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Slippery elm is ideal for the skin and digestion

Slippery elm

Ulmus rubra Ulmaceae

Slippery elm is soothing, nutritive and demulcent to all inflamed tissues with a dual action of soothing and astringing throughout the body.

Sustainability Status

Sustainability status

At risk from overharvesting and habitat loss. Read more about our sustainability guide.

Potential replacement(s): Marshmallow, Mullein,

Key benefits
  • Digestive remedy
  • Mucosal health
  • Demulcent
  • Anti-inflammatory
  • Skin conditions
  • First aid
  • How does it feel?

    Slippery elm has a sweet earthy taste sense that may be likened to the taste of maple. Slippery elm has a beautiful soft and silky texture due to its mucilage content (mucilage is a sort of plant ‘gel’ that coats and soothes the tissues). The essence of this medicine is nurturing and soothing.

  • What can I use it for?

    Slippery elm is a valuable herbal medicine that has a long history of use for conditions of the digestive system and skin. However, due to threat of over-harvesting in the wild, we advise that this plant is not for home use unless it can be confidently procured from a sustainable (non-wild harvested) source. Marshmallow root powder is the perfect substitute for this plant as it bestows much the same properties. See ‘sustainability’ for more information.

    Slippery elm is a soothing, nutritive, demulcent that targets sensitive or inflamed mucous membranes throughout the body, but with a specific action on the skin and digestion. 

    It is also an astringent and has the dual action of soothing and astringing inflamed linings. Slippery elm produces mucilage that will coat inflamed linings, allowing any damaged tissue under the surface to regenerate and repair effectively. 

    The mucilage produced by the plant also acts as an excellent bulk laxative in cases of chronic and acute constipation but also as a wound packer that will draw out heat and infection from inflamed minor wounds. 

    The powdered bark may be added to a little hot water or vegetable glycerin to create a ‘drawing agent’. This can be applied like a poultice over a wound, a thorn in the skin, abscesses or whitlow to draw out the toxins and bring to head. The combined action of mucilage and astringency acts to create a suction over the surface area on which it is applied. This can also be used to help draw out splinters or any remanence from an insect bite or sting. Marshmallow root powder is equally as effective for this application.

    Mucilage is the primary medicinal component of the plant and has a similar chemical composition to the mucilage present in linseed.

  • Into the heart of slippery elm

    Slippery elm bark is classed as a demulcent with anti-inflammatory activity that is focused within the digestive tract and on the skin. 

    Energetically slippery elm is best for dry, atrophic or inflamed conditions. The cooling and moistening demulcent properties are largely due to the high levels of mucilage found in the bark.

    This quality makes slippery elm a fantastic anti-inflammatory and vulnerary with an affinity for the digestive, respiratory and integumentary system. It is long used as a medicine for convalescence, because as a deeply nutritive and fiber-rich bulk, it can nourish the body and restore tissue integrity in the gastrointestinal tract.

    This mucilaginous quality also helps to absorb and draw out excess heat, infection or debris from minor wounds or inflamed mucous membranes encouraging effective wound repair mechanisms. It is indicated in any generalised inflammation of the digestive tract including gastritis, duodenal ulcers, haemorrhoids, constipation, diarrhoea, dysentery and enteritis.

    This drawing action is also understood to act upon the mucosal linings inside the visceral organs to allow for improved cellular detoxification (3).

  • Traditional uses

    The bark was traditionally used as an external treatment for burns, ruptures, skin complaints and wounds and is considered to be naturally incredibly soothing and nourishing for the whole body.

    Slippery elm was considered to be one of the best demulcent and internal and external uses. It was used as a lubricant to sooth alimentary mucosa, relieving intestinal irritation. It was also said to quieten the nervous system (4).

  • Traditional actions

  • Traditional energetic actions

    Herbal energetics are the descriptions Herbalists have given to plants, mushrooms, lichens, foods, and some minerals based on the direct experience of how they taste, feel, and work in the body. All traditional health systems use these principles to explain how the environment we live in and absorb, impacts our health. Find out more about traditional energetic actions in our article “An introduction to herbal energetics“.

  • What practitioners say

    The elm leaves and bark are classed as demulcents with anti-inflammatory activity that is focused within the digestive tract but also on the skin.

