): Alka-Seltzer™, Axid®, Bromo-Seltzer, Duracid™, Gaviscon®, Maalox®, Mylanta®, Nexium®, Pepcid®, protein-pump-inhibitors (PPIs), Prevacid®, Prilosec®, Rolaids®, Tagamet®, Tums®, and Zantac®.

These medicines are all mentioned in a great book I am tardily reviewing, Why Stomach Acid is Good for You, by Jonathan V. Wright, MD, and Lane Lanard, PhD (2001). Most of them are also mentioned in Consumer Reports on Health (CRH) (24, No. 7, 2012). The CRH is usually a bit more conventional than Jonathan Wright, a great holistic physician, and me, a mediocre botanist. Under the title, Soothe the Fire in Your Belly, CRH has a picture that looks like a hot dog on fire (one item on Wright’s list responsible for firing up acid indigestion). CRH tells us that the average person with GERD spends an estimated $3,355 a year on medications, etc., to help control symptoms—that’s nearly ten dollars a day! And more than 50 million U.S. citizens experience heartburn every month, with about 15 million enduring daily flare-ups.

One prescription drug proton-pump-inhibitor (PPI), Nexium®, earned more than $6 billion in 2011. CRH admits that PPIs are overused, overly hyped by Big Pharma. According to CRH, “studies have found that up to 70% of people who take a PPI may not have GERD and may not need such a potent, expensive medication” (CRH, p. 5). CRH enumerates some serious side effects of PPI’s, including bone fractures, Clostridium, diarrhea, gastrointestinal problems, muscle spasms, osteoporosis, and pneumonia.

Unlike CHR, Wright and Lane, Helen and I suggest cheap bitters might do more good for the average American, especially older Americans. In their book, Wright and Lane list barberry, caraway, dandelion, fennel, gentian, ginger, globe artichoke, milk thistle, peppermint, the famous wormwood, and yellow dock as the most common bitters used in western medicine. We have them all in the Green Farmacy Garden, except the gentian. We have always fared badly with gentian, even when we started with nursery-bought plants. But we have the king of the bitters, creat (Andrographis paniculata). It is time we harvested it before frost and get our bitters ready for the window, and for those days when it is too cold to harvest the ubiquitous dandelion. Either dandelion or creat could keep our digestive juices flowing.

Andrographis paniculata, Creat, flower

In Wright’s Takoma clinic, over 90% of the people over 40 complaining of gas, heartburn, and indigestion were carefully tested for acid and were found low, not high, in stomach acid. On p. 124, Wright rephrases that as “more than 9 out of ten of us who suffer from so-called ‘acid indigestion’ actually have lack of acid indigestion.” Yet Americans and their allopaths foolishly treat lack of acid with antacids.

Hyperacidity, or High Acid, is much overhyped in the press; hypoacidity, or Low Acid, which probably more of us have, is scarcely mentioned. Dandelion as a bitter can help in many cases of hypoacidity, more often the culprit in older Americans. The allopaths do not know, as do I, that dandelion has level 2 evidence for many indications, not just indigestion (dyspepsia), the subject of today’s rant. (Note: Jim Duke assigns a rating score of level 2, “if the aqueous extract, ethanolic extract, or decoction or tea derived from the plant has been shown to have the activity, or to support the indication in clinical trials.”) Dandelion is probably most familiar of the many bitters that can help in indigestion. It is approved in Europe also for bladder stones, bronchitis, gas, hepatitis, kidney stones, urinary difficulties, and lack of appetite.

My friends Simon Mill and Kerry Bone have a detailed account of bitters in their excellent book, Principles of Herbal Pharmacology (2000), which notes, “Bitter drinks taken before meals are still called apertifs.” Many Europeans believe, with good reason, that bitters are a cheap and safe corrective for indigestion. Here in the Green Farmacy Garden, I myself had not gotten into the European school of thought. But Helen, having been exposed to British Simon Mills and Australian Kerry Bones, and now me through osmosis here in the garden, would recommend a dash of bitters with every meal to prevent dyspepsia. I have on my desk as I write this half a jar of Angostura bitters. My wife Peggy’s mother, Hazel Wetmore Kessler, had a strongly British air about her. Hazel lived with us her last years, and while she was alive, instead of having a dash of bitters with each meal, she had a dash of angosturas with her whiskey sour. That was at our Happy Hour preceding dinner. I now have a dash of Angostura with my gin and ginger ale. (Ginger is also viewed as a bitter.)

