1/4 Herbal Adaptogens: Balancing Immunity Naturally
This article is number two in a series (of four) in which I examine herbal adaptogens, medicinal mushrooms, vitamins and minerals, antioxidants and other supplements, and the immune system.
We have focused on ARI's acute respiratory illnesses, such as the common cold, influenza, coronaviruses and pneumonia.
You have probably been recommended multiple remedies for treating the cold or flu, some standard and some based on traditional medicine. But do any of them actually work? Have they been adequately studied for their effectiveness?
This blog examines four naturally occurring herbal adaptogens with significant clinical studies published on ARIs. They are:
Echinacea, Elderberry, Andrographis and Astragalus.
I have also included links to the reviews published to allow you to make your own decisions.
What is an adaptogen?
Adaptogens have long been used in traditional medicine to help the body resist stress and adapt to environmental challenges, including immune stress.
If I'm honest, I disregarded many of these due to ignorance before educating myself in nutrition and functional medicine. So, if you're a medical professional, jump to the papers and make up your own mind.
There have been Cochrane reviews, systematic reviews, and hundreds of double-blinded trials that provide evidence of their effectiveness and explain the mechanism of action. They are a powerful natural tool for managing flu, coughs, colds, and systemic inflammatory illnesses.
Our focus is on the most rigorously studied adaptogens with immune-boosting properties, providing you with a clear path to natural immune support.
The four we found with the strongest evidence:
- Echinacea (Echinacea purpurea) strength 400mg
- Elderberry (Sambucus nigra L.) 300mg
- Andrographis (Andrographis paniculata) 400mg
- Astragalus Root (Astragalus membranaceus) 500mg
Click the link to see the full details of what we put in our Advanced Immune Support Stack.
1. Echinacea (Echinacea purpurea) recommended dose 400mg per day
Echinacea is one of those I had unfairly dismissed as nonsense, classic Doctor! Still, I was surprised to find that it had the most compelling evidence, including a positive Cochrane review. It is particularly good for respiratory illnesses or those who get sick when stressed.
Good for:
Those susceptible to respiratory infections or weakened immune systems where it was shown to have HALF the incidence of recurrent respiratory infection.
Evidence level: Strong (Cochrane review)
Why we chose it: Echinacea is one of the most researched herbs for immune health. It stimulates the production of white blood cells, which are critical for fighting infections.
What does the evidence say?
- One of the most respected levels of evidence is the Cochrane Review. These are meta-analyses that look at multiple clinical studies. A 2014 review looked at 24 trials of 2,458 participants. They concluded echinacea extracts were associated with a reduced risk of recurrent respiratory infections.
- Three independent studies found that in individuals with higher susceptibility, stress or a state of immunological weakness, echinacea halved the risk of recurrent respiratory infections.
Conclusion:
Evidence indicates that echinacea potently lowers the risk of recurrent respiratory infections and complications. Immune modulatory, antiviral, and anti-inflammatory effects contribute to the observed clinical benefits, which appear strongest in susceptible individuals.
Our take: The evidence is robust, especially if you are run down or susceptible to chest infections.
Key clinical paper
Schapowal A, Klein P, Johnston SL. Echinacea reduces the risk of recurrent respiratory tract infections and complications: a meta-analysis of randomized controlled trials. Adv Ther. 2015;32(3):187-200. doi:10.1007/s12325-015-0194-4
2. Elderberry (Sambucus nigra L.) recommended dose 300mg
Elderberry sambucus has robust evidence for shortening illness, and its results are even comparable to pharmaceutical antivirals in clinical trials with no side effects.
Good for:
Reduces the duration of illnesses. It has been shown to shorten flu (by four days in a large study) as well as cold duration- Why we chose it: Elderberry is a potent antiviral with high levels of flavonoids, which help neutralise viruses and reduce inflammation.
- Clinical Evidence: A 2021 systematic review of 1187 records with randomised trials showed that elderberry extract does not reduce the risk of developing the cold, but it does reduce the duration and severity with a lower risk of complications when compared to antivirals (oseltamivir). A 2019 study showed that elderberry extract could shorten the duration of influenza symptoms by four days, highlighting its antiviral power.
