Following on from Part 1, Amie Skilton joins us once again to continue the discussion on influencing immunity.
In part 2, we dive into the evidence and safety of herbal medicines for immunity.
Covered in this episode
[00:00:42] Welcoming back Amie Skilton
[00:01:02] Part 2: Herbal medicines for immunity
[00:02:07] Stimulating vs. modulating the immune system
[00:04:44] The complexity of the immune system biology
[00:07:56] Having a 'first line of defence' first aid kit
[00:08:56] Echinacea: The 'poster child' for immunity
[00:17:55] Olive Leaf: how does it exert antiviral activity?
[00:25:31] Working with fever
[00:35:17] Is glutathione appropriate for immunity?
[00:37:51] Andrographis: The King of Bitters
[00:46:36] Ginger and Licorice
[00:47:38] Elderberry, Pelargonium & Sweet Ivy
[00:48:59] Amie's favourite herb of all Thyme
[00:51:47] Andrew's favourite herb: Holy Basil
[00:54:23] Lung tonics
[00:55:30] Lymphatic herbs
[00:59:44] Astragalus
[01:04:31] Final Q & A's from the live audience
Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook and welcome to Part 2 of Influencing Immunity with Amie Skilton. Now in Part 1, we discussed some of the nutrients that were useful in combating infections, mainly viral but obviously also bacterial.
Obviously, this is a very complex issue so there's only so much that we can cover, but today we'll be discussing some of the herbal options we have at our disposal. Amie, welcome back to FX Medicine. How are you?
Amie: Thank you so much, Andrew, for having me back. I'm so excited to be...
Andrew: I'm sorry. I'm cutting you off.
Amie: ...having this conversation with you again. We got through so much in Part 1 but there's just still so much to share.
Andrew: Yes, and obviously this is an extremely complex issue. It's so hard to go into the biochemistry that happens in our immune system which often gets oversimplified. We talk about macrophages. We don't talk about the influences upon the macrophage. We don't talk about the various white blood cells. What about the CD4:CD8, the Tregs? It's all about...da, da, da.
There's so much to cover. You can't do it in one podcast, but we're going to give hopefully the practitioners out there some herbal options and give them maybe some things to think about especially in the current situation that we have affecting us all.
Amie: Yes, absolutely.
Andrew: So where do we start? How about we start with the concept of stimulating the immune system versus modulating the immune system?
Amie: Yes, that was a question that got submitted for the podcast last time and we didn't end up getting to it. I think it's worth having that conversation now, especially because there's a lot of misinformation going around at the moment as well. I've seen actually medical doctors suggesting that stimulating the immune system is equivalent to triggering an autoimmune disease.
Now, as you said, it's very difficult to explain things succinctly in five seconds, but that is really a blatantly incorrect statement. We know we can upregulate and downregulate immune function that is completely independent of the target of the immune function. Whereas, the autoimmune condition, of course, is when your immune system fails to recognise the tissue that is yours and begins to attack it.
Now, if you have an autoimmune condition and you're in a flare-up, then herbs or pharmaceutical medications that stimulate white blood cell activity might not be the right choice for you in that moment because you don't want to speed up the destruction of your own tissues. However, when you're fighting an infection and obviously that aside accelerating the rate at which your immune system can get on top of an infection is, of course, a good idea most of the time.
Having said that, there are different ways of how you can, I guess, define stimulation of the immune system, and we did mention it in the context of vitamin C because vitamin C increases white blood cell activity. Having said that, I feel like maybe what you're really doing is providing more and more of the fuel that they need to do their job more and more efficiently is that really stimulating them or are you ultimately just optimising...
Andrew: Or, are they just cleaning up debris?
Amie: Totally. Totally. It's tricky to peg that down in black and white but, if we use the term “increases white blood cell activity” as a measure of stimulating the immune system, then, yes, we can achieve that with a number of different herbs which of course is just one part of tackling an infection. That's what makes Echinacea so popular because that is one of the properties that it has.
Andrew: Yes. As we said, the immune system is so complex. Indeed, there was a beautiful thing that I saw the other day, and it just went into just some of the complexities of our immune system including just the CD sets. When you look at the CD sets and therefore what interleukin involvement is invoked, it's...
Amie: Wild. I know. It's wild.
Andrew: Far more than we are exposed to by many companies and just this simplistic thing. In fact, even the Th1-Th2 seesaw, that's so '80s or '90s. That was by Dunston. It was basically, the limitation was due to the machinery, if you like, the equipment that he had to assay as we indeed now know that that seesaw is basically like a bendy seesaw with some roundabouts going in the background as well. You can have Th1-Th2 comorbidities at the same time. You can also have this sort of thing going on.
Amie: Well, I mean ultimately, when it comes down to that, you've got naïve T cells that are being directed to… You've got Th1, 2, 7, 22, 17, 8, 9, and it's not necessarily that, say, Th2 or Th1 response at the start is inappropriate either.
However, when there's a loss of the promotion of regulatory T cells, which I like to call the peacekeepers of the immune system, you can't switch off these immune responses. That's when they can become aberrant and cause problems for people. This, everybody, is why that, when you're looking at using herbal medicine to support your immune system, it's important to see someone's who's qualified in herbal medicine because they understand how to apply it and what's happening underneath the hood inside your body.
Andrew: Yeah. Indeed, this is why that naturopathic idiom about treating the gut: "first, treat the gut.” It still stands.
Amie: It does.
Andrew: Indeed, even with regards to SARS-CoV-2. It is a gut-based disease in many instances. Now we're seeing this incredible diversity of symptoms now including rashes and vasculitis and all of that sort of thing, but importantly in so many people is gastrointestinal symptoms which present first.
Amie: Yes. And we know of course when you've got that inflammation presenting at the gut, we start to see degradation of the integrity of that tissue and translocation of LPS and other endotoxins into the bloodstream, which of course is partly responsible for the systemic effects that occur in the later stages of that condition and can, of course, happen in major infections of any other nature as well. That's probably, gosh, a fourth podcast that we need to talk about, how to drive regulatory T cells and keep inflammation under control.
But having said all of that, if your body can get on top of an infection quickly, you then really drive down the risk of that perpetual inflammation starting to cause collateral damage in the body. Which is why I think you really need to act at the first sign of anything and really take care of yourself at the first moment where you think, "Uh-oh, I might be coming down with something."
That's where I think herbs are most effective to use. As soon as you intervene at the first sign of symptoms, you can sometimes avoid getting sick, in the sense of being so unwell you can't go to work or function as a human being. There's lots to choose from, isn't there?