    Digestive system: Slippery elm has a wide range of applications for gastrointestinal health. It may be applied to treat gastric or duodenal acidity or ulcerations. Conditions such as heartburn and reflux or chronic constipation may also be improved through the internal use of this medicine. However it is important to note that other causative factors should always be identified for such ongoing conditions (2).

    The other indications for slippery elm are for any such conditions with general inflammation of the digestive tract. These may include gastritis, haemorrhoids, constipation, diarrhoea, dysentery and enteritis. There are more serious conditions that herbs like slippery elm may be used such as for inflammatory bowel disease, Crohns disease and diverticulosis/itis (2). These more chronic diseases are treated by a medical herbalist as part of a holistic approach alongside other specific herbs and interventions.

    Slippery elm can be a valuable medicine in these conditions as it is also considered to be incredibly soothing and nourishing for the whole body taken internally as a nutritive food.

    Respiratory system: Slippery elm may be indicated for dry, unproductive type coughs. As a soothing demulcent the potential of this plant to reduce inflammation in the mucosa of the respiratory tract may see it being used for a number of conditions such as pharyngitis, pneumonia and pleurisy (2).

    Skin: The bark is traditionally used as an external treatment for burns, infected or inflamed wounds and other ruptures and skin complaints. Additionally, the external application of slippery elm is indicated in other skin inflammations and irritations such as abrasions, minor burns, scalds, boils and abscesses.

  • Research

    Ulcerative colitis: An in vitro study was carried out to investigate the antioxidant effects of herbal therapies used by patients with inflammatory bowel disease. Some of the herbs used were slippery elm, fenugreek, devil’s claw, tormentil and wei tong ning

    Chemiluminescence was used to identify the effects of the herbs on oxygen radicals under mucosal biopsies taken from patients with active ulcerative colitis. It is unclear whether the herbs were applied in combination or individually for this study. The results showed that oxygen radical release from biopsies was reduced after incubation.

    The study concludes that all six herbs have antioxidant effects. Slippery elm, along with the other herbs, was found to elicit a similar response in patients with ulcerative colitis, when compared with 5-aminosalicylic acid. Further investigation is needed to assess the effects of slippery elm as a novel therapy in inflammatory bowel disease (6). 

    Irritable bowel syndrome: A pilot study which included 31 patients with irritable bowel syndrome. The patients in the study received either one of two formulas depending on whether they were diarrhoea or alternating bowel habit-predominant (formula 1) or constipation prominent (formula 2). The first consisted of a mixture of dried, powdered bilberry fruit, slippery elm bark, agrimony aerial parts, and cinnamon quills. The second formula consisted of a mixture of dried powdered slippery elm bark, lactulose, oat bran, and liquorice root. 

    Patients in either group showed significant increase in bowel movement frequency, and a reduction in abdominal pain, straining, flatulence and global IBS symptoms. The latter formula was associated with the addition of stool consistency improvements. The study concludes that formula 1 was not effective in improving bowel habit in individuals with diarrhoea – predominant or alternating bowel habit although it did significantly improve IBS symptoms generally. Formula 2 significantly improved both bowel habit and IBS symptoms in patients with constipation-predominant IBS (7).

    Laryngeal/Pharyngeal irritation: A randomised control single blind design was used to investigate the effects of slippery elm on pharyngeal/ laryngeal sensations. 24 participants were recruited to take either a hot liquid preparation either containing slippery elm powder or placebo. The group who received slippery elm reported a higher rating of soothing sensations than that which was reported by the placebo group (7).

  • Did you know?

    In some traditions, elm was known as ‘chew-bark’ as both animals and humans would self-medicate by chewing the bark of this tree when they had an upset digestion.

Additional information

  • Botanical description

    The elm is a small tree native to Northern parts of America, but is now naturalised across Europe. The tree produces a particularly rough bark and the leaves are also toothed with a rough surface and a fine layer of hair. The leaf buds are covered in a characteristic dense yellow ‘woolly’ fibres. It is the inner bark of the tree that is used medicinally.

  • Common names

    • Red elm
    • Gray elm
    • Soft elm
    • Moose elm
  • Safety

    Slippery elm is not recommended for use in infants or small children. There is conflicting data regarding the use of slippery elm during pregnancy. However, the most current information on oral use of slippery elm is that it is considered safe for use in pregnancy. 

    There is reference to miscarriages in women using slippery elm vaginally in powder or pessary form as inserted into the cervical. This was described to have been due to its ability to expand and absorb moisture locally (5).

