The surprising truth about Echinacea

There’s hardly another herb I can think of that’s as misunderstood as Echinacea. It’s been the subject of a considerable amount of misinformation and misunderstanding concerning its active principles, mode of action, clinical efficacy, and cautions and contraindications.

It’s no wonder there’s such confusion. Over the years, doctors have used various parts of the plant, prepared in drastically different ways. Naturally, these would have varying effects on the body.

Yet they are typically discussed in popular writing, on websites, and even in the scientific literature under the generic term ‘Echinacea’, as if they shared identical properties. Hence a very basic concept of phytotherapy – the overriding importance of the part of the plant being used – appears to have been overlooked or ignored.

That’s why I’d like to answer a couple of the most common questions about Echinacea. Believe me, the answers will surprise you.

But first, let’s take a look at how this confusion got started to begin with.

The most misunderstood herb

One important reason behind all this confusion is the many types of Echinacea products on the market – and it all has to do with Echinacea’s historical background.

The Native Americans – and the Eclectic physicians who adopted their use of Echinacea – preferred the root. In fact, the Eclectics only used a water-ethanol (lipophilic) extract of dried Echinacea angustifolia root high in alkylamides.

In Europe during the 1930’s, however, the German herbalist Madaus promoted Echinacea purpurea as it was easier to grow. Being somewhat influenced by the homeopathic approach of using fresh plant tinctures, his firm eventually developed a hydrophilic product prepared from the stabilised juice of fresh E. purpurea tops (aerial parts). This is still the most popular form of Echinacea in Germany. Another popular European product is a fresh plant tincture of the whole plant of E. purpurea.

As might be expected, these different products exhibit substantial variations in their phytochemical content (and hence by definition, the effect they have on the body).

The way Echinacea is prepared also creates large differences. (Specifically, the hydrophilic type of product will be low in alkylamides and higher in water-soluble compounds such as polysaccharides, whereas a lipophilic product will be much higher in alkylamides, especially if prepared from the root.)

That’s how this root has come to be one of the most misunderstood herbs on the market. But my 27 years of experience has helped me cut through the confusion in order to take advantage of Echinacea’s benefits – and I’m going to pass that knowledge along to you today.

So let’s start with question #1:

Can Echinacea be used to treat infections?

Believe it or not, the answer is ‘not likely’.

There are actually relatively few clinical trials of Echinacea root in the treatment of acute respiratory infections, and the results of such trials are mixed. Acute viral respiratory infections were certainly not the mainstay of the traditional use of Echinacea root by the eclectic physicians. This common misconception of the role of Echinacea has developed in modern times, probably as an extrapolation of its immune system reputation and driven by companies wishing to exploit a ready over-the-counter sale.

Research I have been involved in, either as a co-author or adviser, has provided us with an interesting perspective on this topic, as it applies to a combined lipophilic extract of E. angustifolia and E. purpurea roots.

The first trial, of which I was a co-author, is relatively recent and received considerable media coverage in the US. In a well-designed trial involving 719 patients, a combination of E. purpurea and E. angustifolia roots standardised to 4.2mg alkylamides/tablet did not substantially alter the course of the common cold.1 Patients were assigned to one of four parallel groups: no tablets, placebo tablets (blinded), Echinacea tablets (blinded), or Echinacea tablets (unblinded, open-label). Echinacea groups received the equivalent of 10.2g of dried Echinacea root during the first 24 hours, and 5.1g during each of the next four days.

Global severity was assessed twice daily by self-report using the Wisconsin Upper Respiratory Symptom Survey (WURSS). Of the 713 who completed the trial, the average global severity was 236 for the blinded Echinacea group, 258 for the unblinded Echinacea group, 264 for the blinded placebo group, and 286 for the no-pill group.

A comparison of the two blinded groups showed a 28point trend toward benefit for Echinacea (p=0.089). The average length of illness in the blinded and unblinded Echinacea groups was 6.34 and 6.76 days, respectively, compared with 6.87 days in the blinded placebo group and 7.03 days in the no-pill group. A comparison of the blinded groups showed a non-significant 0.53-day benefit (p=0.075) for Echinacea.

