Herbs And Phytochemicals: Randomized Clinical Trial Shows That Aniseed Powder Can Be Used To Treat Gastrointestinal Issues In COVID-19 Infections!

Herbs And Phytochemicals: The ongoing COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has brought to light various facets of the disease, extending beyond the initially recognized respiratory symptoms. Among these manifestations, gastrointestinal (GI) symptoms have gained prominence, revealing their association with an elevated risk of disease severity. A groundbreaking randomized clinical trial, conducted by a collaborative effort involving Shiraz University of Medical Sciences in Iran, Holistic Integrative Medicine in Rio de Janeiro, Brazil, and the Health Research Group in Sydney, Australia, has explored the efficacy and safety of aniseed (Pimpinella anisum L.) powder as an additional therapeutic intervention for adults experiencing acute SARS-CoV-2 infection with GI symptoms.


Aniseed Powder Can Be Used To Treat Gastrointestinal Issues In COVID-19 Infections
 
Investigating the Gastrointestinal Realm in COVID-19
In the initial phases of the pandemic, the primary focus was on respiratory symptoms such as cough and fever. However, as the understanding of the virus deepened and new variants emerged, attention turned to extrapulmonary manifestations. Over 70 clinical manifestations of COVID-19 have been identified, with 10 specifically related to the gastrointestinal system. Anorexia, diarrhea, and abdominal pain are among the most common GI symptoms, with their prevalence exceeding 20%.
 
While the overall prevalence of GI symptoms may not differ significantly from the general population, their presence in COVID-19 patients has been linked to an increased risk of disease severity. Complications such as gastrointestinal bleeding and small intestine necrosis have been reported, underlining the importance of addressing these symptoms in the overall management of the disease.
 
Clinical Guidelines and the Need for Tailored Treatments
Current clinical guidelines for managing COVID-19 offer non-specific recommendations for treating GI symptoms. Antipyretics for pain and rehydration for vomiting or diarrhea are commonly suggested, but a targeted approach is lacking. This gap in guidance has prompted researchers to explore alternative therapies, such as herbal remedies, in the quest for effective and safe interventions.
 
One such herbal candidate is aniseed, derived from the Pimpinella genus. With a history of traditional use and generally regarded as safe, aniseed has shown promise in addressing conditions such as irritable bowel syndrome and postprandial distress syndrome. The current clinical trial aimed to evaluate the potential of aniseed powder in alleviating GI symptoms associated with acute SARS-CoV-2 infection.
 
The Methodological Framework
Herbs And Phytochemicals clinical trial adopted a rigorous randomized parallel-group double-blinded placebo-controlled add-on therapy design. Adult participants with acute SARS-CoV-2 infection, not requiring hospitalization, and reporting at least one GI symptom in t he preceding 48 hours were eligible for inclusion. The 225 participants were randomly assigned to either the aniseed group (45 participants) or the placebo group (180 participants). Both groups were instructed to use 25 g of powdered aniseed or placebo twice daily for a duration of two weeks.
 
Primary outcomes included assessing the proportion of patients experiencing an improvement in symptoms. Clinical evaluations and monitoring of adverse events were conducted at the trial's initiation, one week later, and at the conclusion of the two-week period.
 
Detailed Insights into the Results
The results of the trial demonstrated significant improvements in participants of the aniseed group compared to the placebo group, specifically in the realms of abdominal pain, anorexia, and diarrhea. While the improvements were notable, no significant effects were observed for nausea/vomiting or bloating. Adverse events reported were generally mild to moderate, with participants in the aniseed group noting throat itching and thirst, and those in the placebo group reporting cough and abdominal cramps. Importantly, none of the participants discontinued the intervention or withdrew from the study due to adverse events.
 
Considerations and Limitations
Despite the promising outcomes, the study is not without its limitations. The absence of recorded dietary information and the potential impact of taste differences between aniseed and placebo on blinding were noted limitations. Additionally, the lack of statistical adjustments for multiple comparisons raises considerations. However, the small p-values for all three significant differences in the primary endpoints mitigate concerns regarding Type 1 error.
 
