Echinacea

• Do you often feel as though you’re on the verge of developing a cold?
• Do you want to avoid coming down with serious flu or influenza?
• Do you find that, if you do get a cold, it lingers on for weeks, making you feel run-down and tired?
• Do you suffer from recurrent vaginal or systemic yeast (Candida albicans) or bacterial bladder infections (cystitis), and you’ve had all the necessary elimination tests for serious diseases (such as urine analysis, renal function tests, blood sugar estimation, full blood count and erythrocyte sedimentation rate)?
• Do you often suffer from cold sores and mouth ulcers?
• Are you fed-up with always getting a prescription for antibiotics?

If you answered yes to any of these questions, Echinacea might be the herb to use for a period of time to assist your immune system in returning to health.

Echinacea (Echinacea purpurea, angustifolia or pallida) is also known by gardeners as the ornamental plant, the purple coneflower. It is native (indigenous) to the US and was widely used as a medicine for many centuries by the Indians of the Central Plains of America to treat snake bite and all kinds of infections. It was also used to assist in wound healing. The leaf and root are mildly anti-bacterial, anti-viral and anti-fungal. Echinacea can be tried as a first line of treatment for common infections before using conventional antibiotics.

Echinacea increases the non-specific activity of the immune system. Unlike a vaccine, which is active only against specific bacteria, viruses or group of bacteria and viruses (like the flu vaccine), Echinacea stimulates the general activity of the white blood cells responsible for fighting all kinds of infections, whether bacterial, viral or fungal in origin. Contrary to antibiotics which kill only bacteria directly, Echinacea makes our own immune cells more efficient in attacking disease-causing bacteria, viruses, fungi and abnormal cells such as cancer cells.

Echinacea also facilitates wound healing, lessens symptoms of and accelerates recovery time from viral infections. Because of its anti-inflammatory effects, Echinacea is useful in treating inflammatory skin conditions externally. This would include eczema and psoriasis. It may also increase immune system efficacy and therefore the body’s resistance to Candida albicans infection, bronchitis, herpes and other chronic infections.

The root of the plant has been used historically in American and European herbalism. Nowadays nearly all parts of the plant are used, including the root, leaves, flowers and seeds. There are 3 species of Echinacea (E. purpurea, pallida and angustifolia – E. purpurea). Combinations of all 3 species are most commonly used and are available commercially as the dried root or herb in the form of liquid extracts of all its parts, powders, capsules, tablets, creams and gels. Echinacea preparations are approved drugs in European countries.

In Germany a specially assigned commission compiled the Commission E monographs on herbal products. The herbal product is deemed safe if the manufacturer meets certain quality requirements set by the monograph or provides additional evidence of safety and efficacy gleaned from existing literature, anecdotal information from practising physicians as well as ongoing clinical trials.

The German Commission E monograph and the British Herbal Pharmacoepoeia recommend that Echinacea be used in either of the following forms:

• Liquid extracts or tinctures, alcohol or glycerine based. Extract strength varies and manufacturer’s directions are important. Recommended amounts range from 1 – 5 droppers full per use (0,5 – 5ml) 3 times a day.
• Capsules or tablets may contain root powder or the whole herb extract may be used in powder form in a gelatin capsule. The recommended usage is 0,5 – 2 gram 3 times a day.
• Echinacea tea where the root and / or whole herb is brewed as a tea with 0,5 – 2 gram taken 3 times a day.

Echinacea appears to lose its effectiveness with long-term use, probably because its effect on the immune system becomes less pronounced. It is therefore recommended that Echinacea be used for no longer than 6-8 weeks at a time. Echinacea is not effective as a treatment or as a substitute for other medical therapies in rapidly deteriorating or serious infections. If the condition persists or deteriorates, seek medical advice. Serious medical conditions are an example of where Western medicine reaches its full potential in making a difference to your life expectancy. Serious infections could be life threatening and should never be self-diagnosed or self-treated. These conditions require the supervision of suitably qualified health care providers to make the correct diagnosis and to treat appropriately.