I know there were a lot of details in there, but the bottom line is this: Taking a reasonably high dose of a lipophilic Echinacea root product after an infection started had only a modest impact (if at all) on the infection’s severity and duration. Even if a higher dose was used, the best outcome that could be expected might be a shortening of the infection by up to one day.

Far better not to get the infection at all!

Which brings us to question #2:

Can Echinacea be used to prevent infections?

This time, the answer is more positive. The ability of Echinacea root to prevent infections is supported by two clinical trials where I had an advisory role. The first is from some time ago.

In an unpublished study presented by the late Dr. Anna Macintosh at the 1999 Convention of the American Association of Naturopathic Physicians, an Echinacea root formulation was compared against a herbal adaptogenic formulation and a placebo in the prevention of winter colds over a 90-day period.2

The trial recruited 260 medical students who were under stress from their studies. The placebo group averaged an infection rate of 10 per cent. By day 70, the Echinacea group’s infection rate dropped to as low as 2 per cent (p=0.013). The daily dose of Echinacea root was 1.7 or 3.5g (two doses were consecutively trialled in the study).

  1. purpurea and E. angustifolia extract tablets (containing the equivalent of 1.275g of root and standardised to 4.4mg/tablet alkylamides) or placebo tablets. Participants received two tablets/ day before travelling, four tablets/day while travelling, and six tablets/day if they got sick.

The researchers assessed the outcomes using questions about upper respiratory symptoms related to quality of life (based on WURSS-44). Each participant completed the survey before travel (baseline), less than one week after travel, and at four weeks after return from travel. Compared with baseline, the average WURSS44 scores for both groups increased immediately after travel (p<0.0005). However, the placebo group had a significantly higher average WURSS-44 score (around double) compared with the Echinacea group (p=0.05).

To cut through the numbers and get to the bottom line, here’s what you need to know: Supplementing with Echinacea before and during travel appeared to have a protective effect against the development of respiratory symptoms (and hence infection) during travel associated with long-haul flights.

That brings us to question #3:

Is Echinacea only effective for short periods after getting an infection?

Most people would say that Echinacea is only effective for short periods of time, and as a treatment for infection, but the results of these trials reverse this common (mis)understanding of Echinacea. In fact, the opposite is true. As I’ve just shown you, Echinacea root only has a modest benefit when taken after an infection, and its real value lies as a preventative.

These trial results confirm my experience of 27 years in herbal practice: The real value in Echinacea root lies in its continuous use, at least during times when infection is more likely, such as stressful periods or during travel. (I have been taking Echinacea root almost continuously for 15 years and during that time have suffered only a handful of infections.)

There is no evidence to suggest that Echinacea root will wear out the immune system (that is, cause immune system tachyphylaxis). In a clinical study, the oral administration of E. purpurea root tincture over a five-day period increased white blood cell activity compared with controls.4 Only when the Echinacea was stopped did activity decline to normal (pre-test) values, demonstrating a typical washout effect. This German research has been widely mistranslated and misinterpreted as prolonged Echinacea use having a detrimental effect on immune function, which it clearly did not.

So have no fear about using Echinacea root long-term. You may even live longer. Mice certainly did. As touched on above, one of the persistent controversies about Echinacea is whether it is safe to be taken consistently for long periods. The answer, at least in mice, appears to be in the affirmative. Mice were fed E. purpurea root from seven weeks of age to 13 months at typical human doses.5 Long-term use of Echinacea was, in fact, beneficial. By 13 months of age, 46 per cent of the control mice fed the standard chow were still alive, compared with 74 per cent of those consuming Echinacea.

I recommend taking 1.5g to 4.5g of Echinacea purpurea root daily, standardised to 5mg to 15mg of alkylamides.

To your better health,

Kerry Bone
Nutrition & Healing

Volume 6, Issue 2 – February 2012

Full references and citations for this article are available in the downloadable PDF version of the monthly Nutrition and Healing issue in which this article appears.

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