Echinacea: No better than blessings

Back in the sixth century AD, most of Europe was succumbing to the bubonic plague.  One of the first signs of the plague was sneezing, and so as legend has it, Pope Gregory the Great was the first to say “God bless you” when anyone sneezed, presumably as a pre-emptive death rite.

The practice of saying “Bless you” to any and all steternatory reflexes spread across Europe just as quickly as the plague did, and then to other parts of the world where they developed their own local variation (for example, apparently people in Arabic countries say, “Alhamdulillah,” which means, “praise be to God.” Hindus say, “Live!” or “Live well!”).  There were also some superstitious meanings attached.  For example, people can to believe that a sneeze was someone’s soul detaching itself and exiting the body, and saying “Bless you” would stop Satan from stealing their untethered soul (http://goo.gl/znyyuY).

These days, we know that the humble sneeze has nothing to do with detaching souls or the Bubonic Plague, but interestingly, the cultural phenomenon of blessing people every time they sneeze is something that lives on.

While it’s not the only reason people sneeze, we know that the main cause for sneezing, especially at this time of year, is viruses.  There are lots of different home and herbal remedies that people swear by for colds and flus.  I hear about them every winter.  Last year I reviewed the effectiveness for Olive Leaf Extract.  Another popular herbal remedy is Echinacea.

Echinacea is a family of perennial flowering plants which are in the same broad class as sunflowers.  Early botanists gave the flowers the name Echinacea, from the Greek root word is rooted in the Greek word ‘echinos’ because the distinct spiky appearance and feel of the flower heads looks a little like an echidna or hedgehog.

Traditionally, Echinacea products are thought to enhance the action of the white blood cells, which in turn, is supposed to help the body fight off various sorts of infections.  There are many different variations of Echinacea products that are available for consumers, but these vary widely in composition. They contain different extracts from different bits of different Echinacea species which result in vastly different chemical compositions between the products.

So, do Echinacea products work?  Are they worth the money people are spending on them?

As I was poking around the internet today, I came across this article in Natural News.  The article boasted: “Echinacea preparation as effective as Tamiflu in early flu cases in large clinical trial” … “Echinaforce Hotdrink has here been demonstrated as attractive therapy for acute influenza treatment with better safety and comparable efficacy profile to the neuraminidase inhibitor Oseltamivir.” (Oseltamivir is also known as Tamiflu, the gold standard influenza treatment).

That sounded promising, until I looked at the actual paper the article was referencing.  Natural News failed to report the most important paragraph, “This study was sponsored by A. Vogel Bioforce AG, Roggwil, Switzerland, manufacturer of Echinaforce Hotdrink. R. Schoop is an employee of Bioforce AG, and K. Rauš and P. Klein have received honorarium funds from the study sponsor.” [1]  In other words, this journal article was the scientific equivalent of an infomercial.  No particularly independent or trustworthy results there.

What about independent trials into Echinacea?  Do they show any benefit?

Ah, that would be “no”.  Echinacea products have been reviewed several times in the past [2-4] and the same conclusion has been reached every time.  In fact, a Cochrane review (the gold standard of clinical research) was published on the use of Echinacea for the common cold in 2014 [5].  The best that it could say for Echinacea was that there was a weak trend towards benefit for prevention of colds, but there was also a trend towards people dropping out of the study because of side effects.  There was no evidence at all for treating a cold with Echinacea.

In biostatistics lingo, ‘trend’ means there was a small blip one way or another, but it could be entirely related to random chance.

The bottom line is that there’s no strong evidence that Echinacea does anything for a cold or influenza.  In terms of health benefits, taking Echinacea for a cold is equivalent to saying “bless me” whenever you sneeze.  At least blessings don’t cost $15 dollars a bottle.

So when you’re inevitably struck down by the modern plague of common colds this winter, stick to rest, fluids, and some paracetamol.  They’re much more of a blessing than Echinacea supplements.

References

[1]        Raus K, Pleschka S, Klein P, Schoop R, Fisher P. Effect of an Echinacea-Based Hot Drink Versus Oseltamivir in Influenza Treatment: A Randomized, Double-Blind, Double-Dummy, Multicenter, Noninferiority Clinical Trial. Curr Ther Res Clin Exp 2015 Dec;77:66-72.
[2]        Barnes J, Anderson LA, Gibbons S, Phillipson JD. Echinacea species (Echinacea angustifolia (DC.) Hell., Echinacea pallida (Nutt.) Nutt.,Echinacea purpurea (L.) Moench): a review of their chemistry, pharmacology and clinical properties. J Pharm Pharmacol 2005 Aug;57(8):929-54.
[3]        Hart A, Dey P. Echinacea for prevention of the common cold: an illustrative overview of how information from different systematic reviews is summarised on the internet. Preventive medicine 2009 Aug-Sep;49(2-3):78-82.
[4]        Allan GM, Arroll B. Prevention and treatment of the common cold: making sense of the evidence. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne 2014 Feb 18;186(3):190-9.
[5]        Karsch-Volk M, Barrett B, Kiefer D, Bauer R, Ardjomand-Woelkart K, Linde K. Echinacea for preventing and treating the common cold. The Cochrane database of systematic reviews 2014;2:CD000530.

