Herbal Sports Cream: Pain Killer, Magical Cure, Or a Placebo Effect?

 

 Tom Hildebrandt

            The Internet’s size and easy access for consumers encourages small businesses to provide information about their products in addition to the common overabundance of imagery and advertising slogans.  However, this information is not always accurate or patrolled for misleading or incorrect assumptions.  The goal of this paper is to examine Epicure Crystal Sports Cream, a sore muscle/weightlifting aid, and the claims made about it on the web (www.choicemail.com/epicure).  In addition to the claims made about this particular product, each active ingredient has a literature provided by the large number of alternative medicine and herbal specialist sites on the Web.  After describing this consumer information, I will provide you with a survey of the clinical research that supports, denies, or falls short of these claims.

            There are several active ingredients reported by the “specialists” at Epicure: Bellis Perennis (Daisy), Calendula Officinalis (Garden Marigold), Echinacea Angustifolia (Cone Flower), Symphytum Officinale (Comfrey), Aconitum Napellus (Aconite), Arnica Montana (Leopard’s Bane Root). Hypericum Perforatum (St. John’s Wort), Ledum Palustre (Wild Rosemary), and Ruta Graveolens (Rue).  Each of these ingredients comprises a cream that “conquers pain from sports related or other injuries which might otherwise lead to a missed workout” (www.choicemail.com/epicure).  Among the other claims provided by Epicure are relief of “sports injuries, pain, minor inflammation of various origins, sprains, strains, discomforts, and bruises” (www.choicemail.com/epicure).  This product, because of its claims and apparent success is currently involved in a clinical study guided by Prodigy, Inc., at the Vanderbilt University Sport’s Medicine Center.  However, this project is not yet completed and the results are not available to report.  It is for this reason that the best examination of the product is to research each of the active ingredients for potential success in application for the above-mentioned ailments.

            The Internet provides countless web sites where one can learn about the various ingredients of Epicure Crystal Sports Cream.  Bellis Perennis, more commonly known as daisy, has an interesting literature on the Web.  Once called “Bruisewort,” by 14th Century healers, this flower is well known for it ability to help cure fresh wounds, gout, or fever (www.botanical.com/botanical/mgmh/d/daisyc03.html).  Other sources report that daisy is best used for arthritis, rheumatism, diarrhea, liver and kidney problems (www.virtualciti.com/sushruta/pages/researcher.htm).  Certain circles of alternative medicine also believe that these flowers have a more religious healing power and are best used on a different level.  For instance, daisy is thought to calm abusive households and help in war; additionally, daisy is good for the sudden shock, trauma, or head trauma associated with these environments (www.medicinegarden.com/ne/bellis_perennis.html).  Strangely, I found very few places that claimed daisy was a useful treatment for sports related complaints.  In fact, the only site that claimed daisy as a useful treatment in sports problems simply stated that daisy had an “affinity for sore muscles” (www.mothernature.com/ency/Homeo/Athletic_Support_hm.asp).

           

 

 

 

 Calendula Officinalis or the Garden Marigold, as reported on the Web, cures many types of pain.  As with daisy, Marigold is best used to heal wounds and bruises; but other reported uses include headaches, earaches, and fever (www.kcweb.com/herb/herbmain.htm).  In addition to pain relief, this flower kills bacteria and fungus on the skin (www.vineherbal.com.html).  Marigold has religious uses such as increasing energy of the environment as well as the user (www.mothernature.com/ency/Herb/Calendula.asp).  Finally, this cure-all flower is good for treating minor burns, reducing swelling and curing skin disease (www.mothernature.com/ency/Herb/Calendula.asp).  Part of these reported effects originate from the high flavonoid content of marigold, which is a “natural” anti-inflammatory (www.mothernature.com/ency/Herb/Calendula.asp).  Although the reported effects of this flower seem applicable to sports injuries, no sites reported specific uses for sports medicine.  This could be because marigold is not as effective as other herbal aids in curing common pains associated with sports, or because marigold’s curative powers are so broad as to be assumed as applicable to sports related discomfort. 

