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Mastic gum

Over-the-counter botanical supplement, the resin of Pistacia lentiscus var. Chia (Chios mastic), cultivated on the island of Chios in Greece; marketed for functional dyspepsia and H. pylori

ATC code: A02BX-MASTIC

Brand names – supplements: Jarrow Formulas Mastic Gum 500 mg, Now Foods Mastic Gum 500 mg, Mastiha Shop Chios Mastic, Allergy Research Group MasticaSupplements are not tested in clinical trials and are not registered as medications.

Updated · Methodology

Indications

C

Functional dyspepsia

Adjunct

Mastic gum is an over-the-counter botanical supplement with traditional use for mild dyspepsia. HMPC 2015 included Pistacia lentiscus in a community herbal monograph as a traditional use product for symptomatic relief of mild dyspepsia and superficial skin inflammation. A small RCT by Kottakis (J Ethnopharmacol 2008) in 60 patients with dyspepsia showed an improved symptom score after 4 weeks of 350 mg mastic three times daily. The sample is small with no PPI comparison. Per Rome IV 2016 and 2017 functional dyspepsia is a diagnosis of exclusion after H. pylori testing and alarm symptom assessment; standard care is H. pylori test-and-treat (Maastricht VI 2022), empirical PPI for 4–8 weeks and a prokinetic in post-prandial distress. Mastic is not mentioned as an option in the guidelines. If mastic is considered as a mild adjunct alongside a PPI, discuss with a gastroenterologist – it is well tolerated but does not stand in for standard therapy.

Sources

  1. J Ethnopharmacol (Kottakis et al.): Effects of mastic gum (Pistacia lentiscus var. Chia) on Helicobacter pylori positive subjects with dyspepsia (2008)
  2. Rome Foundation: Rome IV criteria: Functional dyspepsia (2016)
  3. ACG / CAG: ACG and CAG Clinical Guideline: Management of Dyspepsia (2017)

ICD-10: K30 · ICD-11: DD90.3

C

Helicobacter pylori infection

Adjunct

Mastic gum in H. pylori is not a replacement for standard eradication therapy but a possible mild adjunct. A small RCT by Dabos (Phytomedicine 2010) in 52 patients with H. pylori without ulcer compared mastic 350 mg three times daily for 14 days with pantoprazole and triple therapy: mastic monotherapy eradicated H. pylori in about 30–35% versus 77% in the triple therapy arm. This is well below the standard. Maastricht VI 2022 and the Spanish AEG/SEPD 2022 consensus place quadruple bismuth therapy first-line (omeprazole + bismuth + tetracycline + metronidazole for 10–14 days) or clarithromycin-based therapy in low-resistance regions; the target eradication rate is above 90%. In Spain Maastricht VI 2022 recommends quadruple bismuth first-line because of high clarithromycin resistance. The Cochrane systematic review by Wang (2016) on herbal adjuvants in H. pylori shows that some preparations improve adherence and reduce antibiotic side effects but do not replace them. If mastic is considered alongside eradication therapy, discuss with a gastroenterologist – as a stand-alone way to «treat H. pylori without antibiotics» it does not work.

Sources

  1. ESGE / EHMSG / ESPGHAN: Management of Helicobacter pylori infection – the Maastricht VI/Florence Consensus Report (2022)
  2. Phytomedicine (Dabos et al.): The effect of mastic gum on Helicobacter pylori: a randomized pilot study (2010)
  3. N Engl J Med (Huwez et al.): Mastic gum kills Helicobacter pylori (1998)
  4. Cochrane (Wang et al.): Adjuvant therapies with herbal preparations for Helicobacter pylori eradication: a systematic review (2016)

ICD-10: B98.0 · ICD-11: DA42.1

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

D

Superfoods and adaptogens (marketing category)

Not recommended

Chios mastic is marketed as a «natural antibiotic against H. pylori without side effects», a «Crohn and ulcerative colitis remedy», a «liver detox» and a «gastric cancer drug». These claims are not supported by data. HMPC 2015 recognizes only traditional use for mild dyspepsia and superficial skin inflammation. Small pilot studies in Crohn disease and ulcerative colitis are not confirmed in large RCTs. Maastricht VI 2022 and 2022 for Crohn disease and ulcerative colitis recommend 5-ASA, corticosteroids, immunosuppressants and biologics – mastic is not mentioned in these guidelines. The «liver detox» concept does not exist in modern physiology. The «natural antibiotic» idea creates a risk that patients drop standard H. pylori eradication and progress to atrophic gastritis with raised gastric cancer risk. AEMPS and AESAN classify mastic as a complemento alimenticio without therapeutic indication. If mastic was bought «instead of standard treatment», discuss the plan with a gastroenterologist – real diagnoses are treated with drugs of proven efficacy.