The Benefits of Bitters: A Look at the Literature

Many Europeans believe that bitters work by stimulating the digestive juices—bile, gastrin, HCl, pepsin, pancreatic enzymes, even saliva—and not by turning them off as most over-the-counter (OTC) and prescription drugs do. Unlike the OTC’s, you do not even have to consume the bitter to have this effect. Science has proven that in some people, some bitters need only to be tasted to get those juices flowing.

The more I looked into the literature, searching for solutions to my own litany of conditions, the more I have finally become convinced. I have been a high fiber freak for decades, participating in at least five dietary fibers studies at the USDA in Beltsville. Two of the study leaders warned me that I might be stripping myself of minerals. Wright and Lane specifically mention yet another USDA researcher, Elaine T Champagne, PhD, stressing the dangers of hypoacidity, inadequate pepsin production, and poor protein metabolism. Champagne adds that taking most of those commercial antacids named earlier in this rant ultimately generates the same problem. The bitter truth is bitters can prevent many if not all of those problems from which I am probably suffering.

Historically, many American Indians, e.g. Apache, Cherokee, Iroquois, Kiowa, Malecite, Menominee, Meskwaki, Micmac, Mohegan, Ojibwa, etc., ate dandelion, often boiled as a potherb. The Winnebago make wine from the flowers when someone marries. The tender leaves are valued worldwide as a potherb. Dandelion is sometimes eaten raw in salads, but often blanched like endive and used as a green; it is frequently cooked with salt pork or bacon to enhance the flavor. Roots are sometimes pickled. Ground roasted roots are used for dandelion coffee, and sometimes are mixed with real coffee. Redneck me, I like the Potawatomi recipe, i.e., cooked with vinegar and maybe with a little pork or venison.

I also like the title “Dyspepsi Kola” used in my best book The Green Pharmacy (Rodale Press, 1997), which consists of one dash each, as available, of angelica, anise, chamomile, coriander, fennel, ginger, rosemary and turmeric, and two dashes marjoram and peppermint. Today I would add licorice, having relieved my dyspepsia several times with DGL (deglycyrrhinated licorice). But when I wrote that book, I was not aware of the multitude of health benefits of the classical bitters.

In Herbal Drugstore (Rodale Press; White, et. al., 2000) Linda White, MD, says, “You have to eat the bitter to get the digestive effect.” Not everyone would agree with this; some say all you need do is taste. However, Dr. White, like most Europeans, suggests a bitter containing gentian, mugwort or wormwood 3 times a day before meals, 1/8-1/2 teaspoon or a full dropper. She also suggests bitters to boost overall energy, improve endocrine function, and improve digestive functioning, even hypothyroidism.

In Clinical Botanical Medicine (2003), authors Yarnell, Abascal and Hooper recommend bitters for depression among the elderly. Gut function declines with age. Many over 50 have low levels of gastric acidity. They quote famed German physician, Rudolph Weiss, who found the effects of bitters increases with prolonged usage. Weiss claimed that bitters would neutralize the negative influence of chronic stress on digestion partially by stimulating the liver. Their table for choosing a bitter herb lists gentian first, then dandelion, followed by (in order) wormwood, Oregon grape, swertia, yarrow, ginger, and horehound.

I suspect if you ask 100 herbalists for their favorite bitters, you will end up with an even longer list. I shall resume chewing my simple mugwort as another approach to bitters; or sip on Helen’s very interesting complex of yellowroot, goldenseal, wormwood, dandelion leaf, dandelion root, chicory, boneset, feverfew, skullcap, fennel seed, anise hyssop, sweet cicely, hops, and brandy.

Chicory, Cichorium intybus

Another great book I should mention is Botanical Medicine for Women’s Health (2010), written by a friend I admire, Aviva Romm, MD. She also happens to be, first, an herbalist, second, a midwife, and finally, a physician. Dr. Romm cites the usual bitters yarrow, wormwood, mugwort, barberry, centaury, boneset, gentian, goldenseal, horehound, chamomile, rue, tansy and last dandelion (They were ordinated by scientific names and dandelion was alphabetically last, not necessarily last.) Perhaps all of these share the beneficial activities she (and many other authors, including us) cites for bitters:

• Stimulate appetite;

• Stimulate release of digestive juices from pancreas, duodenum, and liver;

• Stimulate flow of bile, aiding in liver detox;

• Help regulate pancreatic secretions that regulate blood sugar, insulin and glucagon; and

• Help the gut wall repair damage.

