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Dietary Supplements

Experience and review of Echinacea purpurea

The daily consumption of dietary supplements is common among athletes and non-athletes for much of the world's populations. Around the globe in countries where the population has the means to acquire, and the supply, people take a wide range of herbs and vitamins in an effort to enhance their wellness. In the US, dietary supplements are not required to be submitted to the FDA for evaluation of safety and efficacy. Absorption of certain supplements and the dose response in not always clear, which can lead to expensive urine, adverse side effects, or in some cases, if an athlete is unaware or uneducated, penalty for using a banned substance. Still, herbs, vitamins, and other supplements are swallowed by the handfuls everyday.

In early 2013, a friend recommended a sports supplement to me called EPO-BOOST. The brand is growing in popularity and is advertised worldwide in many of the top sports magazines. The product's label reads, "Improves Athletic Endurance and Performance."1 It further states that the product is, "Safe, effective, legal" and that it increases circulating erythropoietin levels.1 The company's website lists many anecdotal statements from athletes expressing improved performance and better results connected with use of the product. However, online chats reveal mixed opinions.

I bought a bottle of the supplement, if for nothing more than to say to my friend that I'd looked more closely at the product. After a quick search of the ingredients to verify safety, I expected the product would simply increase the expense of my urine. Nevertheless, I followed the label's instructions, assuming when the bottle was empty the chapter on EPO-BOOST would be closed. A few days before the bottle was completely consumed I competed in an Ironman 70.3 event. I recorded a significant improvement over my prior 70.3 distance - this being my 7th at that distance - despite having my overall worst swim time.

The Ironman 70.3 event was on a Sunday. I packed up and flew home on Monday. Tuesday I did a recovery ride of 30 miles. Wednesday I trained with a group of competitive cyclists, another 37 miles on the bike followed by a 10K run. Surprisingly, I felt far more recovered than at any other time post-race of a 70.3 distance. As I mentioned the race I'd completed was my seventh 70.3 event over the past six years along with three Ironman 140.6 events. Throughout this time I'd also completed 78 other events, among them numerous marathons, half marathons, duathlons and other triathlons. That experience along with decades of competitive cycling taught me what to expect post competition. Following my most recent 70.3 triathlon, I was clearly feeling less of an impact from the event than experience dictated. The only change to my training or diet was the new (to me) supplement. This warranted a more serious look into the scientific literature specific to the main active ingredient in the supplement.

PubMed (National Library of Medicine) is a great place to find peer-review medical and scientific articles. Although some non-professional researchers consider online chats among the cyber-space intellectuals the optimal source for academic information my bias for data lays elsewhere. Searching PubMed for the main ingredient of the supplement coupled with key words like: sports, athletes, VO2(max) and other related phrases uncovered a number of interesting medical and scientific articles.

The main active ingredient in EPO-BOOST is Echinacea purpurea; a flowering plant nature to North American.2 On Wikipedia, the description of E. purpurea provides reference to studies done in rats.3 The Wikipedia article further suggests E. purpurea stimulates the immune system.2,4,5 Pubmed yielded more results.

One group of investigators looked into dietary supplements in elite figure skaters.6 Their work revealed that Echinacea was popular among this group. A main reason the skaters expressed to the researchers for taking the herb was to decrease illness (both male and female).6 Other studies suggest that Echinacea extract demonstrates efficacy in the prevention of colds in athletes, attenuates mucosal immune suppression known to occur with intense exercise, and reduces the duration of upper respiratory tract infection.7,8 The evidence in medical literature suggests that E. purpurea is effective and safe for respiratory tract infections long term, short term and acute treatment.9 Additionally, of 755 healthy subjects monitored over a 4-month period, Echinacea reduced cold episodes, cumulated episode days and pain-killer medicated episodes compared to placebo.10 Furthermore, in animal experiments, E purpurea has shown anti-inflammatory effects.11 All very interesting yet says nothing related to enhanced athletic performance.

What the data thus far suggested is that Echinacea is good for fighting colds among athletes and non-athletes.7-10 While that alone is beneficial, it did not address why my recovery from a 70.3 mile triathlon was so quickly accomplished. Neither does the literature, to this point, indicate that Echinacea has any impact on athletic performance. From a respiratory care perspective as well as a athletic, Echinacea as a supplement to assist in fighting colds is appealing.

Athletes have increased physical demands that can depress immune cell function as noted by Gleeson.12 Gleeson called for a study of Echinacea specifically on athletes to learn whether there is a benefit.12 Parallel to Gleeson's call for a study, Ross reported on the efficacy for treatment and prevention of colds in athletes using Echinacea7 while Schoop, et al, concluded Echinacea is an effective prophylaxis, as well as for treatment of the common cold in persons actively participating in sports.13 Schoop, et al's, work is additionally supported by Megna, et al, that Echinacea enhanced the immune system and decreased oxidative damage associated with exercise induced stress.14 A reduced amount of oxidative damage, per Megna, et al, may be associated with the faster recovery I'd noted.

The literature thus far suggests that Echinacea may reduce the negative impact of colds on athletes. A reduction in colds, cumulative days of illness and oxidative damage does suggest that Echinacea as a dietary supplement can lead to an overall increase in quantity (days available to exercise /train for competition) of time available for sports activity.7,10,13,14 This leads to the question of whether or not Echinacea has any measureable affect on the athlete's performance.

