What is dgl licorice

The authors of one study found that 8 of 11 Chinese herbal creams purchased without prescription in England contained a powerful steroid drug used to treat inflammatory skin conditions. Many of the same herbs that are helpful for peptic ulcers may also aid people with gastritis. Licorice root, for example, has been traditionally used to soothe inflammation and injury in the stomach.

Its flavonoid constituents have been found to stall the growth of H. However, there have been no clinical trials using licorice to treat gastritis. To avoid potential side effects, such as increasing blood pressure and water weight gain, many physicians recommend deglycyrrhizinated licorice DGL.

This form of licorice retains its healing qualities by removing the glycyrrhizin that causes problems in some people. Licorice root Glycyrrhiza glabra contains antiviral substances and ointments containing related substances are effective in treating herpes infections. While the use of topical licorice preparations to prevent or treat genital herpes has not been studied, some alternative healthcare practitioners recommend applying creams or gels containing licorice three to four times a day.

The Japanese herbal formula known as sho-seiryu-to has been shown to reduce symptom, such as sneezing, for people with hay fever. Sho-seiryu-to contains licorice , cassia bark, schisandra , ma huang, ginger , peony root , pinellia, and asiasarum root. The Chinese herb bupleurum , as part of the herbal formula sho-saiko-to, has been shown to have beneficial immune effects on white blood cells taken from people infected with HIV. Sho-saiko-to has also been shown to improve the efficacy of the anti-HIV drug lamivudine in the test tube.

One preliminary study found that 7 of 13 people with HIV given sho-saiko-to had improvements in immune function. Other herbs in sho-saiko-to have also been shown to have anti-HIV activity in the test tube, most notably Asian scullcap.

Therefore studies on sho-saiko-to cannot be taken to mean that bupleurum is the only active herb involved. Demulcents herbs may be used to treat indigestion and heartburn. These herbs seem to work by decreasing inflammation and forming a physical barrier against stomach acid or other abdominal irritants.

Examples of demulcent herbs include ginger , licorice , and slippery elm. Licorice protects the mucous membranes lining the digestive tract by increasing the production of mucin, a compound that protects against the adverse effects of stomach acid and various harmful substances.

The extract of licorice root that is most often used by people with indigestion is known as deglycyrrhizinated licorice DGL. Glycyrrhizin, which occurs naturally in licorice root, has cortisone-like effects and can cause high blood pressure , water retention , and other problems in some people. When the glycyrrhizin is removed to form DGL, the licorice root retains its beneficial effects against indigestion, while the risk of side effects is greatly reduced.

The usual suggested amount of DGL is one or two chewable tablets — mg per tablet , chewed and swallowed 15 minutes before meals and one to two hours before bedtime.

Although many research trials show that DGL is helpful for people with peptic ulcers , the use of DGL for heartburn and indigestion is based primarily on anecdotal information. A variety of herbs with weak estrogen-like actions similar to the effects of soy have traditionally been used for women with menopausal symptoms.

These herbs include licorice , alfalfa , and red clover. In a double-blind trial, a formula containing tinctures of licorice, burdock , dong quai , wild yam , and motherwort 30 drops three times daily was found to reduce symptoms of menopause. No effects on hormone levels were detected in this study. In a separate double-blind trial, supplementation with dong quai 4. A double-blind trial using a standardized extract of subterranean clover Trifolium subterraneum , a relative of red clover , containing 40 mg isoflavones per tablet did not impact symptoms of menopause, such as hot flashes, though it did improve function of the arteries.

An extract of red clover, providing 82 mg of isoflavones per day, also was ineffective in a week double-blind study.

In another double-blind study, however, administration of 80 mg of isoflavones per day from red clover reduced the frequency of hot flashes in postmenopausal women.

The benefit was noticeable after 4 weeks of treatment and became more pronounced after a total of 12 weeks. Licorice has been used by doctors as a topical agent for shingles and postherpetic neuralgia; however, no clinical trials support its use for this purpose.

Glycyrrhizin, one of the active components of licorice, has been shown to block the replication of Varicella zoster. Licorice gel is usually applied three or more times per day. Licorice gel is not widely available but may be obtained through a doctor who practices herbal medicine. Aloe vera juice has anti-inflammatory activity and been used by some doctors for people with UC. No significant side effects were seen. The amount of aloe used was ml approximately 3. Other traditional anti-inflammatory and soothing herbs, including calendula , flaxseed , licorice , marshmallow , myrrh , and yarrow.

Many of these herbs are most effective, according to clinical experience, if taken internally as well as in enema form. Enemas should be avoided during acute flare-ups but are useful for mild and chronic inflammation. It is best to consult with a doctor experienced with botanical medicine to learn more about herbal enemas before using them.

