Can St John’s Wort cause an upset stomach? (5 tips)

This article will discuss whether Saint John’s Wort can cause an upset stomach. It will explain the possible mechanism by which it can cause this side effect and will explore studies on Saint John’s Wort’s induced upset stomachs.

The article will additionally mention factors that influence the risk of Saint John’s Wort-induced upset stomach. It will also provide suggestions on what to do if Saint John’s Wort causes a stomach ache.

Can St John’s Wort cause an upset stomach?

Yes, Saint John’s Wort (SJW) can cause an upset stomach. Gastrointestinal discomfort is the most reported side effect of Saint John’s Wort. However, SJW is generally a very safe herb, and the gastrointestinal discomfort that it causes is usually mild and tolerable.

However, people respond differently to medications. While SJW’s gastrointestinal side effects are tolerable and mild for most people, it is important to consider that a few people may not tolerate these side effects and find them highly undesirable.

Thus, if you experience an upset stomach while taking SJW, you must know the possible helpful management strategies. Moreover, if this side effect is severe and persistent, it is recommended that you consult with a doctor.

How can SJW cause an upset stomach?

Research on the mechanisms by which Saint John’s Wort can cause an upset stomach is limited, but a study found that most people with IBS and stomach aches had increased serotonin levels, which are the main neurotransmitters responsible for transmitting signals from the central nervous system to the gut [1].

This suggests that a change in serotonin levels can lead to GIT disturbances like nausea, diarrhea, constipation, bloating, and flatulence. Moreover, multiple studies have shown that selective serotonin reuptake inhibitors (SSRIs) are commonly associated with an upset stomach [1, 2].

Saint John’s Wort actions also inhibit the reuptake of serotonin and increase its availability. Thus, despite the lack of research directly studying the mechanism by which St. John’s Wort can cause gastrointestinal discomfort, it can be concluded that its effects on serotonin contribute to this side effect [3].

What does research suggest?

In a research study examining the safety and effectiveness of Saint John’s Wort, the most commonly reported adverse effect, impacting 0.6% of the subjects, was stomach pain. Furthermore, another study found that eighteen out of 3250 patients experienced gastrointestinal adverse effects from SJW [4,5].

Additionally, the safety of St. John’s Wort and fluoxetine was evaluated in another study, and it was discovered that GI issues were the only negative effect that over 2% of the SJW-treated people had reported [6].

In fact, only 5% of individuals taking SJW reported gastrointestinal issues, compared to 6% of those taking fluoxetine [6].

What factors influence SJW-induced upset stomachs?

Multiple factors can increase the risk of experiencing an upset stomach while taking Saint John’s Wort. For example, overeating, or eating a lot of stomach-irritating foods, like citrus fruits, spicy foods, fatty foods, or tomatoes, can increase this side effect.

Excessive stress can also lead to stomach aches. Moreover, smokers, or those who consume a lot of caffeine, are more likely to experience stomach aches while taking SJW. Suffering from certain diseases or concurrently taking certain medications may increase this side effect.

The following table mentions the medications and diseases that increase the risk of having an upset stomach while taking SJW [7]:

What to do if SJW causes an upset stomach?

If your symptoms are severe, persistent, or intolerable, you should talk to a doctor. They will assess your condition and medical history and determine the cause of your upset stomach.

If St John’s Wort is what’s causing your symptoms, the doctor may reduce your dose and monitor your response. If this doesn’t work, they may suggest discontinuing this herb and recommend an alternative medicinal plant or drug with fewer gastrointestinal side effects.

On the other hand, if the doctor finds that you are suffering from a condition that causes stomach pain, they will prescribe medications for this condition. For example, if you are suffering from a peptic ulcer or GERD, the doctor will likely prescribe a proton pump inhibitor, like omeprazole, and an antacid.

If your concurrent medications are causing this side effect, your doctor may replace them with other drugs that are safer for your gastrointestinal system. For example, they may replace NSAIDs with COX-2 inhibitors. However, this should only be done under a physician’s supervision.

Tips to manage an upset stomach while taking St John’s Wort

Some habits and lifestyle adjustments can help with St John’s Wot-related stomach aches. These include:

• Eating small meals more frequently, rather than eating a few big meals, may help reduce the frequency and intensity of your stomach pain.

• Try to increase your physical activity. Regular exercise improves digestion and reduces stomach aches.

• Avoid foods that hurt your stomach. Some people get an upset stomach after consuming eggs, cow milk, and beans. Spicy foods, fatty foods, tomatoes, citrus fruits, and caffeine can also irritate the stomach. It is recommended to avoid such foods or drinks.

• Drinking certain herbal drinks, such as chamomile tea, anise tea, ginger tea, and green tea, may help relieve your stomach ache. 

These strategies can only help in mild cases. However, if your stomach ache persists, or if it is very severe, you should discuss this with a doctor. 

Understanding the link between SJW and upset stomachs

Based on my research, I concluded that it is common for Saint John’s Wort to cause an upset stomach. I also found that this is likely because of its ability to increase serotonin levels.

Based on my knowledge, people who take high doses of SJW, or those who consume a lot of caffeine, are most likely to experience this side effect. From my perspective, diseases like IBS, Crohn’s disease, peptic ulcer, inflammatory bowel disease, and GERD increase the risk of SJW-induced stomach ache.

Moreover, I believe that people taking NSAIDs, certain antidepressants, oral contraceptives, DMARDs, or bisphosphonates are more likely to suffer from an upset stomach while taking SJW.

If you experience an upset stomach while taking Saint John’s Wort, I recommend changing your eating habits. You should also consult with a doctor. They will assess your condition and recommend a course of action accordingly. The doctor may suggest taking a lower dose or stopping this herb altogether. 

The doctor may also prescribe additional medications if they find that you have a condition that causes an upset stomach. Additionally, they may adjust your treatment plan and your medications if they find that another drug that you’re taking is causing these symptoms.

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