 

           

Echinacea Angustifolia or Cone Flower is thought of as one of the wonder drugs in herbal medicine.  Many people take this supplement orally to fight diseases such as the flu, cold, or strep throat.  However, it can also be used topically for treating eczema, burns, canker sores, herpes, vaginitus, or abscesses (www.pharmor.com/index_vit_spec.html).  The Cone Flower has an interesting past as plains Indians reportedly used it topically to treat insect and snake bites, toothaches, wounds, mumps, small pox, and measles (www.kcweb.com/herb/herbmain.htm).  In 1887 this herb made it to American Medicine as a treatment for syphilis and the common cold (www.mothernature.com/ency/Herb/Echinacea.asp). However, the recent jump in popularity has brought a more informative nature to discussion of this herb on the Web.  One site dedicated to accurate information about herbs reports the components of Echinacea to be “essential oil, polysaccharides, poluacetylenes, betain, glycoside, sesquiterpenes and caryophylene.  In addition to these complex biologic constituents, Echinacea contains copper, iron, tannis, protein, fatty acids, and vitamins A, C, and E.  This site continues by claiming that recent research shows that Echinacea can improve the migration of white blood cells to foreign microorganisms (www.kcweb.com/herb/echin.htm). 

            Despite the large amount of information on Echinacea taken as an oral supplement, very little exists on the Web describing Echinacea’s properties when applied to the skin.  Some sites mention that Echinacea has use topically, but few expound upon these uses.  However, this is a trend that appears repeatedly throughout the Internet literature on herbs. 

            Symphytum Officinale or Comfrey is not mentioned as routinely as many other herbs on most Web sites.  It is most commonly know for its blood cleansing properties, but is reportedly used to treat swelling, cramps, tuberculosis, pain and burns (www.healthrise.com/pr/herb_cd.html).  However useful, this herb taken orally can cause liver damage (www.healthrise.com/pr/herb_cd.html).  In fact, one site warned that Comfrey should not be taken until further evidence of its safety can be established (www.pharminfo.com/pubs/pnn/pnn37_3.html).  Other reported uses include wounds, sores, bruises, broken bones, and sprains (www.wic.net/waltzark/herbencc.htm).  Religiously, this herb will bring good luck to the user, but must only be used externally or your luck will become bad (www.wic.net/waltzark/herbencc.htm).  Like many of the other ingredients in Epicure Crystal Sports Cream, there appears to be little other than the common use to treat pain that would justify the herbal concoction reported Epicure.

            Although Comfrey is scarcely discussed on many herbal sites, Aconitum Napellus or Aconite is even less popular.  Some circles refer to Aconite as “monkshood” because of the shape of the flower, which appears to be protective (www.medicinegarden.com/ne/aconite.html).  It is recommended to be taken orally when feeling anxious, fearing death, heavy head, vertigo, dry mouth, gums are inflamed, red eyes, chest pressure, throat irritation or experiencing chills (www.medicinegarden.com/ne/aconite.html).  Interestingly, there were no sites that described this herb’s uses in topical treatment.  Although, this may be due to Aconite’s lack of discussion of the Web in general and not due to unreported use of the herb as an external remedy. 

           

 

Arnica Montana or Leopard’s Bane Root is a widely used herbal remedy.  More than 100 homeopathic drug preparations use this plant as a main ingredient (www.kcweb.com/herb/arnica.htm).  The active components are sequiterpene lactones, “which are known to reduce inflammation and decrease pain” (www.kcweb.com/herb/arnica.htm).  This process works by increasing white blood cell activity, especially those that digest congested blood, and releasing built up fluids from bruises or joints and muscles (www.kcweb.com/herb/arnica.htm).  The most common uses for this herb are arthritis, burns, ulcers, eczema, and acne, but it also has strong anti-bacterial and anti-inflammatory properties  (www.kcweb.com/herb/arnica.htm).  Arnica is also mentioned as a good first aid salve for sport injuries and discomforts (www.mothernature.com/ency/Homeo/Athletic_Support_hm.asp). 