Having accentuated the positives, Aviva also wisely discusses the cautions of counter indications, including gallbladder disease, gastritis, GERD (with which I have been diagnosed, rightly or wrongly), hiatal hernia, kidney stones, peptic ulcer, and pregnancy.

Hydrastis canadensis, Goldenseal flower above, roots below

Before Beginning With Bitters…

Because of the possibility of counter indications, I appreciate Wright’s cautious approach (p. 155) to identify first the cause of the problem before beginning with bitters. He tabulates some common causes, listed here, and to which I’ve added a few also suggested by the 2012 issue of the CRH as no-no’s. They are: alcohol; allergens; carbonated beverages; chocolate; citrus fruits and juices; coffee; fats; fried food (from CRH); garlic (CRH); mints (although I disagree; I think peppermint settles my upset stomach); onions (which I love); pizza (which I love; CRH); salsa (another love; CRH); spicy foods (more favorites) and tomato based foods (uh oh, my absolute favorites). There are so many things on this hit list that I love, I will try to moderate them and move on to bitters therapy without giving up my favorite foods.

If, after identifying the cause of your problem, eliminating potential causes does not do the trick, Wright and Lane suggest trying bitters, saying, “It is always preferable to try bitters before moving on to acid replacement therapy with HCL and pepsin.” If the bitters do not help, you could also try 1-2 tsp cider vinegar or lemon juice, perhaps with a little water, near the beginning of a meal. Then they suggest proteolytic enzymes. If you are still failing to help yourself, try to get an accurate measurement of your gastric acidity levels, which is, admittedly, easier said than done. A simple test with bicarbonate of soda, repeated three mornings in a row, suggested I was hypoacidic, just because I did not burp.

Ultimately failing with these gentle herbal approaches, it is best to see a gastroenterologist to check for serious esophageal or gastric problems. I suppose that even at age 83, I’ll do that if the bitters have not done the tricks I need. Nutritionists have advised me that for my rare and serious GERD attacks, I need proteolytic digestive enzymes like bromelain from pineapple, papain from papaya, and zingibain from ginger—a pleasant tropical, proteolytic, anti-GERD vegetarian fruit cocktail. Dr. Wright recommends non-vegetarian pancreatin after, not before, meals. All can help break the proteins down into needed amino acids.

A final rant! Those “ambulance-chasing” lawyers one sees advertising these days on TV always amuse me. Something like, “If you have taken drug X, recently reported to cause disease Y, call us right way if you have been hurt by disease Y. You may be entitled to compensation.”  And the same or another hungry law firm might say, drawing on the CRH report (p. 5), “If you have taken a PPI and experienced one or more of the following problems (bone fractures, Clostridium, diarrhea, enterosis, muscle spasms, osteoporosis, and/or pneumonia), call us right away! You may be entitled to compensation.”

Those lawyers ought to love Wright & Lane’s book, which indirectly accuses all the antacid drugs so widely advertised on TV as possibly being partially responsible for a host of conditions, including acne rosacea, Addison’s disease, aging, allergic reactions, bacterial infections, celiac disease, childhood asthma, cholera, chronic autoimmune hepatitis, depression, dermatitis, diabetes (type 1), eczema, gallbladder disease, gallstones, gastric cancer, graves disease (hyperthyroid), hepatosis, lupus erythematosus, macular degeneration, multiple sclerosis, myasthenia gravis,  osteoporosis, pernicious anemia, polymyalgia rheumatica, Reynaud’s syndrome, rheumatoid arthritis, scleroderma, Sjogren’s syndrome, ulcerative colitis, urticaria, and vitiligo (p. 41, p. 103). Conversely, and still somewhat facetiously, dandelions (and/or other bitters) may help prevent such, trivially or significantly.

Bitters taken three times a day
Might keep your heartburn away
Cheaper than OTCs and PPIs

Taraxacum officinalis, Dandelion seed head

Bitters better than you realize.
A bitter a day
Keeps the doctor away,
A PPI a day

May put you away.

