At long last, a randomized controlled trial for the resin of Pistacia lentiscus . . .

New research finds that mastic can eradicate H. pylori infections 

Such things as are good for the stomach above other simples are these, rosemary, elecampane [also called horse-heal], mastic, wormwood, sage, mint.

I allow pills of aloes, mastic, and saffron, winter-time, taken before dinner . . . [emphasis added] — Francis Bacon, a contemporary of Shakespeare, who established and popularized an inductive methodology for scientific inquiry

During the time of Shakespeare, in the late 16th Century, the plague fell on London. All theaters (including those where Shakespeare’s plays were performed) and places where large groups of people gathered were closed until the disease had run its course (see the movieShakespeare in Love). To avoid catching the plague, Dr. Thomas Cogan, an English physician, gave specific advice:1

On leaving one’s home each morning, a person should drink a sweet-smelling elixir containing the following:

  • 3 drams each of aloe, fine cinnamon and myrrh

  • 1 dram each cloves, mace, lignum aloe, mastic, and bole armeniac (a mineral-rich clay prescribed for diarrhea, dysentery, and hemorrhage)

“Mix all these things together in a clean mortar and take two pennyweights of the mixture in a half glass of white wine. And so may you go safely into all infection of the air and plague.”

For the first time, a randomized study 
has found that mastic gum 
eradicates H. pylori in patients 
who are infected with it, 
about half as well as 
the conventional treatment, 
triple therapy.

Model of Shakespeare’s Globe Theatre, the successor to the Curtain Theatre
Did it work? Surprisingly, it may have been of some benefit. The plague is caused by a bacterium, Yersinia pestis,carried typically by fleas on the bodies of rats. In our time, it has been found that Y. pestis can be treated with antibiotics, including tetracycline, fluoroquinolones, and doxycycline. These are antibiotics that have proven their effectiveness in the treatment of the ulcer-causing bacteria, Helicobacter pylori; they are used in so-called triple or quadruple therapy to eradicate H. pylori. As we shall learn, mastic compares favorably to certain antibiotics in the treatment of H. pylori. It is not so far a stretch that it, too, might be effective against Y. pestis, and thus the plague. Whatever the case, the theaters reopened, and Shakespeare went on write some of his greatest work.* (See the sidebar, “Making Theaters Safer During Pandemics.”)

*Lost to the Bubonic Plague: Shakespeare’s sisters Joan, Margaret, and Anne; his brother Edmund; his only son Hamnet, who died when he was just eleven years old; as well as many friends, fellow actors and acquaintances.

Making Theaters Safer During Pandemics

While viral pandemics have replaced the bubonic plague for contagious concerns, it may no longer be necessary to close down theaters to prevent the spread of disease. That’s because Sanyo has recently announced a high-tech anti-virus air filtered Virus Washer air conditioning system which it has installed at Warner Mycal’s flagship Criterion 6 cinema in Santa Monica, California. Visitors there will breathe air that has been piped through the Washer and stripped of H1N1, the avian flu virus, pollen and dirt by a roof-mounted filter packing powerfully electrolyzed water.

Sanyo claims the Virus Washer removes 99 percent of bacteria, smells and the unpleasantness. The result is an atmosphere in the theater that is as pure as an industrial clean room for the manufacture of vaccines or electronic components.

Moreover, moviegoers have given their approval. Prior Sanyo surveys show that about 70% report that “the air feels better” after being stripped of virus and other contaminants by the Virus Washer. So strongly is this interpreted, that Sanyo has announced it will roll out the Virus Washer to all 60 Warner Mycal cinemas across Japan by August 2011.

Breakthrough Study

For the first time, a randomized study has found that mastic gum eradicates H. pylori in patients who are infected with it, about half as well as does the conventional treatment, triple therapy, but without the threat of significant side effects.2 This study was conducted on the island of Chios, Greece, at the Skylitsion General Hospital, in the Department of Gastroenterology. Chios is where most commercial mastic is grown and harvested.

In the study, fifty-two patients (male and female adults, between 18 and 75 years of age) were randomized to receive either one of the following 4 regimes:

  1. 350 mg mastic gum, three times per day (total 1.05 g/day), for 14 days (Group A)

  2. 1.05 g mastic gum, three times per day (total 3.15 g/day), for 14 days (Group B) 

  3. 20 mg pantoprazole, twice a day, plus 350 mg mastic gum, three times per day (total 1.05 g/day), for 14 days (Group C) 

  4. 20 mg pantoprazole, twice daily (total 40 mg/day), plus 1 g amoxicillin, twice daily (total 2 g/day), plus 500 mg clarithromycin, twice daily (total 1 g/day), for 10 days (Group D)

Pantoprazole is a proton pump inhibitor drug used for short-term treatment of erosion and ulceration of the esophagus caused by gastroesophageal reflux disease. Amoxicillin is a moderate-spectrum, bacteriolytic, broad class antibiotic, used to treat bacterial infections caused by susceptible microorganisms. Clarithromycin is a type of antibiotic used to treat upper respiratory tract bacterial exacerbation of chronic bronchitis, pneumonia, as well as skin and skin structure infections.

