Echinacea - Have Mercy!
I suppose the good news is that no one is claiming that Echinacea is unsafe -- just that it doesn't work. In case you missed the news, another study has recently been published claiming that Echinacea is ineffective at preventing colds and may have only a mild ability to shorten their duration once you get them.
What is that now -- three major studies trashing Echinacea in the last year alone?
At a certain point, the preponderance of evidence wears you down and you give up and agree that Echinacea is useless -- unless you actually look at the studies and see what they're talking about.
But before we get to the study in question, let's trace a little history.
A look at contradictory Echinacea trial claims
There are indeed studies that show Echinacea works, that it can help reduce the severity of cold symptoms and shorten the duration of a cold by one or two days:
- Dorn M, Knick E, Lewith G. Placebo-controlled, double-blind study of Echinaceae pallidae radix in upper respiratory infections. Complement Ther Med 1997;5:40-2.
- Hoheisel O, Sandberg M, Bertram S, Bulitta M, Schäfer M. Echinagard treatment shortens the course of the common cold: a double-blind, placebo-controlled clinical trial. Eur J Clin Res 1997;9:261-9.
- Brinkeborn RM, Shah DV, Degenring FH. Echinaforce and other Echinacea fresh plant preparations in the treatment of the common cold. A randomized, placebo controlled, double-blind clinical trial. Phytomedicine 1999;6:1-6.
Or does it? Several studies, including two NCCAM-funded studies (2002 & 2003) did not find a benefit from Echinacea:
- A 2000 study (Turner RB, Riker DK, Gangemi JD. Ineffectiveness of Echinacea for Prevention of Experimental Rhinovirus Colds. Antimicrob Agents Chemother. 2000 Jun;44(6):1708-9) pretty much says it all in its title. (But the study failed to report the Echinacea species used in the study, the plant parts used, the formulation, and the method of extraction used.)
- Taylor JA, Weber W, Standish L, et al. Efficacy and safety of Echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. Journal of the American Medical Association. 2003;290(21):2824–2830. (This study tested Echinacea "juice.")
- Barrett BP, Brown RL, Locken K, et al. Treatment of the common cold with unrefined Echinacea: a randomized, double-blind, placebo-controlled trial. Annals of Internal Medicine. 2002;137(12):939–946. (For the record, as stated in the title, this study used whole unrefined plant material -- not concentrated extracts; nor was any determination made as to the quality of the herb used.)
The bottom line is that we can disregard the above three studies because of the type of Echinacea tested. No real herbalist uses Echinacea "juice" or "unrefined plant matter." They use Echinacea extracts, either liquid or dry, with concentrations of up to 30:1. Using unrefined Echinacea or Echinacea juice (a pressing from the aerial parts of the plant) to evaluate the effectiveness of the herb is like claiming alcohol doesn't get you drunk by testing what happens when you drink "near beer."
No wait, it does work on cold symptoms
A 2003 study published in Seminars in Integrative Medicine showed that Echinacea may be beneficial in treating upper respiratory infections.
- Fugh-Berman A. Echinacea for the prevention and treatment of upper respiratory infections. Seminars in Integrative Medicine. 2003;1(2):106–111.
But then again
A more recent study shows it doesn't work. In 2005, researchers at the University of Virginia School of Medicine dosed students with Echinacea and then sprayed cold viruses up their noses. Their conclusion was that Echinacea did nothing to prevent or alleviate colds. (Turner RB, Bauer R, Woelkart K, Hulsey TC, Gangemi JD. An evaluation of Echinacea angustifolia in experimental rhinovirus infections. N Engl J Med. 2005 Jul 28;353(4):341-8) I dealt with that study just last August, and for the record it had three major flaws.
- First, the researches prepared their own Echinacea extracts, which is like putting the proverbial fox in charge of the henhouse. (For example, they used only a 20% alcohol solution, which is less than half the strength required to pull the active biochemicals from Echinacea root. )
- The dosage they used (less than 1 g per day) was a third of normal??!!
