Essiac
  
Essiac
Background
Essiac® contains a combination of herbs, including burdock root ( Arctium lappa ), sheep sorrel ( Rumex acetosella ), slippery elm inner bark ( Ulmus fulva ), and Turkish rhubarb ( Rheum palmatum ). The original formula was developed by the Canadian nurse Rene Caisse (1888-1978) in the 1920s ("Essiac" is Caisse spelled backwards). The recipe is said to be based on a traditional Ojibwa (Native American) remedy, and Caisse administered the formula by mouth and injection to numerous cancer patients during the 1920s and 1930s. The exact ingredients and amounts in the original formulation remain a secret.
During investigations by the Canadian government and public hearings in the late 1930s, it remained unclear if Essiac® was an effective cancer treatment. Amidst controversy, Caisse closed her clinic in 1942. In the 1950s, Caisse provided samples of Essiac® to Dr. Charles Brusch, founder of the Brusch Medical Center in Cambridge, Massachusetts, who administered Essiac® to patients (it is unclear if Brusch was given access to the secret formula). According to some accounts, additional herbs were added to these later formulations, including blessed thistle ( Cnicus benedictus ), red clover ( Trifolium pratense ), kelp ( Laminaria digitata ), and watercress ( Nasturtium officinale ).
A laboratory at Memorial Sloan-Kettering Cancer Center tested Essiac® samples (provided by Caisse) on mice during the 1970s. This research was never formally published, and there is controversy regarding the results, with some accounts noting no benefits, and others reporting significant effects (including an account by Dr. Brusch). Questions were later raised of improper preparation of the formula. Caisse subsequently refused requests by researchers at Memorial Sloan-Kettering and the U.S. National Cancer Institute for access to the recipe.
In the 1970s, Caisse provided the formula to Resperin Corporation Ltd., with the understanding that Resperin would coordinate a scientific trial in humans. Although a study was initiated, it was stopped early amidst questions of improper preparation of the formula and inadequate study design. This research was never completed. Resperin Corporation Ltd., which owned the Essiac® name, formally went out of business after transferring rights to the Essiac® name and selling the secret formula to Essiac Products Ltd., which currently distributes products through Essiac® International.
Despite the lack of available scientific evidence, Essiac® and Essiac-like products (with similar ingredients) remain popular among patients, particularly in those with cancer. Essiac® is most commonly taken as a tea. A survey conducted in the year 2000 found almost 15% of Canadian women with breast cancer to be using Essiac®. It has also become popular in patients with HIV and diabetes, and in healthy individuals for its purported immune enhancing properties, although there is no reliable scientific research in these areas.
There are more than 40 Essiac-like products available in North America, Europe, and Australia. Flor-essence® includes the original four herbs (burdock root, sheep sorrel, slippery elm bark, Turkish rhubarb) as well as herbs that were later added as "potentiators" (blessed thistle, red clover, kelp, watercress). Virginias Herbal E® contains the four original herbs along with echinacea and black walnut. Other commercial formulations may include additional ingredients, such as cat's claw ( Uncaria tomentosa ).
Synonyms
Burdock root (Arctium lappa) synonyms/related terms : Akujitsu, anthraxivore, arctii, Arctium minus , Arctium tomentosa , bardana, Bardanae Radix, bardane, bardane grande (French), beggar's buttons, burr, burr seed, chin, clot-burr, clotbur, cocklebur, cockle button, cocklebuttons, cuckold, daiki kishi, edible burdock, fox's clote, grass burdock, great bur, great burdock, great burdocks, gobo (Japan), Grosse klette (German), happy major, hardock, hare burr, hurrburr, Kletterwurzel (German), lampazo (Spanish), lappola, love leaves, niu bang zi, oil of lappa, personata, Philanthropium, thorny burr, turkey burrseed, woo-bang-ja, wild gobo.