More research needs to be done to determine the effectiveness of these herbs. Licorice has a long and highly varied record of uses.

It was and remains one of the most important herbs in Traditional Chinese Medicine. Among its most consistent and important uses are as a demulcent soothing, coating agent in the digestive and urinary tracts, to help with coughs , to soothe sore throats , and as a flavoring. It has also been used in Traditional Chinese Medicine to treat conditions ranging from diabetes to tuberculosis. The two major constituents of licorice are glycyrrhizin and flavonoids.

According to test tube studies, glycyrrhizin has anti-inflammatory actions and may inhibit the breakdown of the cortisol produced by the body.

Licorice flavonoids, as well as the closely related chalcones, help heal digestive tract cells. They are also potent antioxidants and work to protect liver cells. In test tubes, the flavonoids have been shown to kill Helicobacter pylori , the bacteria that causes most ulcers and stomach inflammation. An extract of licorice, called liquiritin, has been used as a treatment for melasma, a pigmentation disorder of the skin.

There are two types of licorice, "standard" licorice and "de-glycyrrhizinated" licorice DGL. Each type is suitable for different conditions. The standard licorice containing glycyrrhizin should be used for respiratory infections, chronic fatigue syndrome or herpes topical. Licorice root in capsules, 5—6 grams per day, can be used. Concentrated extracts, — mg three times per day, are another option.

Long-term internal use more than two to three weeks of high amounts over 10 grams per day of glycyrrhizin-containing products should be attempted only under the supervision of a doctor. Licorice creams or gels can be applied directly to herpes sores three to four times per day.

DGL is prepared without the glycyrrhizin in order to circumvent potential safety problems see below , and is used for conditions of the digestive tract, such as ulcers. For best results, one — mg tablet is chewed three times per day before meals and before bed. This may be repeated three or four times per day. The flavonoids found in the extract of licorice Glycyrrhiza glabra known as DGL deglycyrrhizinated licorice are helpful for avoiding the irritating actions NSAIDs have on the stomach and intestines.

One study found that mg of chewable DGL taken together with each dose of aspirin reduced gastrointestinal bleeding caused by the aspirin. DGL has been shown in controlled human research to be as effective as drug therapy cimetidine in healing stomach ulcers. An Oriental herb formula containing Glycyrrhiza radix licorice root and Paeoniae radix white peony root successfully restored menses in a year-old woman who had developed amenorrhea lack of menstruation while taking risperidone.

Discontinuation of these herbs while the woman continued taking risperidone again led to disruption of her menses. In another study, treatment with this same formula restored menses in 6 of 18 women who had developed amenorrhea or oligomenorrhea infrequent menstruation from taking risperidone. Controlled research is needed to determine whether supplementation with licorice and peony might help prevent amenorrhea in women taking risperidone.

When applied to the skin, glycyrrhetinic acid a chemical found in licorice Glycyrrhiza glabra increases the activity of hydrocortisone. This effect might allow for less hydrocortisone to be used when combined with glycyrrhetinic acid, but further study is needed to test this possibility. The flavonoids found in the extract of licorice Glycyrrhiza glabra known as DGL deglycyrrhizinated licorice are helpful for avoiding the irritating actions aspirin has on the stomach and intestines.

The potent anti-inflammatory substance known as glycyrrhizin from licorice has been combined with isoniazid for treatment of tuberculosis. An older study found a benefit from combining the two compared to using isoniazid alone. Glycyrrhizin was given by injection, so it is not certain if licorice extracts containing glycyrrhizin would be as effective given by mouth.

The treatment required at least three months of administration. Test tube studies show that the herbal combination sho-saiko-to enhances the antiviral activity of lamivudine. Sho-saiko-to contains extracts of seven herbs, including Bupleuri radix, Pinelliae tuber, Scutellariae radix, Zizyphi fructus, ginseng Ginseng radix , licorice Glycyrrhizae radix , and ginger Zingibers rhizoma.

Controlled studies are needed to determine whether taking sho-saiko-to might enhance the beneficial effects of lamivudine. This interaction applies only to dermatological forms of this drug. Licorice Glycyrrhiza glabra may increase the side effects of potassium-depleting diuretics, including thiazide diuretics.

Thiazide diuretics and licorice should be used together only under careful medical supervision. At the time of this writing, no evidence was found of interactions between deglycyrrhizinated licorice DGL and any diuretic was found in the medical literature. Potassium deficiency increases the risk of digoxin toxicity. Excessive use of licorice plant or licorice plant products may cause the body to lose potassium.

Artificial licorice flavoring does not cause potassium loss. People taking digoxin should read product labels carefully for licorice plant ingredients. Licorice Glycyrrhiza glabra may enhance the side effects of potassium-depleting diuretics, including loop diuretics. Loop diuretics and licorice should be used together only under careful medical supervision. Some studies suggest DGL may be better for stomach or duodenal ulcers.