Echinacea has the following constituents:

• Echinacoside, a glycoside caffeic acid derivative is found in E. angustifolia, but not in E. purpurea. The echinacoside glycosides have a primarily anti-microbial effect. There are, however, many other biologically active substances in the Echinacea species that work synergistically. The polysaccharides possess the best immune stimulating properties. They are also anti-viral. It is, therefore, totally senseless to try to isolate certain active ingredients and to use it as such. The whole plant has all the active ingredients working together.
• Echinacea, like all medicinal plants, also contains sterols and sterolins. These are potent immune system boosters.
• Unsaturated isobutyl, such as echinacin, is found in E. angustifolia and pallida.
• Polysaccharides, such as heteroxylan and arabinorhammogalactan, are found in all 3 species. They are primarily responsible for Echinacea’s immune stimulating effect.
• Polyacetylenes (13 have been isolated) are probably artifacts formed during the storage process of Echinacea products since they are found in the dried, but not the fresh roots of E. pallida.
• Essential oils with humulene, caryophylline with its epoxide germacrene D and methyl-p-hydroxicinnamate have also been identified.
• Bioflavenoids such as quercetin have been identified.
• Various other active substances such as vanillin linolenic acid derivatives, labdane derivatives and the alkylamides (refer following research report) tussilagine and isotussilagine have been identified.
• The sesquiterpene esters identified in commercial samples of E. purpurea, have since been shown to be due to the presence of a common adulterant (a substance that spoils or contaminates a product),Parthenium integrifolium (American feverfew), with a widespread occurrence in commercial samples.

Glycosides from the root of the plant have mild activity against both Staphyloccus aureus and Streptococci species of bacteria commonly responsible for infections in humans. The glycoside, echinacoside, was the most active. About 6mg of this glycoside was equivalent in anti-bacterial activity to 1 unit of penicillin.

Echinacea tincture was able to reduce both the rate of growth and reproduction of Trichomonas vaginalis, a common cause of vaginal and pelvic infections in women. Echinacea was also found to be effective in preventing the recurrence of Candida albicans yeast infection. Candida is a common cause for vaginal and chronic systemic infections in women, contributing to leaky gut, chronic fatigue syndrome (myalgic encephalopathy or yuppie flu) and allergies in women, men and children of all ages.

Echinacea is thought to prevent recurring infections and to promote tissue repair after infections. This probably occurs because Echinacea inhibits the activity of the bacterial enzyme hyaluronidase. The hyaluronidase enzyme inhibiting mechanism is a primary defense mechanism in the body, involving the connective base substance, hyaluronic acid that acts as a barrier against disease causing (pathogenic) organisms. Some pathogens activate the enzyme hyaluronidase which destroys this base substance barrier. The barrier then becomes leaky, pathogens invade the cells, attach themselves to exposed cells, penetrate the cell membrane and kill the cell. This results in an inflammatory infection. Echinacea inhibits the action of hyaluronidase by bonding with it. This results in improved barrier integrity, preventing pathogens from destroying hyaluronic acid, consequently preventing pathogens from entering and destroying healthy cells.

A complex polysaccharide, called echinacin B, mediates this complicated process. This anti-hyaluronidase action assists in the regeneration of connective tissue destroyed during infection and in the elimination of the pathogens responsible for the disease process.

Purified polysaccharides prepared from Echinacea have a strong activating force on the body’s macrophage (macro = big and phage = eater; i.e. white blood cells that recognize, gobble up and destroy foreign invaders) defense system. The polysaccharide’s ability to stimulate phagocytosis is apparently enhanced by components of the alkylamide fraction, namely the isobutylamides, as well as by cichoric acid. Macrophages initiate the destruction of disease causing organisms and cancer cells. Echinacea activates the macrophages independently of T-cell interaction.

An oncolytic lipid –soluble hydrocarbon has been isolated from the essential oil. This has been identified as a tumor growth (cancer) inhibiting substance.

The echinacoside glycosides seem to be the primary antibiotic constituents, but there are many other active substances acting synergistically to assist the glycosides in their antibiotic action.

The polysaccharides have the best immune stimulating properties. They are also anti-viral.

Other, as yet unidentified, constituents have been proven to have anti-tumor, bacteria inhibiting (bacteriostatic) and local pain killing (anaesthetic) activity.

Echinacea is anti-microbial (anti-bacterial), an immunomodulator (regulating the immune system), anti-catarrhal (breaks up the thick mucous associated with upper respiratory infections) and an alterative (immune strengthener, tonic or stimulant).