Andrew: Yeah, absolutely. I mean I totally subscribe to everybody seeing somebody that they trust with regards to the appropriate choices for your particular condition.
But I do subscribe to keeping a first aid kit in the background. And Echinacea being the poster child of immunity, if you like, really as one of the current primary herbs that are just always used. Indeed, I very often use Echinacea on its own straight off the bat when I get that first weird nasopharyngeal irritation, like that “uh-oh” feeling.
Amie: Yes.
Andrew: I really do hammer it. Now, obviously, that is not without its caveats if you have an allergy to the daisy family or indeed you have a particular sensitivity to the particular tingly, burny sensation from the alkylamides from Echinacea. Then obviously you've got to watch that and you choose some other herbs. So, over to you. What sort of other herbs have we got?
Amie: Well, so I'm in the fan club of Echinacea, too. I do want to chat about why it is Western herbal medicine's go-to, but we've just had a comment pop-up from Graham. Thanks, Graham. Graham is...
Andrew: A very good question.
Amie: He is saying: rather than looking at stimulating the immune system when infection occurs, wouldn't it be better to make sure it's supported long-term? Absolutely. I'm pretty sure, Graham, you were in the earlier podcast where we were talking about vitamin D, vitamin C, vitamin A, zinc, selenium, and supporting your immune system by making sure it's nutritionally-replete, as well as avoiding the things that are going to suppress its function are 100% something people should really be looking at daily as a daily support.
But having said that, as a practitioner of almost 20 years, I have got a wintertime protocol which I'm employing right now for obvious reasons. But that doesn't make me bulletproof and, depending on things like my stress levels or the virulence of whatever pathogen is going around, there are of course other things you can have in your cupboard just in case. Which is exactly what I've done. While everyone was pantry hoarding toilet paper, I was buying all the respiratory tract herbal tinctures. We'll talk about those today, but I was ready.
To be honest, I actually did go through symptoms according to the timeline of the virus that's currently going around. I acted in accordance to that and was very grateful to have these next-level tools to call on.
Now, the reason why Echinacea is such a popular herb, in Western herbal medicine, it is really the first thing that herbalists will often reach for when your body is fighting off infection. As you mentioned, there's a number of different components that we now understand the mechanisms of action for how it works.
But ultimately we know that Echinacea is very high in natural antioxidants, and free radical damage is a serious secondary issue when it comes to immune responses. We also know some of those compounds inside the herb actually boost white blood cell activity, meaning that they work to accelerate or support our immune system to work faster to fight off infection.
It's commonly utilised for respiratory tract infections but it's also commonly called on for infections of any nature. In fact, the Native Americans in the US used it for snakebite as well.
Andrew: Don't know how effective.
Amie: Well, look, if I was bitten by a rattlesnake I'd be calling on more than Echinacea, but I do love that they used that traditionally with good results, and I would probably jot that down, too, quite honestly.
Andrew: I think the scenario there is what else did they have? When you've got nothing, something is better than nothing.
Amie: Totally. Yes.
Andrew: If you think historically, more people died who took Echinacea than those who didn't.
Amie: Yes.
Andrew: That would have been why they chose that sort of thing.
Amie: For sure.
Andrew: In our modern era, get thee the hell to hospital.
Amie: All right. Well, let's talk about respiratory tract infections though because we're certainly not recommending Echinacea if you get bitten by a snake. I've got a list here of some of the case studies that have been done on Echinacea as they pertain to respiratory tract infections. You know, we're approaching June very quickly, so it's a great time to be talking about this. In a large randomised, double-blind placebo-controlled trial, there were 755 people who were administered either placebo or Echinacea. Over this four-month period, those that took the Echinacea had a 53% reduction in days experiencing symptoms of a respiratory tract infection.
Now, as a medical herbalist, I'm not a big fan of giving Echinacea as an ongoing herbal medicine. That's almost like flogging a horse. Eventually, it's going to get a little tired.
Andrew: Why? Why would you need to?
Amie: Yeah. It's my preference to save it for times of infection. But I will say, if you're in an occupation that is being exposed to sick people a lot, you might work in retail, like grocery. You might be a medical professional seeing clients in person. You might be a school teacher. Or even someone who...for example, a bus driver where you've got lots of people coming on and off the bus and you're being exposed. There could be an argument there for low-dose Echinacea reducing your risk. I do want to say that, in people who took Echinacea like that, over an 8-week period, it reduced their sick days by 30%. So there is evidence for its use in that way, but more specifically when it comes to being ill, people recovered twice as fast. They get better much quicker.
I also want to say there was a pilot investigation using Echinacea in over 1,500 people who were given either the flu vaccine, Echinacea, or a combination of both. Looking at both symptoms and blood work, Echinacea was more effective than the flu vaccine or the combo at reducing the illness incidence and length of illness. In fact, it was significantly so. And so there is evidence for its use like that, too.
Again, I would prefer that people really focus on the nutrients so the immune system can do the job it's programmed to do. But, like you, I would always have a bottle in the cupboard just in case at that first sign of an itchy nose or a sore throat.
Andrew: Yeah. the research around Echinacea is very interesting, very controversial and certainly not without its issues. But when you look deeper into those people who have a respiratory infection, an URTI, an upper respiratory tract infection, there's both positive and negative papers on Echinacea. It's not just the dry, and it’s not just the dry root, because some of those studies are negative. Indeed, one of the favourite products on the market had a negative trial in airline staff.
Now, let's think about this. Mentioning Graham's question about nourishing the immune system, these people are under constant stress, physical, emotional, circadian stress.
Amie: Not to mention the radiation.
Andrew: That's right. You can't expect particularly a single herb to do the job of eradicating this virus, which by the way mutates very quickly, without looking after and nourishing the body's innate defence systems, i.e. rest, soups, nutrients, nourishment, warmth, all of that sort of thing. So, we've got to look further than what this study says and there is nothing that is so strong that it can outweigh these very basic tenets of nursing your body back to health.
Amie: Not to mention that herbal medicine is not to be administered in the same way generally speaking like a pharmaceutical medicine would. As Sharon's pointed out in the chat, it is not that common to administer single herbs for the management of something like this. And you would. You would carefully choose other immune support herbs, things that directly supported the symptoms that that person might be experiencing and their own unique biochemistry, which is why you see Echinacea usually paired up or in a trio or even in a full herbal medicine combination with other plant medicines as well.