- Their subjects, college students, tend to be at an age where they have highly competent immune systems to begin with, so the effects of immune system boosting would be less noticeable than in many other groups.
Which brings us brings us to the latest study, now appearing in hundreds of news reports over the last 30 days that concluded that Echinacea, when taken in certain forms, may help shorten the duration and severity of cold symptoms a little bit but is not effective for preventing the common cold. (Linde K, Barrett B, Wolkart K, Bauer R, Melchart D. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD000530.) I particularly loved the marvelously damning summary quote that appeared in virtually every news release, "Frankly, I would not actively recommend that consumers take Echinacea preparations at the moment," said lead study author Dr. Klaus Linde of the Center for Complementary Medicine Research, Technical University of Munich.
A field day for the media, but let's take a look at the reality:
- First, it is a review, not a study. It merely reviewed data from existing studies, which means it's only as good as the studies it references. So which studies does it reference? The answer: 16 studies, including all of the studies cited above. So why is that a problem?
- We've already seen that several of the negative studies were fatally flawed. What's that old saying about computer data: "Garbage in; garbage out?"
- The conclusion that Echinacea did not prevent colds (the story the media ran with) was based on only two of the 16 studies, both of which were fatally flawed as cited above.
- This review included unpublished trials indicating that they had not been peer reviewed. The problem is that these unpublished trials may contain errors that would have otherwise been highlighted by peer-review (the step before a paper is published). Even one significant error could have affected the conclusions of the review. Then again, why worry about it. As we've seen time and again, being peer reviewed is no guarantee of accuracy -- particularly when one's peers share the same bias.
- Also, these studies tested Echinacea alone, not in formulations. This kind of testing works well for "drugs," but as we will discuss in more detail at the end of this newsletter, it pretty much neuters the best of alternative medicine. For now, just note that it is well documented that there is a synergistic effect as well as an additive effect when herbs are combined. This is a powerful tool and accounts for a significant difference between an herbalist's product and synthetic drugs. The review in question completely excluded all trials on combinations of Echinacea and other herbs.
- It is invariably true that products available under the label Echinacea differ greatly in their composition and strength. This review had no controls for this admitted variability. There was no control for assuring a representative sample of preparations of various plant parts, herb quality, concentration, or method of preparation.
- Another problem is that reviewers excluded the vast majority of positive Echinacea studies on the basis that they did not qualify as rigorous randomized trials. However, considering how flawed the negative studies were that they considered "rigorous," one has to question their judgment.
- And finally, the people who conducted the review, Linde K, Barrett B, Wölkart K, Bauer R, Melchart D, include some of the same people who conducted the study I mentioned earlier that concluded Echinacea was ineffective in preventing colds, but used only 1/3 the normal dosage in reaching that conclusion. In fact, one finds the same names (Bauer, Barrett, Wolkart, Turner, and Gangemi) appearing over and over in most of the negative studies -- just working together in different combinations. (Now you know why I forced you to wade through all the citations above.) The bottom line is that when the same people keep publishing negative studies, citing their previous flawed negative studies as proof of their new conclusions, you've got to question the validity of those conclusions.
The truth about Echinacea.
- Echinacea DOES keep colds away.
- Echinacea DOES shorten the duration of colds.
- That is if you use Echinacea of sufficient quality, quantity, and concentration.
Echinacea is truly a miracle herb. For one thing, it contains echinacoside (a natural antibiotic, comparable to penicillin in effect) that can kill a broad range of viruses, bacteria, fungi, and protozoa, which makes it invaluable in wound healing and in the treatment of infectious diseases. There is a great deal of research that has reported Echinacea's efficacy in treating colds, flu, bronchitis, tuberculosis, infections, etc.
Echinacea also contains echinacein, a biochemical that protects against germ attack by neutralizing the tissue dissolving enzyme, hyaluronidase, produced by many germs. Also, studies show that Echinacea contains substances that boost the ability of your body's macrophages to destroy germs. And other studies from the University of Munich have shown that Echinacea extracts boost T-cell production by as much as 30% more than immune boosting drugs.
