A review of previously held beliefs on Echinacea spp.
by Michael Lee
For me, studying herbalism has been from the perspective of a nurse, where one foot is firmly planted in the paradigm of evidence based practice and the other is within the philosophy of mind-body-spirit connection and holism. Recently I had started writing my materia medica for Echinacea spp. and came across some interesting examinations of previous scientific research in the 1990’s on the plant in terms of its use in herbalism and how misconceptions and misinterpretations of this plant have impacted practice.
In the 1990’s, I was just out of high school and began reading heavily about different paths in alternative medicine, including Western herbalism. I vividly recall reading books and pamphlets about echinacea being an “immunobooster”, but to only use it for a short period of time or it would have a reverse effect. The hypothetical potential based on this view had impact in terms of suggesting it in treatment of HIV/AIDS due to fear that it would cause rebound leukopenia if used chronically. Many of these ideas came into question for me this week while making this materia medica.
The questions that arise deal with the actual data presented in studies and how misinterpretations and misconceptions arise based on findings that are presented. Examples of misinterpretation of data dealing with the medical use of herbs is not a new phenomenon in scientific research and has been noted in such (case) studies of catnip, burdock root, and willow bark. In the 1969, a study on the hallucinogenic affects of catnip in comparison to marijuana were studied. The participants who used catnip showed signs of being ‘stoned’ and so that is what was presented as findings. Review of the samples of catnip later revealed that they had been contaminated with marijuana (Jackson & Reed, 1969; Petersik, Poundstone, et al., 1969). The point being made is not whether catnip has a hallucinatory effect on humans, but that the study had become invalidated due to errors in its methodology and yet still is used to support catnip as having mild euphoric effects. Any current research or presentation of catnip using this study as a basis for interpretation of data is called into question. Poisonings have been reported in the use of burdock root. When examined, it turns out that the burdock was contaminated with belladonna, which had caused symptoms of atropine poisoning. The reason for the poisoning was due to misidentification of the roots since both look similar (Kuhn & Winston, 2001). Willow bark has salacin, which eventually becomes salicylic acid (the precursor to modern aspirin). Caution has been presented with willow bark causing the same gastrointestinal issues that salicylic acid and aspirin have shown since they initially were researched. The biochemical pathway in which salicin becomes salicylic acid doesn’t actually occur until after it is absorbed in the large intestines (Mills & Bone, 2001). So, basically, the hypothetical concerns of salicin having the same effects on the GI tract as salicylic acid have been unfounded based on current biochemical metabolic pathway analysis.
In the case of echinicea, one misconception is that echinacea can cause immunocompromise (tachyphylaxis) if used for more than a few days (Mills & Bone, 2001). This assumption was based on confusion of interpretation of a study done by Jurick et al (1989). The study was only done over the span of 5 days in which phagocytic activity was higher in echinacea vs. controls. When echinacea was ceased, phagocytic activity returned to a normal level, which is an expected wash out effect. The study has also shown that echinacea had stimulating effects on the immune system for 2 days after it had been held (Mills & Bone, 2001).
An article in The Australian Medical Observer cautioned that echinacea can be harmful to asthmatics (Sharp, 1997). The concerns raised in the study were due to findings of increased tumor necrosis factor-alpha (TNF-a) which increases the inflammation process in asthma. These results were derived from studying in vitro tests of echinacea juice. Per Mills and Bone (2001), it is thought that such studies likely have little relevance to normal oral intake of echinacea. A clinical study supporting this was done by Elsasser-Beile and cohorts (1996) showing that with oral intake of echinacea there were no changes in cytokine activity (specifically TFN-a). In this instance, it was assumed that in vitro studies would have a correlation in effect with taking the herb orally per the Sharp study. Further investigation of echinacea in the Elsasser-Beile study showed this not to be the case.
Another problem that arises in considering herbs such as echinacea is when such herb materia medicas like the German Commissions E monographs (1992) recommend not using echinacea in progressive diseases (i.e. HIV, tuberculosis, multiple sclerosis, autoimmune diseases) even in the face of no documented cases ever being present of adverse reactions to echinacea use in any of these mentioned conditions (Mills & Bone, 2001). The concerns are based on theoretical and hypothetical application. The assumption is that any stimulation of any aspect of the immune system will be detrimental. The reality per Mills and Bone is that the immune system is an incredibly complex system and one herb working predominantly in phagocytosis may actually be of benefit to autoimmunity. In comparison with other countries, the herb is used commonly by both British and Australian herbalists to treat autoimmune diseases as an immune amphoteric (Kuhn & Winston, 2001).