Dandelion

Twice or thrice a day
It’s worth the trying
Keep heartburn away.
~Anon. poet (the bitter end)

Additional Sound Bites On Bitters.  By Helen Lowe Metzman

Bitters are difficult to take—a bitter sorrow, a bitter winter, the bitter Jim Duke, the bitter election, the bitter pill, the bitter truth. But, as Jim Duke rants above, when it comes to stimulating digestion, bitter herbs are exactly what to take. I concur with Jim but also want to dig deeper to understand. Why are plants bitter? How do bitters work in our bodies to promote digestion? Are we in the midst of a bitter revival?

Due to their immobility, some plants protect themselves from predation by secreting unpalatable natural anti-fungal, anti-parasitic, anti-microbial and pesticidal compounds known as secondary constituents. Some of these secondary metabolites that help to deter herbivory are of a bitter flavor and classified as monoterpene iridoids, sesquiterpenes, diterpenes, triterpenes, alkaloids, and phenols. Several members of the Gentian family (Gentianaceae) and the aster family (Asteraceae) contain many of these bitter constituents. Gentian (Gentiana lutea), one of the most bitter and widely used plants in digestive bitters, contains monoterpene secoiridoid glycosides. The bitter qualities in wormwood (Artemesia absinthium), dandelion (Taraxacum officinale) and artichoke (Cynara scolymus) are from sesquiterpene lactones. Bitter alkaloids such as berberine and hydrastine are found in goldenseal (Hydrastis canadensis). Hops obtain their bitterness from resin glands containing alpha acids such as humulone on the female flowers called strobiles.

As two-legged hungry omnivorous mammals, we evolved in a world filled with tempting plants. By necessity, our early ancestors discerned by trial and error what to and what not to eat. There were no field guides to edible and medicinal plants, simply self-discovery or knowledge passed from tribe to tribe. While some people learned to plump up on sweets from fruit or from proteins from nuts and seeds, some perished by ingesting harmful quantities of extremely fatal plants like poison hemlock, castor beans, or jimsonweed. But centuries ago, others learned that in the right dose and by regulation of intake, plants with bitter tastes not only warn of potential toxicity but also aid with belly aches. Thanks to Jim Duke and Steven Foster for writing the Peterson Guide to Medicinal Plants of Eastern and Central North America, so people like me, whose parents never taught us how to use plants as medicine, could learn how to differentiate between the look alike poisonous hemlock and the edible carrot.

It has been a longstanding belief that bitters must be tasted before meals to activate the salivary glands, increase appetite, and stimulate digestion. I was fortunate to receive an email from Kerry Bone containing a 2011 paper by Marco Valussi, “Functional foods with digestion-enhancing properties,” in the International Journal of Food Sciences and Nutrition (PubMed: 22010973), which shed new light on the physiology of bitters and our guts. The paper points out that when we eat plants containing bitter compounds, taste buds on the tongue and throughout the gut are notified of the potential toxins. Signals from the tongue’s bitter receptors are sent directly to the central nervous system (CNS) alerting the brain to fire the vagus nerve that innervates the gut to promote gastric secretions.

Another signal originates from human taste receptor cells, G-protein-coupled receptors, the T2Rs, located on the tongue and throughout the gut. These T2R’s, when activated, trigger enteroendocrine cells to secrete gut peptides, particularly cholecystokinin (CCK). With the release of CCK, the gut gets the message for bile secretion, gastric motility and secretion, pancreatic digestive enzymes, and a reduction of gastric emptying. The action, originating from the release of CCK, is to maximize the digestion of complex carbohydrates, essential fatty acids and vitamins, and minimize the absorption of bitter compounds. The paper suggests that since there are bitter receptors located throughout the gut lining, bitters may not need to be tasted on the tongue in order to be effective and could possibly be administered in the form of a tablet or capsule and delivered directly into the gut.

Although Jim Duke often speaks of his yin/yang valley with its yang south facing slope and its yin north facing slope, this intelligent western trained 83-year old botanist has never fully embraced the notion of plant energetics. (I must confess that I have a far greater grasp of plant energetics than Jim, but at times am still baffled by the application of the terms and usage.) Traditional Chinese Medicine (TCM) herbalists and many trained in the use of North American herbs view plants energetically as either yin, yang, hot, cold, dry, moist, neutral, and with tastes of salty, sweet, bitter, acrid, and sour.