DGL may offer protection against ulcer formation when taken with aspirin. Pediatric Older children who have a sore throat can chew a piece of licorice root or drink licorice tea. Ask your doctor to help you determine the right dose for your child. DO NOT give a child licorice tea for more than a day without talking to your doctor. Never give licorice tea to an infant or toddler.

DO NOT use licorice for longer than a week without talking to your doctor due to the risk of potentially dangerous side effects.

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that can trigger side effects and that can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider in the field of botanical medicine.

Licorice with glycyrrhizin may cause serious side effects. Too much glycyrrhizin causes a condition called pseudoaldosteronism, which can cause a person to become overly sensitive to a hormone in the adrenal cortex. This condition can lead to headaches, fatigue, high blood pressure, and even heart attacks. It may also cause water retention, which can lead to leg swelling and other problems.

Although the dangerous effects mostly happen with high doses of licorice or glycyrrhizin, smaller amounts of licorice may cause side effects. Some people have muscle pain or numbness in the arms and legs. To be safe, ask your provider to monitor your use of licorice. Pregnant or breastfeeding women should not take licorice. Some studies suggest that taking licorice during pregnancy can increase the risk of stillbirth. Licorice may interfere with several medications, including the ones listed below.

If you are taking any medication, ask your doctor before taking licorice. ACE inhibitors and diuretics. If you are taking angiotensin converting enzyme ACE inhibitors or diuretics for high blood pressure, you should not use licorice products.

Licorice could cause these medications to not work as well, or could make side effects worse, including a build up of potassium in the body. ACE inhibitors include:. Because licorice may dangerously increase the risk of toxic effects from digoxin, do not take this herb with this medication. Licorice may increase the effects of corticosteroid medications. Talk to your doctor before using licorice with any corticosteroids.

Insulin or drugs for diabetes. Licorice may have an effect on blood sugar levels. Licorice may cause potassium loss in people taking stimulant laxatives.

MAO inhibitors. Licorice may make the effects of this class of antidepressant stronger. Oral contraceptives. There have been reports of women developing high blood pressure and low potassium levels when they took licorice while on oral contraceptives. Warfarin Coumadin. Licorice may decrease the levels of this blood thinner in the body, meaning it may not work as well.

Medications processed by the liver. Licorice may interfere with several medications processed by the liver, including celecoxib Celebrex , diclofenac Voltaren , fluvastatin Lescol , glipizide Glucotrol , ibuprofen Advil, Motrin , phenytoin Dilantin , piroxicam Feldene , phenobarbital, and secobarbital Seconal.

Diuretics, hormonal medications, and many other medications interact with licorice. Effect of licorice on reduction of body fat mass in healthy subjects. J Endocrinol Invest.

Glycyrrhetinic acid, the active principle of licorice, can reduce the thickness of subcutaneous thigh fat through topical application. Borrelli F, Izzo AA. The plant kingdom as a source of anti-ulcer remedies. Phytother Res. Fetal and neonatal outcomes in women reporting ingestion of licorice Glycyrrhiza uralensis during pregnancy.

Planta Med. Glycyrrhizin, an active component of liquorice roots, and replication of SARS-associated coronavirus. Memory enhancing activity of Glycyrrhiza glabra in mice. J Ethnopharmacol.

Dhingra D, Sharma A. Antidepressant-like activity of Glycyrrhiza glabra L. Prog Neuropsychopharmacol Biol Psychiatry. Antifungal activity of Glycyrrhiza glabra extracts and its active constituent glabridin. Support for the Beneficial Effects of DGL Much of the in vitro data on licorice root is on glycyrrhizin, with less information available on the other constituents of licorice.

For example, glycyrrhizin and its derivatives have been shown to effectively kill Helicobacter pylori strains, including those that are clarithromycin-resistant or metronidazole-resistant. In this same study, DGL delivered intraperitoneally showed reductions of the gastric lesion scores, implying there may be a systemic component to the therapeutic effect.

The 4 include crude extracts of the whole plant, DGL combined with other agents ie, Caved-S , DGL alone, and drug analogs of glycyrrhizin derivatives eg, carbenoxolone, enoxolone. Many reviews, references, and marketing materials on DGL report on these 4 forms interchangeably. A closer look at this indiscriminate use of clinical trial data shows that they are not equivalents, and extrapolation of studies using agents containing glycyrrhizin or glycyrrhizin-like compounds are not relevant when compiling trial data on DGL.