Unveiling Mechanisms of Action Of Aniseed And Its Phytochemicals Especially Trans-Anethole
 
Inhibition of SARS-CoV-2 Proteins
In silico studies have provided insights into the potential mechanisms by which aniseed, particularly its main phytochemical: trans-anethole, may inhibit SARS-CoV-2 proteins. The interaction with the Spike protein and the Chymotrypsin-like protease suggests a direct inhibitory effect on viral replication, especially considering the abundance of ACE-2 receptors in the gastrointestinal tract.
 
Antiviral Properties
While in vitro studies on the antiviral action of aniseed are limited, trans-anethole has demonstrated efficacy against RNA viruses, including herpes simplex. The ability to counteract both Gram-negative and Gram-positive bacteria further supports the antiviral potential of aniseed.
 
Anti-Inflammatory Effects
Invasion of SARS-CoV-2 into GI cells triggers inflammation, leading to mucosal barrier disruption. Aniseed and trans-anethole have demonstrated anti-inflammatory effects by reducing the expression of pro-inflammatory cytokines. This anti-inflammatory activity may contribute to improvements in symptoms like abdominal pain and anorexia.
 
Hepatoprotective and Antioxidant Effects
COVID-19 is associated with liver damage and oxidative stress. Trans-anethole has shown hepatoprotective effects, reducing liver enzyme activity and enhancing antioxidant mechanisms. Aniseed's antioxidant properties further contribute to its potential in mitigating COVID-19-related liver injury.
 
Action on the Gut Microbiome and the Gut Barrier
The disruption of the gastrointestinal microbiome in COVID-19 patients is well-documented. Aniseed's ability to counteract pathogenic organisms and enhance beneficial flora suggests a modulatory effect on the gut microbiome. This, coupled with its potential to support the gut barrier, addresses the multifaceted impact of SARS-CoV-2 on the GI system.
 
The Gut-Lung Axis and Future Prospects
Emerging research on the gut-lung axis highlights the interconnectedness of respiratory and GI systems in COVID-19. Aniseed's traditional use for both respiratory and digestive issues positions it as a potential dual-acting therapeutic agent. The prospect of using aniseed for long-term symptom management in the context of long COVID-19 adds another layer to its potential applications.
 
Prospects for Long COVID-19
Long COVID-19, characterized by persistent symptoms beyond the acute infection, poses unique challenges. Fecal RNA shedding at 4- and 7-months post-diagnosis suggests prolonged viral presence in the GI tract. Aniseed, with its demonstrated efficacy in alleviating GI symptoms over a two-week period, opens avenues for exploring its use in long-term symptom management. Additionally, the potential benefits of aniseed in addressing coexisting conditions like diabetes and hyperlipidemia add to its prospective role in long COVID-19 care.
 
Conclusion
The randomized clinical trial exploring the efficacy and safety of aniseed powder in treating GI symptoms of COVID-19 provides encouraging results. The multifaceted action of aniseed, encompassing antiviral, anti-inflammatory, hepatoprotective, and microbiome-modulating effects, aligns with the known properties of its main metabolite trans-anethole. The potential implications for long COVID-19 management and the gut-lung axis underscore the significance of further research.
 
As the global community grapples with the ongoing pandemic, the study on aniseed opens doors to a holistic approach that integrates traditional remedies into the realm of evidence-based medicine. Larger, multicenter trials with extended follow-up periods are imperative to validate these findings comprehensively. The therapeutic potential of aniseed in addressing the gastrointestinal aspects of COVID-19 provides a glimpse into the rich landscape of herbal remedies, offering hope for more effective and tailored interventions in the future.
 
The clinical study findings were published in the peer reviewed journal: Frontiers in Pharmacology.
https://www.frontiersin.org/articles/10.3389/fphar.2024.1331177/full
 
For the latest on Herbs and Phytochemicals, keep on logging to Thailand Medical News.