Bitters are energetically considered cold, drying and yin. Simon Mills, in Out of the Earth: The Essential Book of Herbal Medicine (Viking, 1991), writes that bitters are directed by the spleen to the heart and flow downwards in the body, and help to treat “deep-seated clinical problems.” He also expresses that bitters are to “sedate, dry and to harden.” Bitters “sedate” a hot temperament as in a fiery individual or in an inflammatory health condition; bitters “dry” damp-heat in a boggy condition (think of a long lasting congestion with lots of mucus); and bitters can “harden” or “consolidate” by “improving assimilation and nourishment.” Cooling and drying bitters such as goldenseal (Hydrastis canadensis), barberry (Berberis spp.) and Oregon grape (Mahonia spp.) with their alkaloids stimulate and help sluggish digestion and the healing of mucous membranes and chronic damp infections. Keep in mind that since bitters are cool energetically, in situations where the person may be cold, it is important to add warming herbs like Angelica (Angelica archangelica) and ginger (Zingiber officinale)to debilitating illnesses and digestion.

History is still in the making, and a bitter revival continues—bitters not just as a digestive aid, but also with the young and hip connoisseurs of food and beverages. Van Gogh’s famous drink of absinthe made with the bitter wormwood (Artemisia absinthium) is not only a main ingredient in vermouth and drank as an aperitif, but was also used in ancient Egypt and included in Ebers Papyrus (ca. 1550 BC) as a medicinal. As far back as two thousand years ago, Mithridates and his herbalist companion, Crateuas, are thought to have included the bitter gentian and possibly thistles in their formulas that served as antidotes for poisons. Dr. Phillipus Paracelsus first formulated the time-tested Swedish Bitters, containing up to 14 herbs, in the 1500’s. The formula was lost but eventually resurfaced in the 1800’s by the Swedish Claus Samst. The bitters went through yet a third revision in the 20th century by Austrian herbalist Maria Treben and her book, Health Through God’s Pharmacy, which highly promoted and touted them as panacea for many ailments.

The misunderstood bitter dandelion greens, despised by suburban homeowners and caricatured on TV while being sprayed with pesticides like Roundup, are now being sold at exorbitant prices in health food stores and local chain groceries. Chicory (Cichorium intybus) roots roasted and ground make a delicious alternative to coffee (minus the caffeine) and are used as a bitter beverage after meals. Coffee (Coffea arabica) is not just a wake-up beverage, but also a digestive aid for foods and a primary medicinal in the Middle East and throughout the world. Europeans have had longstanding culinary practice of eating a salad with endive or arugula and taking a little squirt of bitters with their cocktails before meals to stimulate digestion.

Humulus lupulus, Hops strobiles

Hops (Humulus lupulus) are a bitter relaxant found in beer and also in sleep formulas. Gentian (Gentiana lutea), found in the high Alps, is one of the most popular of classic bitter remedies and an essential ingredient found in many bitter formulas like Angostura. Urban Moonshine, made in Vermont, has produced delicious bitter digestive aids made with the addition of citrus and maple syrup. Boston Bittahs – Bittermens are formulated with citrus, chamomile and more citrus. Dr. Adam’s Boker’s Bitters, originally created in 1828, has been reformulated and released in August 2009. Bitter Truth Bitters, with their myriad flavors, are a retro apothecary of cocktail tonics. Herb Pharm’s Digestive Bitters dependably are found on the shelves of most health food stores. Sweetgrass Farm Winery & Distillery in Maine sells Bitter Blueberry to accompany bitter drinks, bitter humor and bitter cold.

We, at the Green Farmacy Garden, have gotten onto the bitters’ bandwagon. This past autumn, in anticipation of a class focusing on this subject, we made a brew of “Dr. Duke’s Bitters” to serve to the students and to take before our noontime soup. The brew’s ingredients include goldenseal root, yellowroot, dandelion root, chicory root, wormwood leaf, dandelion leaf, hop strobiles, boneset leaf, feverfew leaf, skullcap leaf, fennel seed, anise hyssop leaf, sweet cicely root and brandy. Come by the garden, visit these bitter herbs, and take a sip of this concoction. We guarantee this is a very easy bitter to swallow.