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Nutritional Supplement

Echinacea

  • Immune System Support

    Immune Function

    Studies have found that echinacea stimulates the function of a variety of immune cells, particularly natural killer cells. Taking it appears to speed recovery from the common cold.
    Immune Function
    ×
    In general, human studies have found that echinacea taken orally stimulates the function of a variety of immune cells, particularly natural killer cells.11 The balance of evidence currently available from studies suggests that echinacea speeds recovery from the common cold, via immune stimulation (as opposed to killing the cold virus directly).12 Evidence on preventing the common cold with echinacea is largely negative, suggesting its immune-stimulating activity may be mild in generally healthy people. Other studies on oral echinacea have not found that it stimulates activity of the white blood cells known as neutrophils.13 Many doctors recommend 3 to 5 ml of tincture three times per day for up to two weeks to improve immune function. Echinacea in capsule form is also commonly available.

    Influenza

    Taking echinacea may help clear flu symptoms faster.
    Influenza
    ×

    Echinacea has long been used for colds and flu. Double-blind trials in Germany have shown that infections associated with flu-like symptoms clear more rapidly when people take echinacea.14 Echinacea appears to work by stimulating the immune system. The usual recommended amount of echinacea is 3–5 ml of the expressed juice of the herb or tincture of the herb or root, or 300 mg of dried root powder three times per day.

    Wild indigo contains polysaccharides and proteins that have been reported in test tube studies to stimulate the immune system. The immune-enhancing effect of wild indigo is consistent with its use in traditional herbal medicine to fight the flu.15 However, wild indigo is generally used in combination with other herbs such as echinacea, goldenseal, or thuja.

    Infection

    Echinacea is both immune supportive and antimicrobial.
    Infection
    ×

    In general, human studies have found that echinacea taken orally stimulates the function of a variety of immune cells, particularly natural killer cells.16

    Common Cold

    At the first sign of a cold, taking immune-stimulating echinacea as a juice or tincture may make colds less severe.
    Common Cold
    ×

    Double-blind trials have shown that various echinacea extracts shorten the duration of the common cold.17,18 Fresh pressed juice of echinacea(E. purpurea) flowers preserved with alcohol, and tinctures of echinacea (E. pallida) root are the forms most commonly studied and proven effective. In addition, several double-blind trials have found that echinacea (E. angustifolia) root tinctures in combination with wild indigo, boneset, and homeopathic arnica reduce symptoms of the common cold.19 In one double-blind trial, a proprietary formulation of echinacea, white cedar, and wild indigo, known as Esberitox, reduced the length and severity of cold symptoms significantly more than did placebo.20 One double-blind trial found that echinacea was inffective for treating colds that were induced in research subjects by instilling a cold virus (rhinovirus) directly into their noses.21 However, the relevance of this study to the treatment of naturally occurring colds is not clear. Another double-blind study found that echinacea was not an effective for upper respiratory tract infections in children aged 2 to 11 years.22

    Echinacea is believed to work primarily through immune stimulation. The minimum effective amount of echinacea tincture or juice appears to be 3 ml three times per day. Higher amounts, such as 3 to 5 ml every two hours, is generally better and is safe, even for children.23 Encapsulated products may also be effective, according to a double-blind trial using the root of E. pallida.24 Generally, capsules containing 300 to 600 mg are used three times per day. According to one double-blind trial, employees of a nursing home who consumed echinacea tea at the onset of a cold or flu reduced the duration of their symptoms by about two days when compared with people consuming a placebo tea.25 The participants drank five to six cups of tea on the first day of their symptoms and decreased this by one cup each day over the next five days.

    Most double-blind trials indicate that regular use of echinacea to prevent colds does not work.26,27,28 However, one double-blind trial showed that regular use of echinacea for four months over the winter decreased the number of colds by 21% compared with a placebo, a statistically significant difference. For the treatment of a cold, it is currently recommended to use echinacea for a total of seven to ten days.

    Cold Sores

    In traditional herbal medicine, tinctures of various herbs including echinacea have been applied topically to herpes outbreaks in order to promote healing.
    Cold Sores
    ×
     

    In traditional herbal medicine, tinctures of various herbs, including chaparral, St. John’s wort, goldenseal, myrrh, and echinacea, have been applied topically to herpes outbreaks in order to promote healing.

    Bronchitis

    Echinacea is an immune-stimulating herb that is widely used by herbalists for people with acute respiratory infections.
    Bronchitis
    ×
     

    Antimicrobial and immune stimulating herbs may also potentially benefit people with bronchitis. Echinacea is widely used by herbalists for people with acute respiratory infections. This herb stimulates the immune system in several different ways, including enhancing macrophage function and increasing T-cell response.29 Therefore, echinacea may be useful for preventing a cold, flu, or viral bronchitis from progressing to a secondary bacterial infection.