   

        Among Epicure Crystal Sports Cream’s ingredients is the perhaps the most talked about herbal remedy on the Internet; Hypericum Perforatum or St. John’s Wort is a well known treatment for mild depression, although that statement has yet to be proven by rigorous clinical study.  Despite the large discourse on St John’s Wort, many sites disregard its uses in external treatment.  Some claim that St. John’s Wort is a great treatment for wounds or burns, but do not discuss why an anti-depressant would work in such a way (www.pharmor.com/index_vit_spec.html).  Reportedly, this herb’s 2,400-year safe history includes external uses such as ulcers, arthritis, menstrual cramping, sprains, bruises and varicose veins (www.kcweb.com/herb/stjohn.htm).  The reason for the many wide-ranging curative properties of this plant derives from its more than 50 active ingredients (www.kcweb.com/herb/stjohn.htm).  These include hypericin, pseudohypericin, flavonoids, tannis, and procyanidins (www.kcweb.com/herb/stjohn.htm).  However, the only reported side-effect to any sort of use of this herbal remedy was photosensitivity, so it is thought to be a very safe treatment (www.kcweb.com/herb/stjohn.htm). 

            Ledum Palustre or Rosemary is a common cooking aid and is discussed as both a culinary and healing tool.  The most common uses as an external healing agent, which were repeated on many web sites, include stimulating the circulatory system, treating insect bites and stings, arthritis, and muscle pain (www.wic.net/waltzark/herbencc.htm).  Religiously, Rosemary is thought to be a bodily protector or in some cases used to banish unwanted people or spirits (www.wic.net/waltzark/herbencc.htm).                                          

                    The final active ingredient used by Epicure is Ruta Graveolens, better known as Rue.  This herb is used only in external treatments, mainly to treat poisonous bites, skin blistering, or tendonitis (www.wic.net/waltzark/herbencc.htm).  However, some sites warn of possible adverse reactions to the plant, claiming that touching the leaves can result in an uncomfortable rash (www.storeybooks.com/main/herb/he_pages/herb_ids/HG206A.html).  In addition to skin problems and tendonitis, the “herb of grace” as it is sometimes called cures headaches, sprains, toothaches, and earaches (www.herblink.net/herblink/124ru.htm).  However, this particular remedy should not be taken while pregnant and may cause heavy menstruation (http://www.herblink.net/herblink/124ru.htm). 

            The result of a web search on the nine active ingredients listed under Epicure’s herbal sports cream leaves a lot of unanswered questions.  Although most of these herbal information sites reveal success with treating general aches, pains, and bruises, they do not direct the consumer to use the products for sports related injuries.  In addition, none of the sites surveyed revealed any possible interaction effects among the different herbs.  For the safety of the consumer, this is an important topic.  When evaluating comments on the Web, it is important to look at the reliable information that supports these claims.  The second half of this paper is intended to give a review of the scientific evidence of the Internet statements described previously.

 

PART II

 

            A review of scientific literature proved ineffective in supporting the claims suggested by Internet literature describing Bellis perennis.  Research that may or may not contribute to any such claims about this plant result from European research and were not able to be translated for report here.  However, I will give a brief description of the translated abstracts obtained on MEDLINE.  Avato et al. (1997) report that the essential oil of the common daisy has two components that show some degree of “antimicrobal activity”.  These compounds are deca-4, 6-diynoic acid and deca-4, 6-diyne-1, 10-dioic acid.  Based on the information in the abstract, no concrete claims about possible anti-bacterial effects can be made.  A separate study tested the in vitro and in vivo antifungal properties of Bellis perennis, but the results are unable to be discussed here (Desevedavy et al 1989).  Because of the uncertain amount of literature and the inability to analyze it critically, this herb remains a mystery and that should be considered when using any product which uses it.

            Calendula officinalis has a breadth of literature, which suffers from similar translation and availability problems as the common daisy.  Despite these restrictions, Park et al. (1998) report that lutein from Marigold extract can reduce breast tumor development.  Using mice bread with for developing a certain type of mammary tumor and a separate group inoculated with tumor cells (n=20/treatment), the authors compared different diets containing 0.002, 0.02, 0.2, and 0.4 % lutein from Marigold extract.  The results showed that the lower doses (0.002-0.02%) significantly lowered tumor incidence at a P<0.05 level.  This study hints at a potential cancer fighting agent in Marigold extract, but this is not mentioned in the Internet literature.  In addition, this study uses Marigold taken orally as opposed to used topically.  This prevents any generalization to the ingredient found in Epicure Crystal Sport Cream. 

