ECHINACEA AND THE IMMUNE SYSTEM

By: Natasha Paz NFSC 345: Dietary Supplements and Functional Foods Spring 2013 Due: 5/17/2013

Abstract Echinacea is a flower from the daisy family that has been used throughout history as a natural form of medication. Over the last few years this product has re-emerged on the market as a supplement of controversy. Many consumers take this product to help with a variety of health related disorders, and its purported benefits are extensive. However, Echinacea has a big reputation for supporting immune health, and that is the one that supersedes it. There have been hundreds of different studies conducted on the plant to help determine the efficacy of the product, but with so many confounding factors at play, results are scattered, and an accurate conclusion has not yet been made. There are a few different mechanisms of how the plant is supposed to help boost immune function. Research has looked at the flowers and leaves, which contain polysaccharides that have an immune stimulatory effect that boost the immune system on an ongoing basis. Researchers have also studied the roots which contain alkamides that help reduce the severity of symptoms and are also highly immune supportive. Like all natural products, when considering the physiological effect Echinacea can have on individuals, there are many factors and variables that can interfere with the mechanisms and therefore affect the outcome or effectiveness of the product. There is a lot of contradictory research at hand, but a lot of it has to do with inconsistent studies and samples. Each study is conducted in a drastically different format. The sample population varies from different ethnicities to different health statuses. Different forms of the supplement are used, for example including the entire plant, to just the use of the roots. There are also different periods of time that people use the supplement, so long term use cannot be compared to the same results of short term use. As professionals it is our responsibility to do the in depth research and translate our findings to the public, who may not educated in reading or understanding scientific research papers. There are many different factors that go into the effective ability of the supplement, and its critical that consumers comprehend these limitations, so they can make correct unbiased decisions about their health. Introduction: Echinacea has been used for hundreds of years as an herbal remedy, but recently the mixed results and conflicting evidence in the literature has left the public divided in their beliefs, opinions and knowledge about the effectiveness of this plant. Echinacea is a flower that is a part of the daisy family. There are nine species of the Echinacea flower and several types are used to make medicine from its leaves, flower, and root. This plant has been around for thousands of years and is mainly found in eastern and central North America, where they are found growing in prairies and wooded areas. It was used as a traditional herbal remedy by over 17 different Great Plains Indian tribes, and later settlers followed the Indians example and began using Echinacea for medicinal purposes as well. It was a very popular medicine and by the early twentieth century Echinacea had become one of the top selling herbs in America, until the discovery of Penicillin. Once Antibiotics hit the market, there was a sharp decline in the use of herbal remedies and homeopathic medicines because no trials or research was done to prove their effectiveness, so the public steered towards science. Today there has been a resurgence of natural medicine and the use of plants and alternative cures due

to high tolerance against antibiotics and drug resistant bacteria that are no longer responsive to certain medications sold on the market. There are multiple benefits in the literature that Echinacea can provide. From primarily utilizing leaves for its polyphenol properties, to incorporating all parts of the plant for its immune system benefits; Echinacea has shown positive results in a wide range of diseased states. Some of the benefits include fighting against some viral infections, many infections including the flu and cold, urinary tract infections, yeast infections, bloodstream infections, gum disease, and strep infections. It is also common for people to apply Echinacea to their skin to treat boils, wounds, burns, and eczema. All of these conditions have had mixed results but also show hopeful insight in helping with these conditions. Many populations can benefit from taking Echinacea. One population that would benefit is those who are prone to getting sick. These people include individuals who are under stress, do not get enough sleep, or have a poor diet, because they are more susceptible to illness and more prone to getting colds, because they have a worn down immune system. Taking these supplements enables them to not get sick as often. Another group that is chronically sick and more prone to getting infections is the elderly. Although further research is needed to establish long term effects on health, it seems that short term usage has been proven to help fight off infections and certain sicknesses. There are also specialty Echinacea products on the market for children that include a wide range of benefits from allergy relief to rash serums, which have mixed reviews and are not conclusive with results. Further research is needed to establish the efficacy and safety with children, and is inconclusive. Due to the lack of research on side-effects, pregnant and breastfeeding women should steer clear from taking the supplement, to avoid any potential harm to the fetus or infant. Since Echinacea products come in many forms there are different recommendations and dosages available. Some forms include tablets, juice, and tea. The recommended dose for a tablet containing 6.78 mg of Echinacea purpurea should be two tablets given 3 times daily. Freeze-dried Echinacea juice extract capsules containing 100 mg should be taken three times daily. Echinacea purpurea herb juice has a daily dose of 6-9 mL for up to a maximum of 8 weeks. An Echinacea herbal compound tea should be 5-6 cups of tea on the first day of symptoms and titrating down to 1 cup per day over the next 5 days. Echinacea liquid drops can be 20 drops every 2 hours for the first day of symptoms, then 3 times daily for up to 10 days. These are just a few forms of the product that are on the market, and should be taken accordingly. The variance in time is due to the fact that tolerance to the plant is still unknown and undergoing research. Some studies claim that the body can build up a resistance, and have a decrease in effectiveness, so it is better to take the supplement in increments of time depending on the form. Discussion: Echinacea is widely used to fight infections, especially the common cold. However, research and literature dont specify whether to take it as a preventative supplement, or to help with symptoms once already sick. This is where most