    HIV and AIDS Support

    Supplementing with echinacea may increase immune activity against HIV.
    HIV and AIDS Support
    ×
     

    A controversy has surrounded the use of echinacea in people infected with HIV. Test tube studies initially showed that echinacea’s polysaccharides could increase levels of a substance that might stimulate HIV to spread.30 However, these results have not been shown to occur when echinacea is taken orally by humans.31 In fact, one double-blind trial found that Echinacea angustifolia root (1 gram three times per day by mouth) greatly increased immune activity against HIV, while placebo had no effect.32 Further studies are needed to determine the safety of using echinacea in HIV-positive people.

  • Oral Health

    Gingivitis

    A mouthwash containing sage oil, peppermint oil, menthol, chamomile tincture, expressed juice from echinacea, myrrh tincture, clove oil, and caraway oil has been used successfully to treat gingivitis.
    Gingivitis
    ×
     

    A mouthwash combination that includes sage oil, peppermint oil, menthol, chamomile tincture, expressed juice from echinacea, myrrh tincture, clove oil, and caraway oil has been used successfully to treat gingivitis.33 In cases of acute gum inflammation, 0.5 ml of the herbal mixture in half a glass of water three times daily is recommended by some herbalists. This herbal preparation should be swished slowly in the mouth before spitting out. To prevent recurrences, slightly less of the mixture can be used less frequently.

    A toothpaste containing sage oil, peppermint oil, chamomile tincture, expressed juice from Echinacea purpurea, myrrh tincture, and rhatany tincture has been used to accompany this mouthwash in managing gingivitis.34

    Of the many herbs listed above, chamomile, echinacea, and myrrh should be priorities. These three herbs can provide anti-inflammatory and antimicrobial actions critical to successfully treating gingivitis.

    Canker Sores

    The antiviral, immune-enhancing, and wound-healing properties of echinacea may make this herb a reasonable choice for canker sores.
    Canker Sores
    ×
     

    The antiviral, immune-enhancing, and wound-healing properties of echinacea may make this herb a reasonable choice for canker sores. Liquid echinacea in the amount of 4 ml can be swished in the mouth for two to three minutes, then swallowed. This procedure may be repeated three times per day. However, no research has investigated the possible effects of this treatment.

    Cold Sores

    In traditional herbal medicine, tinctures of various herbs including echinacea have been applied topically to herpes outbreaks in order to promote healing.
    Cold Sores
    ×
     

    In traditional herbal medicine, tinctures of various herbs, including chaparral, St. John’s wort, goldenseal, myrrh, and echinacea, have been applied topically to herpes outbreaks in order to promote healing.

    Gingivitis

    Echinacea provides anti-inflammatory and antimicrobial actions critical to successfully treating gingivitis.
    Gingivitis
    ×
     

    A mouthwash combination that includes sage oil, peppermint oil, menthol, chamomile tincture, expressed juice from echinacea, myrrh tincture, clove oil, and caraway oil has been used successfully to treat gingivitis.35 In cases of acute gum inflammation, 0.5 ml of the herbal mixture in half a glass of water three times daily is recommended by some herbalists. This herbal preparation should be swished slowly in the mouth before spitting out. To prevent recurrences, slightly less of the mixture can be used less frequently.

    A toothpaste containing sage oil, peppermint oil, chamomile tincture, expressed juice from Echinacea purpurea, myrrh tincture, and rhatany tincture has been used to accompany this mouthwash in managing gingivitis.36

    Of the many herbs listed above, chamomile, echinacea, and myrrh should be priorities. These three herbs can provide anti-inflammatory and antimicrobial actions critical to successfully treating gingivitis.

  • Women's Health

    Chronic Candidiasis

    The fresh-pressed juice of Echinacea purpurea has been shown to help prevent recurring yeast infections in one trial.
    Chronic Candidiasis
    ×
     

    The fresh-pressed juice of Echinacea purpurea has been shown to be helpful in preventing recurrence of vaginal yeast infections in a double-blind trial; it may have similar benefit in Yeast Syndrome.37 The typical recommendation for this effect is 2 to 4 ml of fluid extract daily.