New research shows that there are compounds in Echinacea, isobutyl amides, which actually work as immno-inhibitors and anti-inflammatories. These bio-chemicals might explain why several studies find Echinacea effective at reducing the symptoms of colds when taken during the onset stage of infection.
In fact, there is a great deal of valid evidence that Echinacea is an effective treatment for cold symptoms:
- The German Commission E lists that Echinacea preparations "support and promote the natural powers of resistance of the body, especially in infectious conditions of the nose and throat." Blumenthal M, Gruenwald J, Hall T, et al. German Commission E monographs: medicinal plants for human use. Austin (TX): American Botanical Council; 1998.
- A 2006 study, Echinacea extracts modulate the pattern of chemokine and cytokine secretion in rhinovirus-infected and uninfected epithelial cells, concluded that researchers observations provide support for the alleged beneficial uses of Echinacea extracts.
- A 2005 Review, Echinacea: a Miracle Herb against Aging and Cancer? Evidence In vivo in Mice, reported, "Our results have shown that daily consumption of Echinacea is indeed prophylactic, extends the life span of aging mice, significantly abates leukemia and extends the life span of leukemic mice. Given that humans are 97% genetically common with mice and that virtually all our basic physiology is identical, it is neither unjustified to extrapolate these observations to humans nor would it be an arduous task to perform many of these studies in humans, thus establishing viable scientific evidence replacing the anecdotal."
Experience shows Echinacea is an effective treatment for cold symptoms.
- Echinacea has been used for hundreds of years (starting with the American Indians) to treat cold symptoms and boost immune system response.
- Today millions of people successfully use Echinacea regularly based on anecdotal evidence. And before you dismiss anecdotal evidence, did you know that as many as 85% of all medical treatments are based on anecdotal evidence as reported by groups such as The Robert Wood Foundation and the US Government?
- "More than half of all medical treatments, and perhaps as many as 85 percent, have never been validated by clinical trials." Michael L. Millenson, AB: Demanding Medical Evidence: Doctors and Accountability in the Information Age, The Robert Wood Johnson Foundation, Issue 2, September 1998.
- "Only 10-20% of all procedures currently used in medical practice have been shown to be efficacious by controlled trial." Office of Technology Assessment, US Congress. Assessing the Efficacy and Safety of Medical Technologies. Washington DC : Office of Technology Assessment, US Congress; 1978.
How can that possibly happen? Easy! Once approved for use, mainstream drugs and treatments are then available for applications other than for what the original approval was granted. If a doctor notices that the product Megace, that was approved for breast cancer treatment, is being anecdotally reported as useful for increasing appetite, then there is a crossover application that is accepted and applied -- no study required. This happens all the time within our medical system. The bottom line is that we can pretty much throw out the medical establishment's objection to anecdotal evidence when it comes to alternative medicine as hypocritical and self-serving.
If there is one thing you get from this issue of the newsletter, it's to remember that not all Echinacea is the same. As with all herbs, there is a wide range of quality, potency and consistency among the numerous venders so you need to be an informed consumer.
- Grade of herb -- look for high-quality herbs grown organically and with their natural ratio of biochemicals still intact. Did you know that 99% of the herbs used by American companies do not come from the U.S? They are actually imported from Eastern Europe, and from many third-world countries such as India, and China.
The problem here is that these countries use large amounts of insecticides and pesticides in the growing of their herbs. DDT is still commonly used in Asia, and organophosphate nerve-gas based insecticides are commonly used throughout Eastern Europe.
It's also worth noting that most of the areas in which these herbs are grown in these countries are heavily polluted. The herbs are inundated by polluted rain and irrigated by polluted rivers. In Eastern Europe, for example, there have been no environmental laws for decades. Rivers have been used as open sewers. Everything from chemical toxic waste to radioactive waste -- no joke -- has been dumped into these rivers.
