Functional Dyspepsia: The Evidence-Based Supplement Protocol

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Functional dyspepsia is upper-abdominal pain, post-prandial fullness, or early satiety without identifiable organic pathology. PPI therapy and prokinetics remain conventional options. Herbal preparations have unusually strong RCT evidence here — multiple plant extracts have produced effects comparable to PPI therapy in head-to-head trials.

STW5 (Iberogast), 20 Drops Three Times Daily

STW5 is a German fixed combination of nine herbal extracts (bitter candytuft, milk thistle, peppermint, chamomile, caraway, licorice, angelica, celandine, lemon balm). A 2014 meta-analysis of 12 RCTs concluded STW5 outperformed placebo and was non-inferior to cisapride and metoclopramide for functional dyspepsia symptoms. Hepatotoxicity case reports led to label warnings and removal of celandine in some formulations — see updated regulatory status. Effect appears within 2–4 weeks.

Peppermint Oil + Caraway Oil (Enteric-Coated), Twice Daily

The German Menthacarin combination of enteric-coated peppermint oil + caraway oil has produced multiple positive RCTs in functional dyspepsia, with reductions in pain VAS and global symptom scores comparable to PPI therapy. The peppermint component relaxes smooth muscle; caraway has additional carminative effects. See peppermint oil piece.

Ginger (Zingiber officinale), 1–2 g Daily

Ginger accelerates gastric emptying in healthy adults and in delayed-gastric-emptying populations. Multiple trials in functional dyspepsia have shown reduced post-prandial fullness and bloating versus placebo at 1–2 g of ginger powder daily. See our ginger piece.

Deglycyrrhizinated Licorice (DGL), 380–760 mg Before Meals

DGL has been used for decades in functional dyspepsia and mild GERD. The glycyrrhizin removal eliminates the pseudoaldosteronism risk that whole licorice carries. Effect modest but with very clean safety. See DGL vs whole licorice piece.

What NOT to Take

Avoid digestive enzyme megaformulas without confirmed pancreatic insufficiency — see our enzymes piece. Skip apple cider vinegar pills — null evidence for dyspepsia. Avoid whole licorice (glycyrrhizin-containing) — hypertension and hypokalemia risk with chronic use. Skip slippery elm — folklore-grade evidence only. See slippery elm piece.

How to Run the Protocol

Test for H. pylori — its eradication resolves a meaningful fraction of dyspepsia. PPI trial for 4–8 weeks is standard. Among supplements, STW5 has the strongest trial portfolio; peppermint + caraway is the next-best alternative. Add ginger 1 g before main meals if early satiety dominates. Track post-prandial fullness and pain on a daily 0–10 scale. If unresolved at 8 weeks, gastroenterology evaluation. See related IBS and GERD pages.