Please note: While some information will still be current in a year, other information may already be out of date in three months time. If you are in any doubt, please feel free to ask.

nutritional supplements

I have a grandson 8 years with cystic fibrosis. When it prevail problems with the pancreas. Would it just be given a dietary supplement okra pepsin Eze for clearing the accumulated mucus?
Thank you.
Thank you for your question regarding the herbal preparation Okra Pepsin E3. You asked if it would be helpful in clearing accumulated mucus in your grandson who has cystic fibrosis. I gather you are to referring to intestinal mucus?

The basic defect in cystic fibrosis affects epithelial cells that line the passages in the body’s organs causing the production of mucus which is thick and sticky. The two organs most affected are the lungs, where thick mucus causes breathing and digestive problems.

From your question I presume that your grandson has pancreatic insufficiency and takes oral pancreatic enzymes to help him digest food?

You may already know that Okra is a plant used widely in Indian, middle Eastern and Caribbean cuisine. It is also known as Ladys fingers because of its characteristic shape.

As a plant Okra contains both soluble and insoluble fibre. Soluble fibre may help to lower cholesterol and reduce risk of heart disease while insoluble fibre can help to promote a healthy intestinal tract. Okra also is a source of vitamin B6 folic acid, vitamin A. Okra powder in capsule form is unlikely to contain the same levels of dietary fibre, hence the potential health benefits may be lost.
Okra Pepsin E3 is an herbal remedy and the Medicines and Healthcare Products Regulatory Agency (MHRA) provide the following advice:
General advice to consumers
Remember that herbal remedies are medicines. As with any other medicine, you should use them with care while first ensuring they are the correct products for you. Also remember that the phrases ‘natural’, ‘herbal’ and ‘derived from plants’ do not necessarily mean ‘safe’. Many plants can be poisonous to humans, and many pharmaceutical medicines have been developed from plants using the powerful compounds they contain.
• Any medicine - herbal or otherwise - has the potential to have adverse effects (or side effects).
• Herbal medicines can also interact with other medicines you are taking. This could result in reduced or enhanced effects of the other medicines, including side effects. If you are consulting your doctor or pharmacist about your health or are about to have surgery or an operation, always tell them about any herbal medicines you are taking.
• As with all medicines, keep herbal medicines out of the sight and reach of children. (
• Quality control for the safety and efficacy of any herbal remedy is therefore essential. Since 30/042011 new European Union (EU) regulations on herbal medicines have come into force.
• This EU directive aims to protect consumers from possible damaging side effects of over-the-counter herbal medicines. It requires traditional, over-the-counter herbal remedies to be made to assured standards of safety and quality.

As a consequence of the directive other problems in relation to imported goods have arisen.
Imported goods
• Imported herbal products from the USA are subject to almost no quality control, and some combine herbal medicines with vitamins and minerals. Some medical herbalists hope that US companies will reformulate their products to comply with the new EU regulations within the 5-7 year implementation period.
The company that produces Okra pepsin E3 is Standard Process Inc. based in Palmyra, Wisconsin USA. It is worth noting that such nutritional supplements are not regulated by the Food and Drug Administration (FDA). However Standard Process Inc has registered with the FDA their claim that their product has bowel cleansing properties.
Under current law in the USA such nutritional supplements can be produced, marketed and sold without first demonstrating that they are safe and effective, as is required for conventional pharmaceutical drugs. In other words herbal medicines do not have to go through the testing that drugs do. In the case of Okra Pepsin E3 the scientific research to support these claims is non existent and the health benefits of the supplement is unclear.

To my knowledge Okra Pepsin E3 is an unlicensed product in Europe. The MHRA website ( offers very good advice to consumers on what you should know about how herbal medicines are regulated.

The MHRA warns against buying an unlicensed product over the internet and advise the consumer to be alert and exercise caution. They also highlight that children are ‘at risk’ because the safety of many herbal medicines has not been established in this client group.

So in summary, many herbal products are unlicensed and may not have any scientific evidence to support the claims of health benefits. The safety of use of herbal medicines has not been well established especially in children and those who have a chronic condition such as Cystic Fibrosis.
If there are any specific concerns about your grandson’s digestion, I would advise that these are discussed with your Cystic Fibrosis team who can assess him medically and will provide appropriate advice if required.

Finally as a rule, anyone with a history of liver or kidney complaints, or any other serious health condition (for example Cystic Fibrosis) is advised not to take any herbal medicine without speaking to their doctor first.

With best wishes

Dee Shimmin
Clinical Specialist Dietitian

The answer is edited by: Dee Shimmin