Triple Therapy: Effective But Flawed

Together, these three drugs are generally considered to be the most effective conventional arsenal to treat H. pylori. However, an increasing number of infected individuals are found to give refuge to antibiotic-resistant bacteria, resulting in initial treatment failure. This often leads to additional rounds of antibiotic therapy or wider strategies such as a quadruple therapy, which adds a bismuth colloid. But the results are frequently less than satisfying because of adverse effects of each of these drugs. Triple and quadruple therapy can cause multiple side effects (including nausea, vomiting, and diarrhea). Moreover, the antibiotics kill beneficial digestive-tract bacteria, and can contribute to the growing problem of antibiotic resistance. Also, the proton pump inhibitor can alter gastric pH and cause other negative consequences.

Antibiotics kill beneficial 
digestive-tract bacteria, and can 
contribute to the growing problem of 
antibiotic resistance.

Furthermore, while triple (or quadruple) therapy is usually successful in eliminating the bug from the stomach and intestines within a few weeks, the gastrointestinal (digestive) tract begins at the mouth, not the stomach, and H. pylori commonly infects the mouth as well as parts south. Whether or not the bacteria do much damage in the mouth is an open question. Even if they didn’t, though, we would still not want to harbor them there, for one simple reason: things in the mouth can go south. That’s why the reinfection rate with H. pylori is relatively high in people who have eradicated the bug in their stomachs and intestines—sooner or later, some of the bacteria in their mouths may migrate down there and take up residence all over again.

Urea Breath Test

The urea breath test (UBT) is a diagnostic procedure that can readily identify the presence of Helicobacter pylori, a spiral bacterium which has been found to play a causal role in gastritis, gastric ulcer, peptic ulcer disease, and possibly certain gastric cancers. H. pylori is able to convert urea to ammonia, and this is the basis of the UBT test.

First, subjects swallow urea, labeled with an uncommon isotope, either radioactive carbon-14 or non-radioactive carbon-13. Following this, within 10–30 minutes, the subject exhales and the breath is analyzed for any detection of isotope-labeled carbon dioxide indicating that the urea was split. If so, this is likely to be a sign that urease, the enzyme used by H. pylori to metabolize urea, is present in the stomach, and in turn that H. pylori bacteria are present.

Viva la Différence

By gauging the difference between the pre- and post-urea measurements, infection is determined. Results that fall below a cut-off value are assumed to be negative, and those above are assumed positive. Through comparing the results of patients with two or more different detection methods, a cut-off value is determined, with the best combination of sensitivity and specificity paramount for selecting the value.

One caveat: UBT measures active H. pylori infection and if antibiotics are depressing the level of H. pylori present, or if stomach conditions are less acidic than normal, the amount of urease present will be lessened.

Because of this, the test should only be performed 14 days after stopping acid-reducing medication (such as proton pump inhibitors, e.g., pantoprazole) or 28 days after stopping antibiotic treatment. Some studies indicate that a reservoir of H. pylori in dental plaque can affect the result.

Indeed, there have been some “functional medicine” practitioners who have used herbal formulas to treat H. pylori infection and claimed a great rate of success. However, there have been no peer-reviewed clinical studies that provide evidence of the effectiveness of herbal formulas, though many remedies are offered. That is, until now.

Mastic has 
bactericidal activity 
that kills H. pylori in vivo.

Mastic Chalks Up a Success Rate of Nearly 50%

Upon entering the new study, all subjects harbored H. pylori, a fact confirmed by the administration of a (13)C urea breath test (UBT). Five weeks after the completion of eradication regime, all subjects were tested again. Eradication of H. pylori was confirmed in 31% (4/13) of the subjects in Group A and in 38% (5/13) of the subjects in Group B. However, none of the subjects in Group C achieved eradication, whereas 77% (10/13) of the subjects in Group D had a negative UBT. However, while group A (1.05 g mastic/day for 14 days) had a success rate that was 40% of triple therapy and Group B (3.15g/day for 14 days) had a success rate of nearly 50% of triple therapy, mastic has none of the side effects.

It might be possible, as reports from physicians using natural medicine seem to bare out, that a longer protocol can increase the success rate, while at the same time avoiding the failure rate. But there are currently no clinical reports that support this.

Among the individual symptoms 
significantly improved with mastic 
were: stomach pain in general, 
stomach pain when anxious, 
and dull ache in the 
upper abdomen and heartburn.

