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Slippery elm (Ulmus rubra, Ulmus fulva)


Also listed as: Ulmus rubra, Ulmus fulva
Related terms

Related Terms
  • American elm, beta-carotene, beta-sitosterol, calcium oxalate, cholesterol, citrostandienol, dolichol, flavonoids, fructose, glucose, grey elm, hexoses, Indian elm, methylpentoses, moose elm, oleic acid, palmitic acid, pentoses, phytosterols, polyuronidesgalactose, proanthocyanidins, red elm, rock elm, salicylic acid, sesquiterpenes, slippery elm, sweet elm, tannins, Ulmaceae (family), Ulmi rubrae cortex, Ulmus fulva Michaux, winged elm.
  • Select combination products: Essiac®, Essiac®-like products such as Flor-Essence®, Robert's formula.
  • Note: The inner bark of slippery elm should not be confused with the whole bark. Californian slippery elm (Fremontia californica) has similar bark, and although it is unrelated, it is used in a similar way.

  • The slippery elm is native to eastern Canada and the eastern and central United States where it is found mostly in the Appalachian Mountains. Its name refers to the slippery consistency of the inner bark when chewed or mixed with water. Slippery elm inner bark has been used historically for cough, wound-healing, nutrition, or as an agent that soothes mucus membranes or softens and tones the skin. It is included as one of four primary ingredients in the herbal cancer remedy, Essiac®, and in Essiac®-like products such as Flor-Essence®.
  • There is a lack of research for the common uses of this herb, but due to its high gummy content, slippery elm bark may be a safe herbal remedy to treat irritations of the skin and mucus membranes.
  • Allergic reactions have been reported with slippery elm, but reports of toxic effect are lacking. Inner bark of slippery elm is different than the whole bark, which may cause side effects. Californian slippery elm bark has similar uses, but is in a different plant family than slippery elm.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *

Slippery elm is an ingredient in Essiac® and Essiac®-like products which are used for cancer. These products also contain other herbs such as rhubarb, sorrel, and burdock root. Currently, sufficient evidence is lacking to recommend for or against the use of these products for cancer. Further research is warranted.


Slippery elm is traditionally used to treat ulcers and inflammation of the stomach and intestine. Early evidence showed effectiveness of slippery elm with other herbs for inflammatory bowel syndrome. Additional study is needed before a conclusion can be drawn.

* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Abortion inducing, abscesses (pus pockets), anal fissures (skin tears by anus), antacid, anti-parasitic (tapeworm), boils, bronchitis, burns, carbuncles (infection of a group of hair follicles), cleansing impurities from the body, colic, colitis, congestion, constipation, cough, Crohn's disease, cystitis (inflamed bladder), demulcent (soothes skin), diarrhea, diuretic, diverticulitis (inflamed sacs in intestines), enteritis (small intestine inflammation), fever, fever blisters (cold sores), gastric ulcer, gastritis (stomach inflammation), gout, gynecologic disorders, hemorrhoids, herpes, infectious diarrhea, inflammation, joint problems, lactose intolerance, low blood cortisol levels, lung diseases, lung disorders, lung inflammation, nutrition, peptic ulcer disease, poison ivy, promoting healing, toothache, tuberculosis, typhoid fever, skin ulcer, sore throat, stomach acid excess (GERD), swollen glands, synovitis (inflammation of membrane around joints), syphilis, ulcerative colitis (inflamed colon), urinary tract infections, urinary tract irritation, vaginitis (inflammation of vagina), varicose ulcers (wounds due to vein malfunction), wound healing (splinters, pus).


Adults (18 years and older)

  • A proven effective dose for slippery elm is lacking in adults for any indication. In theory, slippery elm may slow down absorption of other medications given by mouth due to its fiber content. Teas, decoctions, liquid extracts, powdered inner bark preparations, and capsules/tablets are all commercially available.

Children (younger than 18 years)

  • Traditionally, it has been accepted that slippery elm may be used safely in children complaining of stomach upset and diarrhea. However, safety studies conducted in this area are lacking, and therefore use in children should only be under the strict supervision of a licensed healthcare professional.


The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.


  • Avoid in people with a known allergy or sensitivity to slippery elm or its constituents.
  • Hives have been reported due to contact with slippery elm.

Side Effects and Warnings

  • Use cautiously in people with diarrhea or those taking laxatives.
  • Use cautiously in combination with other agents, slippery elm may decrease the absorption of agents taken by mouth.
  • Use cautiously in children due to a lack of information.
  • Avoid use in pregnant or breastfeeding women, due to a lack of information. The whole bark of slippery elm may increase the risk of miscarriage.
  • Avoid in people with a known allergy or sensitivity to slippery elm.

Pregnancy and Breastfeeding

  • Avoid use in pregnant or lactating women, due to a lack of information. The whole bark of slippery elm may increase the risk of miscarriage.


Interactions with Drugs

  • Slippery elm may interact with agents taken by mouth, agents that affect the stomach and intestines, agents that soothe and protect mucus membranes, anticancer agents, and laxatives.

Interactions with Herbs and Dietary Supplements

  • Slippery elm may interact with herbs and supplements taken by mouth, herbs and supplements that affect the stomach and intestines, herbs and supplements that soothe and protect mucus membranes, herbs and supplements for cancer, and laxatives.

  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (

  1. Czarnecki D, Nixon R, Bekhor P, and et al. Delayed prolonged contact urticaria from the elm tree. Contact Dermatitis 1993;28:196-197.
  2. DeHaan RL. Home remedies for pets. J Am Holistic Veterinary Med Assoc 1994;12:26.
  3. Ernst E and Cassileth BR. How useful are unconventional cancer treatments? Eur J Cancer 1999;35(11):1608-1613.
  4. Gallagher R. Use of herbal preparations for intractable cough. J Pain Symptom Manage 1997;14(1):1-2.
  5. Hawrelak JA and Myers SP. Effects of two natural medicine formulations on irritable bowel syndrome symptoms: a pilot study. J.Altern.Complement Med. 2010;16(10):1065-1071.
  6. Kaegi E. Unconventional therapies for cancer: 1. Essiac. The Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative. CMAJ 1998;158(7):897-902.
  7. Karn H, Moore MJ. The use of the herbal remedy ESSIAC in an outpatient cancer population. Proc Annu Meet Am Soc Clin Oncol 1997;16:A245.
  8. Kato A, Ando K, Tamura G, et al. Effects of some fatty acid esters on the viability and transplantability of Ehrlich ascites tumor cells. Cancer Res 1971;31(5):501-504.
  9. Locock RA. Essiac. Can Pharm J 1997;130:18-20.
  10. Luo W, Ang CY, Schmitt TC, et al. Determination of salicin and related compounds in botanical dietary supplements by liquid chromatography with fluorescence detection. J AOAC Int 1998;81(4):757-762.
  11. Tamayo C, Richardson MA, Diamond S, et al. The chemistry and biological activity of herbs used in Flor-Essence herbal tonic and Essiac. Phytother Res 2000;14(1):1-14.
  12. Zick SM, Sen A, Feng Y, et al. Trial of Essiac to ascertain its effect in women with breast cancer (TEA-BC). J.Altern.Complement Med. 2006;12(10):971-980.

Copyright © 2011 Natural Standard (

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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