Sources

  1. ECCO: ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment (2022)
  2. ESGE / EHMSG / ESPGHAN: Management of Helicobacter pylori infection – the Maastricht VI/Florence Consensus Report (2022)
How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

Mastic gum is a natural resin tapped from the bark of Pistacia lentiscus var. Chia on the island of Chios. Chios mastic holds a European PDO certificate since 2014. Its chemistry includes triterpene acids (masticadienonic, isomasticadienonic, oleanolic), resins and essential oils. In vitro mastic suppresses H. pylori growth and reduces bacterial adhesion factors; animal models show accelerated gastric ulcer healing. HMPC 2015 recognizes traditional use of mastic for mild dyspepsia and for healing of minor skin wounds and inflammation. Small clinical RCTs by Dabos (Phytomedicine 2010, 52 patients) and Kottakis (J Ethnopharmacol 2008) show partial H. pylori eradication (about 30–35% on mastic monotherapy versus 0% in placebo). This is not the level of triple or quadruple therapy (about 80–90% eradication). The historical Huwez observation (NEJM 1998) showed in vitro bactericidal action, but clinical translation is limited. AEMPS and AESAN classify mastic gum as a complemento alimenticio without therapeutic indication. Market products include Chios Mastic Gum (Mastiha Shop), Jarrow Mastic Gum, Now Foods Mastic Gum.

Safety

Contraindications

  • Known hypersensitivity to Pistacia lentiscus and other Anacardiaceae plants (pistachio, cashew, mango)
  • Pregnancy and lactation (EMA HMPC 2015)
  • Children under 12 years
  • Confirmed H. pylori infection when standard eradication therapy is declined

Serious adverse effects

  • Severe allergic reactions in patients allergic to Anacardiaceae nuts
  • Progression of atrophic gastritis if standard H. pylori eradication is declined

Common adverse effects

  • Gastrointestinal discomfort in the first days of use
  • Nausea
  • Headache

Pregnancy: can you take Mastic gum?

Mastic safety in human pregnancy has not been studied in RCTs. EMA HMPC 2015 advises against use in pregnancy because of lack of data. AEMPS and AESAN advise against supplements without therapeutic indication during pregnancy.

Breastfeeding: can you take Mastic gum?

Lactation safety has not been studied in RCTs. No data on transfer of mastic components into human milk. EMA HMPC 2015 advises against use in lactation.

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Frequently asked

What is Mastic gum used for?

Mastic gum is evaluated for the following indications with varying evidence strength: Functional dyspepsia (evidence tier C), Helicobacter pylori infection (evidence tier C), Superfoods and adaptogens (marketing category) (evidence tier D). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Mastic gum?

Common side effects of Mastic gum (≥ 1 in 100): Gastrointestinal discomfort in the first days of use, Nausea, Headache. See the Safety section for uncommon and serious reactions.

Is Mastic gum safe during pregnancy?

Mastic safety in human pregnancy has not been studied in RCTs. EMA HMPC 2015 advises against use in pregnancy because of lack of data. AEMPS and AESAN advise against supplements without therapeutic indication during pregnancy.

Is Mastic gum compatible with breastfeeding?

Lactation safety has not been studied in RCTs. No data on transfer of mastic components into human milk. EMA HMPC 2015 advises against use in lactation.

Who should not take Mastic gum?

Mastic gum is contraindicated in: Known hypersensitivity to Pistacia lentiscus and other Anacardiaceae plants (pistachio, cashew, mango); Pregnancy and lactation (EMA HMPC 2015); Children under 12 years; Confirmed H. pylori infection when standard eradication therapy is declined. Full list in the Safety section.

Other drugs in this group

Omeprazole, Pantoprazole, Rabeprazole, Slippery elm (inner bark), Deglycyrrhizinated licorice (DGL), Famotidine, Sodium alginate, Almagate