The Consequence of Altering pH

The fact that the combination of mastic gum and pantoprazole showed no effect on H. pylori is somewhat surprising. But here’s a possible answer: Most active substances of mastic gum belong to its acidic fraction, and thus they may require an acidic environment in the stomach to successfully kill H. pylori. Proton pump inhibitors block the hydrogen-potassium ATP enzyme system on the gastric parietal cells. In that way, they increase the intragastric pH (more basic, less acetic) and thus buffer the active components of mastic. This hypothesis needs to be tested in further studies.

The findings of this pilot study are quite clear: mastic gum has bactericidal activity that kills H. pylori in vivo, and that is good news.

Improve Your Thinking with Mastic

A new study recently published in The Journal of Neurology, Neurosurgery, and Psychiatry suggests that good oral care may help keep our thinking skills intact as we age.1 Researchers have found that adults (aged 60 and older) with a larger amount of the gum disease-causing pathogen Porphyromonas gingivalis were cognitively impaired when compared to controls with the least amount of the pathogen. In fact, subjects with this manifestation of bad oral health were three times more likely to have trouble recalling a three-word sequence after some time had passed.

In another measure of mental decline, as per authors Dr. James M. Noble of Columbia College of Physicians and Surgeons in New York City and colleagues, adults with the highest levels of this pathogen were twice as likely to fail three-digit reverse subtraction tests. The study involved more than 2300 men and women who were tested for periodontitis and who then completed a series of thinking-skill tests as part of the National Health and Nutrition Examination Survey III (NHANES-III) conducted between 1991 and 1994. Of the 2300, 5.7% had trouble with certain memory tasks and 6.5% failed reverse subtraction tests. Participants with about twice the pathogen levels (greater than 119 units) versus the lowest (57 units or lower) performed more poorly in these tests.

This type of research is not altogether new—a strong association between poor oral health and heart disease has been established; so too for stroke, diabetes, and Alzheimer’s disease. The researchers hypothesized that gum disease could influence brain function via inflammation throughout the body, a risk factor for loss of mental function.

Commenting in the journal, Dr. Robert Stewart, of King’s College in London, United Kingdom, believes that this study adds to a “quietly accumulating” body of evidence tying oral and dental health with brain function.2

Mastic Kills Porphyromonas gingivalis

As we have previously written, mastic curtails inflammation in the oral cavity by killing P. gingivitis (see “Mastic Helps Curb Inflammation” in the September 2006 issue). To date, several studies strongly suggest that the direct application of mastic gum in the oral cavity could be considered as a treatment of oral malodor and gum disease. And with this latest study, it’s possible that chewing mastic could improve your thinking ability.


  1. Noble JM , Borrell LN, Papapanou PN, Elkind MSV, Scarmeas N, Wright CB. Periodontitis is associated with cognitive impairment among older adults: analysis of NHANES-III. J Neurol Neurosurg Psychiatry 2009;80:1206-1211.
  2. Stewart R. Mouths and brains. Could oral infection be a risk factor for dementia? J Neurol Neurosurg Psychiatry 2009;80:1184.

Mastic Helps with Dyspepsia Too

In another study, conducted by the same researchers at the GI Unit of the Department of Surgery and Medicine at Chios District General Hospital, mastic gum was found to relieve the symptoms of dyspepsia.3 In this double-blind placebo-controlled study, 108 subjects with functional dyspepsia were randomly assigned to receive either 350 mg of mastic, three times/day (total of 1.05 g/day) or placebo. After three weeks of treatment, the change in the severity of symptoms from the baseline measurements was assessed using the Hong Kong index of dyspepsia, along with the subjects global assessment of the treatment’s efficacy.

Mastic gum significantly 
improves symptoms in those with 
functional dyspepsia.

Of 103 subjects providing outcome data, the marked improvement in those taking mastic was 1.83 times greater than those who took placebo. In other words, while 41% of those taking placebo reported improvement, 75% of those taking mastic reported improvement (p<0.03). The symptom score improved significantly overall in patients receiving mastic gum (–8.66 vs. –3.78 in the placebo group) (p<0.05). Among the individual symptoms that showed significant improvement with mastic gum were: stomach pain in general, stomach pain when anxious, dull ache in the upper abdomen and heartburn (<0.05 for all four symptoms).

As with the more recent study, the results are unambiguous: Mastic gum significantly improves symptoms in those with functional dyspepsia.


  1. Cogan T. The Haven of Health. London 1605.
  2. Dabos KJ, Sfika E, Vlatta LJ, Giannikopoulos G. The effect of mastic gum on Helicobacter pylori: A randomized pilot study. Phytomedicine 2009 Oct 28. [Epub ahead of print]
  3. Dabos KJ, Sfika E, Vlatta LJ, Frantzi D, Amygdalos GI, Giannikopoulos G. Is mastic gum effective in the treatment of functional dyspepsia? a randomised double-blind placebo controlled trial. Gut 2007;56:a1-a145. [Abstract.]