Hydrastis: Goldenseal and the common cold: The antibiotic myth
by Paul Bergner
Medical Herbalism 01-31-97 8(4): 1
Goldenseal today has a wide reputation as an “herbal antibiotic,” based on scientific research and the clinical use its constituent berberine. Table 1 shows a list of organisms which berberine can kill or neutralize in the petri dish. When goldenseal is used topically, put directly onto an infected wound or ulcer, the berberine or other alkaloids may have such an effect on the microorganisms in the wound. It may have the same effect in the mouth and pharynx, and possibly on infected gut mucosa. From research such as this, it is enticing to conclude that goldenseal and other berberine-containing plants taken internally act in the body the same way that pharmaceutical antibiotics do, to kill or inhibit bacteria. However, clinical research actually indicates otherwise.
Organisms killed or controlled by berberine sulfate in vitro
(Sources: Amin et al 1969; Choudry et al 1972; Ghosh 1983; Gupta 1975; Johnson et al 1952; Subbaiah and Amin 1967)
First of all, in humans, berberine is very poorly absorbed across in the small intestine (Bhide et al 1961). Four hundred milligrams of berberine sulfate, the amount contained in from about 26 capsules of goldenseal powder, causes blood levels of berberine to rise to 100 micrograms per cent. This is only about 1/200th of the levels that kill the bacteria shown in the accompanying table 13.2 (Bensky and Gamble 1986). Berberine itself thus does not act as a systemic antibiotic, and goldenseal, which contains only a small percentage of berberine cannot either, at least not due to its berberine content. Berberine is excreted through the urine in humans (Chopra et al 1932), so it could conceivably have some antibiotic effect in the concentrated urine in kidney or urinary tract infections — conditions that it was used for by American physicians of the last century.
Table 2: Goldenseal in the Medical Sects
Dr. Benjamin Barton Smith (Regular School) 1798
Bitter tonic, eyewash, alterative to mucous membranes, skin cancer
Constantine Rafinesque (Eclectic School) 1830
Bitter tonic, diuretic, sore eyes, skin cancers, sores and skin ulcers, stimulant
Samuel Thompson (Thompsonian school) 1833
Nausea and heartburn, morning sickness, relief and removal of bowel complaints, sore eyes, stomach problems (The Thompsonian Recorder, 1833)
Dr. John King (Eclectic School) 1852
Alcoholism, bitter tonic, chronic affections of the mucous membranes of the stomach, intestines, and bladder, bitter tonic, indigestion, sore eyes, sores and skin ulcers,
Dr. William Cook (Physiomedicalist School) 1862
Bitter tonic, bladder problems, catarrh, chronic diarrhea, coughs, digestive tonic, diphtheria, dysentery (second stage), eye problems, liver problems, mouth ulcers, mucous membrane tonic, skin ulcers, uterine tonic, venous tonic
Dr. Edwin Hale (Homeopathic School) 1875
Bitter tonic; constipation;
digestive tonic; diuretic; eye inflammations; liver problems; mouth
ulcers; mucous membrane tonic; skin problems; sore throat (chronic)
urinary tract antiseptic.
Dr. John Scudder (Eclectic School) 1874
Bitter tonic, constipation, digestive tonic, eye problems, uterine disorders, poor circulation, skin disorders
Dr. Eli Jones (Eclectic and Homeopathic Schools) 1911
Cancer (breast and stomach); constipation, digestive tonic, liver and gall bladder disease, skin problems
Dr. Finley Ellingwood (Eclectic School) 1919
Alcoholism; bitter tonic; breast cancer; catarrh; constipation; digestive tonic; eczema; eye inflammation; liver congestion and gall bladder problems; menstrual irregularities; mouth ulcers; recuperation after prolonged fever; tonic stimulant; uterine complaints; vaginal discharges
Dr. Harvey Felter (Eclectic School) 1922
Ear infections; Mucous membrane tonic; skin disorders; mouth ulcers; later stages of diarrhea and dysentery; uterine disorders; catarrh; vaginal discharges; bitter tonic; menstrual irregularities
Dr. David Culbreth (Regular School) 1927
Bitter tonic; catarrh; constipation; diuretic; eye problems; liver and gall bladder congestion; mucous membrane tonic; sores and ulcers; sore throat; tonsillitis; uterine disorders; vaginal discharge;
Dr. G. Madaus (German Regular and Homeopathic Schools) 1938
Menstrual irregularities; passive uterine bleeding; uterine fibroids
Dr. A.W. Kuts-Chereaux (Naturopathic School) 1953
Catarrh (chronic); digestive tonic; dysentery; ear problems; eye inflammations; mucous membrane tonic; sore throat; tonsillitis; vaginal complaints
Dr O.J. Carroll (Naturopathic/Thompsonian) 1962
General tonic; bitter tonic; mucous membrane tonic; nasal catarrh; sinusitis
Dr. John R Christopher (Thompsonian/American Physiomedicalist School) 1976
Antiseptic; bitter tonic; constipation; diuretic; eye problems; mucous membrane tonic; venous circulatory tonic
Drs. Calvin and Agatha Thrash (American Naturopathic and Regular School) 1981
Diuretic, eczema, skin infections and inflammations, ulcerative colitis, vaginal infections
Drs. Priest and Priest (British Naturopathic and Physiomedicalist Schools) 1982
Antiseptic; general tonic; laxative;
mucous membrane tonic; skin and mucous membrane ulcers; venous
The pathology of the stages of infection the mucous membranes
Acute: Antibody-laden mucous flows freely, mechanically washing away invaders and/or “tagging” them with IgA antibodies; inflammation and swelling of the tissues walls off invaders to prevent penetration and floods the area with immune cells; any agent penetrating to the level of the lymphatics triggers humoral and cell-mediated immunity.