Andrew: All right. So, let's go on to some of those.
Amie: Yes.
Andrew: Another one. I've got to pick on this: olive leaf.
Amie: All right. Let's talk about olive leaf. Olive leaf is one that I would say a lot of people walk into pharmacies and health stores asking for whenever they're experiencing a cold or maybe something a little more aggressive than that. Olive leaf is an incredibly powerful anti-inflammatory. One of the reasons we feel so terrible when we're fighting off an infection is because of the inflammatory cytokines our own immune system is producing. These can cross the blood-brain barrier, meaning it affects us not just physically, but mentally and emotionally as well. They're not fun. They're certainly not pleasant.
They are part of nature's way of, A: bringing attention to your predicament so that you do something about it and, B: the impact that they have on our brain makes us antisocial, moody, sensitive to light and sound sometimes, tired, and really just generally unenthused with life. Which is the whole point because it drives us back to our bed, keeps us away from other people and making them sick. It actually forces us to take time out and recover.
So, olive leaf is loved and adored because it makes people feel better quicker, and I think there's a real place for that. I don't love the suppressing of symptoms to the point where you could operate like nothing is wrong because that will defeat the purpose of them entirely, but olive leaf does have role to play there.
There is something else about olive leaf though, that I particularly like. Now, what's so special about 2020 and being a herbalist in this time is we're getting more and more sensitive instruments, more and more advances in scientific analysis, and we're beginning to understand more and more on a biochemistry level of how these herbs do the job that they do. There is a very interesting mechanism that is attributed to the oleuropein inside olive leaf as an actual antiviral itself.
Oleuropein is a compound found inside olive leaf extract, although it's a very, very small amount. So if you're looking for this mechanism of action, I would suggest you look for an olive leaf that has been standardised to oleuropein. Now, oleuropein itself is not in and of itself antiviral. However, when it's taken up into our cells, which is exactly where viruses hide up in the nucleus, there's an enzyme in our cell that converts that compound into calcium elenolate and oleanolic acid which becomes an antiviral compound inside the cell where the virus actually is.
I describe it to my clients like pulling the pin out of a hand grenade. It's almost a Trojan horse, if you like, getting into the cell and acting upon the virus inside there. And so I think, as we begin to understand that more, and at what level it has that effect, it's going to really support its use for viral infections, and I guess really continue to champion it for the use in respiratory tract infections, for sure.
Andrew: So, one of the things that I learnt that was really interesting - this was from Ian Breakspear's research, really interesting stuff - was that he assayed products in the retail arena and products in the practitioner arena. Ian, forgive me if I get this wrong, but what happens is, when olive leaf is aged or the more it's aged, the more conversion you get to this compound called hydroxytyrosol. He found higher amounts in the practitioner products available on the Australian market than the retail.
Amie: Right.
Andrew: Now, here's the question: is the fresh olive leaf more potent than the aged? Is higher hydroxytyrosol bad?
Amie: That’s a good question.
Andrew: I don’t know the answer to that question, but it was really an interesting point that came out of it.
Amie: Yes.
Andrew: To me, what's telling is we certainly need to look into the complexity of the herbs. It's not down to one standardised component.
Amie: Yes, absolutely.
Andrew: We really need to refresh our memory that herbs are not drugs. If you want to go with drugs, use drugs.
Amie: Yeah, I agree. It's a real balancing act as a practitioner, isn't it? We've got hundreds sometimes thousands of years of that herbal medicine being used in a particular way, prepared in a particular way. That's a really nice lineage to rest upon and rely upon.
But I also embrace that, in this day and age, we can look inside a plant, and really identify all of its incredible components, and experiment and actually see what they do. In some cases, we may even find better ways of preparing, growing, harvesting, producing, administering herbal medicines that make them even more powerful. That's really exciting. But I think what some people forget is science doesn't dictate what is so. It seeks to explain what is so.
Andrew: Well said.
Amie: Yeah, and I'm really enjoying watching science explain what we already know to be true about herbal medicines over and over again. And it's really exciting to be able to actually understand the plant a bit deeper, and the way it works with our own biochemistry. But just because a study hasn't been done on this, or we don't quite understand that, doesn't mean it isn't the case until science says so.
And so I think, in practice, you have to really work on your own, what we know traditionally, what science is informing us or sharing with us, what we're seeing in practice, and how our patients are responding, and just really using our own knowledge as well to be able to really personalise prescriptions for people.
Andrew: You know, one thing that I just thought of with regards to olive leaf, and it certainly suits the scenario, and I'm not saying that this is a treatment. There is no evidence on this treatment but, I think, isn't it very interesting that olive leaf works mainly as an antihypertensive?
Amie: Yes.
Andrew: What's the major presenting comorbidity with the current immune issue worldwide?
Amie: Mm-hmm. Yeah, 100%. Yep, very interesting.
Andrew: I wonder how it works. I wonder if it's got anything to do with age, too.
Amie: Yeah, that's a worthy line of investigation, and I think given what's going around at the moment is quite complex. There's a lot that has yet to be explained because everyone's in crisis mode trying to stop people dying, but those are the questions that need to be asked when we have got the time and the space to actually take a look at those mechanisms. I think that's a very worthy line of investigation.
The other thing I want to share about olive leaf is it's also supportive for fever. It's antipyretic and so that's also an important consideration if you're choosing to include it in a herbal formula for somebody as well.
Andrew: Okay, so we're going to be talking about thyme a little bit later on. When we're talking about combining these herbs, one's an antipyretic and thyme is used to enhance sweating, how do we modulate that? Let's bring it up now.
Amie: Well, so from a Western herbal medicine perspective, there isn't a clash there using those two herbs.
Andrew: I guess not, yeah.
Amie: Yeah, those two herbs are providing lots of different properties and ultimately supporting the immune system to do its job. From a naturopathic point of view, we don't consider fever to be a problem or something that should be immediately addressed and shifted.
Now, we know obviously dehydration is a thing that needs to be managed. We also know that the comfort of the patient is incredibly important. Modulating that for patient comfort is also really important, and of course prolonged protracted and very high fevers can bring some complications with it as well, so it does need to be managed very carefully.
But the increase in temperature increases the immune system activity. It's a way of actually driving up immune function and your body trying to accelerate that rate at which it gets on top of this infection. So, removing it is counterproductive. Having said that, in order to keep the body comfortable, diaphoretics that help with sweating to actually maintain that fine balance between I guess, for want of a better term, a healthy fever versus an unhealthy fever is a way of allowing the body to keep getting on with its job without too much interference, but keeping the patient more comfortable.