Conclusion:
Evidence suggests that it helps reduce severity and symptoms but does not show that it reduces the chance of getting the cold.
Key clinical paper
Wieland LS, Piechotta V, Feinberg T, et al. Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review. BMC Complement Med Ther. 2021;21(1):112. Published 2021 Apr 7. doi:10.1186/s12906-021-03283-5
Echinacea and elderberry synergy:
Mechanism: Both echinacea and elderberry are known to modulate the immune system by increasing the activity of cytokines (small proteins that regulate the immune response). Echinacea is particularly effective in activating white blood cells (macrophages and T-cells), while elderberry enhances antiviral defences through its high concentration of flavonoids.
3. Andrographis (Andrographis paniculata) recommended dose 400mg
So, Andrographis was one that I was more aware of. It is used in functional medicine and is well known for inhibiting pro-inflammatory cytokines (especially NF-kB), which is why it is often used in people with systemic inflammatory conditions.
It also has direct antiviral action. The actual clinical studies are less impressive than those of echinacea, but a combination of the studies, my use, and fellow doctors is why I am keen on this one.
Good for:
Preventing upper respiratory tract infections and shortening the severity
Evidence level: Medium
Why we chose it: Andrographis has strong anti-inflammatory and antiviral properties, effectively treating upper respiratory infections.
Clinical Evidence: Multiple systematic reviews have shown that it effectively prevents and shortens respiratory tract infections. Further studies have also shown that it is effective for inflammatory bowel disease.
Jadhav AK, Karuppayil SM. Andrographis paniculata (Burm. F) Wall ex Nees: Antiviral properties. Phytother Res. 2021;35(10):5365-5373. doi:10.1002/ptr.7145
4. Astragalus Root (Astragalus membranaceus) 500mg
Astragulus is another traditional medicine that is popular in functional medicine. The mechanism of action is well understood: The polysaccharides (particularly astragaloside) stimulate the immune system, activate T cells, have antiviral action, and suppress key inflammatory mediators TNF-a and IL-6. The evidence for immune health is not as strong as the other 3; however, given its powerful inflammation-reducing activity, it gets a mention here.
In the longevity community, it has also gained attention. Astragaloside IV, one of the main active ingredients, is unique in that it protects telomeres, the caps on the end of chromosomes. Protecting telomeres is one of the key targets for healthy ageing. Chronic illness and inflammation prematurely shorten them, but it appears that this can be reduced, which led to a lot of excitement around the TA-65 supplement.
Evidence level: medium-lowWhy we chose it: A staple in traditional Chinese medicine, astragalus strengthens the immune system by increasing the production of immune cells and enhancing the body’s defence against respiratory infections.
Key clinical paper:
Clinical Evidence: Research from 2015 showed that astragalus boosts the production of T-cells and macrophages, immune cells crucial for fighting infections.
Zhang X, Qu X, Zou Y. The Effect of Astragalus on Humoral and Cellular Immune Response: A Systematic Review and Meta-Analysis of Human Studies. Effekt von Astragalus auf die humorale und zelluläre Immunantwort: Eine systematische Übersicht und Metaanalyse von Studien am Menschen. Complement Med Res. 2023;30(6):535-543. doi:10.1159/000534826
Liu P, Zhao H, Luo Y. Anti-Aging Implications of Astragalus Membranaceus (Huangqi): A Well-Known Chinese Tonic. Aging Dis. 2017 Dec 1;8(6):868-886. doi: 10.14336/AD.2017.0816. PMID: 29344421; PMCID: PMC5758356.
Two which we don't recommend:
1. A popular one with littlet evidence that we don't recommend is colloidal silver. We could not find convincing evidence of a significant gain in immune health.
2. Boswellia: although it may have inflammatory benefits these are not well researched and there are reports of significant gastro side effects. So we suggest giving this one a miss.
Summary:
Many traditional medicines, herbs and roots have been studied for their effectiveness in treating acute respiratory illnesses. Maybe because we now understand the mechanism and the large-scale reviews have meant that in Western Medicine, we are more open to using these as treatments.
All four of the above-mentioned products are safe, and the reported side effects are minimal. They are certainly worth considering if you have a Winter bug.
My top picks are using echinacea and elderberry together.
Dr Geoff Mullan
Functional Medicine Doctor
