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Mastic - Pistacia lentiscus

Mastic, primarily derived from Pistacia lentiscus var. chia, is a resinous exudate that has been used in traditional medicine for centuries across Mediterranean and Middle Eastern cultures. This review examines the scientific evidence for its therapeutic applications, safety profile, and pharmaceutical developments.

Image source and license: https://commons.wikimedia.org/wiki/File:Pistacia_lentiscus._Llentiscu.jpg.
Modified by Peter Jorgensen.

Botanical Classification and Common Names

The primary source of medicinal mastic is Pistacia lentiscus var. chia, commonly known as mastic, mastic gum, or Chios mastic (named after the Greek island Chios where it is primarily cultivated). Other Pistacia species with medicinal properties include Pistacia atlantica (Atlas mastic) and Pistacia terebinthus (terebinth or turpentine tree). These should not be confused with the unrelated mastic tree (Pistacia chinensis) or with different genera such as Schinus (Peruvian pepper) sometimes incorrectly called "mastic."

Bioactive Compounds

Mastic contains a complex mixture of bioactive compounds including triterpenic acids (such as masticadienonic acid, isomasticadienonic acid, and oleanolic acid), phytosterols, polyphenols, and a variety of volatile compounds including α-pinene, β-pinene, limonene, and myrcene. The composition varies by geographical origin, harvest time, and extraction method, which has implications for standardization in clinical applications.

Therapeutic Applications Supported by Clinical Evidence

• Helicobacter pylori infection and peptic ulcers: Multiple clinical trials demonstrate efficacy in reducing H. pylori bacterial load and improving gastrointestinal symptoms
• Dyspepsia and functional gastrointestinal disorders: Clinical evidence supports symptom improvement
• Inflammatory bowel disease: Moderate evidence for symptom reduction in ulcerative colitis and Crohn's disease
• Dental health: Antibacterial properties against oral pathogens with evidence for reducing dental plaque and gingivitis
• Hyperlipidemia: Clinical trials show modest improvements in lipid profiles, particularly total cholesterol and LDL reduction
• Liver protection: Some evidence for hepatoprotective effects and improvement in liver enzymes

Therapeutic Applications with Preliminary Evidence

• Diabetes mellitus: Animal and limited human studies suggest potential benefits for glycemic control
• Dermatological conditions: Anti-inflammatory and antimicrobial properties relevant to acne, eczema, and wound healing
• Cancer: In vitro and animal studies show antiproliferative and proapoptotic effects against various cancer cell lines
• Respiratory conditions: Anti-inflammatory effects potentially beneficial in asthma and chronic bronchitis
• Antioxidant activity: General health benefits through free radical scavenging

Recommended Dosages

Clinical studies have used various preparations and dosages, making standardized recommendations challenging. However, the following ranges have shown efficacy in studies:

• Helicobacter pylori infection: 1-3g daily of whole mastic gum for 2-3 weeks
• Dyspepsia: 350-500mg three times daily
• Dental applications: 350mg twice daily or mouthwash containing 0.4-0.7% mastic extract
• Hyperlipidemia: 1-5g daily, with most studies using around 3g

Standardization remains problematic. Research suggests that products standardized to contain 30-45% triterpenic acids (particularly masticadienonic and isomasticadienonic acids) may offer more consistent clinical outcomes. Many commercial preparations fail to specify standardization parameters, complicating dosage recommendations.

Safety Profile and Side Effects

• Generally recognized as safe (GRAS) status in the United States
• Reported side effects are typically mild and include headache, gastrointestinal discomfort, and allergic reactions
• Dose-dependent contact dermatitis has been reported in sensitive individuals
• Potential for hypersensitivity reactions in individuals with allergies to Anacardiaceae family plants (e.g., cashews, pistachios)
• Limited data on long-term safety (beyond 6 months of use)
• Interaction with anticoagulants and antiplatelets is theoretically possible due to its effects on platelet aggregation

High-Dose Studies and Knowledge Gaps

Studies investigating doses above 5g daily are limited. A small number of trials using 6-10g daily for Helicobacter pylori eradication reported no significant increase in adverse effects compared to lower doses. However, there is insufficient data to draw firm conclusions about the safety and efficacy of high-dose regimens.

Specifically, there is limited information on:

• Long-term safety of high doses
• Potential for hepatotoxicity at doses above 10g daily
• Dose-response relationships for most therapeutic applications
• Pharmacokinetics and bioavailability of different formulations

Commercial Pharmaceutical Products

• Mastiha Caps®: Standardized capsules containing 350mg mastic gum
• Mastident®: Dental products containing mastic extract for periodontal applications
• Elma®: Chewing gum with mastic for dental hygiene

Note that most mastic products globally are marketed as dietary supplements rather than registered pharmaceuticals, which has implications for quality control and therapeutic claims.

References

Al‐Habbal, M. J., Al‐Habbal, Z., & Huwez, F. U. (1984). A double‐blind controlled clinical trial of mastic and placebo in the treatment of duodenal ulcer. Clinical and experimental pharmacology and physiology, 11(5), 541-544.

Dimas, K. S., Pantazis, P., & Ramanujam, R. (2012). Chios mastic gum: a plant-produced resin exhibiting numerous diverse pharmaceutical and biomedical properties. in vivo, 26(5), 777-785.

Di Pierro, F., Sagheddu, V., Galletti, S., Forti, M., Elli, M., Bertuccioli, A., & Gaeta, S. (2021). Antibacterial activity of a fractionated Pistacia lentiscus oil against pharyngeal and ear pathogens, alone or in combination with antibiotics. Frontiers in Microbiology, 12, 686942.

Georgiadis, I., Karatzas, T., Korou, L. M., Agrogiannis, G., Vlachos, I. S., Pantopoulou, A., ... & Perrea, D. N. (2014). Evaluation of Chios mastic gum on lipid and glucose metabolism in diabetic mice. Journal of medicinal food, 17(3), 393-399.

Kartalis, A., Didagelos, M., Georgiadis, I., Benetos, G., Smyrnioudis, N., Marmaras, H., ... & Andrikopoulos, G. (2016). Effects of Chios mastic gum on cholesterol and glucose levels of healthy volunteers: A prospective, randomized, placebo-controlled, pilot study (CHIOS-MASTIHA). European journal of preventive cardiology, 23(7), 722-729.

Milia, E. P., Sardellitti, L., & Eick, S. (2023). Antimicrobial Efficiency of Pistacia lentiscus L. Derivates against Oral Biofilm-Associated Diseases—A Narrative Review. Microorganisms, 11(6), 1378.

Soulaidopoulos, S., Tsiogka, A., Chrysohoou, C., Lazarou, E., Aznaouridis, K., Doundoulakis, I., ... & Lazaros, G. (2022). Overview of chios mastic gum (Pistacia lentiscus) effects on human health. Nutrients, 14(3), 590.

Spyridopoulou, K., Tiptiri-Kourpeti, A., Lampri, E., Fitsiou, E., Vasileiadis, S., Vamvakias, M., ... & Chlichlia, K. (2017). Dietary mastic oil extracted from Pistacia lentiscus var. chia suppresses tumor growth in experimental colon cancer models. Scientific reports, 7(1), 3782.