controversy revolves around this particular supplement, however to determine which is most beneficial, it is important to understand how the active compounds of the supplement work. In a 5 year study conducted by NCCAM (National Center for Complementary and Alternative Medicine), results revealed that there are two main health benefits in how Echinacea stimulates the immune system. One decreases the frequency of colds, and the other reduces the severity of symptoms. They found that polysaccharides that are found in the flowers and leaves have an immune stimulatory effect that boost the immune system on an ongoing basis. This aspect is believed to help decrease the frequency of sickness because these immune polysaccharides enable people who are immune compromised to help support natural immune cells of the body. These include white blood cells such as Macrophages and T-cells. Macrophages undergo phagocytosis which allows the cells to engulf and then digest cellular waste and other pathogens. This helps to rid the body of harmful substances and also helps to stimulate lymphocyte and other immune cells to respond to the harmful pathogens. This is great supporting evidence to how Echinacea might prevent sickness, by supporting the macrophage health and enabling them to fight off pathogens and sickness before they have the chance to multiply in the body. T cells also play a role in immunity. There are several different types of Tcells and each one has a different function; however, they are all involved in fighting pathogens. Echinacea helps to encourage the formation and maturation of a variety of T-cells, and then provides the body with a good defensive system that can prevent sickness. Research shows that benefits arise from multiple parts of the plants. The flowers provide the polysaccharides which stimulate and boost immune system on an ongoing basis. However, the roots that are harvested in the fall provide alkamides, which quickly reduce duration and severity of colds and other respiratory problems. These chemicals are found in vitro to be highly immune supportive, and activate chemicals in the body that decrease inflammation, which reduce cold and flu symptoms. There are some conflicting results in the various studies and meta-analysiss. Some studies have used different types of Echinacea plants and different methods of preparation. Some studies say they use a variety of different parts of the plants and since each part provides different benefits it is not surprising that different studies show different results. Since the studies have not been consistent, this has led to the general public doubting the effectiveness of the product. Another point that came up was even if it helps for treating a cold, the benefit will likely be modest at best. Since a virus enters the body and goes through its different stages naturally, once it has already attached to the host its unlikely that Echinacea will affect the lifecycle of the virus, however the research suggests that it may help with symptoms and make the illness more manageable. Also, if taken regularly, Echinacea may also have some preventative properties, so your body is able to fight off viruses and other pathogens more efficiently. It can interfere with the implantation of the virus, and prevent it from actually entering the cell. This will reduce the likelihood of becoming ill, or might lessen how many times you get sick annually.

