Echinacea: A User’s Guide

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When Kris Chavez decided that she wasn’t going to miss one day of work this year because of a cold, she turned her attention to echinacea. The forty-nine-year-old had read about the herb and was intrigued. Not only had it been used by Native Americans more than any other medicinal plant, but scientific research was backing up its reputation as an effective remedy for the common cold. By the time Chavez stepped into the supplement section of her local health-food store, she felt well-informed. But by the time she left, she felt frustrated and less than eager to try herbal medicine.

Chavez probably isn’t alone in her plight. Take a look at the echinacea shelf of almost any health-food store and the choices before you can be daunting. In a recent visit to a local supplement supplier, Herbs for Health staff members found more than twenty different echinacea products costing an average of $10 apiece, including five specifically for kids. It’s an echinacea jungle out there, and, unless your store has particularly well-informed salespeople standing ready to answer questions, you’re basically on your own.

To help solve that problem, we asked experts for advice on choosing an echinacea product. We hope their guidance gives you confidence as you step up to the echinacea shelf.

An Expert’s Way Of Choosing

Varro Tyler, Ph.D., author of The Honest Herbal (Pharmaceutical Products Press, 1993) and one of the country’s most respected authorities on medicinal herbs, says choosing an echinacea product involves two key factors: product form and plant species.

First, Tyler says, there is some indication that tinctures and extracts–products made of echinacea, alcohol, and water–are more rapidly absorbed than solid forms, including tablets or capsules. However, the drawback of tinctures is that many aren’t standardized, a means of ensuring that a product contains a specific amount of medicinal compounds. On the other hand, some solid forms are standardized by content of echinacosides, compounds found in echinacea. Although it isn’t believed that echinacosides contribute to echinacea’s health benefits, Tyler says, they are valid markers, or identification tags, indicating that the product is indeed made from the echinacea plant. Furthermore, echinacea decomposes readily in liquid, so liquid preparations may not be effective. One way to check the efficacy of an echinacea tincture, he says, is to put a few drops on your tongue. If your tongue tingles, the tincture probably contains echinacea compounds that hold up well in liquid.

Second, echinacea supplements are commonly made from three species of the plant. Echinacea angustifolia and ­ E. pallida roots have been used in the United States since the late 1800s to make echinacea preparations. In Germany, the above-ground parts of E. purpurea are pressed into a juice and sold in a popular liquid echinacea product. In the United States, it was once believed that preparations of E. angustifolia root were best; then it turned out that the species was often confused with its relative, E. pallida. Meanwhile, German users have found products made from E. purpurea to be effective.

“Which is best? No one really knows,” Tyler says. Of the many studies of echinacea, none has been duplicated in terms of species and other parameters, so “it’s hard to find any two studies that substantiate the effect of one thing,” Tyler says. As a result, major drug manufacturers tend to be skeptical of echinacea’s ability to fight colds, he says.

“Now, that having been said, I think it works,” Tyler adds. “We have solid anecdotal data on echinacea. Native Americans have been using it for years, and it was introduced in pharmacies here beginning in the 1890s.”

For himself, Tyler uses an extract made from the root of E. angustifolia or E. pallida, saying that he bases his choice on their standing in the pharmacological history of the United States, and on research that shows echinacea exerts an indirect effect on the immune system (see box, page 28).

A System Dependent On Consumer Knowledge

David Kroll, assistant professor of pharmacy at the University of Colorado School of Pharmacy in Denver, says pharmacists suggest that people use echinacea to treat colds because the herb has “a unique mechanism of action–there is evidence that it can decrease the severity of colds by increasing the abilities of the immune system.” But as for choosing an echinacea product, consumers are “at the mercy of the company,” Kroll adds.

Greg Grey, vice president of the American Herbal Products Association (AHPA), says he understands the frustration associated with choosing an echinacea product. Under current U.S. law, herbal supplement labels may not contain claims about what the products can do. Labels must, how­ever, list the contents of the product, the dosage recommendation, and any warnings about health risks associ­ated with taking the herb.

Additionally, the herbal supplement industry is new in the United States, Grey says, so consumer guidance is “one of the problems this industry faces as it grows up.”

“This is a real big consumer education issue,” Grey says. “People do have access to this information, it’s just that manufacturers can’t make claims. So it’s difficult. Once a product is on the shelf, consumers must rely on the brand name and reputation of the manufacturer.”

Moreover, the number of echinacea choices can be mind-boggling. Echinacea is one of more than 700 herbs listed in Herbs of Commerce, a government manual consulted by herbal supplement manufacturers, and the “potential for herbal combinations is incredible,” Grey says.

Grey suggests that consumers learn about herbal remedies and call manufacturers with any questions about their products. Mindy Green of the Herb Research Foundation, a nonprofit group based in Boulder, Colorado, concurs.

“There’s a lot of good information out there about echinacea, but not a lot about choosing a good product,” Green says. “A good choice rests with a good knowledge level on the part of the consumer and of the salesperson.”

Wayne Silverman of the American Botanical Council, another nonprofit organization whose goal is to provide the public with bias-free information about herbal remedies, suggests that consumers seek echinacea products made from plants that are certified organically grown.

“If the label of the product states that it is made from certified organic material, then consumers can at least be ensured of the product source,” Silverman says. He adds that consumers should critique product labels. “The more information a company gives, the more it shows that they are trying to meet some sort of standards,” he says.

