The Cheyenne used it for sore gums, the Comanches, for toothaches and sore throats. Other Native Americans kept it on hand for snakebites or syphilis.
Modern Americans seem to love the stuff, too, even if we can’t pronounce it. In fact, echinacea – that’s eck-in-EH-shia – is now the top selling herbal remedy in health food stores, though garlic and ginseng claim top honors in overall sales.
Unlike many medicinal herbs, this daisy-like flower, also known as purple coneflower, quite literally has its roots in America, not Asia. And compared to many plant medicines, there’s a fair amount of research on it – 350 studies by some counts.
Some people swallow the nasty-tasting liquid form of echinacea or sip it as tea at the first sign of a cold or flu. Others use it as a salve on burns or wounds that won’t heal. Others gargle it for strep throats or take it, internally and externally, for herpes. Some even give it, in small doses, to their kids.
But at $ 10 to $ 20 a bottle for the liquid stuff – depending on how much you use, a bottle may last three weeks – should we?
The answer, say many pharmacognocists, or scholars of medicinal herbs, is a hearty “why not?” It appears safe for many people and may, as advertised, stimulate the immune system. If you’re allergic to ragweed, though, or have HIV/AIDS or an autoimmune disease like lupus or multiple sclerosis, you should probably give it a miss.
While some of the research on echinacea may still not meet rigorous scientific standards, researchers in Germany – where doctors prescribed echinacea 2.5 million times in 1994 alone – have come up with provocative findings in recent years.
In one double-blind, placebo-controlled study of 180 volunteers, a German team found in 1992 that high doses of an alcohol-based extract of Echinacea purpurea root seemed to reduce the severity and duration of cold and flu symptoms.
But the dose appeared to be crucial. People who took 900 milligrams (or 180 drops) a day showed significant improvement. Those who took half that were no better off than people given a placebo, or dummy drug.
In another 1992 double-blind, placebo-controlled study of 108 people with chronic upper respiratory infections, those given 4 milliters of E. purpurea in liquid form twice a day for eight weeks had fewer infections than those taking a placebo.
In 1994, another German researcher reviewed 26 controlled human studies. Together, he concluded, the studies suggest that echinacea can stimulate the immune system.
But caveats are in order. The studies involved three types of echinacea, as well as combinations of types, and the quality of some studies was low, warns Steven Foster, an Arkansas plant photographer who writes on herbal research for the American Botanical Council, a research and educational group.
While echinacea does not kill bacteria, research suggests it does increase the number of white blood cells, as well as the process of phagocytosis, or the gobbling up of invading organisms by immune cells. It may also block an enzyme that helps infections spread.
There’s some evidence that echinacea also stimulates cells called fibroblasts, which play a role in healing wounds, says Cathy Crandall, a researcher of medicinal plants at Washington University in St. Louis.
The problem, though, says Dr. Jerome Groopman, an immunologist and chief of experimental medicine at Beth Israel Deaconess Medical Center, is that “you’re kind of poking in a black box.”
Lots of natural products stimulate some parts of the immune system, he says, but what’s needed is a “rigorous evalution” of echinacea and other herbs.
Still, those who do study herbs seriously, among them Gail Mahady, a pharmacognocist at the University of Illinois in Chicago, say the data on echinacea are a lot more solid than that on some herbal remedies.
“I don’t think anyone could look through the literature and honestly say echinacea doesn’t stimulate the immune system,” she says.
Echinacea “is one of the few herbs I take,” adds Varro Tyler, who has studied dozens of herbs and is professor of pharmacognosy emeritus at Purdue University.
So far, no one is sure which of echinacea’s constituents might account for such effects, though there’s some evidence that one component, high molecular weight polysaccharides, can activate cells that gobble up invading germs.
A more pressing question, for most consumers, is which kind of echinacea – E. angustifolia, E. pallida or E. purpurea – to take, and in what formulation.
Most of the research has been done on E. purpurea, and it is this type of echinacea that the German Commission E, the leading authority on herbal remedies, recommends for colds and respiratory infections and for urinary tract infections as well.
The Germans endorse the above-ground parts of E. purpurea – not the roots – taken either as pressed juice in an alcohol solution or as an injection. (Injections of echinacea are not available in this country, though they are in Germany.)
There has been less study of E. angustifolia, notes Tyler, though he thinks the roots of this form may actually be the best product. In practice, many of the dozens of echinacea products sold in America are combinations of all three types.
If you do take a combination product, says Mahady of Chicago, try to get one that contains the above-ground parts of E. purpurea and the roots of E. angustifolia and E. pallida. Some products give this information on the label.
Mahady takes the stuff herself – the 22 percent liquid formulation, not the capsules – whenever she feels a cold coming on. “It tastes terrible,” she says, but seems to help.
And if you take echinacea, the German Commission suggests, stop before eight weeks because it loses effectiveness over time.
Dr. Carol Englender, a Newton physician who also uses herbal remedies, says she recommends echinacea often. “Just today, I told four people to take it for the rest of the winter,” she said recently. “It’s good stuff.”
And while some think echinacea in an alcohol solution works best, Englender believes the capsules are effective, too.
Dr. Edward Chapman, another Newton physician who recommends echinacea to patients, adds that “the nice thing is it’s safe, and you can use if for kids.”
For adults, he says, the usual recommendation is 90 drops a day – you quickly learn how to gauge how many drops are in a dropperful – spread over three doses. Manufacturers – backed by German research – often recommend as much as 150 drops a day. For small children, Chapman says, 10 drops a day often help, and for kids between 5 and 10 years of age, 20 drops.
But the bottom line, says Arkansas herbalist Foster, is that when it comes to choosing the best dose and a formulation, “what we don’t know is greater than what we do know.”
Fuzzy thinking about herbs
Despite the booming popularity of herbal remedies among consumers, a number of myths remain, perhaps the silliest of which is the idea that anything “natural” must be safe and anything synthetic, dangerous.
But mushy thinking among fans of herbal medicine often goes further than that, verging on what Varro Tyler, an herb scholar and professor of pharmacognosy emeritus at Purdue University, calls “paraherbalism,” a belief in the superiority of anything natural and organic.
Other tenets of paraherbalism, which Tyler discusses in his 1994 book, “Herbs of Choice,” include these beliefs:
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There is a conspiracy by the medical establishment to discourage the use of herbs. Wrong, says Tyler. It’s just that doctors know little about herbs because medical schools don’t teach them and pharmaceutical firms don’t bother studying herbs because they see no profit in doing so.
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Herbs cannot harm, only cure. Wrong again. Some highly toxic substances, including the amatoxins, strychnine, ricin and many others are derived from plants.
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Whole herbs are more effective than their components. For every example that supports this, says Tyler, there’s another that contradicts it, because many herbs also contain toxins.
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Reducing the dose of a medicine increases its efficacy. This is a central tenet of homeopathy, an enterprise philosopically different from herbal medicine. Many scientists, Tyler among them, think homeopathy makes no sense.
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Herbs were created by God specifically to cure disease. “This thesis,” as Tyler puts it, “is not testable and should not be used as a substitute for scientific evidence.”