June Russell's Health Facts

Caveats: Conflicting Reports about Echinacea

[Controversial Studies] [Dose and Response] [Timing, Response, and Herb Quality] [Effectiveness on Illness Duration and Severity] [Safety] [Other Reports] [Related Links about other Herbal Supplements] [Related Links about Other Supplements]

Controversial Studies on Echinacea

Echinacea, or purple coneflower, is sold over-the-counter in pills, drops and lozenges, and has reported annual sales of more than $300 million. It is one of the most popular medicinal herbs used by people to treat colds. New research finds that taking the popular herbal remedy Echinacea does nothing to prevent a cold. Fans and foes of such herbal supplements say they have long needed rigorous, scientific testing, and this study found that patients who took an Echinacea plant extract fared no better than those who took a dummy treatment. This study, which appeared in the July 28, 2005 New England Journal of Medicine, was led by Dr. Ronald Turner of the University of Virginia School of Medicine.
{"UVa study debunks herbal cure," AP, The Daily Progress, Charlottesville, VA, July 28, 2005}

--- Media Misinformation about Echinacea ---

The media reports about the study in the New England Journal of Medicine, reporting that Echinacea angustifolia doesn’t help colds, were just as flawed as the study. Editor's comments: They studied the less frequently used species: the extracts were made from the roots of Echinacea angustifolia. Though E. angustifolia formerly was the most commonly used species of Echinacea, more recent herbal preparations use E. purpurea (because E. angustifolia has been over-collected from the wild.) The different species of Echinacea all have similar medicinal properties, though the species differ in the ratio of medicinal constituents. Other studies utilizing the flowers and the roots of E. purpurea show it is effective. More importantly, the researchers did not use a high enough dosage to be effective. The college students in this study were given 300 mg of E. angustifolia daily, however, the World Health organization (WHO) says that 3 g (3,000 mg) a day is the proper dosage for this species. Thus the participants in the study received only one-tenth the recommended effective dose!

Researchers from the University of Wisconsin whose study appeared in the Annals of Internal Medicine, say that Echinacea has no effect on colds. Yet the lead author, Assistant Professor of Family Medicine, Dr. Bruce Barrett, says that there is a lot of evidence from other studies suggesting that Echinacea is effective. He doesn’t think this study proves it doesn’t work. Dr. Ronald B. Turner, Professor of Pediatrics at the University of Virginia School of Medicine pointed out that there are so many variables with the herb. There are 3 different species that are used for medicinal purposes: it is hard to make a recommendation just based on this study.
{"Echinacea has no effects on colds," healthscout.com, Dec. 2002}

A study reported in the December 17, 2002 issue of the Annals of Internal Medicine reported that there was little difference in the group that took Echinacea and the group that took a placebo at the onset of a cold. Editor's note: disregard the study because there are 3 factors that could explain why the studies were different from the expected outcome:

Dried unrefined roots and whole plants (as opposed to an extract of leaves) were used in this study. This is significant because there have not been any studies to date that indicate the effectiveness of dried leaves. Studies that demonstrate Echinacea’s efficacy use formulas containing an extract of roots, seeds, and flowers.
There are actually 9 species of Echinacea, 3 of which are typically combined in varying amounts and dosages in over-the-counter products. Very few studies used the compounds with the same mix of the 3 species, so the findings have been inconsistent.
There is a popular belief that healthy individuals, like the college students used in this study, do not gain much from taking Echinacea as people with a history of frequent colds or viral illnesses. It seems that the herb’s secret of success is its ability to boost a weakened immune system, not the ability to fight the virus itself.

{"Catch This!", reported in e-mail newsletter from Susan Lark, MD, Jan. 9, 2003}

The participants were young and probably had strong immune systems. Over 400 subjects were tested, a better study would have included older people with more compromised immunity. If Echinacea boosts immunity, it has a greater effect on people with lowered immunity than those who are not.
{"Media misinformation about Echinacea: another blow to truth in reporting," Dr. Nan Fuchs, Women’s Health Letter, July 28, 2005.}
{Dr. Betty Kamen, PhD and Michael Rosenbaum, MD, "Nutrition Hints," #1901, July 30, 2005}

Dose-related Response to Echinacea

In Germany, over 1.3 million prescriptions are issued each year for Echinacea-based products to treat minor respiratory infection. More than 400 studies have attested to the safety and efficacy of Echinacea, and more studies are being conducted every year. In one German trial designed to examine the effectiveness of Echinacea in reducing flu symptoms, 180 participants were given a daily dose consisting of one of the following: (1) 450 mg of Echinacea, (2) or 900 mg of Echinacea, or (3) a placebo. Those taking 900 mg of Echinacea reported a significant reduction in weakness, chills and muscle soreness. Those taking either the 450 mg dose or a placebo reported no improvement.
{"Natural Health Bible," Bratman, 1999}.

Response to Dosage Timing and Quality of Herb Extract

Echinacea is most effective in the first 48 to 72 hours of use, and less effective if used longer than 2-3 weeks. Avoid alcoholic tinctures of Echinacea which destroy much of the active ingredients. We recommend glycerin extracts for children and freeze-dried extract capsules of Echinacea root complex for adults.
{Mitch A. Fleisher, MD, www.alternativemedcare.com} Editor's comment: Dr. Fleisher is a board-certified family physician whose focus is classical homeopathy, nutritional and botanical medicine, chelation and bio-oxidative therapy.