Echinacea is one of the first choices in natural remedies to assist the body in getting rid of infections. It is mostly effective against bacterial and viral micro-organisms and may be used to treat mild infections caused by these organisms, whether systemic (inside the body) or topical (on the skin or in the mucosal membranes of the mouth and genital tract). Echinacea is especially helpful in the treatment of infections of the upper respiratory tract such as colds, flu, sinusitis, laryngitis, tonsillitis and middle ear infection. It is also used with great success to treat boils, septic skin wounds, cuts and all other skin conditions as well as to prevent or treat secondary infections.

Evidence supports taking Echinacea several times a day at the first sign of a cold to diminish the chances of a full blown upper respiratory infection developing. A 1997 German study found that by doing so, the duration of colds were shorter and the symptoms less severe. Research is still inconclusive when it comes to whether to take Echinacea to prevent an illness before it starts.

Echinacea can be used together with other anti-bacterial and anti-inflammatory herbs such as yarrow, golden seal, garlic, astragalus, sweet orange, camomile and cranberry as a treatment for any mild infection such as colds, flu, sore throats, tummy upsets, tonsillitis, cystitis and so forth. It is important to have tests in the case of recurring bladder infections to exclude anatomical problems such as narrowing of the ureters or urethra in men, women and children. For example, prostate enlargement in men can lead to an obstruction of urine outflow with a residual amount staying behind in the bladder. This is an ideal growth medium for bacteria.

Echinacea is one of the best researched herbs in the world today. More than 500 scientific research studies have documented the pharmacology, biochemistry and clinical uses of Echinacea. It has consistently been proven that Echinacea stimulates phagocytosis. Phagocytosis is the process whereby scavenger white blood cells like neutrophils, monocytes, macrophages and lymphocytes recognise, attack, gobble up and then destroy invading disease causing organisms and cancer cells.

A study released early 2005 on cutting edge research done on the Echinaforce product of Dr A Vogel by ETH Zurich Laboratory, has finally shown the molecular mode of action of Echinacea. The research was done with the specific active components, manufacturing process and the standardisation as done on this product. It is therefore not advisable to take the results as necessarily true for all products containing Echinacea.

Infections trigger a cellular immune reaction which means that the genes in immune cells are activated to produce the substances for the body’s defense. One of the key substances is tumor necrosis factor alpha (TNFá), one of the most important messenger substances of the immune system. Without Echinaforce, the immune response is elevated dramatically for a short period of time. It then declines so that TNFá falls. This is important because TNFá attacks foreign bodies, but also the body’s own substances if too high for too long. If TNFá levels do not fall, auto immune diseases such as rheumatoid arthritis might occur. The active alkylamides in Echinaforce tincture bind to the CB2 receptor on T-cells and put the genes inside the T-cells on standby. These then become moderately active for a longer period once the body comes into contact with infectious substances, and the immune reaction becomes necessary. Echinaforce therefore leads to improved TNFá with a gradually increasing level that remains elevated for longer, rather than an acute peak with positive, but also negative effects. The symptoms of infections such as high fever, sore muscles and headaches are often due to the acutely high levels of TNFá during infection. Echinaforce therefore ensures a more moderate and effective immune response with less acute symptoms and a shorter period of illness. It’s important to take the alkylamides in a comprehensive plant extract, not as isolated ingredients. The active components in herbs work together in synergy with many more therapeutic effects, even though some ingredients may be more active in certain instances than other. This means that to isolate the alkylamides as such, might not lead to the same immune modulating effect at all.

1. Alkylamides of Echinacea molecule 2. Binds to the cannabinoid receptor (CB2) on T-cells that leads to 3. Activation of the gene for Tumor Necrosis Factor – TNFá

TNFá plays an important role in the fever and other symptoms associated with the normal process of inflammation and sepsis whether bacterial or viral in origin. TNFá is essential for the general immune defense, plays a role in obesity, and to maintain the circadian rhythm. Levels remain abnormally high in those with rheumatoid arthritis and arthritis.