    Vaginitis

    Echinacea is antibacterial and known to improve resistance to infection.
    Vaginitis
    ×
     

    Teas of goldenseal, barberry, and echinacea are also sometimes used to treat infectious vaginitis. Although all three plants are known to be antibacterial in the test tube, the effectiveness of these herbs against vaginal infections has not been tested in humans. The usual approach is to douche with one of these teas twice each day, using 1–2 tablespoons (15–30 grams) of herb per pint of water. One to two pints (500–1,000 ml) are usually enough for each douching session. Echinacea is also known to improve immune function in humans.38 In order to increase resistance against infection, many doctors recommend oral use of the tincture or alcohol-preserved fresh juice of echinacea (1 teaspoon (5 ml) three or more times per day)—during all types of infection—to improve resistance.

    Abnormal Pap Smear

    Though not proven in clinical trials, these herbs are used for their antiviral actions and thought to stimulate tissue healing. Consult a healthcare professional.
    Abnormal Pap Smear
    ×
     

    Several other herbs have been used as part of an approach for women with mild cervical dysplasia, including myrrh, echinacea, usnea, goldenseal, marshmallow, and yarrow.39 These herbs are used for their antiviral actions as well as to stimulate tissue healing; they are generally administered in a suppository preparation. No clinical trials have proven their effectiveness in treating cervical dysplasia. A doctor should be consulted to discuss the use and availability of these herbs.

  • Kidney and Urinary Tract Health

    Yeast Infection

    Echinacea, which enhances immune function, has been used successfully to treat yeast infections.
    Yeast Infection
    ×
     

    Many doctors recommend that people with recurrent yeast infections take measures to support their immune system. Echinacea, which has the capacity to enhance immune function, is often used by people who suffer from recurrent infections. In one study, women who took echinacea experienced a 43% decline in the recurrence rate of yeast infections.40

  • Children's Health

    Ear Infections

    Children with recurrent ear infections may benefit from taking echinacea, as it has been reported to support healthy immune function.
    Ear Infections
    ×

    Echinacea has been reported to support healthy short-term immune response. As a result, it has been suggested that some children with recurrent ear infections may benefit from 41 1–2 ml (depending on age) of echinacea tincture taken three times per day or more.42 Doctors who use echinacea suggest that supplementation be started as soon as symptoms start to appear and continued until a few days after they are gone. Nonetheless, research has not been done to determine whether echinacea supplementation either reduces symptoms or prevents recurrence of ear infections.

  • Ear Health Support

    Ear Infections

    Children with recurrent ear infections may benefit from taking echinacea, as it has been reported to support healthy immune function.
    Ear Infections
    ×

    Echinacea has been reported to support healthy short-term immune response. As a result, it has been suggested that some children with recurrent ear infections may benefit from 43 1–2 ml (depending on age) of echinacea tincture taken three times per day or more.44 Doctors who use echinacea suggest that supplementation be started as soon as symptoms start to appear and continued until a few days after they are gone. Nonetheless, research has not been done to determine whether echinacea supplementation either reduces symptoms or prevents recurrence of ear infections.

  • Pain Management

    Wound Healing

    Echinacea is used among European practitioners of herbal medicine to promote wound healing.
    Wound Healing
    ×
     

    Echinacea is used among European practitioners of herbal medicine to promote wound healing45 and is approved by the German government for this use.46 Creams or ointments are applied several times a day to minor wounds.

  • Skin Protection

    Wound Healing

    Echinacea is used among European practitioners of herbal medicine to promote wound healing.
    Wound Healing
    ×
     

    Echinacea is used among European practitioners of herbal medicine to promote wound healing47 and is approved by the German government for this use.48 Creams or ointments are applied several times a day to minor wounds.

  • Healthy Pregnancy and New Baby

    Chronic Candidiasis

    The fresh-pressed juice of Echinacea purpurea has been shown to help prevent recurring yeast infections in one trial.
    Chronic Candidiasis
    ×
     

    The fresh-pressed juice of Echinacea purpurea has been shown to be helpful in preventing recurrence of vaginal yeast infections in a double-blind trial; it may have similar benefit in Yeast Syndrome.49 The typical recommendation for this effect is 2 to 4 ml of fluid extract daily.

What Are Star Ratings?
×
Reliable and relatively consistent scientific data showing a substantial health benefit.
Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

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Traditional Use (May Not Be Supported by Scientific Studies)

Echinacea was used by Native Americans for a variety of conditions, including venomous bites and other external wounds. It was introduced into U.S. medical practice in 1887 and was touted for use in conditions ranging from colds to syphilis. Modern research started in the 1930s in Germany.

References

1. See DM, Broumand N, Sahl L, Tilles JG. In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. Immunopharmacology 1997;35:229-35.