  • Interactions

    None known

  • Contraindications

    Slippery elm should be used with caution if taking any medications, as theoretically it may reduce the absorption of orally administered medications (4). It should therefore be taken 2 hours before or after other medications (5).

  • Preparation

    • Powdered (inner bark)
    • Capsules
  • Dosage

    Dried: Use 1 part powdered root to 8 parts water (or mix 1 tablespoon in 1 pint of water) and drink.

    Decoction: Use 1 part powdered root to 8 parts water, bring to the boil and then simmer gently until it starts to form a paste. The paste can be taken internally and also added to wounds.

    External uses: Apply to burns, wounds, inflammation, anal fissures. Drawing for boils, abscesses.

  • Plant parts used

    Inner bark

  • Constituents

    • Mucilage polysaccharides: hexose and pentose (hydrolysis yields glucose) (2), galactose, rhamnose, galacturonic acid (4)
    • Tannins (unto 6.5%)
    • Sterols
    • Sesquiterpenes 
    • Minerals (2)
  • Habitat

    Slippery elm can be found in North Dakota to Texas and over to the Atlantic Ocean. It grows in parts of every state except for Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. 

    It is also found in the Canadian provinces of New Brunswick, Ontario, and Quebec. Slippery elm trees prefer part to full sun and moist, limestone filled soil. The trees grows best in riparian forests and buffers—areas of forested land along the edges of freshwater or rivers (1).

  • Sustainability

    There are many references to sustainability concerns for this species as it has become ever more popular as an over the counter herb for digestive issues. According to United Plant Savers, a number of threats are faced by this species. 

    Both over harvesting in the wild and the increase in Dutch Elm disease mean that there are very few mature slippery elm trees left in the wild. Harvesting healthy trees for lumber or bark is likely to make the tree more vulnerable to disease and reduce its resistance from the gene pool (1). 

    Due to the declining wild populations of slippery elm, herbalists often advise not use any wild-harvested bark – unless harvested from naturally felled trees. Marshmallow (Althaea officinalis), mullein (Verbascum spp.) or powdered psyllium husk are equally as effective in the treatment of most conditions for which slippery elm may be applied (1).

    Habitat loss and over harvesting from the wild are two of the biggest threats faced by medicinal plant species. There are an increasing number of well-known herbal medicines at risk of extinction. We must therefore ensure that we source our medicines with sustainability in mind. 

    The herb supplement industry is growing at a rapid rate and until recent years a vast majority of medicinal plant produce in global trade was of unknown origin. There are some very real and urgent issues surrounding sustainability in the herb industry. These include environmental factors that affect the medicinal viability of herbs, the safety of the habitats that they are taken from, as well as the welfare of workers in the trade.

    The botanical supply chain efforts for improved visibility (transparency and traceability) into verifiably sustainable production sites around the world is now certificated through the emergence of credible international voluntary sustainability standards (VSS). Read our article on sustainable sourcing of herbs to learn more about what to look for and questions to ask suppliers about sustainability.

  • Quality control

    Herbal Medicines are often extremely safe to take, however it is important to buy herbal medicines from a reputed supplier. Sometimes herbs bought from unreputable sources are contaminated, adulterated or substituted with incorrect plant matter.

    Some important markers for quality to look for would be to look for certified organic labelling, ensuring that the correct scientific/botanical name is used and that suppliers can provide information about the source of ingredients used in the product. 

    A supplier should be able to tell you where the herbs have come from. There is more space for contamination and adulteration when the supply chain is unknown.

  • How to grow

    Slippery elm tree is easy to grow. The seeds (samaras) which are similar to the helicopter sycamore seeds can be gathered in spring when they are full ripe and fall from the tree. Slippery elm is most suitable for arid areas, due to its drought-resistance. It requires a moderately sunny to full sun position in order to thrive. Good drainage is important for successful growing of this beautiful tree.