            Other studies on Marigold’s healing properties suggest that it can reduce reverse transcription of HIV-1 in controlled cell cultures (Kalvatchev et al. 1997).  However, this has not been proven in human trials.  Research on Marigold’s anti-inflammatory effects does exist, but these articles could not be obtained.  Loggia et al (1994) report that triterpenoids are effective in reducing inflammation, but Calendula officinalis has many active components (Abstract).  In addition to its healing properties, Marigold has been shown to genotoxicity in heterozygous diploid D-30 of Aspergillus nidulans (Ramos et al 1998).  This has no generalizing effects to humans, but is an example of the potential danger observed with Calendula officinalis.  In conclusion, Marigold may be an important active ingredient in Epicure Crystal Sports Cream by providing anti-inflammatory effects, but other assumptions made about the herb lack significant research.

            On of the most popular and most researched herbs on the ingredient list for Epicure’s sports cream is Echinacea.  However, researchers are more interested in the effects of this drug when taken orally.  Several review articles include discussion of this herb and its potential hepatoxicity (Hill and Van Haselen 1996; Miller 1998; Ness et al. 1999).  This is of particular importance to those who use steroids because it may increase the risk of hepatoxicity (Miller 1998).  Hill and Van Haselen (1996) examined the effects of Prrrikweg gel on insect bites.  This homeopathic gel includes Echinacea and Ledum Palustre, which are both ingredients in Epicure’s sports cream.  The study demonstrated that this gel is unable to relieve itching, but the methodological design of the experiment cannot be evaluated.  Final evaluation of this herb is that not much is known about how it affects humans when applied topically. However, since there are some athletes who use steroids, any product that contains this herb should be considered an increased risk to hepatoxicity.

            Little research exists on Comfrey and its efficacy in treating pain or swelling.  Hirono et al. (1978) reports that the pyrrolizidine alkaloids in Symphytum officinale increase the rate of tumors when fed to rats as compared to controls.  In all conditions of experimental group, 3 groups eating different parts of the plant (leaf, stem, and root), there was an increased rate of tumors.  No studies were found that discussed the topical treatment, human subjects, or efficacy of the herb.  This herb has no standing for its claims and could poses potential cancer causing agents.

            Aconitum Napellus may be widely used by homeopaths but there are some side effects to its use.  According to Ameri  (1998) the most active components in this herb are the Aconitum Alkaloids.  These components activate voltage gated NA+ channels and block the reuptake of adrenaline.  This causes an inexcitability and suppression of pain transmission at the neuronal level.  However, too much of this can be toxic.  The author suggests that the next important step to studying this herb is to develop a dose dependent curve for neurotoxicity, which will better allow physicians and homeopaths to understand what dosages are safe.  As with the other Epicure ingredients, this drug has no substantial literature to link it to treating sports injuries, or to support the various other curative suggestions mentioned on the Web.

            Ernst and Pittler (1998) reviewed the efficacy of homeopathic Arnica, which is the most frequently studied placebo-controlled herbal remedy.  Of the eight studies reviewed, all had severe methodological flaws that prevent any concrete conclusions.  Many of these shortcomings include high dropout rates, no randomization, or extremely small sample size.  The authors conclude that the curative use of Arnica Montana for sore muscles, pain, or trauma is not justified in the scientific literature.  In addition, both Kaziro (1984) and Hart et al (1997) report an increased swelling and pain in patients who just had their wisdom teeth removed and no effect on abdominal hysterectomy recovery respectively.  Both of these studies were double-blind, placebo controlled studies and provide the best methodological evidence for any curative effect of Arnica.  Additionally, Vickers et al. (1998) reported no effect for decreasing pain 400 long distance runners in a randomized, double-blind, placebo controlled trial.  Because this plant seems to provide mixed results in clinical studies and is not viewed by the scientific literature as providing significant scientific evidence for its use, it’s use in Epicure’s sports cream remains unjustified. 