Certainly if someone's presenting with a fever, and they're feeling very cold, they're shivering, very uncomfortable, then there are other obviously recommendations you can make, too. But herbs that address that are certainly important to include in the formulation as well.
Andrew: Really interesting when you consider these points of management and it's really interesting. When we get caught up in excitement about something and we forget where it originated from. And in all cases, if you think about diaphoretics, how do you manage a fever? Then diaphoretics are useful but obviously, that's losing fluid, so hydration. You go back to these really basic tenets—hydration, rest, avoiding the...
Amie: I know. It's not glamorous, and I think it doesn't have the same glamour as a fancy pharmaceutical drug with a powerful instrument with a single action that is just like flipping a switch. It also requires more effort than popping a pill. You've got to line yourself up with fluids, electrolytes. You're going to be sweating away, which might mean changing the sheets and including a waterproof mattress cover for the time being. It means maybe a few days at home feeling pretty ordinary or less than ordinary.
We live in a society and a time where the badge of busy is something people still laud over each other, and that is a real problem because it doesn't suit our physiology.
Andrew: No that’s right.
Amie: I’m just going to answer a question here. Sharon's asked about high temperature in children particularly young children. Now, what I know to be true is children can go down with infection very, very fast. They can also recover a lot quicker than adults, which means they have to be watched much more closely by their parents or their caregivers in conjunction with whoever is providing them medical care.
But it's really old-fashioned and not in line with the evidence to treat a fever in a child with something like paracetamol. In fact, finally allopathy are catching up. I lectured at a conference for one of the large pharmacy chains in February, and they were specifically saying we do not recommend you give baby pharmaceuticals or child pharmaceuticals to lower a fever except in extreme cases. The evidence is not there. In fact, what we also know to be true is that, in doing so, you disable a key arm of their immune system by reducing their glutathione status, which is actually harmful.
Obviously, a clinician always has to make the right call for the child that they're treating. However, more often than not, the evidence does not support that as a mode of action and, in fact, it can be harmful. In naturopathic medicine, the first rule is do no harm. It's not something that we recommend. Yes, monitor it very tightly.
Some of the key recommendations around what way you choose, is to look at the child. Now, it's normal for a human, big or small, to go off their food when they are feeling unwell. That's a way of the body conserving energy and taking pressure off the gut and the immune system down there to deal with what's going on. It's normal to feel more tired and be resting more.
But the key in children is to look for their responsiveness. Are they still alert? Are they still engaged? If they're starting to look...obviously, dehydration in children is probably the biggest risk, to be honest, so making them electrolyte-based ice blocks or warm broths if they're looking for warmer fluids and monitoring them closely is key. But if they start to get listless and less responsive, their consciousness levels start looking like they're sort of heading on the way out, that's when you need to act. But outside of that, the evidence is not there to support the administration of pharmaceuticals for bringing down fever.
And, if in the event you have to do that...sorry to cut you off, Andrew. I'm a little on a roll here. But give glutathione. It's not a hard and fast rule not to do it either. If you feel, as a clinician or as a parent, that you're... You know your child best. If you're watching them and you don't like how things look and you feel like that is the best course of action, just know you can shore up the, I suppose, negative impact that it's having by giving something like glutathione or N-acetylcysteine to just balance out the collateral damage if you like.
Andrew: Or, indeed, in the child, whey. If you give good whey, undenatured whey that still has the alpha-lactalbumin and the gamma globulins, things like that, intact, then that has been shown to increase glutathione.
Amie: Yes.
Andrew: If you think about a food that can be used with kids that they will take because it tastes reasonably nice, whey. You can get some beautifully formulated wheys out there that aren't sweetened with nasties, so just be careful about that.
The other thing is of course with temperature...I mean I'm not a fan of not bringing down the temperature. I'm a fan of managing a temperature.
Amie: Yes.
Andrew: but what's interesting to me is that I was reading a paper just the other day about this. It was what do medical professionals, including specialists and GPs, feel about temperature. A lot of them actually thought, unduly, that it had dire consequences. Whereas, what's been shown is that the vast majority of kids, even if they fit, don't have long-lasting problems with that.
Amie: That’s true.
Andrew: Having said that, it would be an extremely scary thing to witness particularly if you're a parent. I'm of a parental opinion to manage the fever and, as you say, hydration. Interestingly sitting a child in a hot bath could bring out erythema, which I found very useful as a parent. Indeed, when a temperature was run away, our kids hated this, but we did it. What we did is we put them into a lovely hot bath, not too hot but a warm bath, very warm, and then we took them out and put them in front of a fan and held them. They screamed. They did not like it but, boy, did it drop that fever.
Amie: Yes.
Andrew: Now, I take your point. I totally take your point about managing the fever and not suppressing a fever. I'm well-versed from this naturopath who used to, as you say, put a plastic mat down on his bed and manage the sweating of his fever with adequate hydration and things like that. But, that is somebody who knows what to do when things occur, not for the layperson, so I defer to what the practitioner says.
Amie: Yeah, and it also depends on, does the child have other health conditions that you might need to be mindful of, how equipped is the parent appear to be to manage it? The stress of the parent is definitely something that also needs managing, and no one wants their child to have a fit. If you can avoid it, great.
Andrew: Absolutely.
Amie: But it is nice that parents know that, for the most part, it doesn't actually end up causing any long-term challenges.
There’s a question here from Helene about glutathione. Would you include it in the immune program?
There's a real balancing act when it comes to recommending nutrients and herbs and other interventions. Not many people have an unlimited financial budget, and I've never met a supplement I didn't love, but I also have a limit on how many things I'm willing to swallow in a day. And so you've got to sort of draw the line and think, "Right, what are my primary recommendations? What are my secondary recommendations? What are my tertiary recommendations?"
If I was treating, say, an adult for common wintertime lurgy, if they weren't already on a nutrient protocol of vitamin A, D, C, zinc, selenium, that would be the first thing that I would look at, and then I would look at a herbal mixture specific to them. Glutathione, I would love to put that in there, too, but it's not often something I include in that initial recommendation because it's just another thing.
Andrew: It tastes horrible.
Amie: Well, yeah, that doesn't help. I actually have a genetic polymorphism that impacts my ability to produce glutathione, and that means I'm much more vulnerable to ending up with not enough in my system. That is something...liposomal glutathione, I always have it in my fridge. If I knew that about the person that I was treating, maybe I would prioritise glutathione a bit more, but it really comes down to the individual, and it isn't often something that I would include.
