Slide deck by Dr Jason A. Hawrelak (Naturopathic Symposium, 27–28 May 2023) presenting black pepper (Piper nigrum) as an under-utilised therapeutic agent. Covers botany, traditional uses (Western, Ayurvedic, TCM), energetics, major actions (digestive stimulant, stimulates saliva and gastric secretion, enhances bile and digestive enzymes, slows gastric transit, enhances nutrient and drug/phytochemical bioavailability via inhibition of P-glycoprotein/CYP3A/UGTs/SULTs), minor actions (hepatoprotective, anticonvulsant, neuroprotective, antibacterial/anti-biofilm), dosing (1:2 tincture, 60% alcohol, weekly dose 5–25 mL; ~15–25 mg piperine per mL), indications (digestive dysfunction, malabsorption, improving herb/supplement bioavailability), cautions (gastritis, peptic ulcer, GORD, SIBO, high pitta/yin deficiency, pregnancy caution), potential for significant drug interactions (P-gp, CYP3A, UGT and SULT inhibition), clinical case studies illustrating analgesic adjunctive use and infection management, and a detailed references list.

Questions this document answers

1:2 tincture in 60% alcohol.

5–25 mL per week.

Approximately 15–25 mg piperine per 1 mL.

P-glycoprotein (P-gp), CYP3A (notably CYP3A4), UDP-glucuronyltransferases (UGT1A6, UGT1A8), and sulfotransferases (SULT1A1, SULT1A3).

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