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Olive Leaf Extract – A potential treatment, but not for what you think

Here in Australia, it’s winter. It’s currently warmer in the fridge than it is outside. We’ve just been blasted by a wall of frigid air straight from Antarctica, and much of the south-eastern corner of our continent has snow drifts over parts that not so long ago were baking under the hot Autumn sun. It’s not something we’re used to in Australia.

Of course, now that winter is firmly entrenched, more people are coming to see me with their viral upper respiratory tract infections, better known as ‘colds’. Yes, ’tis the season to be sneezin’!  Over my years of practice, I’ve seen enough people with a cold to last me a thousand winters.

What always fascinates me are the things that people try to use to cure their cold. I think I’ve heard everything over the last decade: garlic, ginger, peppermint, chicken soup, honey, tea, honey mixed with lemon mixed with tea, or honey mixed with lemon mixed cayenne pepper mixed with tea.   Some people rub Vicks on their feet. Other people douse their pillows in eucalyptus oil.

Another common recommendation that gets around the grape vine and social media is olive leaf extract, used in traditional ‘medicine’ for thousands of years, and those witch-doctors and shamans can’t all be wrong.

One published review described the ‘science’ of olive leaf extract: “Constituents of the olive tree, Olea europaea, have been studied and utilized in folk medicine for centuries. Olive leaf extract, derived from the leaves of the olive tree, contains phenolic compounds, specifically oleuropein, that have demonstrated potent antimicrobial, antioxidant, and anti-inflammatory activity. Oleuropein and derivatives such as elenolic acid have been shown to be effective in in vitro and animal studies against numerous microorganisms, including retroviruses, coxsackie viruses, influenza, and parainfluenza as well as some bacteria. Research suggests that olive leaf constituents interact with the protein of virus particles and reduce the infectivity and inhibit replication of viruses known to cause colds, influenza, and lower respiratory infection. Olive leaf extract has also been shown to stimulate phagocytosis, thereby enhancing the immune response to viral infection. Anecdotal reports indicate olive leaf extract taken at the onset of cold or flu symptoms prevents or shortens the duration of the disease. For viral sore throats, gargling with olive leaf tea may alleviate symptoms, possibly by decreasing inflammation and viral infectivity.” [1]

It’s always a concern when a supposedly peer reviewed journal allows an article to get through which seriously discusses anecdotal evidence as something worthy of attention. Anecdotal evidence is the weakest level of evidence possible. Anecdotal evidence is essentially just stories and opinion [2]. There’s anecdotal evidence for the Tooth Fairy. The other ‘evidence’ that this review describes is from in vitro studies, which are trials in test tubes not in people. In vitro evidence is only helpful in a general sense. Just because a reaction happens in a test tube or petri dish doesn’t mean that it will happen in a real life human being.

So then, do the claims for olive leaf extract stand up to the rigors of modern scientific enquiry or is it like every other cold and flu ‘remedy’ – just another individualised mythology?

Being sceptical, I wanted to find out. So I searched through the published medical literature for quality clinical trials that studied olive leaf extract in humans, and I found only six trials. Interestingly, all of the trials studying olive leaf extract weren’t looking at its effect on immune function but on cholesterol and blood sugar control, blood pressure, and oxidative stress.

In 2009, Kendall et al published a single-centre, randomized, single-blinded, prospective pilot comparison of the effect of dietary supplementation with olive leaf extract on the markers of oxidative stress in 45 healthy young adult volunteers. They found that olive leaf extract had no effect on oxidative stress compared to the control group [3].

Susalit et al (2011) published a double-blind, randomized, parallel and active-controlled clinical study looking at the tolerability, cholesterol-lowering and anti-hypertensive effect of Olive leaf extract in comparison with Captopril (a common blood pressure medication) in patients with early hypertension. After 8 weeks of treatment, there were similar reductions in blood pressure in both the olive leaf extract and the blood pressure pill groups. There was a significant drop in triglyceride levels in the olive leaf extract group, but not in Captopril group [4].

