Andrographis as a dietary supplement
Andrographis is a dietary supplement derived from a shrub native to India and parts of Asia, often referred to as Indian echinacea. Traditionally used during epidemics, its primary proposed benefit is in the prevention and treatment of the common cold, with evidence suggesting it can reduce the severity of cold symptoms and potentially help prevent colds altogether. Additionally, Andrographis has been investigated for various other health applications, including anti-cancer properties, immune support, and relief from conditions such as osteoarthritis and inflammatory bowel disease.
Research indicates that a proprietary extract of Andrographis is effective in lessening symptoms associated with acute respiratory infections. Typical dosages range from 400 mg to 2,000 mg per day, often standardized to a specific content of andrographolide. While generally considered safe in human studies, concerns have been raised about possible fertility impairments in animal studies, particularly regarding pregnant women and those with certain medical conditions. Overall, Andrographis shows promise as a natural supplement, but potential interactions with medications and health implications should be considered, warranting consultation with healthcare professionals before use.
Andrographis as a dietary supplement
- DEFINITION: Natural plant product used as a dietary supplement for specific health benefits.
- PRINCIPAL PROPOSED USE: Common cold prevention and treatment
- OTHER PROPOSED USES: Anti-cancer, anti-inflammatory, Familial Mediterranean fever, heart disease prevention, immune support, inflammatory bowel disease, liver protection, osteoarthritis, stimulating gallbladder contraction
Overview
Andrographis is a shrub found throughout India and other Asian countries, sometimes called Indian echinacea. It has been used historically in epidemics, including the 1919 Indian flu epidemic, during which andrographis was partially credited with lessening the impact of the disease.
Uses and Applications
A proprietary extract of andrographis (sold with Eleutherococcus) has become popular in Scandinavia as a treatment for colds. It is also available in other regions. Reasonably good evidence shows that either form of this extract can reduce the severity of cold symptoms. It may also help prevent colds.
Although it is not known how andrographis might work for colds, preliminary evidence suggests that it might stimulate immunity, potentially making it useful for general immune support.
Andrographis combined with Eleutherococcus, licorice, and schisandra has shown promise for a genetic disease called familial Mediterranean fever. Preliminary studies in animals weakly suggest that andrographis may also offer benefits for preventing heart disease. In addition, highly preliminary studies suggest that andrographis may help protect the liver from toxic injury, perhaps more successfully than the better-known milk thistle, a liver-protective herb. It also appears to stimulate gallbladder contraction. Andrographis does not appear to have any antibacterial effects.
Andrographis was studied for additional health benefits as well. Scientists investigated andrographis for its potential antiviral properties. It also continued to be studied for its general immune-boosting functions. Preliminary studies indicated andrographis might have natural anti-inflammatory effects. These findings led to initial studies into its use for patients with osteoarthritis and inflammatory bowel disease. Laboratory studies suggested andrographis might also be beneficial for its anti-cancer properties, but studies in humans were necessary to confirm these findings.
Scientific Evidence
Reducing cold symptoms. A meta-analysis (statistically rigorous review of studies) published in 2004 found seven double-blind, controlled trials of reasonable quality, enrolling 896 persons, and evaluating the use of a proprietary andrographis extract to treat acute respiratory infections. The combined results indicate that this andrographis extract is more effective than a placebo for reducing symptoms.
For example, a four-day, double-blind, placebo-controlled study of 158 adults with colds found that treatment with andrographis extract significantly reduced cold symptoms. Participants were given either a placebo or 1,200 milligrams (mg) daily of an andrographis extract that was standardized to contain 5 percent andrographolide. The results showed that by day two of treatment, and even more by day four, participants who were given the actual treatment experienced significant improvements in symptoms compared with participants in the placebo group. The greatest response was seen in reduced symptoms of earache, sleeplessness, nasal drainage, and sore throat, but other cold symptoms improved too.
Three other double-blind, placebo-controlled studies, enrolling about four hundred people, evaluated a related proprietary herbal combination treatment containing both andrographis and Eleutherococcus senticosus. (This proprietary combination is sold under the name Kan Jang. The manufacturer claims that this combination is more effective than andrographis alone.) Another study found this combination more effective than echinacea for colds in children.
A different formulation of andrographis has been compared with acetaminophen (Tylenol). In a double-blind study of 152 adults with a sore throat and fever, participants received andrographis (in doses of 3 or 6 grams [g] per day for seven days) or acetaminophen. The higher dose of andrographis (6 g) decreased symptoms of fever and throat pain to about the same extent as acetaminophen, but the lower dose of andrographis (3 g) was not as effective. There were no significant side effects in either group. A Russian study of questionable quality apparently found andrographis extract approximately as effective as the drug amantadine for influenza infections.
Preventing colds. According to one double-blind, placebo-controlled study, andrographis may increase resistance to colds. A total of 107 students, all eighteen years old, participated in this three-month trial, which used the same proprietary extract of andrographis as already noted. Fifty-four of the participants took two 100-mg tablets standardized to 5.6 percent andrographolide daily, which is considerably less than the 1,200 to 6,000 mg per day used in studies on the treatment of colds. The other fifty-three students were given placebo tablets with a coating identical to the treatment. Then, once a week throughout the study, a clinician evaluated all the participants for cold symptoms.