Echinacea does work if you use an effective product. The single most important aspect in getting results from an Echinacea product is to make sure that it is guaranteed to provide sufficient levels of all 3 classes of all 3 key categories of active compounds in their proper ratio. Results can be impressive when a high quality product is used. In a double-blind study in the Feb. 2004 issue of J. Clin. Pharm. Ther., either an Echinacea preparation or a placebo was given to 282 subjects aged 18-65 years with a history of 2 or more colds in the previous year. Subjects were instructed to start the Echinacea or placebo at the onset of the first symptom related to a cold, consuming 10 doses the first day and 4 doses per day on subsequent days for 7 days. The total daily symptom scores were found to be 23% lower in the Echinacea group than in the placebo group. The researcher concluded that early intervention with this standardized Echinacea product results in reduced symptom severity in subjects with upper respiratory tract infection. Some people cleared up their cold symptoms nearly 3 times faster than the placebo group.
{"Top ten clinical research studies with natural products in 2004," in Dr. Murray’s Natural Facts newsletter, Jan. 17, 2005} Editor's comment: Michael T. Murray, ND, is regarded as one of the world’s leading authorities in natural health, and has written many books.

German researchers conducted a randomized double-blind, placebo controlled study in 1999, and concluded that the herbal remedy Echinacea is effective and safe. They noted that the therapeutic benefit was a rapid improvement of cold symptoms, and recommended taking Echinacea as soon as initial cold symptoms are detected.
{Curr. Med. Res. Opin. 1999}

Effect of Echinacea on Duration and Severity of Illness

In a double-blind study, 120 people were given Echinacea, or a placebo for 10 days as soon as they started showing signs of a cold. Of those taking Echinacea, fewer actually developed full-blown colds. The study showed only 40% of those taking Echinacea became ill, versus 60% of those taking placebo. Interestingly, among those who came down with colds, improvement in the symptoms started soon in the Echinacea group.
("Natural Health Bible," Bratman, 1999).

Taking Echinacea can cut the duration or severity of the common cold. That’s the conclusion of 8 of 9 major placebo-controlled tests of Echinacea on 2,300 subjects. It is thought that Echinacea boosts the immune system, and possibly acts as an antiviral agent. It should be taken when you first notice a sore throat or the sniffles. The usual recommendation is to continue taking it for as long as two weeks. "Echinacea might shorten a 7-day cold by as much as 3 days," says herbal expert Varro Tyler, Professor Emeritus, Purdue University School of Pharmacy. On the other hand, there is little evidence that taking Echinacea regularly to prevent colds does much good. Check the label for recommended dose for adults. Children are given half as much.
{"These all-star supplements really can heal: new medical research confirms it’s well worth trying these natural remedies," USA Weekend, March 24-26, 2000}

Echinacea is a valuable cold treatment for kids, though it may not shorten a cold or make it less severe if given after they already have the sniffles (according to a study of 524 children, ages 2 to 11, by researchers from Puget Sound Pediatric Research Network at Bastyr University, WA). Instead, the herbal remedy appears to reduce the odds that they’ll develop a secondary infection such as tonsillitis, bronchitis, sinusitis, or an ear infection.
{Douglas Schar, DipPhyt, MCPP, Prevention magazine, Mar. 2004}

Safety of Echinacea

Another study, conducted in 1997, seemed to confirm these findings. Healthy individuals and patients with either chronic fatigue syndrome or AIDS were given extracts of Echinacea. The extract actually increased the cellular immune function in all groups, leading researchers to conclude that Echinacea enhances immune function in those suffering from depressed cellular immunity such as AIDS.
{Immunopharmacology, Jan. 1997} Editor's note: Even the School of Pharmacy in Richmond, Virginia found that Echinacea is safe, as reported in the June 2000 issue of Pharmacotherapy.

According to Varro Tyler’s "Herbs of Choice," Echinacea should not be used by those suffering from severe systemic illnesses such as tuberculosis, leucosis, collagen diseases, and multiple sclerosis. Germany’s Commission E, a government-established committee to determine safety and efficacy of herbal remedies (similar to our FDA), recommends that use should not exceed a period of 8 successive weeks. Infrequently allergies may occur, especially in people allergic to members of the sunflower family (Asteraceae).
{Varro Tyler, "Herbs of Choice," Pharmaceutical Products Press, 1994}

Echinacea has been used safely for centuries. It raises white blood cell counts and increases the body’s inherent powers of resistance, stimulates killer cells and demonstrates antiviral properties.
{Butram, Encyclopedia of Herbal Medicine, 1995}

It would appear that individuals with overactive immune systems shouldn’t take this immune-enhancing herb. However, I believe that Echinacea works not by stimulating immune function, but rather by modulating it, that is the activity of some types of immune cells increases, while the activity of others decreases. As a result, I think it is safe for people with autoimmune disorders to use Echinacea on a short-term basis to deflect a cold or the flu. I would not recommend it for long-term use in cases of autoimmunity.
{Dr. Andrew Weil, Self Healing newsletter, Apr. 1998}

Other Reports about Echinacea

A 1997 study found that Echinacea actually stimulates macrophages (which have been shown to have greater antiviral effect than unstimulated cells) to produce cytokines, which help regulate the immune system.
(International Journal of Immunopharmacology, 1997).

Many herbal medications can cause negative effects when taken with alcohol.
{Alcohol Research and Health, niaaa.NIH.gov, 2005}

Echinacea is the perfect choice for battling colds and flu and may even help bolster the immune system in AIDS sufferers.
{"Echinacea, bolstering your immune system," email newsletter, Vitamin Research News, Nov. 2000}