Important note: TNFá is only activated by Echinaforce in the presence of infection, otherwise the genes are on standby and exerts no discernable effect. It can therefore be concluded that Echinacea acts as an immune modulator (and not a stimulant, as was previously believed) that will only have an effect once infection becomes immanent.

To summarise, Echinacea increases the quantity and activity of all normal, mature white blood cells, including anti-tumour (anti-cancer) cells. The white blood cells are the neutrophils, eosinophils, basophils, monocytes and lymphocytes (T- and B-lymphocytes).

It promotes T-cell activation and –function. T-cells or T-lymphocytes are white blood cells that are involved in cell-mediated immunity. This is a function of T-cell immunity when they become activated and are involved in reactions such as the body’s defense against bacteria and viruses that invade the body cells. They also regulate many of the other immune reactions.

The T-cells are activated as soon as the B-cells or B-lymphocytes (white blood cells with antibodies against the antigens of specific foreign organisms on their cell membranes) connect with an antigen. The antigen fits the antibody receptor on the B-cell’s membrane like the piece in a jigsaw puzzle. The cascade of the immune system is then activated.

Some of the T-cells become killer cells that destroy the foreign organism (antigen).

Cell-mediated (T- and B-cell) immunity is particularly important for the body’s resistance to bacteria, yeast and fungi such as Candida albicans, parasites and viruses (such as cold and flu viruses, Herpes simplex, Epstein Barr, Coxsackie and hepatitis).

There are also some T-cells that are called T-helper cells. They help the B-cells to make antibodies against antigens so that the B-cell can activate the immune response. T-memory cells help the B-cells to remember the antigen next time it comes around.

T-suppressor cells are T-cells that prevent the B-cells from making too many antibodies. They make sure that the immune reaction stops at the appropriate time.

Cell-mediated immunity is also responsible for protecting the body against cancer cells, auto-immune diseases (such as lupus and rheumatoid arthritis) and allergies. T-cell function (in particular the T-helper cell function) is suppressed in people who have Aids. Ongoing research on the use of Echinacea as a complementary short term treatment for the infections so common in Aids sufferers, is very promising.

Echinacea stimulates the growth of new tissue where injury has taken place. This accelerates wound healing.

Echinacea reduces inflammation in all forms of arthritis and skin disorders. It can be applied directly and undiluted, to insect bites, fever blisters, mouth ulcers and infected open wounds.

Echinacea has mild antibiotic activity. It suppresses bacterial growth. It is anti-viral (suppresses growth of viruses) and anti-fungal (suppresses growth of fungi and yeasts)

Echinacea suppresses the enzyme hyaluronidase which enables bacteria to destroy the cell membranes of healthy cells, thereby giving them access to the healthy cells. The suppression of hyaluronidase is probably the reason for Echinacea’s efficacy against snakebite.

There has been anecdotal reports from people with various nasal allergies such as hayfever, rhinitis and sinusitis that Echinacea is of benefit in preventing secondary infection but also in lessening the frequency, severity and duration of allergic attacks. There may be a mechanism similar to a desensitisation with allergy injections involved. Because the immune system is already overactive in people with allergies, there does exist the potential that symptoms may also worsen instead of improve.

More and more research is showing that Candida albicans yeast infection may be the cause of many upper respiratory allergies and infections as well as food intolerance. Echinacea has proven very effective in the treatment of Candida infection and in this way could have an additional beneficial effect in the treatment of allergies.

Echinacea stimulates, among others, also the natural killer T-cells, a key to the immune system’s cancer defenses. These cells are often abnormally low in people with CFS. This is the reason why some immunologists are concerned that people with CFS may have an increased risk for developing certain types of cancer like lymphomas or cervical cancer. These types of cancer are associated with immune deficiencies. Echinacea might help to restore the natural T-cell function in these patients.

