Common Medical Conditions Digestive Bitters Are Prescribed For: Plus Specialty Lab Testing That Can Help Individualize Treatment

For centuries, bitter plants have been a staple in the diet and traditional Eastern medicine practices to support digestion and overall wellness. You may have read about digestive bitters as a natural remedy for treating common digestive symptoms, including bloating, heartburn, and acid reflux, and acting as a general tonic to support optimal digestion. If you're interested in digestive bitters, keep reading to learn about what they are and how they work.

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What Are Digestive Bitters?

Digestive bitters refer to plants and herbs with bitter and pungent qualities that stimulate the function and motility of the entire gastrointestinal (GI) tract to promote healthy digestive processes. Bitter herbs are used to formulate concentrated herbal extracts called tinctures and are sold as botanical digestive supplements.

Bitters are gaining rapid popularity today through their incorporation into craft cocktail recipes. However, what many people may not know is that the history of bitters dates back centuries ago. Traces of bitter herbs have been found on pottery jars in Egyptian tombs, and it was common practice in ancient Rome to infuse wine with bitters to boost digestion. (1)

How Do Digestive Bitters Work?

There are four models to explain bitters' effect on digestion:

1. Cephalic Vagal Reflex: The stimulation of bitter receptors in the mouth and throat reflexively increases saliva and vagal stimulation to the digestive organs.
2. Local Reflex: The stimulation of bitter receptors in the mouth, throat, and GI tract locally increases digestive secretions.
3. Alcohol used in bitter extracts improves digestion
4. Bitters increase circulation to the abdominal organs and GI tract

Let's dive into these concepts in more detail. The bitter taste is mediated by specialized receptors in the mouth called T2Rs. Holding bitters in the mouth activates T2R taste receptors, which sends a signal to the vagus nerve in the brain. The vagus nerve is the main nerve of the parasympathetic ("rest and digest") division of the autonomic nervous system. It is an essential roadway for communication between the brain and the other body systems. When activated, the vagus nerve relays signals to the digestive tract and accessory organs, including the salivary glands, stomach, pancreas, liver, and gallbladder, to stimulate digestive processes and secretions.

Additionally, T2R receptors are located along the duration of the GI tract. So as the bitter herbs travel and bind to these receptors, local stimulation enhances digestion, blood flow, and intestinal motility. (2)

Bitters collectively help regulate hormones relating to gut health and increase gut motility. Actions attributed to bitter herbs include increasing stomach secretions (e.g., hydrochloric acid), increasing circulation to and upregulating mucin and prostaglandins production within the GI tract, modulating appetite, increasing exocrine pancreatic secretions, increasing parasympathetic activity, acting as a mild laxative, and stimulating brush border enzymes within the small intestine. (2, 3)

Common Medical Conditions Digestive Bitters Are Prescribed For

Digestive bitters are primarily indicated to increase digestive secretions, promote healthy digestion, and enhance the absorption of nutrients. However, thanks to the gut-brain connection, bitters can also positively affect the immune system and stress.

When digestion is sluggish, bitters can act as a digestive aid, easing indigestion, heartburn, nausea, cramping, bloating, and gas. Bitters are also indicated in chronic digestive conditions, including atonic constipation, gastroparesis, hypochlorhydria, exocrine pancreatic insufficiency (EPI), gallbladder dysfunction, and liver disease.

Digestive enzyme insufficiency can increase the pH of the digestive tract, predisposing an individual to dysbiosis, small intestinal bacterial overgrowth (SIBO), and intestinal fungal overgrowth. Therefore, practitioners often recommend digestive bitters and other digestive enzyme supplements as a preventive measure for dysbiosis.

Other bitter and aromatic herbs have additional benefits that may warrant their use in clinical practice. Herbs, including burdock, ginger, and turmeric, are potent anti-inflammatories that effectively reduce inflammation and oxidative stress and regulate the immune system in humans. Some bitters, like bitter melon, can also inhibit sweet-responsive neurons and block the response to sweet taste, curbing sugar cravings and lowering blood sugar levels (4, 5).

Top Digestive Bitters Used in Integrative Nutrition

Digestive bitters are prescribed to take 10-15 minutes before eating a meal. However, it can be easy to forget, so taking them with or just after eating can still be helpful. The general recommendation for dosing bitter tinctures is to take one teaspoon before a main (large) meal, a half teaspoon before a small meal, and 1.5 teaspoons before a very large meal. Very strong bitters may need to be given in smaller doses.

Common bitters used in digestive tonics include wormwood, gentian, yarrow, barberry, goldenseal, chamomile, dandelion, artichoke, and hops. Bitter foods can just as easily be eaten in small quantities, or incorporated into meals, to aid digestion. These may include artichokes, arugula, dandelion greens, dill, radicchio, dark chocolate, and black coffee.

Specialty Tests That Can Be Useful When Prescribing Digestive Bitters

While digestive bitters are safe to take long-term in the proper amounts, an optimally functioning digestive tract and nervous system shouldn't require them daily. The following specialty tests can help doctors to assess the health and function of the digestive tract, adrenal glands, and nervous system so that factors negatively impacting the gut-brain axis can be corrected.

Comprehensive Stool Test

A comprehensive stool test is one of the best functional tools for assessing gut health and function. Stool tests measure byproducts of digestion to screen for maldigestion and malabsorption; these results provide insight into digestive enzyme insufficiencies that may be present. Additionally, intestinal inflammation and microbial markers screen for dysbiosis, infection, and immune dysregulation that can contribute to gut symptoms. This test helps practitioners decide if advanced imaging and testing are warranted during a diagnostic evaluation and make targeted nutritional and botanical recommendations to optimize digestive health.  

SIBO Breath Test

A comprehensive stool test cannot diagnose SIBO. When SIBO is suspected due to patient history and the presence of bloating, abdominal pain, and abnormal bowel movements, a breath test can diagnose and subtype SIBO.

Micronutrient Testing

Poor digestion and chronic stress can lead to nutritional deficiencies and vice versa. A micronutrient test is a screening test that can assess nutritional status and help providers target nutritional and supplemental recommendations to restore nutrient status for optimal digestive function, stress management, and overall wellness.

Adrenal & Stress Testing

The adrenal glands are crucial in producing hormones and neurotransmitters that help the body cope with stress. Increased cortisol, epinephrine, and norepinephrine can impair gut function during acute and chronic stress. Physicians often use cortisol and neurotransmitter tests to evaluate the function of the adrenal glands and nervous system and assess an individual's stress response. This test can be valuable in diagnosing functional adrenal disorders and managing stress-related digestive dysfunction.

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Summary

It's no wonder bitters continue to grow in popularity with their numerous beneficial qualities. If you feel you need help with digestion, talk with a functional medicine doctor to see if bitters are indicated for you. Individualizing bitter formulas can target an individual's specific needs, and functional testing can help get to the root cause of digestive and nervous system dysfunction contributing to digestive symptoms.