2. Leuttig B, Steinmuller C, Gifford GE, et al. Macrophage activation by the polysaccharide arabinogalactan isolated from plant cell cultures of Echinacea purpurea. J Natl Cancer Inst 1989;81:669-75.

3. Melchart D, Linde K, Worku F, et al. Immunomodulation with echinacea—a systematic review of controlled clinical trials. Phytomedicine 1994;1:245-54 [review].

4. Dorn M, Knick E, Lewith G. Placebo-controlled, double-blind study of Echinacea pallida redix in upper respiratory tract infections. Comp Ther Med 1997;5:40-2.

5. Hoheisel O, Sandberg M, Bertram S, et al. Echinacea shortens the course of the common cold: a double-blind, placebo-controlled clinical trial. Eur J Clin Res 1997;9:261-8.

6. Braunig B, Dorn M, Limburg E, et al. Echinacea purpurea radix for strengthening the immune response in flu-like infections. Z Phytother 1992;13:7-13 [in German].

7. Brikenborn RM, Shah DV, Degenring FH. Echinaforce® and other Echinacea fresh plant preparations in the treatment of the common cold. A randomized, placebo-controlled, double-blind clinical trial. Phytomedicine 1999;6:1-5.

8. Melchart D, Walther E, Linde K, et al. Echinacea root extracts for the prevention of upper respiratory tract infections: a double-blind, placebo-controlled randomized trial. Arch Fam Med 1998;7:541-5.

9. Grimm W, Mueller HH. A randomized controlled clinical trial of the effect of fluid extract of Echinacea purpurea on the incidence and severity of colds and respiratory infections. Am J Med 1999;106:138-43.

10. Coeugniet E, Kuhnast R. Recurrent candidiasis. Adjuvant immunotherapy with different formulations of Echinacea. Therapiwoche 1986;36:3352-8 [in German].

11. See DM, Broumand N, Sahl L, Tilles JG. In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. Immunopharmacology 1997;35:229-35.

12. Melchart D, Linde K, Worku F, et al. Immunomodulation with echinacea—a systematic review of controlled clinical trials. Phytomedicine 1994;1:245-54 [review].

13. Melchart D, Linde K, Worku F, et al. Results of five randomized studies on the immunomodulatory activity of preparations of echinacea. J Alt Compl Med 1995;1:145-60.

14. Braunig B, Dorn M, Limburg E, et al. Echinacea purpurea radix for strengthening the immune response in flu-like infections. Z Phytother 1992;13:7-13 [in German].

15. Beuscher N, Kopanski L. Stimulation of immunity by the contents of Baptisia tinctoria. Planta Med 1985;5:381-4.

16. See DM, Broumand N, Sahl L, Tilles JG. In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. Immunopharmacology 1997;35:229-35.

17. Brown D. Echinacea root fails to prevent upper respiratory tract infections. Healthnotes Rev Compl Integr Med 1999;6:6-7 [review].

18. Hoheisel O, Sandberg M, Bertram S, et al. Echinagard treatment shortens the course of the common cold: A double-blind, placebo-controlled clinical trial. Eur J Clin Res 1997;9:261-8.

19. Melchart D, Linde K, Worku F, et al. Immunomodulation with echinacea—a systematic review of controlled clinical trials. Phytomedicine 1994;1:245-54 [review].

20. Henneicke-von Zepelin H, Hentschel C, Schnitker J, et al. Efficacy and safety of a fixed combination phytomedicine in the treatment of the common cold (acute viral respiratory tract infection): results of a randomised, double blind, placebo controlled, multicentre study. Curr Med Res Opin 1999;15:214-27.

21. Turner RB, Bauer R, Woelkart K, et al. An evaluation of Echinacea angustifolia in experimental rhinovirus infections. N Engl J Med 2005;353:341-8.)

22. Taylor JA, Weber W, Standish L, et al. Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. JAMA 2003;290:2824-30.

23. Schilcher H. Phytotherapy in Paediatrics: Handbook for Physicians and Pharmacists. Stuttgart: Medpharm Scientific Publishers, 1997, 43-5.

24. Dorn M, Knick E, Lewith G. Placebo-controlled, double-blind study of Echinacea pallidae radix in upper respiratory tract infections. Compl Ther Med 1997;5:40-2.

25. Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study. J Altern Comp Med 2000;6:327-34.

26. Melchart D, Walther E, Linde K, et al. Echinacea root extracts for the prevention of upper respiratory tract infections: a double-blind, placebo-controlled randomized trial. Arch Fam Med 1998;7:541-5.

27. Grimm W, Mueller HH. A randomized controlled clinical trial of the effect of fluid extract of Echinacea purpurea on the incidence and severity of colds and respiratory infections. Am J Med 1999;106:138-43.