Subacute: The initial fever or inflammation subsides; the area may become congested with the boggy byproducts of the immune battle. The process that initially walled off the area in a protective way now blocks out the influx of immune components. Ulceration, scarring, and other lesions begin to develop. Secondary infections may start to set in. Meanwhile, the body has begun accumulating high levels of antibodies the infectious agent, but they cannot get to the congested tissues.
Chronic: Ulceration and scarring of the membranes; membranes become dry and cracked as mucous secretions are blocked or deranged. Bleeding may occur. Secondary infections may occur due to weakened circulation of immune components.
Colds and flu
In my experience both selling herbs at retail, and seeing patients in the clinic, not even 10% of the goldenseal use in the U.S. is clinically appropriate. When someone pops large amounts of goldenseal “for a cold,” especially in its early stages, they are wasting both their money and an endangered plant. People in our culture are conditioned to think “I need an antibiotic” when they have a cold, although neither conventional nor herbal antibiotics are appropriate for such viral conditions. Table 3 shows the traditional medical uses of goldenseal. In it we find not one single reference to the use of goldenseal for colds, flu, or similar infections. Its use is limited to topical application, including douche for vaginal infections, diarrhea and dysentery (later stages) or as a bitter tonic or mucous membrane alterative. Traditional physicians used goldenseal in subacute and chronic mucous membrane conditions, not in acute inflammations of the same. Table 2 shows the dynamics of a mucous membrane infection.
Taking goldenseal or berberine internally will not directly kill or inhibit bacteria or other infectious agents in most of these conditions, unless coming in direct contact with the infected tissue. What they will do, according to traditional herbal medicine, is excite the mucous membranes “to unusual secretion.” In doing so, in the second and third stages of the pathology, the fresh and abundant mucous can soothe, clean, disinfect, and heal the tissues. Taking goldenseal too early in the process — especially in doses higher than the traditional 15 drops of tincture — can have negative effects. it may:
- Exhaust the mucous glands, by overstimulating them, causing dry membranes. Two to three goldenseal capsules has a distinct drying effect on the membranes.
- Inhibit the healthy inflammatory
reaction, weakening the immune response, and prolonging the illness.
- Weaken the digestive system.
A cold may seem to get better because of the drying effect, but it actually inhibits the natural defenses against whatever bug has got your patient. It may be appropriate on the third or fourth day of a cold or flu, when there is any fear of a bacterial infection setting in. At that stage, in smaller doses, goldenseal will restore a healthy flow of mucous to the stagnant membranes.
Goldenseal provides its internal benefits in small doses — 10-15 drops of a tincture or fluid extract in a glass of water — and does its work in a few days to a week. Larger doses or long duration can begin to cause side effects. Here is how the homeopath Dr. Edwin Hale described the effects of taking too much goldenseal, after many homeopathic provings in the mid-nineteenth century:
“The increased digestive power gives way to indigestion; the increased power of assimilation to deficient nutrition; and apparent strength to real debility the natural secretion [of the mucous membranes] is at first increased; then it becomes abnormal in quantity and quality. At first, clear, white, and transparent, it becomes yellow, or thick, green and even bloody, and nearly always tenacious....The distance traversed by the primary mucous flux passes from simple increase of mucous, to erosion and ulceration. Its secondary effects are exhaustion and destruction of the glandular sources of the mucous — a condition in which the mucous surface is dry, glazed, and its functions destroyed.