• Colds, flu, coughs as well as other upper respiratory complaints such as croup and bronchitis.
• Enlarged lymph nodes, sore throat (streptococcus bacteria) and tonsillitis (staphylococcal bacteria).
• Toothache, mouth and gum infections – apply directly to affected area, or gargle with Echinacea extract and swallow it.
• Urinary tract infections such as cystitis (bladder infection), urethritis (infection of the urethra) and prostatitis.
• Other minor infections and chronic infections such as fybromyalgia, chronic fatigue syndrome (ME or yuppie flu) and leaky gut syndrome. In Europe, Echinacea is often used as co-therapy to complement antibiotics and chemotherapy. It is especially effective against infections where there is no chronic immune deficiency dysfunction.
• As co-therapy in the treatment of Herpes and Candida infections.
• Useful in the treatment of superficial wounds, to promote skin regeneration and healing and for skin infections such as impetigo caused by he Staphylococcal species. It could be used for infection of the nails (paronychia) and for any other persistent skin complaint or infection (topical or external use and taken internally). It can be used for skin ulcers such as diabetic and varicose vein ulcers which respond well if the infected area is kept covered with Echinacea ointment. Echinacea is effective for all insect bites and stings, even snakebite – used topically and taken per mouth. Echinacea works well for boils, carbuncles, abscesses and acne – also applied on the lesions and taken per mouth.
• Echinacea can be used to treat blood and food poisoning – take maximum dosages every 2 hours.
• For burns it can be applied on the skin and taken per mouth.
• For pelvic infections.
• As co-therapy in psoriasis, eczema and other inflammatory skin conditions (external or topical use).

Echinacea is safe for children. Childhood is the time when most upper respiratory infections occur. Children have to be exposed to various foreign organisms in order to develop a broad spectrum resistance or immunity as they grow older. Antibiotics over the long term and especially with chronic misuse, lead to a suppressed immune system and poor resistance to infections as well as allergies. Prescription antibiotics should be reserved for really serious infections. This would reverse the problem of the increasing resistance most bacteria have developed to antibiotics. Echinacea is an excellent alternative to antibiotics that can improve and support the immune system while acting as a mild anti-bacterial and anti-viral agent. Children under 10 years of age should use half the adult dose and children under 4 years, a quarter of the adult dosage. It is safe, even for infants to use.

Patients with Aids or chronic fatigue syndrome often have suppressed cell-mediated immune function. In a recent study, researchers treated white blood cells taken from patients with either Aids or CFS with extracts of Echinacea purpurea and ginseng. Both herbals enhanced immune response in both groups. This was measured by increased natural killer T-cell function. Both extracts also increased the B-cell antibody cytotoxicity. This is the ability of B-lymphocytes to search out and destroy infected cells. Both herbs seem to be a safe, relatively low cost therapy for patients with compromised cell-mediated immune function.

Echinacea, as one of its immune support functions, also improves the ability of the T-cells to exert their anti-tumour or anti-cancer effect. This assists the body in being better able to fight cancer. Various studies have explored the use of Echinacea as a co-therapy treatment to chemotherapy and radiotherapy to lessen these treatments’ immune suppressive effects. Echinacea thus has a potential dual benefit for cancer patients: enabling T-cells to fight cancer more efficiently while supporting the immune system throughout cancer therapy to prevent opportunistic infections in cancer patients. There are no harmful side effects to the use of Echinacea and cancer patients might want to explore the possible benefits of Echinacea, together with their health care providers.

Experimental studies on patients who have undergone surgery and/or radio- and chemotherapy for late stage colo-rectal or metastatic oesophageal cancer were given the fresh juice of Echinacea purpurea. The natural killer T-cell activity increased by 221%, the numbers of T-helper cells increased by 27%, T-suppressor cells by 16% and natural killer cells by 32%. These results were duplicated in other studies.

• Use Echinacea at least 3 times a day while the infection persists. Echinacea can be used every 2 hours while the infection is at its zenith.
• A liquid made from the root of the plant has a sharp, slightly numbing taste. Put a drop of Echinacea on your tongue before buying it. If it doesn’t give you a numbing sensation, don’t buy it – the product is either not fresh, or not of a good quality.
• The dried root can be brewed as a tea and 1-2 grams taken 3-6 times a day.
• The freeze-dried plant can be used in capsule or tablet form: 325-650mg or 3 capsules 3-6 times a day.
• Echinacea tincture (1:5) 3-4 ml in a little water 3-6 times a day.
• Drops – 20-30 drops in a little water 3-6 times a day.
• Some products contain Echinacea in combination with other anti-bacterial and anti-inflammatory herbs such as garlic, golden seal, yarrow, astragalus, sweet orange and camomile. Use as per manufacturer’s directions.