Sheep sorrel (Rumex acetosella) synonyms/related terms : Acedera, acid sorrel, azeda-brava, buckler leaf, cigreto, common sorrel, cuckoo sorrow, cuckoo's meate, dock, dog-eared sorrel, field sorrel, French sorrel, garden sorrel, gowke-meat, greensauce, green sorrel, herba acetosa, kemekulagi, Polygonaceae (family) , red sorrel, red top sorrel, round leaf sorrel, Rumex scutatus , Rumex acetosa L., sheephead sorrel, sheep's sorrel, sorrel, sorrel dock, sour dock, sour grass, sour sabs, sour suds, sour sauce, Wiesensauerampfer, wild sorrel.
Slippery elm inner bark (Ulmus fulva) synonyms/related terms : Indian elm, moose elm, red elm, rock elm, slippery elm, sweet elm, Ulmaceae , Ulmi rubrae cortex, Ulmus fulva Michaux, Ulmus rubra , Winged elm.
Turkish rhubarb (Rheum palmatum) synonyms/related terms : Baoshen pill, Canton rhubarb, Chinesischer Rhabarber (German), Chinese rhubarb, chong-gi-huang, common rhubarb, da-huang, Da Huang, daio, Da huang Liujingao, English Rhubarb, Extractum Rhei Liquidum, Himalayan Rhubarb, Indian rhubarb, Japanese rhubarb, Jiang- Zhi Jian-Fel Yao (JZJFY), Jinghuang tablet, medicinal rhubarb, pie rhubarb, Polygonaceae (family), Pyralvex, Pyralvex Berna, racine de rhubarbee (French), RET (Rhubarb extract tablet), rhabarber, rhei radix, rhei rhizoma, rheum, Rheum australe , Rheum emodi Wall, Rheum officinale Baill, Rheum rhabarbarum , Rheum rhaponticum L., Rheum tanguticum Maxim, Rheum tanguticum Maxim. ex. Balf., Rheum tanguticum Maxim L., Rheum undulatum , Rheum x cultorum , Rheum webbianum (Indian or Himalayan rhubarb), rhizoma, rheirhubarbe de chine (French), rhubarb, rubarbo, ruibarbo (Spanish), shenshi rhubarb, tai huang, Turkey rhubarb.
Evidence
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Uses based on scientific evidenceGrade*Cancer
There are no properly conducted published human studies of Essiac® for cancer. A laboratory at Memorial Sloan-Kettering Cancer Center tested Essiac® on mice during the 1970s, although results were never formally published and remain controversial. Questions were raised of improper preparation of the formula. A human study was started in Canada in the late 1970s but was stopped early due to concerns about inconsistent preparation of the formula and inadequate study design. In the 1980s, the Canadian Department of National Health and Welfare collected information about 86 cancer patients treated with Essiac®. Results were inconclusive (17 patients had died at the time of the study, inadequate information was available for 8 patients, "no benefits" were found in 47 patients, five reported reduced need for pain medications, and 1 noted subjective improvement). Most individuals also received other cancer treatments such as chemotherapy, making the effects of Essiac® impossible to isolate. Currently, there is not enough evidence to recommend for or against the use of this herbal mixture as a therapy for any type of cancer. Different brands may contain variable ingredients, and the comparative effectiveness of these formulas is not known. None of the individual herbs used in Essiac® has been tested in rigorous human cancer trials (rhubarb has shown some anti-tumor properties in animal experiments; slippery elm inner bark has not; sheep sorrel and burdock have been used traditionally in cancer remedies). Numerous individual patient testimonials and reports from manufacturers are available on the Internet, although these cannot be considered scientifically viable as evidence. Individuals with cancer are advised not to delay treatment with more proven therapies.
C
* Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
AIDS/HIV, appetite stimulant, arthritis, asthma, bladder cancer, "blood cleanser," breast cancer, chelating agent (heavy metals), chronic fatigue syndrome, colon cancer, "detoxification," diabetes, endometrial cancer, energy enhancement, head/neck cancers, Hodgkin's disease, immune system enhancement, kidney diseases, leukemia, lip cancer, liver cancer (hepatocellular carcinoma), longevity, lung cancer, Lyme disease, lymphoma, multiple myeloma, Non-Hodgkin's lymphoma, nutritional supplement, ovarian cancer, supportive care in advanced cancer patients, pancreatic cancer, paralysis, prostate cancer, reduction of chemotherapy side effects, stomach cancer, systemic lupus erythematosus, throat cancer, thyroid disorders, tongue cancer, well-being.