Tyler, too, says consumers must carefully check out a company before they buy, but adds that this can be a task beyond the scope of most consumers who just want to cure a cold.

“All that a consumer can do is to try a product and see if it works,” he says. But “nobody wants to be a guinea pig,” he adds. “For the layperson, it’s a minefield or a dismal swamp. We need a Good Housekeeping Seal of Approval for herbs, but no one is willing to take it on because of our litigious society.”

The Mean Season

It’s September and the start of the common cold season, which will continue through the winter until April or May. Researchers can only guess at the cold’s seasonal character: It may be that cold weather’s drying effect on the nasal passages increases their susceptibility to viral invaders, or it may be that people tend to congregate indoors during cold weather, with doors and windows shut tight, which may allow viruses to spread more easily than during the warmer seasons.

The common cold is the most frequent disease striking the upper respiratory tract. According to the Columbia University College of Physicians and Surgeons, colds are caused by more than 100 types of viruses that attach themselves to the cells lining the nasal passage and sinuses and cause the discharge of large amounts of mucus.

Viruses are probably spread through hand contact, which is why cold prevention starts with frequent hand-washing. Once contact with a cold virus is made, it takes an average of two to three days for the victim to experience symptoms that include nasal discharge, congestion, swelling of the sinuses, sneezing, a sore and scratchy throat, coughing, and slight fever. Colds usually last from one to two weeks, and smoking delays recovery.

Echinacea Label Language

Although U.S. herbal supplement manufacturers are prohibited by law from making claims about what their products will do, they are required to provide information about what their products contain, including:

• The contents of the herbal supplement
• The dosage recommendation
• Any contraindications, or cautions, about possible side effects or warnings to people whose health conditions
• May prohibit them from safely taking the product.

On echinacea products, you may find the following information:

The name of the plant species: Echinacea angustifolia, E. pallida, and E. purpurea are the three species most commonly used in commercial echinacea products.

The part of the plant used: Root, upper parts, or the whole plant.

The processing method: Scientific research shows that the immune system is stimulated by the expressed juice of the upper parts of E. purpurea and the alcoholic extracts of the roots of E. angustifolia, E. pallida, and ­E. purpurea. Expressed juice and alcoholic extracts refer to processing methods and not to product. For example, an echinacea tablet may be made from an echinacea juice extract.

If you are uncertain about the meaning of the language on the label of your echinacea product, call the company. Many manufacturers have 800 numbers for their consumers and will be happy to answer, or find answers to, your questions about their products.

Echinacea Facts

Echinacea (pronounced ek-i-NAY-sha) is known to many people as purple coneflower. It resembles the daisy, and both plants belong to the Asteraceae, or aster, family.

Nine species of echinacea are native to North America, and three are used to make medicinal products–the roots of Echinacea angustifolia, E. pallida, and E. purpurea, and the dried tops of E. purpurea.

The three species are native to the Midwest. The entire world supply of E. purpurea, the most widely used of the three species, is cultivated. E. angustifolia and E. pallida are becoming scarce, so some commercial cultivation of these two species has developed.

According to Varro Tyler, most of the scientific and clinical studies on echinacea have been carried out in Germany. Many studies have reported on echinacea’s ability to stimulate the immune system, and it is this ability that many researchers believe gives echinacea its power against the common cold.

Some studies suggest that echinacea increases phagocytosis, or the ability of white blood cells and lymphocytes to attack invading organisms. Other studies suggest that it prevents the formation of hyaluronidase, an enzyme that destroys the natural barrier between healthy tissue and unwanted pathogenic organisms such as cold viruses.

Echinacea possesses many constituents that are generally known to benefit health, including flavonoids, cichoric acid, and polysaccharides. But researchers don’t know which chemical constituent, or combination of constituents, in echinacea is responsible for its immune-boosting activity.

In Germany, the government recognizes that E. pallida root and E. purpurea stems and flowers possess positive human health benefits. The German government allows echinacea preparations to be labeled as nonspecific stimulants to the immune system for use in the treatment of colds and chronic infections of the respiratory tract.

Echinacea appeared in U.S. pharmacies by the late 1800s and, until the 1920s, U.S. physicians prescribed echinacea more than any other native plant. But the use of medicinal herbs in the United States, including echinacea, dissipated as antibiotics and synthetic drugs were discovered. Today, however, echinacea is the top-selling herbal remedy in the United States, accounting for nearly 10 percent of the total sales of herbal supplements, according to a Whole Foods magazine survey. One reason behind its popularity may be that it has minimal side effects (see below) compared with many synthetic cold remedies.

Cautions: There are no known serious side effects to taking echinacea, but people who are allergic to other members of the aster family, such as ragweed, may also be allergic to echinacea. The German government recommends that people with impaired immune response, including multiple sclerosis and HIV infection, shouldn’t use immunostimulants like echinacea whose action is nonspecific.

The research institute of Bastyr University in Seattle announced earlier this year that it was beginning a clinical trial to investigate the effectiveness of the pressed juice of echinacea in reducing the frequency and severity of respiratory tract infections. The 16-month double-blind, placebo-controlled trial, sponsored by Madaus AG of Cologne, Germany, will involve 160 volunteers.

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