The reason most American companies use these herb sources, regardless of the problems just mentioned, is that they are cheap -- with herbs costing just pennies a pound. Good quality organic and wild crafted herbs cost as much as 20 times more. Before you use any company's herbal formulations, you should learn where their herbs come from.
- Test Potency -- look for the signature characteristics of Echinacea potency. When a droppers worth is placed in your mouth you can tell how potent it is by the amount of numbing and tingling you feel. The more numbing and tingling the higher the potency. A couple of years ago, I went into a local health food store and purchased every brand of Echinacea they had. Only one had any serious activity.
- Standardization -- Standardization seeks to control one, two, or three "identified" active ingredients at the expense of all the other "active" ingredients that we don't yet know about. If used to boost the "value" of low quality herbs, standardization "distorts" plant synergy, and it disrupts the natural ratios of active ingredients inherent in the plant itself and replaces them with "arbitrary" ratios as determined by today's researchers. Guaranteed minimum potency is a better alternative.
- Find a good vendor -- look for a vendor with a consistent reputation. Just as you would look for a vineyard offering a consistently fine wine, look for an herbal vendor with a reputation for consistency and quality. (I'm certainly partial to my own formulations at www.baselinenutritionals.com, but Gaia Herbs also makes high quality extracts.)
Use formulas, not single herbs -- There's another issue that we need to deal with when talking about herbal medicine -- another way in which herbs differ from drugs. At its best (most powerful, most effective, most healing), herbal medicine makes use of herbal formulations as opposed to single herbs. As in:
- You're anxious, take Kava kava
- You have a cold, take Echinacea
That's medical doctor thinking. That's turning herbs into drugs. It's the least effective way to use herbs. Herbal formulas, on the other hand, not only address particular symptoms, they also support the body as a whole. In addition, they make use of the synergistic effect inherent in many herbs. For example, when building an immune formula, why not complement Echinacea with herbs such as:
- Astragalus, which increases not only the interferon response to viral infection but also phagocytic activity and antibody levels, while improving the functioning of natural killer cells.
- Suma is an adaptogen that works by helping to balance out the endocrine system and reducing the effects of stress on the body -- thereby supporting your body's own efforts to rebuild its immune system.
The bottom line is that a good formula is substantially more than the sum of its parts, and as such is the antithesis of modern pharmaceutical solutions.
A few simple, easy to remember guidelines to follow are:
- Look for herbal formulations made from organic or wild crafted herbs.
- Look for formulations designed by real herbalists.
- Look for herbal tinctures processed using the "Barron Effect®" to be sure of the highest potency and quality.
- Look for (and expect) dramatic results.
How to use Echinacea effectively
Yet another source of confusion when it comes to Echinacea is how to use it effectively. Recommendations vary -- young people should take it -- young people shouldn't take it -- adults should take it -- adults shouldn't take it -- you should take it daily -- you should not take it long term -- you should only take it for short periods -- you should take it at the first sign of a cold -- you need to take it before you get a cold….well you see what I mean. And with conflicting research it is no wonder that there would be confusion about effective use.
- The important thing to understand is that the immune system responds best to periodic stimulus, as opposed to constant stimulus. That is to say, you don't want to use an immune tonic every day. It's not that anything bad happens; it just becomes less effective as the body becomes used to the stimulation.
- Each month take a minimum of one consecutive week off from any formula you are using. Use a different formula to cover the time off. For example, when not using an Echinacea based formula, you can use an AHCC or beta glucan formula to keep your immune system at peak levels.
Don't you find it fascinating that peer reviewed studies almost never have anything good to say about alternative therapies? They conclude that they are either dangerous (Kava kava, chaparral, St. John's wort, etc.) or ineffective (Echinacea). Why, if you were to believe the subtext of all these studies, you might come to the conclusion that nothing in nature is very healthy for you -- and that the only things you can count on are produced by the major pharmaceutical companies. As if.