28. Brikenborn RM, Shah DV, Degenring FH. Echinaforce® and other Echinacea fresh plant preparations in the treatment of the common cold. A randomized, placebo-controlled, double-blind clinical trial. Phytomedicine 1999;6:1-5.

29. See DM, Broumand N, Sahl L, Tilles JG. In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. Immunopharmacology 1997;35:229-35.

30. Luettig B, Steinmuller C, Gifford GE, et al. Macrocytic activation by the polysaccharide arabinogalactan isolated from plant cell cultures of Echinacea purpurea. J Natl Cancer Inst 1989;81:669-75.

31. Elsasser-Beile U, Willenbacher W, Bartsch HH, et al. Cytokine production in leukocyte cultures during therapy with Echinacea extract. J Clin Lab Anal 1996;10:441-5.

32. Berman S, See DM, See JR, et al. Dramatic increase in immune mediated HIV killing activity induced by Echinacea angustifolia. Int Conf AIDS 1998;12:582 [abstract no. 32309].

33. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34-7.

34. Yamnkell S, Emling RC. Two-month evaluation of Parodontax dentifrice. J Clin Dentistry 1988;1:A41.

35. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34-7.

36. Yamnkell S, Emling RC. Two-month evaluation of Parodontax dentifrice. J Clin Dentistry 1988;1:A41.

37. Coeugniet EG, Kuhnast R. Recurrent candidiasis: adjuvant immunotherapy with different formulations of Echinacin®. Therapiewoche 1986;36:3352-8.

38. Melchart D, Linde K, Worku F, et al. Immunomodulation with echinacea—a systematic review of controlled clinical trials. Phytomedicine 1994;1:245-54 [review].

39. Hudson T. Women's Encyclopedia of Natural Medicine. Lincolnwood, IL: Keats, 1999, 54.

40. Coeugniet E, Kuhnast R. Recurrent candidiasis: Adjuvant immunotherapy with different formulations of Echinacin®. Therapiewoche 1986;36:3352-8.

41. Brown DJ. Herbal Prescriptions for Better Health. Rocklin, CA: Prima Publishing, 1996, 213-4 [review].

42. Schilcher H. Phytotherapy in Paediatrics: Handbook for Physicians and Pharmacists. Stuttgart: Medpharm Scientific Publishers, 1997, 43-5.

43. Brown DJ. Herbal Prescriptions for Better Health. Rocklin, CA: Prima Publishing, 1996, 213-4 [review].

44. Schilcher H. Phytotherapy in Paediatrics: Handbook for Physicians and Pharmacists. Stuttgart: Medpharm Scientific Publishers, 1997, 43-5.

45. Hobbs C. Echinacea: A literature review. HerbalGram 1994;30:33-48 [review].

46. Blumenthal M, Busse WR, Goldberg A, et al (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston: Integrative Medicine Communications, 1998, 122-3.

47. Hobbs C. Echinacea: A literature review. HerbalGram 1994;30:33-48 [review].

48. Blumenthal M, Busse WR, Goldberg A, et al (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston: Integrative Medicine Communications, 1998, 122-3.

49. Coeugniet EG, Kuhnast R. Recurrent candidiasis: adjuvant immunotherapy with different formulations of Echinacin®. Therapiewoche 1986;36:3352-8.

50. Brown DJ. Herbal Prescriptions for Better Health. Rocklin, CA: Prima Publishing, 1996, 63-8.

51. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 121-3.

52. Kocaman O, Hulagu S, Senturk O. Echinacea-induced severe acute hepatitis with features of cholestatic autoimmune hepatitis. Eur J Intern Med 2008;19:148 [Letter].

53. Mullins RJ. Echinacea-associated anaphylaxis. Med J Austral 1998;168:170-1.

54. Gallo M, Sarkar M, Au W, et al. Pregnancy outcome following gestational exposure to echinacea. Arch Intern Med 2000;160:3141-3.

55. Duke, JA. Handbook of Phytochemical Constituents of GRAS Herbs and Other Economic Plants. Boca Raton, FL: CRC Press, 1992.

56. Carabin IG, Flamm WG. Evaluation of safety of inulin and oligofructose as dietary fiber. Regul Toxicol Pharmacol 1999;30:268-82 [review].

57. Coussement PA. Inulin and oligofructose: safe intakes and legal status. J Nutr 1999;129:1412S-7S [review].

58. Gay-Crosier F, Schreiber G, Hauser C. Anaphylaxis from inulin in vegetables and processed food. N Engl J Med 2000;342:1372 [letter].

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The information presented by Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2019.