Dosing
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Standardization
Standardization involves measuring the amount of certain chemicals in products to try to make different preparations similar to each other. It is not always known if the chemicals being measured are the "active" ingredients. Because the formula for Essiac® remains a secret, it is not clear what standards for manufacturing are followed. Some brands of Essiac-like products publish the amounts of herbal constituents, although the basis for standardization of those individual ingredients is not always clear.
Adults (over 18 years old)
Historically, Essiac® was administered by mouth or injection. The most common current use is as a tea. There are no reliable published human studies of Essiac® or Essiac-like products, and safety or effectiveness has not been established scientifically for any dose. Instructions for tea preparation and dosing vary from product to product. Patients are advised to read product labels and speak with their cancer healthcare provider before starting any new therapy, such as Essiac® or Essiac-like products.
Children (under 18 years old)
There is not enough scientific data available to recommend the safe use of Essiac® or Essiac-like products in children.
Safety
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Allergies
There are no reports of allergy to Essiac® in the published scientific literature, although reactions potentially can occur due to any of the included herbs. Anaphylaxis has been reported after rhubarb leaf ingestion, and there are reports of allergic reactions to sorrel products taken by mouth. Contact dermatitis (skin rash after direct contact) has been reported with exposure to burdock, slippery elm bark, and rhubarb leaves. Cross-sensitivity to burdock may occur in individuals with allergy to members of the Asteraceae/Compositae family, such as ragweed, chrysanthemums, marigolds, and daisies.
Side Effects and Warnings
The safety of Essiac® is not well studied scientifically. Safety concerns are based on theoretical and known reactions associated with herbal components of Essiac®: burdock root ( Arctium lappa ), sheep sorrel ( Rumex acetosella ), slippery elm bark ( Ulmus fulva ), and Turkish rhubarb ( Rheum palmatum ). However, the safety and toxicities of these individual herbs are also not well studied. Various Essiac-like products may contain different or additional ingredients, and patients are advised to carefully review product labels.
Potentially toxic compounds present in Essiac® include tannins, oxalic acid, and anthraquinones. Tannins, present in burdock, sorrel, rhubarb, and slippery elm, may cause stomach upset, and in high concentrations may lead to kidney or liver damage. In theory, long-term use of tannins may increase the risk of head and neck cancers, although there are no documented human cases.
Oxalic acid contained in rhubarb, slippery elm, and sorrel, can cause serious adverse effects when taken in high doses (particularly in children). Oxalic acid toxicity/poisoning may be associated with nausea, vomiting, mouth/throat burning, dangerously low blood pressure, blood electrolyte imbalances, seizure, throat swelling that interferes with breathing, and liver or kidney damage. Deaths from oxalic acid poisoning have been reported in an adult man eating soup containing sorrel and in a 4-year-old child eating rhubarb leaves. The lethal dose of oxalic acid for adults has been estimated as 15 to 30 grams, although doses as low as 5 grams may be fatal. The amount of oxalic acid in Essiac® preparations is not known. In cases of suspected oxalic acid poisoning, medical attention should be sought immediately. Regular intake of oxalic acid may increase the risk of kidney stones.
Anthraquinones in rhubarb root or sheep sorrel may lead to diarrhea, intestinal cramping, and loss of fluid and electrolytes (such as potassium). Use of rhubarb may lead to discoloration of the urine (bright yellow or red), or of the inner mucosal surface of the intestine (a condition called melanosis coli). Fluoride poisoning has been reported with the use of rhubarb fruit juice. Rhubarb products manufactured in China have been contaminated with heavy metals. Chronic use of rhubarb products may lead to dependence.