    • The seeds need to be air dried, which usually takes a week. The seeds then need to be stratified at around 5°C in a moist medium for between 60- 90 days before planting.
    • Seedlings will sprout in a moist rich soil after having undergone the above process.
    • Once they reach around 8- 10 cm tall with 2 – 3 sets of leaflets they can be transplanted into a large pot of container, or directly out into the garden.
    • Overall, once established this tree will be able to absorb all the water it needs by its self.
  • References

    1. United Plant Savers. (n.d.). Slippery Elm – Ulmus rubra. [online] Available at: https://unitedplantsavers.org/species-at-risk-list/slippery-elm-ulmus-rubra/.
    2. Menzies-Trull, C. (2013). Herbal medicine keys to physiomedicalism including pharmacopoeia. Newcastle: Faculty Of Physiomedical Herbal Medicine (Fphm).
    3. Wood. M. 2004. The Practice of Traditional Western Herbalism: Basic Organs and Systems. North Atlantic Books,U.S.
    4. Hoffman, D. (2003). Medical Herbalism: The Science Principles and Practices Of Herbal Medicine. Hardback (1st Edition). Independently published.
    5. Clinical Advisor (2016). Slippery elm: an effective anti-inflammatory agent – Clinical Advisor. [online] Clinical Advisor. Available at: https://www.clinicaladvisor.com/home/features/alternative-meds-update/slippery-elm-an-effective-anti-inflammatory-agent/.
    6. Langmead, L., Dawson, C., Hawkins, C., Banna, N., Loo, S. and Rampton, D.S. (2002). Antioxidant effects of herbal therapies used by patients with inflammatory bowel disease: an in vitro study. Alimentary Pharmacology and Therapeutics, 16(2), pp.197–205. doi:10.1046/j.1365-2036.2002.01157.x.
    7. Hawrelak, J.A. and Myers, S.P. (2010). Effects of Two Natural Medicine Formulations on Irritable Bowel Syndrome Symptoms: A Pilot Study. The Journal of Alternative and Complementary Medicine, 16(10), pp.1065–1071. doi:10.1089/acm.2009.0090.
    8. ResearchGate. (n.d.). (PDF) Slippery Elm, its Biochemistry, and use as a Complementary and Alternative Treatment for Laryngeal Irritation. [online] Available at: https://www.researchgate.net/publication/265058434_Slippery_Elm_its_Biochemistry_and_use_as_a_Complementary_and_Alternative_Treatment_for_Laryngeal_Irritation.
An ‘aromatic’ remedy, high in volatile essential oils, was most often associated with calming and sometimes ‘warming’ the digestion. Most kitchen spices and herbs have this quality: they were used both as flavouring and to ease the digestion of sometimes challenging pre-industrial foods. Many aromatics are classed as ‘carminatives’ and are used to reduce colic, bloating and agitated digestion. They also often feature in respiratory remedies for colds, chest and other airway infections. They are also classic calming inhalants and massage oils, and are the basis of aromatherapy for their mental benefits.
Astringent taste
The puckering taste you get with many plants (the most familiar is black tea after being stewed too long, or some red wines) is produced by complex polyphenols such as tannins. Tannins are used in concentrated form (eg from oak bark) to make leather from animal skins. The process of ‘tanning’ involves the coagulation of relatively fluid proteins in living tissues into tight clotted fibres (similar to the process of boiling an egg). Tannins in effect turn exposed surfaces on the body into leather. In the case of the lining of mouth and upper digestive tract this is only temporary as new mucosa are replenished, but in the meantime can calm inflamed or irritated surfaces. In the case of open wounds tannins can be a life-saver – when strong (as in the bark of broadleaved trees) they can seal a damaged surface. One group of tannins, the reddish-brown ‘condensed tannins’ are procyanidins, which can reduce inflammation and oxidative damage.
Bitters are a very complex group of phytochemicals that stimulate the bitter receptors in the mouth. They were some of the most valuable remedies in ancient medicine. They were experienced as stimulating appetite and switching on a wide range of key digestive functions, including increasing bile clearance from the liver (as bile is a key factor in bowel health this can be translated into improving bowel functions and the microbiome). Many of these reputations are being supported by new research on the role of bitter receptors in the mouth and elsewhere round the body. Bitters were also seen as ‘cooling’ reducing the intensity of some fevers and inflammatory diseases.
Blue-purple colouring
Any fruits with a blue-purple colouring contain high levels of the polyphenols known as anthocyanins. These work 1) on the walls of small blood vessels, helping to maintain capillary structure to reduce a key stage in inflammation, and improving the microcirculation to the tissues; 2) to improve retinal function and vision; 3) to support connective tissue repair around the body.
Traditional ‘cold’ or cooling’ remedies often contain bitter phytonutrients such a iridoids (gentian), sesiquterpenes (chamomile), anthraquinones (rhubarb root), mucilages (marshmallow), some alkaloids and flavonoids. They tend to influence the digestive system, liver and kidneys. Cooling herbs do just that; they diffuse, drain and clear heat from areas of inflammation, redness and irritation. Sweet, bitter and astringent herbs tend to be cooling.