Now, if it was for a child and let's say I've been treating them for a while and I knew that whenever they got a cold or some virus that they always had a very high temperature, maybe they’ve fitted in the past, then, yes, this is something I would include. For the family's sake, it might be something I would say, "All right, well, then if you notice that gets to this point or you notice the child is starting to fade away a little bit in terms of energy and vitality, then you can use something to address the fever and use this as well."
So it really does depend on the person you're caring for and a number of factors, but if you have got the budget for it and you're happy to take anything and everything, yes, I would include that in your protocol.
Andrew: My opinion because of the taste and because I'm a male wimp: go with whey.
Amie: Use whey or use a capsule or...there's lots of actually...
Andrew: Adults, take what you get.
Let’s move on, Amie, because again we're going to run out of time and we've gotten back on to nutrients. More herbs. Andrographis.
Amie: Yes.
Andrew: Andrographis, I remember reared its head and sort of became popular when I was in practice. I was extremely hesitant, I must say, to embrace Andrographis. I still use it with certain hesitations but only in certain instances. The reason is because of its common name. So let's talk about Andrographis for a tick.
Amie: Yes. So, when it comes to herbs, just like with pharmaceutical medications, you've got different safety profiles. You've got different strengths and activity levels. Whilst Andrographis doesn't have a narrow therapeutic index like something like poke root does for example, when you look at it in the context of traditional Chinese Medicine model, it is an extreme herb. We were talking earlier, and I said it's the Mike Tyson of respiratory tract herbs. It is a heavy, heavy hitter.
Any time you choose to employ a herb that has very powerful activity and, in this case, it's on the extreme of the yang scale in traditional Chinese Medicine and it's extremely bitter. The more away from the centre of that model you get, the more it has the potential to unbalance somebody.
I know that sounds very esoteric, but we're going somewhere with this. Where I'm going with that is is, whenever you're looking at herbs that have a very aggressive action, the risk for unusual responses starts to increase quite rapidly.
Because Andrographis has got a very solid evidence and solid use, it's called Indian Echinacea by the way, for respiratory tract infections, it's very popular. For the people that it suits, they love it. Since it burst on to the scene since 2006, there's been lots of celebrities that tout its benefit, and the people who love it are just like president of the VIP club, but there are some people that it has an undesirable response in. I do want to talk about how useful it is for upper respiratory tract infections but, before we dive into that, I just want to warn people that it just doesn't always suit everyone.
Number one, because it is an extremely bitter herb, it has an aggressive stimulating effect on our bitter receptors. As a result, it can change the way things taste and therefore also smell. For some people, everything just tastes like dirt, which is not fun. It's not fun. When things don't smell and taste right, it can be very distressing. For anyone who experiences that response to Andrographis, stop taking it immediately. This is not the herb for you next time you want to tackle a respiratory tract infection for yourself. There's also an even smaller subset of people who are allergic to it. ...experience an allergic...
Andrew: I've seen that.
Amie: Yeah. What have you seen?
Andrew: It was actually a friend of mine who… I'll try and simplify the story, but it was the first - it wasn't her, it was a colleague of hers - the first time they took something with Andrographis in it, they had a slight wheezing and quizzically this certain person took it again. Even though this friend of mine said “that's not for you.”
Amie: Don't do this at home.
Andrew: Yeah. Anyway, but this friend of mine said...
Amie: You're right. She had to be.
Andrew: ..."This is not for you. Don't take it," and this other person took it again and ended up in the hospital.
Amie: Yeah. Look, you can be allergic to anything, right? Skincare products, foods, herbal medicines, pharmaceutical medications, things like latex found in Band-Aids for instance. If you're taking it for the first time...in fact, sometimes it doesn't always happen the first time, although it's more common that it does. If you experience any allergy-type symptoms, so you're getting hives, itchy, red, wheezy, sneezy, anything like that, you need to get medical attention immediately, and do not take it again. Because typically what will happen, even though it might not end up in full anaphylactic shock on that first occasion, if you persistently take it, that's likely where it's going to conclude for you.
Andrew: I think the important point here is to see your practitioner. If nothing else drives this home, it is this example.
Amie: Yes, yes. Yeah, 100%. I think, because it is so popular, people rave about it. This might well be why your friend thought, "Oh, I'll give it another go and just see if it happens again," but medically speaking that is absolutely not what our advice would be.
For those that can tolerate it, it makes an excellent choice for upper respiratory tract infections. There's been a number of double-blind clinical trials that have shown it reduces these symptoms of respiratory tract infections, including sore throat, mucus, coughing, runny nose. This makes it a very powerful instrument when you're fighting off infection, and they now also understand that it improves antibody responses and also phagocytosis by macrophages meaning you have a reduced risk, potentially, of secondary bacterial infections. That's all kind of wrapped up in a beautiful bow of immune stimulation as well. That's why it's so popular for the people who absolutely love it, because it works very, very well.
Andrew: You know what? I'm going to ask our viewers out there to get their opinion between tableted versus liquid versions of Andrographis. Being the king of bitters, do they find actually that it has a better effect if they get it in a liquid form, albeit it's going to taste disgusting? That's the issue I have. I have a real physical aversion to it in too hight a dose. I normally got a cast iron gut so it's really weird.
But anyway I'd love your opinion out there. What's your clinical opinion of the tableted versus the liquid herbs? I've got to say, although tableted versions are very popular and they have their place, I always think about them, as you mentioned, the patient symptoms picture changing. This is why I love herbal medicines in the liquid form so much, because you can change that formula as the patient picture changes.
Amie: Yes.
Andrew: I just think this is one of the beauties of liquid herbs for me.
Amie: I'm enamoured with being able to personally formulate for people as well. Not to mention that, from an energetic point of view, and I imagine a lot of herbalists would agree with me, the vitality in a tincture, there's a level of vitality that you can't get in a tablet. Look, I absolutely use and recommend tableted herbal medicines quite regularly, and they're great. But if I was given the exact same choice, tablet or liquid, I'd go for liquid, absolutely. They're also absorbed a bit quicker, which means you feel better faster. In the case of infection, that's always a win in my book.
Andrew: If I had the option, I would always add liquid formula to a tablet so at least I could vary this, you know?
