Essiac : Dosing and Safety

by MedlinePlus

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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 professional 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 professional, 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.

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