Traditional ‘hot’ or ‘heating’ remedies, often containing spice ingredients like capsaicin, the gingerols (ginger), piperine (black or long pepper), curcumin (turmeric) or the sulfurous isothiocyanates from mustard, horseradich or wasabi, generate warmth when taken. In modern times this might translate as thermogenic and circulatory stimulant effects. There is evidence of improved tissue blood flow with such remedies: this would lead to a reduction in build-up of metabolites and tissue damage. Heating remedies were used to counter the impact of cold, reducing any symptoms made worse in the cold. .
Mucilages are complex carbohydrate based plant constituents with a slimy or ‘unctuous’ feel especially when chewed or macerated in water. Their effect is due simply to their physical coating exposed surfaces. From prehistory they were most often used as wound remedies for their soothing and healing effects on damaged tissues. Nowadays they are used more for these effects on the digestive lining, from the throat to the stomach, where they can relieve irritation and inflammation such as pharyngitis and gastritis. Some of the prominent mucilaginous remedies like slippery elm, aloe vera and the seaweeds can be used as physical buffers to reduce the harm and pain caused by reflux of excess stomach acid. Mucilages are also widely used to reduce dry coughing. Here the effect seems to be by reflex through embryonic nerve connections: reduced signals from the upper digestive wall appear to translate as reduced activity of airway muscles and increased activity of airway mucus cells. Some seed mucilages, such as in psyllium seed, flaxseed (linseed) or guar bean survive digestion to provide bulking laxative effects in the bowel. These can also reduce rate of absorption of sugar and cholesterol. .
New-mown hay aroma
The familiar country odour of haymaking, of drying grass and other plants, is largely produced by coumarins (originally isolated from tonka beans – in French coumarou) and widely used in perfumery. They are chemically categorised as benzopyrone lactones and are important phytochemicals, with strong antioxidant activity in the laboratory and likely effects in modulating inflammation. They were most often associated with the calming effect linked to their use in stuffing mattresses and pillows and plants, high In coumarins were commonly used for these properties.
Resins are most familiar as tacky discharges from pine trees (and as the substance in amber, and rosin for violin bows). They were most valued however as the basis of ancient commodities like frankincense and myrrh (two of the three gifts of the Three Wise Men to the baby Jesus) and getting access to their source was one benefit to Solomon for marrying the Queen of Sheba (now Ethiopia). Resins were the original antiseptic remedies, ground and applied as powders or pastes to wounds or inflamed tissues, and were also used for mummification. With alcohol distillation it was found that they could be dissolved in 90% alcohol and in this form they remain a most powerful mouthwash and gargle, for infected sore throats and gum disease. They never attracted much early research interest because they permanently coat expensive glassware! For use in the mouth, gums and throat hey are best combined with concentrated licorice extracts to keep the resins in suspension and add extra soothing properties. It appears that they work both as local antiseptics and by stimulating white blood cell activity under the mucosal surface. They feel extremely effective!
The salty flavour is immediately distinctive. A grain dropped onto the tongue is instantly moistening and a sprinkle on food enkindles digestion. This easily recognisable flavour has its receptors right at the front of the tongue. The salty flavor creates moisture and heat, a sinking and heavy effect which is very grounding for the nervous system and encourages stability. People who are solid and reliable become known as ‘the salt of the earth'.
The sharp taste of some fruits, and almost all unripe fruits, as well as vinegar and fermented foods, is produced by weak acids (the taste is generated by H+ ions from acids stimulating the sour taste buds). Sour taste buds are hard-wired to generate immediate reflex responses elsewhere in the body. Anyone who likes the refreshing taste of lemon or other citrus in the morning will know that one reflex effect is increased saliva production. Other effects are subjective rather than confirmed by research but there is a consistent view that they include increased digestive activity and contraction of the gallbladder.
In the days when most people never tasted sugar, ‘sweetness’ was associated with the taste of basic foods: that of cooked vegetables, cereals and meat. In other words sweet was the quality of nourishment, and ‘tonic’ remedies. Describing a remedy as sweet generally led to that remedy being used in convalescence or recovery from illness. Interestingly, the plant constituents most often found in classic tonics like licorice, ginseng are plant steroids including saponins, which also have a sweet taste.

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