Echinacea is most effective when taken at the first signs of a cold or other infection, but it will also accelerate healing and lessen symptoms when an infection or cold already exists or the cold has developed into flu, sinusitis or bronchitis.

When there is already a pre-existing cold, it is important to use the maximum recommended dose until the symptoms subside.

There have been no reports of any adverse reactions, drug interactions or side effects from the oral use of Echinacea products in the medical literature and the US FDA regards it as probably safe.

Herbs are regulated as over the counter (OTC) drugs in Germany and the German Commission E monograph regards oral use of Echinacea as safe. They do, however, strongly advise against the intramuscular or intravenous use of Echinacea by injection. Fever, nausea, vomiting and anaphylactic shock are listed as possible side effects after this parenteral route of administering Echinacea. Echinacea injections are not available in America, but can be found in some European countries.

Echinacea has a very low toxicity profile. I strongly recommend, however, that you use the prescribed dosage for your condition. If a little bit of something is good for you, more isn’t necessarily better! Echinacea shows a remarkable lack of side effects in long term studies. It is a very safe product to use and is well tolerated by most people. The herb is generally well-tolerated and suitable for long-term oral use for people of any age group, even for very young babies. It is recommended that Echinacea should not be used for longer than 8 weeks at a time, but has shown no side effects even with periods as long as 12 weeks. It is most often used at the first sign of infection, and then continued for a few days until symptoms improve. It is not meant as a daily supplement! Echinacea shows no interaction with other medication and can be used with any other prescription drug.

The Commission E monograph for Echinacea lists the following contraindications for its use: it is not recommended during pregnancy or breast feeding, in progressive systemic and auto-immune disorders such as tuberculosis, connective tissue disorders, collagen vascular diseases and related diseases such as lupus. It is safe for children to use as and when indicated. Echinacea’s use in Aids or opportunistic infections in Aids patients is still controversial. However, the latest research findings on its immune modulating (rather than previously thought, immune stimulating) effect on CD2 cells, should change this view in the foreseeable future.

The German Commission E monograph regards progressive systemic diseases such as tuberculosis, leukemia (cancer of the white blood cells), collagen vascular disorders and multiple sclerosis as contra-indications for the use of Echinacea. There is no good reason for TB being listed. Leukemia is a disease where there are abnormal white blood cells present. The early stem or mother cells, normally found only in the bone marrow, replicate abnormally, and appear in the circulating blood, suppressing the maturation of stem cells to mature white blood cells. It could be that researchers may suggest that Echinacea could possibly exacerbate this situation. Echinacea only supports the action of normal, mature white blood cells, so it is unlikely that it would in any way have a negative outcome on the progress of leukemia. However, until research clearly establishes this, patients with leukemia should probably not use it.

Echinacea belongs to the daisy and sunflower family. People who are allergic to those, might also be allergic to Echinacea.

It is always important to remember that optimal immune system function also depends on a healthy lifestyle, with good eating habits, including lots of fruit, vegetables, nuts and seeds, correct use of food supplements, finding your soul’s purpose, lots of laughter, regular exercise and heart centered daily stress management and relaxation techniques.

Dr Arien van der Merwe MBChB (Pretoria) FRIPH (London) FRCAM (Dublin) MISMA (UK) is a medical doctor and author who specialises in natural, complementary & body-mind medicine, women’s and general wellness, stress management and health promotion. She is a Fellow of the Royal Institute of Public Health, Fellow of the Royal College of Alternative Medicine, and Member of the International Stress Management Association.

Dr van der Merwe is the owner and medical director of the Centre for Health & Wellbeing opening on 1 March 2006 in Menlo Park, Pretoria. It is a multidisciplinary centre which also acts as an urban retreat for city dwellers. The Centre provides full medical services and HRA’s, genetic risk assessments, natural medicine, body-mind medicine and wellness consultations. There is a fulltime medical doctor, psychologist, nutritionist, biokineticist and massage therapist on board, with many other health care practitioners consulting on a regular basis. Regular wellness and stress management lectures & workshops; yoga, pilates & Nia dance classes; meditation & relaxation sessions; healthy cooking & creativity workshops; and healing group sessions for chronic illness, are also scheduled every day of the week. The Centre boasts the only labyrinth in Pretoria!