The digestive tract is especially susceptible to such effects, and individuals who pop goldenseal for their colds are usually injuring their stomach and intestines instead of helping their cold. This effect is consistent with the caution in traditional Chinese medicine that bitter herbs taken inappropriately or in too high a dose can injure “the spleen” — the intestinal function in Western terminology.
Goldenseal and normal bowel flora
One side effect of the myth that goldenseal is an antibiotic is that it might, like conventional antibiotics, disrupt the balance of normal bacteria in the intestine. This action is responsible for some of the minor or serious side effects of antibiotics. We have no evidence, either from traditional use or from scientific experiments, that either berberine or goldenseal can cause this problem. In fact, in one trial indicates the opposite.
Berberine sulfate is used clinically
in Asia to treat diarrheal infections. In one double-blind
placebo-controlled trial, 400 mg doses of berberine sulfate were given
orally to men with E. coli-induced diarrhea. The group
receiving the berberine had a 48% reduction is stool volumes, and 42%
of the men in the group stopped having watery stools within 24 hours,
compared with 20% in the control group, who received only a placebo.
The results are typical of treatment of diarrhea with berberine. This
trial is frequently cited by herbal companies as “proof” that
berberine-containing plants kill bacteria in the intestine, even though
the authors of that trial reach the opposite conclusion. They found
that pathogenic bacterial counts in the patients were unchanged
(Rabbani et al 1987). Berberine in such high doses (the equivalent of
about 26 capsules of goldenseal) did not appear to disrupt the
pathogenic bacteria, much less the beneficial ones. I first heard about
this possibility in the mid-1980s. I’ve been looking for a single case
report of this effect ever since, and have never heard of one.
So how does it work?
One traditional use of goldenseal is as a mucous membrane tonic. Note that it does not have to come in contact with the mucous membranes to have this effect. Hold some goldenseal in your mouth for a minute or two, and you can feel the effect on the mucous membranes in your nose and sinuses. Traditional doctors stated that goldenseal increases the secretion of the mucous membranes. At the same time, goldenseal contains astringent factors, which also counter that flow. Thus it was referred to as a mucous membrane “alterative,” increasing deficient flow but decreasing excessive flow. How this happens has not been determined by science, but is thoroughly supported by the traditional uses by some of the physicians in Table 3.
It is my opinion that goldenseal acts as an “antibiotic” to the mucous membranes not by killing germs directly, but by increasing the flow of healthy mucous, which contains it’s own innate antibiotic factors — IgA antibodies. This effect is unnecessary in the early stages of a cold or flu, when mucous is already flowing freely.
Amin, A.H., Subbaiah, T.V., and Abbasi K.M. Berberine sulfate: antimicrobial activity, bioassay, and mode of action. Can J Microbiol 1969;15:1067-1076
Bensky, D. and Gamble, H. Chinese Herbal Medicine: Materia Medica Seattle, Washington: Eastland Press, 1986
Bhide, M.B., Chavan, S.R., Dutta, N.K. Absorption, distribution and extretion of berberine. Indian J Med Res 1969;57:2128-2131
Chopra, R.N., Dikshit, B.B., Chowhan, J.S. Pharmacological action of berberine. Ind J Med Res 1932;19:1193-1203
Choudry, V.P., Sabir, M., and Bhide, V.N. Berberine in giardiasis. Ind Pediatr 1972;9:143-146
Ghosh, A.K. Effect of berberine chloride on Leishmania donovani. Ind J Med Res 1983;78:407-416
Gupta, S. Use of berberine in the treatment of giardiasis. Am J Dis Child 1975;129:866
Hale, E.M. Materia Medica and Special Therapeutics of the New Remedies. Fourth Edition. Chicago, Illinois: 1875. Reprinted by Jain Publishers, New Delhi, 1995
Johnson, C.C., Johnson, G., et al. Toxicity of alkaloids to certain bacteria. Acta Pham Tox. 1952;8:71-78
Rabbani, G.H., Butler, T., Knight, J., et al. Randomized controlled trial of berberine sulfate therapy for diarrhea due to enterotoxigenic Escherichia coli and Vibrio cholerae. J Infectious Dis 1987;155(5):979-984
Subbaiah, T.V., and Amin, A.H. Effect
of berberine sulfate on Entamoeba histolytica. Nature 1967;215;527-528