Another point in regards to autoimmune diseases is a growing amount of research indicating that inappropriate response to infectious organisms leads to molecular mimicry (Bone 1995a, Bone 1995b). If this is truly what is happening, echinacea (as well as other phagocytosis stimulating herbs) might be of benefit by decreasing microbial populations systemically. At a minimum, a growing body of observations by herbal clinicians supports echinacea safely being used long-term (Mills & Bone, 2001). A case study on long term use of echinacea in clinical lymphocytic leukemia showed no adverse side effects from echinacea (McLeod, 1996) as well as supporting evidence based on a risk-benefit assessment of use over 12 weeks (Bauer & Wagner 1996.)
In vitro studies (Wagner, Protsch, Riess-Maurer, et al., 1985; Stimpel, Proksh, Wagner, et al., 1984; Leuttig, Stienmueller, Gifford, et al., 1989; Bauer & Wagner, 1991) showing immune boosting activity has been heavily extrapolated leading to unsupported statements that echinacea is mitogenic to T-lymphocytes that ethanolic extracts of echinacea are ineffective, that it will accelerate pathology in HIV/AIDS and that it will aggravate asthma (Mills & Bone, 2001). The only activity well supported by experimental research is nonspecific enhancement of phagocytic activity (Hoffman 2003). Hoffman’s approach to classifying echinacea’s actions is that it has surface immune activation and hence is considered “immunomodulatory” instead of “immune boosting”.
Translation of studies in foreign languages has led to other misinterpretations of data findings. A German study was mistranslated into English, stating that the effects of echinacea wear off if you continue to take it when what was actually stated was that it will wear off if you stop taking echinacea (Bergner, 1994).
I think that herbal research is as much an evolving entity as the experience of the practicing herbalist is an evolving process. The above experience of researching this herb for a materia medica would lead me to believe that it is important to always review what has been presented in the past and previously held beliefs of practice with continually updated information and clinical observations by mentors and experts in the field of herbalism. It is my hope that, based on mistakes made in the past with regard to interpreting data on herbal studies, evidence based practice and clinical herbalism can avoid presenting misinformation and misinterpretation of data in the future.
A site I came across that reviews some of the above authors and researchers is listed below:
Jackson B., Reed A. (1969) Catnip and the alteration of consciousness. JAMA 207(7):1349-1350
Petersik J.T., Poundstone J., Estes J.W., et al. (1969) Of cats, catnip, and Cannabis. JAMA . 208:360.
Mills and Bone (2001) Principles and Practices of Phytotherapy. Churchill Livingston (imprint of Hardcourt Publishers Limited). China
Jurick, K., Melchart, D., Holzmann, M., et al. (1989. Two proband studies for the stimulation of granulocyte phagocytosis through Echinacea extract-containing preparations [German]. Zeitschrift für Phytotherapie. 10: 67-70
Sharp, K. Echinacea a danger to asthmatics. Austrailian Medical Observer 8, August, 1997:1
Elsasser-Beile, U., Willenbacher, W., Bartsch HH et al. (1996) Cytokine production in leukocyte cultures during therapy with Echinacea extract. Journal of Clinical Laboratory Analysis, 10(6) 441-445
German Federal Minister of Justice. German Commissions E for human medicine monograph, Buneds-Anzeiger (German Federal Gazette0, no. 162, dated 29. 08. 1992
Kuhn, M. & Winston, D. (2001) Herbal therapy & supplements. Lippincott. New York, New York.
McLeod, D. (1996) Case history of chronic lymphocytic leukemia. Modern Phytotherapist. 2(3) 34-35
Bauer, R., & Wagner, H. (1996) Wirbel um Echinacea- Präparate. Zeitschrift für Phytotherapie. 17. 251-252.
Bone, K.M. (1995a) Treating autoimmune disease part 1. Modern Phythotherapist. 1(1). 1-8.
Bone, K.M. (1995b) Treating autoimmune disease part 2. Modern Pythotherapist. 1(2). 15-27
Wagner, H., Protsch, A., Riess-Maurer, I.,et al., (1985) Immunostimulating polysaccharides (heteroglycans) of higher plants. Arzneim-Forsch. 35. 1069-1075
Stimpel, M., Proksh, A., Wagner, H., et al., (1984) Macrophage activation and induction of macrophage cytotoxicity by purified polysaccharide fractions from the plant Echinacea purpurea. Infection and Immunology. 46. 845-849
Leuttig, B., Stienmueller, G., Gifford, G.E., et al., (1989) Macrophage activation by the polysaccharide araginogalactan isolated from plant cell cultures of Echinacea purpurea. Journal of the National Cancer Institute. 81. 669-675.
Bauer, R., & Wagner, H. (1991) Echinacea species as potential immunostimulatory drugs. In: Farnsworth NR et al (eds) Economic and medicinal plant research, vol 5. 286-288, 301
Hoffman, D. (2003) Medical Herbalism: The science and practice of herbal medicine. Healing Arts Press. Rochester Vermont.
Bergner, P. (1994) Echinacea myth: Phagocytiosis is not diminished after 10 days. Medical Herbalism Journal. 6(1). 1.
Disclaimer: For educational use only. These statements have not been evaluated by the FDA.