Amie: Yeah. That's a great idea. They're a wonderful way to administer that. I guess we sort of covered those key things that are often selected for cold and flu, but when you're looking at the whole patient, when you've got a liquid formulation that you can craft for them, you can add other herbs that support lung repair, that work as expectorants, bronchodilators. We've got a lot of great herbs to choose from, haven't we?
Andrew: Indeed. Being a fan of licorice and ginger, I very often combine both licorice and ginger, and it certainly suits 30s. What I love about ginger is it gives that warming, soothing sort of feeling to the nasopharynx but also helps in the dispersion of the herbs. What's interesting to me is something I found out about a little bit over a year ago, and that is the ginger talks directly to the genes of your microbes. Gut-based diseases anyone? Gut-based respiratory infections anyone?
To me, it's really interesting how important some of these sidelined herbs are. You don't need a lot of ginger.
Amie: No.
Andrew: I would halve the dose normally recommended. I just put a little tiny bit in there.
Amie: Yeah, 100%.
Andrew: Anyway, so there's so many herbs to go, and there's so little time.
Amie: I know.
Andrew: What about herbs… Even two herbs that have got products on the Australian market that are of S2; that is pharmacist-only medicines. That's pelargonium and elderberry. Let's talk about those for a tick.
Amie: Yes. Well, so elderberry, I guess in the context of taste, is the exact opposite of Andrographis. It's like a yummy little thing to drink. It's really popular for kids for that reason, and it's a great antiviral herb on its own. It's brilliant but, in the context of a well put together formula, it's just such a hero in there as well. Of course it works very well in big kids, too.
Pelargonium is another heavy hitter, although less extreme than Andrographis, which I would certainly look to employ, particularly when you've got chesty stuff going on. Wild ivy is another good one, and again that's such a powerful classic cough herb that's often sold in pharmacies, too, as a single herb. I'm obviously more of a fan of including those herbs in a formulation that does multiple things for someone.
Can I just talk about for a moment my favourite herb to include for lung stuff?
Andrew: It depends what it is. Of course, you can.
Amie: So, my favourite herb of all time, it’s a pun coming here: is thyme.
Andrew: I was scrambling there.
Amie: That was so cringy. Sorry, guys. I couldn't resist. I've got to spice up the Tuesday somehow.
Thyme is obviously a very popular culinary herb. It's something that I always include in my germ juice formulation, which is like another sort of cold remedy that I make for myself and clients. The thing with thyme is, thyme is a very rich source of thymol, which is a volatile oil or an essential oil. All of the essential oils or volatile oils, when swallowed, are absorbed across the stomach lining just like alcohol, which means they get into the system very quickly.
Now, obviously anything that we ingest is metabolised in some way, and oftentimes it's moved out of the body through phase 1 or phase 2 or phase 3 detoxification. In the case of thyme oil, it is metabolised and eliminated by phase 1 enzymes in the lung tissue. Now, what this means is, it's then evaporated up and out and exhaled through the lungs.
Now, naturopathically speaking, we recommend medicated steam inhalations quite regularly. Head over the hot bowl of water, and we add anti-inflammatory or antimicrobial combination of essential oils, and then inhale them deeply into the lungs to soothe the tissue and also effectively disinfect the lungs, for want of a more sophisticated term.
When you ingest thyme as a herb, it's like this reverse shower for your lungs and you're actually exhaling thyme oil. You can smell it on the breath of anyone who's taken it, and it's antitussive so it soothes the respiratory tract, reduces spasmodic coughing, it's antimicrobial. It's also a very gentle bronchodilator, which we need when you've got mucus clogging up your airways. I just think it's brilliant.
Now, if you're a mom or dad at home listening, you can simply add fresh thyme to your dinner meal, for example, or you can pour some boiled water that's cooled a little bit over and make a thyme, and Manuka honey, and ginger tea, and achieve a similar effect. I just think it's such a legendary plant.
Andrew: That's really interesting about the inside out, rather than just inhaling things. Okay, I'm sorry. I can't leave this one out. You talked about your favourite. I'm going to talk about mine.
Before I do that, the polls are in. It seems like it's a dead heat between tablets and liquids.
Anyway, holy basil, something that I spoke to Professor Marc Cohen about, and we started off on one topic and ended off just talking about holy basil. This has become a favourite herb of mine because it works on so many axes. It's not just an immune issue but it's also an adaptogen, and yet it's very safe to use in infections. Let's talk about that just for a minute. We've only got 9 minutes or 8 minutes to go, so we're going to hurry things up.
Amie: Yeah. Tell me your initial thoughts.
Andrew: The thing that I like about it is that it's not just an adaptogen but it's also a great immune-modulatory herb.
Amie: Yes.
Andrew: It also has mood-altering effects. It works on this three-way axes. Probably more. I'm probably being over-simplistic. So that it helps in the sickness syndrome, it helps recover from infections and inflammation, but it also helps stave off future infections as well. It's a beautiful herb.
What got me about Marc… and I've tried three times now to grow the damn herb and I must have got budgie seeds and nothing. Not one thing has grown. So I have to try again because Marc talks about having this as sort of a mini gift like a little plant that you can gift to people.
Amie: Yes.
Andrew: I love that notion of giving this beautiful herb that you can give to people and they can just take two or three leaves and chew on them. It's quite safe. Make sure you've got the right plant.
Amie: Yes.
Andrew: And, yeah, this is a lovely immune gift that you can give to your friends.
Amie: And this is the thing. This is where it comes down to using food as medicine, as well. You can empower patient… thyme, garlic, ginger. You can empower people to implement and include these things as well as everything else they're doing. And something like holy basil, you can chop up finely and put through stir-fries or you can use it through salads. You can then use it as a tea.
It's actually readily available as a herbal tea from the supermarket either on its own, I've got one in combination with ginger, cinnamon. It's almost like a bit of a chai, and it's beautiful. Warming, astringent, perfect for this time of year. It's certainly a great herb.
Obviously lung tonics have their place. Certain herbs like goldenseal are really powerful as well. Elecampane and mullein are popular for lung support. There's also a few specific ones you might drop in based on symptomatology. Wild cherry bark for hacking coughs. You might look at for dry tickly coughs, things like marshmallow. Or, if you've got something that's more chesty and heavy, then wild ivy would be perfect, too.
Herein lies the beauty of obviously personalised medicine when it comes to herbs. What that means, as you said before, often when you get sick, the symptoms you have at the start can shift a little bit through the process and the support you might be getting at the beginning, your needs are different 4 or 5 days down the track.