Wainstein et al (2012) performed a randomized controlled trial on 79 adults with non-insulin dependent diabetes, comparing a single 500mg dose of olive leaf extract with placebo over 14 weeks. They measured the HbA1c (a surrogate measurement of the average blood sugar over a three month period) and plasma insulin levels. They also did studies in rats to study the mechanism of action of the olive leaf extract. In the human trials, the subjects treated with olive leaf extract exhibited significantly lower HbA1c and fasting plasma insulin levels. This effect was thought to be reflected in the rat study which suggested that olive leaf extract reduced the digestion and absorption of starch from the intestines [5].

de Bock et al (2013) did a randomized, double-blinded, placebo-controlled, crossover trial on 46 patients in New Zealand, over a 30 week period. The participants were middle aged and overweight. The researchers were primarily studying insulin sensitivity but they also looked at glucose and insulin profiles, cytokines, lipid profile, body composition, 24-hour ambulatory blood pressure, and carotid intima-media thickness. The olive leaf extract group had a statistically significant improvement in insulin sensitivity and responsiveness of the pancreatic β-cell. Interestingly, the olive leaf extract supplementation improved some inflammatory markers, but not others, and made no difference to the patients lipid profile, blood pressure, body composition (their body fatness), carotid intima-media thickness (a risk predictor of cardiovascular disease), or liver function [6].

For completeness, de Bock lead another trial, also published in 2013, although this trial was more a study of the absorption of the compounds in olive leaf extract than a study of their effects [7]. There was a 1996 Belgian study which was written in French. I’m not very good with French, but according to the English abstract, there was no difference between the olive leaf extract and placebo in terms of blood pressure and blood sugar levels [8].

Reconciling the research on olive leaf extract makes for an interesting narrative. There are a couple of really strong, methodologically robust trials on olive leaf extract, and with positive results in favour of it. However, I can count them on one hand, and while the results are encouraging for proponents of olive leaf extract, there needs to be a lot more research before those claims can be made with certainty. And in contrast to its usual selling points, those positive effects for olive leaf extract were for blood sugar control, not the prevention or treatment of viral illnesses.

The bottom line – olive leaf extract may one day prove to be a useful herbal supplement, but there’s not enough clinical evidence to support it at the present moment. And there’s certainly no evidence that olive leaf extract will do anything for your viral upper respiratory tract infections.

So next time you get a cold, don’t bother spending money on olive leaf extract. Have a couple of paracetamol, a long hot shower and a good rest.

And if symptoms persist, don’t forget to see your GP.

References

[1]        Roxas M, Jurenka J. Colds and influenza: a review of diagnosis and conventional, botanical, and nutritional considerations. Alternative medicine review : a journal of clinical therapeutic 2007 Mar;12(1):25-48.
[2]        Fowler G. Evidence-based practice: Tools and techniques. Systems, settings, people: Workforce development challenges for the alcohol and other drugs field 2001:93-107.
[3]        Kendall M, Batterham M, Obied H, Prenzler PD, Ryan D, Robards K. Zero effect of multiple dosage of olive leaf supplements on urinary biomarkers of oxidative stress in healthy humans. Nutrition 2009 Mar;25(3):270-80.
[4]        Susalit E, Agus N, Effendi I, et al. Olive (Olea europaea) leaf extract effective in patients with stage-1 hypertension: comparison with Captopril. Phytomedicine : international journal of phytotherapy and phytopharmacology 2011 Feb 15;18(4):251-8.
[5]        Wainstein J, Ganz T, Boaz M, et al. Olive leaf extract as a hypoglycemic agent in both human diabetic subjects and in rats. Journal of medicinal food 2012 Jul;15(7):605-10.
[6]        de Bock M, Derraik JG, Brennan CM, et al. Olive (Olea europaea L.) leaf polyphenols improve insulin sensitivity in middle-aged overweight men: a randomized, placebo-controlled, crossover trial. PloS one 2013;8(3):e57622.
[7]        de Bock M, Thorstensen EB, Derraik JG, Henderson HV, Hofman PL, Cutfield WS. Human absorption and metabolism of oleuropein and hydroxytyrosol ingested as olive (Olea europaea L.) leaf extract. Molecular nutrition & food research 2013 Nov;57(11):2079-85.
[8]        Cherif S, Rahal N, Haouala M, et al. [A clinical trial of a titrated Olea extract in the treatment of essential arterial hypertension]. Journal de pharmacie de Belgique 1996 Mar-Apr;51(2):69-71.

Needles of Death

Acupuncture caused womans heart to implode.