Studies on athletes are difficult to perform. The most competitive subjects have demanding schedules, coupled with travel to and from events that make constant data collection a challenge. Such potential subjects have specific training plans, and test protocols may interfere with an established regime. Off-season studies may not provide investigators with peak fitness data. Despite these difficulties, some data on Echinacea has been reported among athlete test subjects. One study looked at Bloodroot and Echinacea in cyclists using a VO2(max) test and measurement of cytokine production. In this study, the investigators discovered their Echinacea extract had alkamide decay associated with a 3-year storage at -80 degrees C.15 Nevertheless, the data revealed enough positive benefit to suggest further research is indicated for the herbal offset of exercise-associated impact on the immune system.

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Another study, this time on runners, Whitehead, et al, sought to determine the effects of a 4 week dietary supplement of Echinacea on erythropoietin (EPO), red blood cells (RBC) count, running economy (RE) and VO2(max).16 Their study was placebo versus Echinacea using a double-blind design. Following analysis the Echinacea group showed a statically significant increase in circulating EPO levels. Additionally, the Echinacea group showed significant increases in maximal oxygen uptake VO2(max)) and running economy.16 This evidence provides a partial explanation of the improvement in overall course time (compared to my prior time) for my recent 70.3 - despite my slowest swim* for that distance; as well as the quicker recovery that I experienced following the race. (*The swim was a time trial start. There was a nearly 2-hour delay while standing queued up waiting to start. Athletes jumped into the water one at a time.)

As with all supplements and medication, the individual considering their use should carefully consider ingesting the substance. No medicaments or supplements are risk free. Prior to consuming any substance, supplement or prescription, the individual should consult a physician as well as read as much is reasonable and warranted on the substance. Combining supplements and herbs with prescription drugs poses additional risk. Always read and follow warning labels and instructions. From the medical literature, in this review of articles listed on PubMed, there is evidence that Echinacea, offers benefits to athletes and those people that are non-athletically inclined. More research can help clarification of the benefit of Echinacea.

References

1) Biomedical Research Laboratories, LLC, EPO Boost, Wilmington, DE
2) Echinacea purpurea, Wikipedia
3) Kurkin VA, Dubishchev AV, Ezhkov VN, Titova IN, Avdeeva EV. Antidepressant activity of some phyopharmaceuticals and phenylpropanoids. Pharm Chem Jr, Nov 2006, Vol 40, Issue 11, pp 614-619
4) http://nccam.nih.gov/health/echinacea/ataglance.htm. NCCAM Pub No. D271, created July 2005, updated April 2012
5) Sadigh-Eteghad S, Khayat-Nuri H, Abadi N, Ghavami S, Golabi M, Shanebandi D (2011). Synergetic effects of oral administration of levamisole and Echinacea purpurea on immune response in Wistar rat. Res Vet Sci 91 (1):82-5
6) Ziegler PJ, Nelson JA, Jonnalagadda SS. Use of dietary supplements by elite figure skaters. Int J Sports Exerc Metab 2003 Sep; 13(3):266-76
7) Ross SM. A standardized Echinacea extract demonstrates efficacy in the prevention and treatment of colds in athletes. Holist Nurs Pract. 2010 Mar-Apr; 24(2):1-7-9. Doi: 10.1097/HNP.0b013e3181d39b3f
8) Hall H, Fahlman MM, Engels HJ. Echinacea purpurea and mucosal immunity. Int J Sports Med. 2007 Sep;28(9): 792-7. Epub 2007 Apr 13
9) Schapowal A. Efficacy and safety of Echianforce® in respiratory tract infections. Wien Med Wochenschr 2013 Feb; 163(3-4):102-5. Doi 10. 1007/s10354-012-0166-0. Epub 2012 Dec 20
10) Jawad M, Schoop R, Suter A, Klein P, Eccles R. Safety and efficacy profile of enchiacea purpurea to prevent common colad episodes: a randomized, double-blind, placebo-controlled trial. Evid Based Complement Med. 2012; 2012:841415. Epub 2012 Sep 16
11) Yu D, Yuan Y, Jiang L, Tai Y, Yang X, Hu F, Xie Z. Anti-inflammatory effects of essential oil in Echinacea purpurea L. Pak J Pharm Sci 2013 Mar;26(2):403-8
12) Gleeson M. Can nutrition limit exercise-induced immundepression? Nut Rev 2006 Mar; 64(3) 119-31
13) Schoop R, Büechi S, Suter A. Open multicenter study to evaluate the tolerability and efficacy of Echinaforce Forte tablets in athletes. Adv Ther 2006 Sep-Oct; 23(5):823-33
14) Megna M, Amico AP, Cristella G, Saggini R, Jirillo E, Ranieri M. Effects of herbal supplements on the immune system in relation to exercise. Int J Immunopathol Pharmacol 2012 Jan-Mar; (1 Suppl):43S-49S
15) Senchina DS, Hallam JE, Dias AS, Perera MA. Human blood mononuclear cell in vitro cytokine response before and after two different strenuous exercise bouts in the presense of bloodroot and Echinacea extracts. Blood Cells Mol Dis. 2009 Nov-Dec; 43(3):n298-303. Doi: 10.1016/j.bcmd.2009.08.003. Epub 2009 Sep 19
16) Whitehead MT, Martin TD, Scheet TP, Webster MJ. Running economy and maximal oxygen consumption after 4 weeks of oral Echinacea supplementation. J Strength Con Res. 2012 Jul;26(7):1928-33. Doi: 10.1519/JSC.0b013e318237e779

David Lain, PhD, JD, FCCP, FAARC has a number of State Championship titles in cycling for the road, time trial, and 200 meter sprint. He also has several silver medals for the kilo and pursuit. He was on the 2007 USAT World Championship Team Long Course Duathlon. Since 2007 he has completed 10 Ironman Events, seven 70.3 and three 140.6 including Kona. Formerly he was a member of the Subaru Cane Creek Cane Cycling Team and the Trek Mid-Atlantic Factory Cycling Team.





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