It allows you, as a herbalist to actually really tweak things to support someone almost on a day-to-day basis or certainly on a week-to-week basis depending on how they're presenting.
Andrew: There's so much more obviously to cover. Really, really, really quickly, what about lymphatic herbs? We haven't even discussed medicinal mushrooms, which I really wanted to discuss. So I think I'll ask you now. Sorry, guys, but this is for me. Would you be amenable to coming back and having a Part 3 of supporting our immunity if we discuss medicinal mushrooms?
Amie: For you, Andrew, of course. Of course. I would never deny you that. I know how much you love them, and you've got some really incredible personal experience with them, too, which I know everyone is going to love hearing about. So, yes, let's park that for next time.
Andrew: Cool. Okay, so lymphatics.
Amie: So, in closing, lymphatic herbs. The lymphatic system, there's a number of different roles the lymphatic system plays in the body, but in one sense, it's a bit like the sewage system of the body. It's such a terrible way to put it because it has such an incredibly important job. But any time it's overloaded or your immune system is weighed down, you can see problems show up there, and that can be in lymphatic congestion which presents any number of ways, but some common presentations in the context of what we're talking about is things like tonsillitis, swollen adenoids, things like that.
If that's what's showing up for somebody, there are some very specific herbs that are excellent traditional choices to address those things. You don't necessarily have to go to a herbalist for these things. Like for example, cleavers is readily available. You can buy it in herbal tea from just about anywhere. You can make even a cold...what's the word? It's not an infusion. Well, yeah, I guess it's a cold infusion. You can even finely chop it and use it in salads and stir-fries but cleavers is one of those herbs you can use to really help to clean out the lymphatics.
But, as a herbalist, probably my favourite one is poke root or Phytolacca americana. This is not something that you should, if you're not a medical herbalist or a naturopath, you would ever self-administer because the therapeutic index is very, very low. A tiny bit is really good and a tiny bit more could potentially be lethal. So this is something that should only ever be dispensed by someone who's trained in it.
However, it is a potent little herb that is really traditionally used for pockets of infection of any kind. Now, naturopaths have used for things like boils, tonsillitis, dental abscesses, anywhere there's like this tiny little trapped pocket of infection. I love it for acne, cystic acne for that reason. It just really helps the immune system to clear that out a little more efficiently.
When it comes to respiratory tract infections, you can see tonsils and adenoids become inflamed and swollen and congested. That's where I would think of using herbs like that to support the patient to recover.
Andrew: Poke root has got a bad rap because, in nature, where particularly those in Europe, used to go out on the London hillside and have a picnic and pick some poke root, the Phytolacca...forgive me. I thought it was the Phytolacca decandra.
Amie: Yeah, there's several different...
Andrew: Several species. So, the problem is that some of the constituents of the herb can vary by like a factor of 10 or 20.
Amie: Yes.
Andrew: Do you get the small amount of the emetic or do you get the maximum amount of the emetic? It's landed people in the hospital. Therefore, it's got a bad rap. But when you're talking about a herbal medicine that's got many plants mixed into one mark and to one food extract from that mark, then obviously that's going to be balanced out. Now, I take the point about safety, but I mean certainly there is a leeway that is allowed, if you'd like, with professional oversight.
But, you know one herb we didn't cover, and that is one of the adaptogenic herbs, or adaptogens: astragalus.
Amie: Oh, yes, we have to talk about that.
Andrew: We need to cover this because there's a lot of meat. We've got one minute left. Please, guys, forgive us. We are going to go a little bit over because we would like to include a couple questions.
But just a quick little thing about astragalus because there was this myth that went round about never using it in an acute infection. I think that's the Western bastardisation of an extremely complex system of medicine, the TCM.
Amie: So, yes, so Western herbal medicine and Traditional Chinese Medicine have a lot in common but also there are certain applications that are quite different. Excuse the truck going past. Can you hear that?
Andrew: Only mildly.
Amie: Am I still on mute? Oh, great. Sorry, everyone.
What I was saying about astragalus is there's evidence that shows astragalus increases white blood cell production. Now, we know in times of good health, if you do a white blood cell count, there is a reference range that's considered to be healthy and normal. It's very natural and normal and healthy that, when a pathogen presents itself, whether that's a virus, bacteria, fungi, protozoa, parasite, whatever, we'll see a particular type of white blood cell count go up, which tells us, "Oh, that person's battling a virus right now or a bacteria or a fungal infection."
The thinking behind saying “you shouldn't use it in acute infection” is, in that initial immune response where the white blood cell count is greatly upregulated, we don't want to be sort of adding fuel to the fire, especially if the body is doing the job properly. However, the immune system can get a little worn out. Just like we talk about adrenal fatigue, we could talk about immune fatigue and we can see an initial rise in white blood cell count go up but then, if the immune system fails to get on top of the infection and we start to see leukocytes dying off, we start to see that cell count come down, and we see a weaker and weaker immune response.
So I think there's a place for it in managing infection during acute infection, but I wouldn't personally use it in that first initial few days, or maybe even in the first five to seven days. Now, if someone's not at least 50% better in that first week, I would then go, "All right, their immune system is actually struggling to get on top of it," and it's at that point that I would personally go, "I might just actually help support that white blood cell production now, because whatever they've got right now is not getting on top of it, and therefore they need a bit of an extra boost."
Now every clinician has to make their own call. Every clinician has to look at the evidence for themselves and decide what they're comfortable with, but having looked at the evidence for myself, that's where I sit, as far as the use of astragalus goes. Do you have any strong feelings about that?
Andrew: So, looking at the very small amount of data that there is on astragalus with viral infections, it's really interesting that it helped to stave off upper respiratory tract infections. My point I guess is that it is an adaptogen and therefore should only be used in those places where the chi, or the qi, is depleted. But, if they are depleted and they have an acute episode, that's okay to use an adaptogenic herb.
Amie: Yes.
Andrew: They are depleted. I think we've got to get away with what's acute and chronic versus the patient. We've got to always think about the patient.
Amie: Yeah, and it's always about looking at the person. That's what makes naturopathic and herbal medicine very different. Whilst you're trying to support that person with whatever condition or disease, or illness, or infection that they have, ultimately who you're looking after is the person that the condition has, not the condition that the person has. That's where the skill and the subtlety has to be applied alongside whatever science can share with us as well.
Andrew: In explaining what we see. That's really interesting.