By the end of the trial, only sixteen people in the andrographis group had experienced colds, compared with thirty-three of the placebo-group participants. This difference was statistically significant, indicating that andrographis reduces the risk of catching a cold by a factor of two compared with placebo.
Osteoarthritis. A double-blind, placebo-controlled trial published in the journal Phytotherapy Research found that participants with knee osteoarthritis who took an andrographis supplement significantly reduced their pain and increased mobility compared to the placebo group.
Dosage
A typical dosage of andrographis is 400 mg three times a day. Doses as high as 1,000 to 2,000 mg three times daily have been used in some studies. Andrographis is usually standardized to its content of andrographolide, typically 4 to 6 percent. Note that virtually all published studies of andrographis have involved a single proprietary product. It is not clear that the results of these studies apply to products using different andrographis sources or different methods of extraction.
Safety Issues
In human studies, andrographis has not been associated with any side effects. In one study, participants were monitored for changes in liver function, blood counts, kidney function, and other laboratory measures of toxicity. No problems were found.
However, some animal studies have raised concerns that andrographis may impair fertility. One study found that male rats became infertile when fed 20 mg of andrographis powder daily. In this case, the rats stopped producing sperm and showed physical changes in some of the testicular cells involved in sperm production. Researchers also detected evidence of degeneration of other anatomical structures in the testicles. However, another study showed no evidence of testicular toxicity in male rats that were given up to 1 gram per kilogram of body weight daily for sixty days, so this issue remains unclear. Furthermore, a human trial using the widely tested andrographis-Eleutherococcus combination found no adverse effect on male fertility measurements such as sperm quality and number.
One group of female mice also did not fare well on high dosages of andrographis. When fed 2 grams per kilogram of body weight daily for six weeks (thousands of times higher than the usual human dose), all female mice failed to get pregnant when mated with males of proven fertility. Meanwhile, of the control females, 95 percent got pregnant when mated with a similar group of male mice. Another study found a potential explanation in evidence that andrographis relaxes the uterus. While andrographis is probably not a useful form of birth control, these results are worrisome regarding the use of andrographis by pregnant women.
Finally, if andrographis does indeed stimulate the immune system, this would lead to a whole host of potential risks. The immune system is carefully balanced. An immune system that is too relaxed fails to defend the body against infections, but an immune system that is too active attacks healthy tissues, causing autoimmune diseases. A universal immune booster might cause or exacerbate lupus, Crohn’s disease, asthma, Graves’ disease, Hashimoto’s thyroiditis, multiple sclerosis, and rheumatoid arthritis, among other illnesses.
Those taking aminophylline should be aware that combining andrographis with this drug may increase the risk of side effects. Also, chemotherapy drugs, blood pressure drugs, or anticoagulants have been shown to interact negatively with andrographis.
Safety in young children, nursing women, or those with severe liver or kidney disease has also not been established. Also, because andrographis may stimulate gallbladder contraction, it should not be used by persons with gallbladder disease except under physician supervision.
Bibliography
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Hancke, Juan L., et al. "A Double-Blind, Randomized, Placebo-Controlled Study to Assess the Efficacy of Andrographis paniculata Standardized Extract (ParActin®) on Pain Reduction in Subjects with Knee Osteoarthritis." Phytotherapy Research, vol. 33, no. 5, 2019, pp. 1469-1479, doi.org/10.1002/ptr.6339. Accessed 10 Oct. 2024.
Li, Xiaohong, et al. "Andrographolide, a Natural Anti-inflammatory Agent: An Update." Frontiers in Pharmacology, vol. 13, 2022, p. 920435, doi.org/10.3389/fphar.2022.920435. Accessed 10 Oct. 2024.
Mkrtchyan, A., et al. "A Phase I Clinical Study of Andrographis paniculata Fixed Combination Kan Jang Versus Ginseng and Valerian on the Semen Quality of Healthy Male Subjects." Phytomedicine, vol. 12, 2005, pp. 403-409.
Panossian, A., et al. "Plasma Nitric Oxide Level in Familial Mediterranean Fever and Its Modulations by Immuno-Guard." Nitric Oxide, vol. 9, 2003, pp. 103-110.
Siridechakorn, Ittipon, et al. "Inhibitory Efficiency of Andrographis Paniculata Extract on Viral Multiplication and Nitric Oxide Production." Scientific Reports, vol. 13, no. 1, 2023, pp. 1-14, doi.org/10.1038/s41598-023-46249-y. Accessed 10 Oct. 2024.
Yusuf, Aisha L., et al. "Effects of Dietary Supplementation of Leaves and Whole Plant of Andrographis Paniculata on Rumen Fermentation, Fatty Acid Composition and Microbiota in Goats." BMC Veterinary Research, vol. 13, no. 1 Nov. 2017, p. 349, doi:10.1186/s12917-017-1223-0.