The last piece that was unclear was the subject pool and their lifestyle choices and health status prior to the study. In the sample, they didnt have clear distinctions on a baseline health status so that may interfere with the study results. Aspects such as exercise, frequency of illness, regular fruit or vegetable intake, or other nutrient deficiencies werent measured prior to the study, and those are all critical points to consider when evaluating a change in health. It is also known that certain populations have different biological immune responses, so age, ethnicity, gender and other varying factors can determine how the individual recovers from sickness and the time/frequency they get sick. If the study was broken down and had stricter criteria for these different aspects, then the results might be more conclusive. Conclusion After all the research has been analyzed it appears that Echinacea is likely safe for most people when used shortterm, but there is not enough information to know if Echinacea is safe for long-term use. There are some concerns that may affect the general population, so it is critical to ask a physician, or ask potential clients about certain drugs or allergies they may have. One concern is allergic reactions. Because Echinacea belongs to a family of daisies, people who have allergies to these flowers or ragweed should not take the product. People who suffer from Autoimmune disorders (such as MS or lupus), might be a risky group since Echinacea has an effect on the immune system, scientists think that it could make these conditions worse, and dont know what the side effects could potentially be. Echinacea use is also possibly safe for children. It seems to be most safe in children ages 2-11 years, however, about 7% of kids develop a rash which seems to be related to allergies, but not enough data is known. This also pertains to pregnant or breastfeeding women, and since there is no evidence based research, these two groups should refrain from taking the supplement. In the past some Echinacea products have been contaminated with selium, arsenic, and lead, and that could have been a main concern, but now that companies are more regulated, this is no longer a major concern for the public. It should also be stated that certain products may react with Echinacea. One of these is Caffeine. When the body breaks down caffeine Echinacea slows down how quickly the body disposes of it, so taking Echinacea along with caffeine might cause a buildup of caffeine in the bloodstream and increase the risk of overdose. Some medications are also known to interact with Echinacea. It might change how the body breaks down some medications and might increase the effects or side effects of some medications. Some medications include lovastatin (Mevacor), clarithromycin (Biaxin), cyclosporine (Neoral, Sandimmune), diltiazem (Cardizem), estrogens, and many others. After all the key findings have been analyzed, my professional opinion would be that Echinacea is an acceptable product and can be used to help boost the immune system, and should be taken according to the recommended doses. I would also only recommend using this product after consulting with a doctor to ensure no medications will be interfered with and no allergic reactions will occur.

Echinacea has been around for hundreds of years and with further research we may discover other pathogens or disease causing agents that can be cured with its use. The public needs to focus more on the literature and less on the media in order to make educated decisions or form opinions about this product.

References Alkylamides from Echinacea Modulate Induced Immune Responses in Macrophages. Matthias, A. A., Banbury, L. L., Stevenson, L. M., Bone, K. M., Leach, D. N., & Lehmann, R. P. (2007). Alkylamides from Echinacea Modulate Induced Immune Responses in Macrophages. Immunological Investigations, 36(2), 117-130. doi:10.1080/08820130600745786

Efficiency of Echinacea purpurea on performance and immune status in pigs.

Maass, N. N., Bauer, J. J., Paulicks, B. R., Bhmer, B. M., & Roth-Maier, D. A. (2005). Efficiency of Echinacea purpurea on performance and immune status in pigs. Journal Of Animal Physiology & Animal Nutrition, 89(7/8), 244-252. doi:10.1111/j.1439-0396.2005.00501.x

Echinacea intake induces an immune response through altered expression of leucocyte hsp70, increased white cell counts and improved erythrocyte antioxidant defenses. Agnew, L. L., Guffogg, S. P., Matthias, A. A., Lehmann, R. P., Bone, K. M., & Watson, K. K. (2005). Echinacea intake induces an immune response through altered expression of leucocyte hsp70, increased white cell counts and improved erythrocyte antioxidant defences. Journal Of Clinical Pharmacy & Therapeutics, 30(4), 363-369. doi:10.1111/j.1365-2710.2005.00658.x Echinacea vs. the Common Cold Echinacea vs. the Common Cold. (2000). Harvard Women's Health Watch, 7(6), 1. What Is Echinacea? What Are The Benefits Of Echinacea? Nordqvist, Christian. "What Is Echinacea? What Are The Benefits Of Echinacea?" Medical News Today. MediLexicon International, 13 Nov. 2012. Web. 07 Mar. 2013.