Okay. Amie, thank you so much for taking us through. I mean this is a very hurried podcast because there's so much... this is "seminars", not just one. Seminars. This is indeed, learning. I mean this is where we learn.
So thanks so much for taking us through some of the important herbs that we can use in supporting our immunity today, and of course teaming that up with some of the nutrients that we can use again to support the patient in what they present and how they can recover from illness. Thanks so much for joining us today.
We're going to be taking a few questions. We've got a little bit of extra time. We're running overtime I know, but if anybody's got some pressing questions, now is the time to ask. Otherwise, we'll wrap up.
Amie: Yep, awesome. I'm not sure if I did say this at the beginning of the podcast. If I did, I might as well reiterate it now anyway.
The way I view my prescribing protocol is nutrients first, herbs second, because even though herbs, of course, contain trace levels of all kinds of nutrients, when you're using nutrients for a therapeutic purpose, the herb can only do so much on top of a body or cells that are nutrient deficient. We're not nutrient replete.
Andrew: Oh, right.
Amie: Yeah, and so let's say for example, Echinacea increases white blood cell activity. If the white blood cells don't have enough vitamin C on board to do their job, well, then actually the end result isn't going to be what you desire. This is why it's best to use a combination of things that are really specifically chosen for the person that you're looking after.
I'll just have a quick look down here. I think there was a couple more questions about dosage for NAC. It really does depend on the patient as well, but a starting dose is typically 100 to 200 milligrams. As a clinician, I have used higher doses, much higher doses especially if they are very congested, having trouble breathing through the nose, having trouble coughing anything out of the lungs. Certainly, 800 to 1,000 milligrams is not outside a normal recommendation.
Andrew: Yes.
Amie: With thyme, it actually depends on the, first of all...
Andrew: In small amounts.
Amie: Yeah, it's quite small, but it also depends on what ratio of the tincture you've got if you're using a 1:2 versus 2:1 for example. I can't give you an exact dosage for that, I'm afraid. But it would work out to be probably 10% to 15% of the overall formulation if you're using a concentrated form.
Andrew: It's a pretty strong tasting and smelling herb. I use it in smaller amounts. I've never used it as a first massive herb.
Amie: Sure.
Andrew: Ginger, marshmallow...We never spoke about marshmallow but anyway...
Amie: Yeah. Marshmallow is great for sore throats and that dry cough.
Andrew: Wild cherry if you've got a dry cough. I'm not averse to mixing herbs like... Some people might have an aversion to, say, mixing wild cherry which is used for dry cough, so something that you might want to inhibit, versus something like an expectorant like elecampane or licorice, for something that you want to help move things, or even indeed thyme.
So, I'm not averse to combining those things because often you can get this thick mucus which you need breaking up. You've got a dry cough because you've got exposed nerves. Certainly, as I say, you change that formulation as the patient moves through the condition, particularly in post-viral cough. That's just horrible to deal with.
Amie: It's awful. There's one last question here from Helene that I'll answer and squeeze in before you wind me up.
Andrew: Wind you up.
Amie: Wrap it up. Go and be off.
She's asked whether we would recommend taking a mixed immune herbal tincture all the time, or just when something is coming on and, if constantly, at a lower dose. Again, it depends on the herbs that you've chosen. There's something to be said, so herbalists, there is a category or an arm of herbal medicine where you might make up a constitutional tonic for someone.
Again, you might tweak that week to week, month to month, season to season. In wintertime, if you know someone is prone to chesty things, you might actually set them up with what you would call a herbal immune tonic, which might indeed have a very low dose of astragalus, some lung tonics, but certainly in terms of the immune-stimulating herbs, unless you're at a high-risk occupation, I'm not a fan of those being taken constantly even at low dose. Although again, there are exceptions where that might be appropriate. This is where you've got to ask your practitioner for very personalised advice.
Andrew: Yes, absolutely.
Amie: There are indeed herbs and herbal formulations that are designed to specifically support your immune system even when you're well so that it's just slightly more ready. This is actually where medicinal mushrooms come in. I would really hope that you'll tune in for Episode 3, where we talk about that because that is actually really an immune-modulatory symphony of plant compounds that allow your immune system to be highly tuned and serviced, if you like, really if something shows up. So certainly the nutrients would be my primary recommendation but there are some other things you could consider.
Andrew: Yeah, I think with herbs, I don't have a contraindication to using immune stimulating…I have an issue with that term but anyway, immune-stimulating herbs long-term. My only question is, as the clinician, you should be asking the question, “Why does that patient need these?”
And addressing that i.e. adaptogens, nutrachart. I mean, is it an iron deficiency? What's going on? Do they have a hereditary deficiency of secretory IgA? What is going on with that patient? We should be looking at their neutrophil count. We should be assessing what's wrong with them and making a professional decision based on that evidence.
Amie, thank you so much for joining us once again. We certainly look forward to chatting with you in Part 3. This is going to be an ongoing thing, I can tell. Part 3 where we'll be discussing, amongst other things, medicinal mushrooms. Thank so much for joining us today on FX Medicine.
Amie: Catch you then. Bye.
Andrew: This is FX Medicine. I'm Andrew-Whitfield Cook.
Research Explored in this Podcast
- Jawad M, Schoop R, Suter A, et al. Safety and efficacy profile of Echinacea purpurea to prevent common cold episodes: a randomized, double-blind, placebo-controlled trial. Evid Based Complement Alternat Med 2012;2012:1-7.
- Di Pierro F, Rapacioli G, Ferrara T, et al. Use of a standardized extract from Echinacea angustifolia (Polinacea) for the prevention of respiratory tract infections. Altern Med Rev 2012;17(1):36-41.
- Schulten B, Bulitta M, Ballering-Bruhl B, et al. Efficacy of Echinacea purpurea in patients with a common cold. A placebo-controlled, randomised, double-blind clinical trial. Arzneimittelforschung 2001;51(7):563-568.
- Grimm W, Müller HH. A randomized controlled trial of the effect of fluid extract of Echinacea purpurea on the incidence and severity of colds and respiratory infections. Am J Med 1999;106(2):138-143.
- Hall H, Fahlman MM, Engels HJ. Echinacea purpurea and mucosal immunity. Int J Sports Med 2007;28(9):792-797.
Other relevant Research
- El-Radhi AS (2012). Fever management: Evidence vs current practice. World journal of clinical pediatrics, 1(4), 29–33.
- Ray JJ, Schulman CI. (2015). Fever: suppress or let it ride?. Journal of thoracic disease, 7(12), E633–E636.
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