A woman in the prime of her adult life had that life ripped away by acupuncture, a known deadly complementary therapy.  Worse, though, is that acupuncture therapists don’t warn of these potentially fatal outcomes or actively hide them.

Ernst(1) documents two cases of healthy women who have had their lives torn away from them as murderous acupuncture needles were inserted into their vital chest organs causing them to instantly fail.  Each woman would have died in agony as their heart and lungs were unable to get blood to their body’s vital organs.

One woman, a forty-four year old lady, had an acupuncture needle pushed into her heart, causing severe pain and breathlessness.  When she alerted the acupuncturist to her peril, his “cure” was to insert another needle, causing a full-blown cardiac arrest.

Another woman, twenty-six years old, died after an acupuncture needle was inserted into one of her lungs causing the lung to collapse.  She eventually died from a tension pneumothorax, in which the punctured lung leaks air into the chest cavity with every breath, compressing the other chest organs like a Boa Constrictor.  A tension pneumothorax is one of the most terrifying ways to die.

Acupuncture is a multi-billion dollar industry.  Despite its potentially fatal consequences, it goes on, unabated and unregulated.  People need to be warned before more lives are lost to the needles of death.”

Do you feel scared of acupuncture after reading this?  Should you believe it?

These sort of beat up articles occur all the time.  A case report which links a vaccine or drug to an adverse outcome is exaggerated with highly emotional language and posted on conspiracy-driven anti-vaccination blog or site.  Then it gets sent around on Facebook or Twitter like an intellectual virus, taken as evidence of the evils of corporate western medicine by people who take the information on face value.

The latest that came across my Facebook page was of a claim that a 16 year old girls ovaries shrivelled after being exposed to the Gardasil vaccine for the Human Papilloma Virus/cervical cancer.(4)

The problem that these anti-vaccine activists have is that case studies, while interesting, have no evidentiary weight behind them.  Trying to make a case study out to be definitive proof for anything is like putting a grain of salt into a swimming pool and suggesting that you have salt-water.  How many cases of premature ovarian failure have been reported as a direct result of the Gardasil vaccine? I don’t know the exact answer to that, but I’d be surprised if I couldn’t count them on one hand.  Compare that to the hundreds of thousands of women vaccinated with the Gardasil vaccine.

One of the respondents to the anti-Gardasil blog(4) said, “This vaccine has never prevented a single case of oral, cervical, or anal cancer …”  Actually, it has likely prevented thousands.(2)  Case studies can’t see the bigger picture.

And for every case study against western medicine, there are just as many against complementary medicines and practices.  (There would be more, except that the dearth of regulation of the alternative and complementary therapy industry means that most of the adverse outcomes of alternative treatments go unreported).

Braun et al(3) report the case of a twenty-nine year old woman discovered to have an entirely treatable early form of cervical cancer on a pap smear, who died in agony from widespread metastatic cancer of the cervix, despite thirteen years of various complementary medicines (a homeopathic therapy consisting of a vitamin C-containing regimen and subcutaneous administration of mistletoe lectins, “regional hyperthermia”, Horvi-Reintoxin enzyme therapy, and pyrogenic lysates of bacteria combined application of Carnivora-Mistletoe-Ukrain).  This woman’s cancer was caused by HPV-18, which would have been prevented by Gardasil (if it was available to her.)

The point of the story is this: All treatments have side effects or complications.  If you look hard enough, you will find case reports of direct or associated illness from just about any traditional or complementary therapy.  But case studies are not good evidence.  They do not see the bigger picture.  They can not be generalised.

In trained hands, and for the right uses, acupuncture can be a very powerful therapeutic tool.  Acupuncture still does more good than harm.

In trained hands, and for the right uses, Gardasil and vaccines in general are very powerful preventative tools.  Vaccines still do more good than harm.

Neither are “needles of death”.

References

1. Ernst E. Acupuncture – a treatment to die for? Journal of the Royal Society of Medicine. 2010 Oct;103(10):384-5. PubMed PMID: 20929887.

2. Jin XW, Lipold L, Sikon A, Rome E. Human papillomavirus vaccine: safe, effective, underused. Cleveland Clinic journal of medicine. 2013 Jan;80(1):49-60. PubMed PMID: 23288945.

3. Braun S, Reimer D, Strobl I, Wieland U, Wiesbauer P, Muller-Holzner E, et al. Fatal invasive cervical cancer secondary to untreated cervical dysplasia: a case report. Journal of medical case reports. 2011;5:316. PubMed PMID: 21767367. Pubmed Central PMCID: 3156764.

4. http://www.thelibertybeacon.com/2013/07/22/gardasil-destroys-girls-ovaries-research-on-ovaries-never-considered-10497/