Crude extracts of licorice are a traditional use of the plant and led to the initial interest of Revers and others in proving its therapeutic use for ulcers. Since the crude extract contains glycyrrhizin, and glycyrrhizin has been shown to heal ulcerative lesions as a single agent, the efficacy of licorice crude extract can be assumed to be at least partly due to the glycyrrhizin content. DGL by definition is lacking glycyrrhizin; therefore its efficacy in ulcerative complaints must be proven independently from data on crude extracts.

Carbenoxolone and the newer analogue, enoxolone, both have a well-documented risk of inducing symptoms of a hypermineralcorticoid state. The induction of side effects with a glycyrrhetinic acid analogue is to be expected, as glycyrrhizin and its metabolites have long been identified as the agents inducing these side effects.

That leaves clinical trials with DGL as a single agent or DGL in combination with other compounds as the only relevant trials in an assessment of the clinical evidence. The components of Caved-S per tablet are DGL mg , bismuth subnitrate mg , aluminium hydroxide gel mg , magnesium subcarbonate mg , sodium bicarbonate mg , and frangula bark 30 mg. It is essential to note that the term DGL is often used synonymously with Caved-S in the primary publications as well as in current reviews and marketing materials.

For this reason, the form of the intervention used is included in the table summarizing the available trial data Table. There have been no new clinical trials on the use of DGL for ulcers in more than 20 years. The trials that have been published on Caved-S and DGL, as a whole, have been criticized for their lack of rigorous design. Most trials were small the largest trial evaluated 96 patients. Not all trials were blinded, and many did not include a placebo control group or the placebo was not adequately matched to the intervention group.

Further, the natural course of ulcerative disease is one of exacerbation and remission, leading to a significant number of results in which participants experienced improvements regardless of the intervention. This makes a statistically significant improvement in the rate of healing difficult to obtain in trials with small numbers of patients. A comparison of the results derived from these trials provides conflicting results without trend or obvious conclusions able to be drawn.

A cursory look at the summary of clinical trials Table shows no standard dosage, delivery, trial duration, or methodology used in the majority of trials. How efficacy was assessed varied between the trials as well with questionnaires, clinical observation, barium radiography, or endoscopic assessments used. Despite these many shortcomings, the results of some trials are intriguing enough to merit deeper exploration. The most impressive trial demonstrating benefit, published in , enrolled 40 patients with more than 6 relapses of duodenal ulcer in the prior 12 months.

The study clinic was also a surgical clinic, and all patients had been referred to the clinic for consideration of duodenal resection from a community physician. Since these patients were severely ill, no placebo was offered; instead 2 levels of moderate and intense intervention with Caved-S was used. The moderate intervention included 8 tablets 8 times daily for 8 weeks, and intense intervention was 12 tablets 8 times daily for 16 weeks.

While none of the patients required surgical intervention in the ensuing year, the cohort consuming the higher dosage for longer duration had significantly fewer symptomatic events during that year as well. Both groups used a dosage of Caved-S significantly higher than most trials, with a total DGL consumption of 4, mg per day in the high-dose group. Larkworthy and colleagues, the intervention closely matched the above intervention of over 4 g daily, except it used DGL as a single agent and there was a mastication group to see if chewing conferred any benefit.

This may be due to the suggestion of 5 meals per day for all study participants. This frequency of eating increased the salivation of all participants, which has been independently proven to have an antiulcer effect.

As an aside, Larkworthy and colleagues suggest that further trials must include endoscopic assessment, as symptoms do not always correlate with healing of ulcers. Why is there such a lack of trials in the past 20 years?

With the advent of H 2 blockers in the late s and early s, the medical management of ulcers changed dramatically, followed by the even more dramatic shift toward use of antibiotics after the widespread acceptance of the role of H pylori i n ulcer etiology in most patients in the s. DGL was no longer being studied for up-front application in the healing of ulcers but as maintenance therapy alone or with H 2 blockage agents.

Caved-S was demonstrated to be equivalent to cimetidine in the prevention of relapse in a 2-year follow-up study undertaken by A. Morgan and colleagues. This drug class has a more powerful acid suppression effect than the older class of H 2 blockers, and there is no data on the use of DGL with proton pump inhibitors.

Nevertheless, cumulatively the data suggest DGL may have a role in protecting the erosion of mucosa and decreasing relapse; therefore it deserves continued consideration for adjunctive management in these patients. She received her naturopathic doctorate from National University of Natural Medicine and completed her residency in naturopathic oncology at Cancer Treatment Centers of America, Tulsa, Oklahoma.

She is the past president and treasurer of the Oncology Association of Naturopathic Physicians and secretary of the American Board of Naturopathic Oncology. She is the editor of the Textbook of Naturopathic Oncology. She has been published in several peer-reviewed journals. Kaczor is based in Portland, Oregon. Shibata S. A drug over the millennia: pharmacognosy, chemistry, and pharmacology of licorice.