Can Herbal Supplements Cause a Cytokine Storm?

Herbal Supplements and Cytokines: If you follow natural health and supplement news, you may have noticed a rise in immune-supporting herbal supplements in the past few years. In reality, herbs like echinacea and elderberry are not new and have been used for decades by herbalists and traditional medicine.

It wasn’t until more recently that people started questioning these herbs’ safety connected with a medical condition known as a cytokine storm. While herbs can be a powerful addition to your health, this connection is a reach. It’s essential to understand the science behind cytokine production and the relationship to herbal supplements.

What are cytokines?

Cytokines are a group of chemical messengers secreted by immune cells that signal and help mediate the immune response. There are many different types with different cellular targets and mechanisms of action. Some help regulate cellular processes or promote tissue repair and maintenance. Others help to control the response of the immune system by either ramping up inflammation to facilitate the healing process or acting as anti-inflammatories to help balance the reaction. They have an essential job, signaling to the immune system in the presence of disease or infection.

Most of the time, inflammation is considered a negative adaptation in the body. Chronic inflammation (mostly from diet and lifestyle) is a known root cause of many chronic diseases. But inflammation is also an essential part of the healing process. When the body recognizes the presence of a pathogen or illness, the inflammatory process is the first step in waking up the immune system. This initial inflammation helps prevent things from getting worse until the body can send in the correct immune cells to heal and eventually recover. Inflammation only becomes a problem when the on switch is stuck, so there is a constant cascade of inflammatory messengers upregulating the immune system when it should be calming down.

As a result, some cytokines can be pro-inflammatory but a significant, positive part of the immune response. It is the balance of the types of cytokines that helps regulate the immune system. The overproduction of cytokines can be a problem, but so is an underproduction.

When cytokines are produced in excess, and the inflammatory process is not in balance, it can result in pain or disease. This response is seen in autoimmune conditions such as rheumatoid arthritis (RA) when the body no longer can regulate the immune response. For people with RA, the constant overproduction of inflammatory cytokines leads to tissue damage as the body begins to attack itself.

Herbal Supplements and Cytokines: What is a cytokine storm?

While the overproduction of cytokines is associated with autoimmune conditions and body pain, the phenomenon known as a cytokine storm is very different. While a cytokine storm is the result of an over-the-top immune response, it typically occurs with patients in critical care ICU who are in late stages of the disease process. It has been associated with influenza, especially with SARS and H5N1, when people were dying despite no underlying conditions and being younger. It’s a life-threatening immune complication where the body starts to attack its tissue and cells, similar to what is seen with autoimmune diseases but much more severe.

In cytokine storms, the number of circulating inflammatory cytokines increases significantly. As the immune system recruits more inflammatory cytokines, they can start attacking healthy tissue and cells. There is longer a balance of regulatory cytokines, resulting in significant tissue damage and leading to multiorgan failure and death.

Can herbal supplements like elderberry or echinacea provoke a cytokine storm?

The short answer is no. And here’s why.

Recently there has been some concern regarding the use of herbal immune-supporting supplements and their relationship to cytokine production. While it is true that herbs like echinacea or elderberry support health by stimulating the immune system, the attempt to connect their use with cytokine storms is weak.

It’s essential to understand how these herbs work. Echinacea is an herb used to support the immune system by increasing the number of white blood cells. Studies have shown positive benefits for the use of echinacea to help the common cold and possibly the recurrence of upper respiratory infections.

Elderberry is a supplement derived from the Sambucas tree with multiple documented health properties. It is high in vitamin C, antioxidants, and acts as an anti-viral by inhibiting the flu virus. It also supports the immune system by increasing and balancing the amount of supportive inflammatory and anti-inflammatory cytokines in circulation, therefore revving up the immune system. Research supports its use for shortening the duration and severity of the flu.

As you just learned, an actual cytokine storm presents as an exaggerated end-stage response to severe infections. While elderberry can increase inflammatory cytokines to activate the immune system, this is not the same type of activation that occurs with a cytokine storm. And this activation of the immune system is seen as a positive response to support the healing process through balance and regulation of cytokine production.

What is likely more important to assess true risk is the baseline health status of the person – do they have chronic inflammation due to lifestyle or blood sugar imbalance? Do they have an autoimmune disease that predisposes them to inappropriate immune reactions? These are all things that may predispose a person to a higher risk of cytokine storm if they end up ill with a virus. And even then, although researchers are still trying to learn more about why certain people are more at risk.

As many master herbalists point out, herbs are used for prevention or support of acute conditions. While they play an important role in health, by the time a patient is in the ICU with a risk of cytokine storm, herbs are no longer a part of the treatment plan. A person who takes elderberry supplements at home is very different than a critically ill patient in the hospital.

Herbal Supplements and Cytokines: The Takeaway

For most people, herbal supplements that support the immune system are safe, well-tolerated, and can play an essential part of your wellness program. Of course, it is important to check with your health care provider before starting immune-modulating supplements, especially if you have a known autoimmune disease. However, there is no evidence that preparations of elderberry or echinacea play a role in the development of the cytokine storm.

References:

^[1] Sm, Opal, and DePalo Va.  “Anti-Inflammatory Cytokines.” Chest.  Chest, April 2000.  https://doi.org/10.1378/chest.117.4.1162.

^[2] Zhang, Jun-Ming, and Jianxiong An.  “Cytokines, Inflammation and Pain.” International Anesthesiology Clinics 45, no.  2 (2007): 27–37.  https://doi.org/10.1097/AIA.0b013e318034194e.

^[3] Hunter, Philip.  “The Inflammation Theory of Disease.” EMBO Reports 13, no.  11 (November 2012): 968–70.  https://doi.org/10.1038/embor.2012.142.

^[4] “Cytokines in the Pathogenesis of Rheumatoid Arthritis | Nature Reviews Immunology.” Accessed September 10, 2020.  https://www.nature.com/articles/nri2094.

^[5] Liu, Qiang, Yuan-hong Zhou, and Zhan-qiu Yang.  “The Cytokine Storm of Severe Influenza and Development of Immunomodulatory Therapy.” Cellular and Molecular Immunology 13, no.  1 (January 2016): 3–10.  https://doi.org/10.1038/cmi.2015.74.

^[6] NCCIH.  “Echinacea.” Accessed September 10, 2020.  https://www.nccih.nih.gov/health/echinacea.

^[7] Ulbricht, Catherine, Ethan Basch, Lisa Cheung, Harley Goldberg, Paul Hammerness, Richard Isaac, Karta Purkh Singh Khalsa, et al.  “An Evidence-Based Systematic Review of Elderberry and Elderflower (Sambucus Nigra) by the Natural Standard Research Collaboration.” Journal of Dietary Supplements 11, no.  1 (March 2014): 80–120.  https://doi.org/10.3109/19390211.2013.859852.

^[8] Krawitz, Christian, Mobarak Abu Mraheil, Michael Stein, Can Imirzalioglu, Eugen Domann, Stephan Pleschka, and Torsten Hain.  “Inhibitory Activity of a Standardized Elderberry Liquid Extract against Clinically-Relevant Human Respiratory Bacterial Pathogens and Influenza A and B Viruses.” BMC Complementary and Alternative Medicine 11 (February 25, 2011): 16.  https://doi.org/10.1186/1472-6882-11-16.