Flu Fighters

For the Birds

Bird flu has been grabbing headlines for months. But how big of a threat is it? Technically known as avian influenza A (H5N1), bird flu is a lethal strain of flu that affects birds and occasionally pigs. Rarely is it ever passed to humans — and up until press time, only when the human has had contact with an infected bird. What has scientists worried is the possibility that the virus will morph into a bug that can be passed from human to human, potentially creating a worldwide pandemic.

In an effort to anticipate the possibility of a pandemic, scientists and government officials are looking at existing drugs that may have an impact on the H5N1 bug. One that has gained the spotlight is Tamiflu, an antiviral drug that uses pharmaceutical derivatives of a compound found in Chinese star anise (Illicium verum). The problem is, no one knows for sure how well Tamiflu will stack up against H5N1. But, like elderberry, Tamiflu is effective against a wide variety of flu strains.

Can you get the same flu-fighting effect by megadosing with Chinese star anise? It’s highly unlikely, and doing so may make you ill. “Since the extract is a distant relative of the active drug, eating lots of star anise is very probably not going to protect one from the flu,” says Gayle Engles, education director of the American Botanical Council. Instead, use a combination of immune-enhancing herbs known for their ability to thwart the flu.

Echinacea Controversy

Echinacea’s (Echinacea spp.) effectiveness in treating the common cold has been hotly debated for years. One camp’s research supports the belief that echinacea can help reduce the severity and duration of the common cold, while the other camp claims research proves that echinacea does not effectively reduce cold symptoms. In response to a July 2005 clinical trial published in the New England Journal of Medicine, a premier medical journal, much of the popular press has jumped on the bandwagon, negatively portraying one of the bestselling herbs in the United States.

In the study in question, researchers from the University of Virginia, Charlottesville who conducted the randomized, double-blind, placebo-controlled study concluded that extracts of E. angustifolia root have no clinically significant effects on rhinovirus infection rate or common-cold symptoms. The E. angustifolia extracts they evaluated were produced by the researchers, rather than prepared commercially. The echinacea preparations were from a single lot of E. angustifolia root, and each dose of 1.5 milliliters contained the equivalent of 300 mg of dried, powdered root. Each subject received three doses per day, for a total daily dose of approximately 900 milligrams of root per day. Healthy young adult students were sequestered in a hotel room and began taking the extract or placebo seven days before they were exposed to the rhinovirus. They then were exposed to the virus and continued taking the assigned treatment for the duration of the study. The subjects rated their symptoms: sneezing, nasal discharge or stuffiness, sore throat, cough, headache, discomfort and chilliness. Nasal discharge specimens also were collected and evaluated immunologically.

The study results showed no significant effect of echinacea prophylaxis (taken before the onset of a cold) on rhinovirus infection and no effect on the rate of infection. In addition, on the basis of the total symptom score, treatment with the echinacea extract had no effect on common-cold-related symptoms. Also, there was no significant effect immunologically. The authors concluded that additional evidence is needed to prove that echinacea is effective. They did concede that because of the wide variety of commercial echinacea preparations, “It will be difficult to provide conclusive evidence that this herb has no role in treating the common cold.”

The dose researchers used was too low for the type of echinacea selected for the study.

Responding to the Results

Reactions to the study from the medical and herbal community have been widespread and varied. Wallace Sampson, M.D., clinical professor emeritus of medicine at Stanford University and editor in chief of the Scientific Review of Alternative Medicine, responded to the study findings in the New England Journal of Medicine. He wrote, “Unless some obscure protocol violation occurred, the trial results are real. The clinical trial found no evidence of any clinically significant efficacy of echinacea.” But Mark Blumenthal, founder and executive director of the nonprofit American Botanical Council, an herbal research and education organization, responded and said, “Contrary to the statement in the media, this is not the definitive study. There are problems with the study.”

Blumenthal said a major problem with the study is that the dose researchers used was too low for the type of echinacea selected. According to the researchers, the dose of E. angustifolia used in the study was assigned based on the dosage recommended by the German Commission E for E. pallida root, because the Commission E does not have a specific recommendation for E. angustifolia. Therefore, the study published evaluated a dose of only 900 milligrams, much lower than the standard dose of 3,000 milligrams the World Health Organization (WHO) recommends for E. angustifolia. WHO does recommend the use of E. angustifolia for the treatment of the common cold, but the recommended dose is 3 grams (or 3,000 milligrams) a day of the dried, powdered root, more than three times the amount used in the study. Michael McGuffin, president of the American Herbal Products Association, commented, “it is not unlike taking one-third or less of the dose of cough syrup and wondering why you are still coughing.”

This study also did not comply with the standards normally required of drug-efficacy studies. The rigors of conventional drug screening typically involve conducting a dose-response study. In other words, several doses of a pharmaceutical are evaluated to see which dose is most effective. Contrary to this standardized approach, the researchers of this study only evaluated one dose. Blumenthal says he questioned the researchers as to their absence of a dose-response study. According to Blumenthal, the researchers admitted that they had budget constraints.

When Blumenthal is sick, he says he still considers echinacea an important and effective element of his get-well regimen. Along with an echinacea preparation, he recommends taking astragalus (Astragalus membranaceus), andrographis (Andrographis paniculata) and elderberry (Sambucus nigra) extract. Astragalus has immune-enhancing properties. It has a good safety record, but there is little clinical research on the herb. Andrographis and elderberry have an abundance of scientific and clinical research supporting their use and also are very safe. (Andrographis should not be confused with the “andro” used for muscle enhancement.) The American Botanical Council’s website (www.HerbalGram.org) contains additional information on echinacea and other herbs.

Heather S. Oliff earned a Ph.D. in pharmacology and toxicology from the University of California, Irvine. After conducting research for many years, she left the laboratory to become a full-time medical/science writer. Oliff specializes in the nutraceutical industry and over the past decade has published numerous articles in scientific journals, magazines, books and websites.