Based on animal research and limited human study, burdock may cause either increases or reductions in blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider, and medication adjustments may be necessary. Diuretic effects (increasing urine flow) and estrogen-like effects have been reported with oral burdock use in patients with HIV.
Reports of anticholinergic reactions (such as slow heart rate and dry mouth) with the use of burdock products in the 1970s are believed to be due to contamination with belladonna alkaloids, which resemble burdock and can be introduced during harvesting. Burdock itself has not been found to contain constituents that would be responsible for these reactions.
Pregnancy and Breastfeeding
There is not enough scientific evidence to recommend the safe use of Essiac® or Essiac-like products during pregnancy and breastfeeding, and there are potential risks from the included herbs. Oxalic acid and anthraquinone glycosides in the included herbs may be unsafe during pregnancy. Rhubarb and burdock may lead to contraction of the uterus; some publications note that whole slippery elm bark can lead to abortion, although there is limited supporting scientific evidence.
References
1. Bever BO, Zahnd GR. Plants with oral hypoglycaemic action. Quart J Crude Drug Res 1979;17:139-196.
2. Boon H, Stewart M, Kennard MA, et al. Use of complementary/alternative medicine by breast cancer survivors in Ontario: prevalence and perceptions. J Clin Oncol 2000;18 (13) :2515-2521.
3. Bryson PD, Watanabe AS, Rumack BH, et al. Burdock root tea poisoning. Case report involving a commercial preparation. JAMA 1978;239(20):2157.
4. Bryson PD. Burdock root tea poisoning. JAMA 1978;240(15):1586.
5. C Geyer, L Hammond, T Johnson, et al. Dose-schedule optimization of the hexacyclic camptothecin (CPT) analog DX-8951f: a phase I and pharmacokinetic study with escalation of both treatment duration and dose (meeting abstract). Proc Ann Meet Amer Soc Clin Oncol 1999:A813.
6. De Jager R, Cheverton P, Tamanoi K, et al. (DX-8931f Investigators). DX-8951f: summary of phase I clinical trials. Ann NY Acad Sci 2000;922:260-273.
7. Dog TL. Author of CME article offers clarification about Essiac. Altern Ther Health Med 2001;7(4):20.
8. Fraser SS, Allen C. Could Essiac halt cancer? Homemaker's 1977 (August issue).
9. Kaegi E. Unconventional therapies for cancer: 1. Essiac. The Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative. CMAJ 1998;158(7):897-902.
10. Karn H, Moore MJ. The use of the herbal remedy ESSIAC in an outpatient cancer population (meeting abstract). Proc Ann Meet Amer Soc Clin Oncol 1997:A245.
11. LeMoine L. Essiac: an historical perspective. Can Oncol Nurs J 1997;7(4):216-221.
12. Rhoads PM, Tong TG, Banner W, Jr., et al. Anticholinergic poisonings associated with commercial burdock root tea. J Toxicol Clin Toxicol 1984;22(6):581-584.
13. Rhoads PM, Tong TG, Banner W, Jr., et al. Anticholinergic poisonings associated with commercial burdock root tea. J Toxicol Clin Toxicol 1984;22(6):581-584.
14. Silver AA, Krantz JC. The effect of the ingestion of burdock root on normal and diabetic individuals: a preliminary report. Ann Int Med 1931;5:274-284.
15. Tamayo C, Richardson MA, Diamond S, et al. The chemistry and biological activity of herbs used in Flor-Essence herbal tonic and Essiac. Phytother Res 2000;14(1):1-14.
16. Thomas R. The Essiac report: the true story of a Canadian herbal cancer remedy and of the thousands of lives it continues to save. Los Angeles: Alternative Treatment Information Network, 1993.
17. US Congressional Office of Technology Assessment. Essiac. Washington, DC: US Government Printing Office, 1990.
18. Zarembski PM, Hodgkinson A. Plasma oxalic acid and calcium levels in oxalate poisoning. J Clin Path 1967;20:283-285.
January 01, 2004 
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