slippery elm

What Is It?
Health Benefits
Dosage Information
Guidelines for Use
General Interaction
Possible Side Effects
Evidence Based Rating Scale

What Is It?

Well before the first European settlers arrived in North America, Native American tribes had discovered that by scraping away the rough outer bark of the majestic slippery elm tree (Ulmus rubra), they could uncover a remarkable healing substance in the inner bark. They beat the bark into a powder and added water to create a "slippery" concoction ideal for soothing toothaches, healing scrapes, and dispelling constipation.

Later, surgeons in the American Revolution turned to this wilderness remedy to treat gunshot wounds. During the same period, a wholesome and nutritious broth made from the bark was fed to infants and older people.

Long recognized by health authorities in the United States as an effective medicine, slippery elm bark has been approved by the Food and Drug Administration as a nonprescription demulcent (soothing agent) that can be taken internally. (1)

Various sources refer to this classic North American Herb as American elm, Indian elm, moose elm, red elm, and sweet elm. No matter the name of the product, the important thing to look for is that it contains the pale inner bark of Ulmus rubra Muhl (once also known as Ulmus fulva Michx). Do not confuse with whole bark products, which do not contain the applicable constituents of slippery elm.

Health Benefits

The popularity of slippery elm bark has endured, no doubt, because it works so well for coating and soothing irritated or inflamed Mucous membranes. This is the work of an ingredient in the inner bark called mucilage, a gummy, gel-like substance that when ingested forms a protective layer along the throat, digestive tract, and other areas. Astringent compounds in the herb called tannins help tighten and constrict the tissue.

For the same reasons, salves and ointments containing slippery elm have long been popular for coating well-cleaned minor wounds and burns to protect them from further injury.

Specifically, slippery elm may help to:

Soothe a cough, sore throat, and bronchitis. Slippery elm throat lozenges are particularly effective for easing a cough and soothing a sore throat, coating the area and reducing irritation. Warm slippery elm bark tea also may help to ease a cough and sore throat, as does a liquid Extract. The demulcent and emollient properties of slippery elm, which help to sooth irritation and inflammation, seem to be derived from a gelatinous liquid called mucilage that is found in the inner bark of the tree. (2, 3) When ingested, mucilage forms a protective layer along the throat, digestive tract and other areas, coating and soothing mucous membranes that have become inflamed and suppressing cough receptors in the throat and larynx. Several sources have cited this component of slippery elm as a primary treatment for sore throats and cough, particularly when added to throat lozenges. (4-8) However, no scientific studies have confirmed these benefits of slippery elm. In one related trial in 1998, in which the use of hybrid protocols (using one, two or three treatments simultaneously) to restore immune function was studied, slippery elm was listed as a safe alternative therapy for inflammatory conditions. (9) For the pain of acute bronchitis, there may be no more soothing balm than several cups of slippery elm tea. The herb may be beneficial in thinning, loosening and bringing up mucus secretions during an attack of acute bronchitis, according to the 1999 Review of Natural Products by Facts and Comparisons. (10) While slippery elm has a long history of this use, no scientific studies have been conducted to evaluate its efficacy in treating bronchitis.

Ease gastrointestinal symptoms of conditions such as Crohn's disease. Slippery elm's soothing mucilage effect is also used for disorders of the gastrointestinal (GI) tract. It is part of the herbal combination called "Robert's Formula," which is widely prized by naturopathic physicians to treat intestinal inflammations caused by conditions such as gastritis or Inflammatory Bowel Disease (IBD, Crohn's disease ulcerative colitis). Even the discomforts of heartburn or an ulcer may respond to this old-time home remedy. When used internally, according to the same 1999 review listed above, slippery elm’s mucilage seems to stimulate nerve endings in the GI tract to secrete mucous, thereby relieving irritation. (10) Scientific trials, however, are in early stages. A 2002 in vitro study of several herbal therapies found slippery elm to also have antioxidant properties that scavenge free radicals in inflamed human colorectal tissues, suggesting potential efficacy in treating IBD in humans. (11)



  • tincture
  • tablet
  • powder
  • ointment
  • lozenge
  • liquid
  • dried herb/tea

Dosage Information

To prepare a decoction, use 1 part herb to eight parts boiling water. Alternatively, mix 1 teaspoon (5ml) of liquid extract (1:1 in 60% alcohol) in 8 ounces of hot water to make a tea, or extract can be taken directly. Lozenges and tablets may be taken ad lib.

For cough, sore throat, or acute bronchitis:

Drink one cup of slippery elm tea or a slippery elm-containing herbal cough tea three times a day. 1-4 tsp. of decoction may be taken as needed, or suck on a slippery elm lozenge every two to three hours, as needed.

For bronchitis:

Chronic: Use the doses above during flare-ups; otherwise drink the tea once a day.

For Crohn's disease and other gastrointestinal upset: Use 1 teaspoon of liquid extract diluted in 8 ounces of hot (not boiling) water OR take 2 capsules of Robert's Formula (which contains slippery elm) four times a day.

Guidelines for Use

Slippery elm throat lozenges are easy to find at health-food stores.

General Interaction

There are no known drug or nutrient interactions associated with slippery elm.

Possible Side Effects

  • Some people develop an allergic rash when slippery elm is applied to the skin; stop using (externally and internally) if this happens.

  • Aside from the risk of an allergic skin reaction, there are no side effects associated with the use of slippery elm at commonly recommended dosages.

  • Cautions

    • Slippery elm is considered a safe herb when taken at commonly recommended dosages. However, because of unknown health risks associated with using the whole bark, make sure to buy products that only contain the inner bark.

    • The risks of using slippery elm preparations during pregnancy or while breast-feeding are unknown.


    1. Tyler V. Herbs of Choice, The Therapeutic Use of Phytomedicinals. Binghamton, NY: Pharmaceutical Products Press. 1994;93, 94.
    2. Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.
    3. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
    4. Covington TR, et al. Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association, 1996.
    5. Kemper, K. The Longwood Herbal Task Force. The Center for Holistic Pediatric Education and Research: Slippery Elm (Ulmus rubra or U. fulva). September 25, 1999.
    6. Pierce A. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York: The Stonesong Press, 1999:19.
    7. Robbers JE, Tyler VE. Tyler’s Herbs of Choice: The Therapeutic Use of Phytomedicinals. New York, NY: The Haworth Herbal Press, 1999.
    8. Braun, Lesley. Slippery Elm. J Complement Med. Jan/Feb 2006;5(1):83-4, 86.
    9. [No authors listed] Hybrid protocols plus natural treatments for inflammatory conditions. Posit Health News. 1998 Fall;(No 17):16-8.
    10. The Review of Natural Products. Slippery Elm. St. Louis, MO: Facts and Comparisons. Feb 1999.
    11. Langmead L, Dawson C, Hawkins C, et al. Antioxidant effects of herbal therapies used by patients with inflammatory bowel disease: an in vitro study. Aliment Pharmacol Ther. 2002 Feb;16(2):197-205.

     Evidence Based Rating Scale 

    The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies with what our clinical advisors have found to be efficacious in their personal practice. This tool is meant to simplify which supplements and therapies demonstrate promise in the treatment of certain conditions. This scale does not take into account any possible interactions with any medication/ condition/ or therapy which you may be currently undertaking. It is therefore advisable to ask your doctor before starting any new treatment regimen.































    Historically used to clear and soothe irritated airways associated with bronchitis. Scientific studies are lacking. More research is needed to confirm or refute efficacy. (10)




















    Date Published: 04/19/2005

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