            St John’s Wort has a similar place to Echinacea in the scientific literature; there is an abundance of studies that report the effects of this herb when taken orally, but very little when administered via the skin.   Ness et al. (1997) reviewed the literature on St. John’s Wort and concluded that it is effective in treating mild depression to the factor of 2.7 x more than placebo, but it may have the side effects of dizziness, dry mouth, fatigue, constipation and nausea.  No studies of topical treatment were discussed, and none were found.  In light of this finding, one must again question the justification of its inclusion in Epicure’s sports cream.

            Rosemary and Rue are not adequately discussed in the scientific literature.  Only one abstract was located which reported that alopecia areata was treated successfully by an essential oil of rosemary.  However, this study had a low sample size (n=8) and the dermatologists who applied the procedures were not blind.  In addition, Hill and Van Haselen (1996) reported the ineffectiveness of a gel with Rosemary to relieve the itching of an insect bite.  I found no applicable studies relating to Rue that could be discussed here.   

            The conclusion of this review of scientific literature is that it is scarce, diverse, and generally unsupportive of any justification in the use of Epicure’s sports cream or the sister claims made by herbal sites on the Internet.  Whenever using a herbal remedy or cure, be sure to consult a physician or be extremely critical of the research and/or claims made on the Internet.  They remain unmonitored and lack control of the Federal Drug Administration (FDA).  If you are considering using Epicure Sports Cream, be aware of the lack of scientific evidence supporting Epicure’s claims and be sure to consider the possible adverse effects associated with the ingredients. 

 


Works Cited

Ameri A. (1998).  The effects of Aconitum alkaloids on the central nervous system.  Progression in Neurobiology, 56: 211-235.

 

Avato P, Vitali C, Mongelli, & Tava A. (1997).  ABSTACT: Antimicrobal activity of polyacetylenes from Bellis perennis and their synthetic derivatives.  Planta Med, 63(6): 503-507.

 

Della Loggia R, Turbaro A, Sosa S, Becker H, Saar S, & Isaac O. (1994).  The role of triterpenoids in the topical anti-inflammatory activity of Calendula officinalis flowers.  Planta Med, 60(6): 516-20.

 

Deseveday C, Amoros M, Girre L, Lavaud C, & Massiot G. (1989).  ABSTACT: Antifungal agents: in vitro and in vivo antifungal extract from the common daisy, Bellis perennis.  Journal of Nat Prod, 52(1): 184-85.

 

Ernst E, & Pittler MH. (1998).  Efficacy of Homepathic Arnica.  Archives of Surgery, 133: 1187-1190.

 

Kaltvatchev Z, Walder R, & Garzaro D. (1997).  Anti-HIV activity of extracts from Calendula officinalis flowers.  Biomedicine and Pharmacotherapy, 51:176-180.

 

Kaziro GSN. (1984).  Metronidazole (flagyl) and Arnica Montana in the prevention of post-surgical complications, a comparative placebo controlled clinical trial.  The British Journal of Oral and Maxillofacial Surgery, 22: 42-49.

 

Hart O., Mullee MA, Lewith G, Miller J. (1997).  Double-blind, placebo controlled, randomized clinical trial of homeopathic arnica C30 for pain and infection after abdominal hysterectomy.  Journal of Royal Society of Medicine, 90: 73-78.

 

Hay, IC, Jamieson, M., & Ormerond (1998) ABSTRACT: Randomized trial of aromatherapy.  Successful treatment for alopecia areata.  Archives of Dermatology, 134(11): 1349-52.

 

Hill, N, Stam, C, Van Haselen, RA (1996).  ABSTRACT: The efficacy of Prrrikweg gel in the treatment of insect bites: a double-blind, placebo controlled clinical trial.  Pharmacology World Science, 18(1): 35-41.

 

Hirono, Iwao, Mori, Hideki, & Haga, Masanobu ((1978).  Carcinogenic Activity Symphytum officinale.  Journal of the National Cancer Institute, 64(3): 865-868.

 

Miller L G. (1998).  Herbal medicine: selected clinical considerations focousing on known or potential drug-herb interactions.  Archives of Internal Medicine, 158(20): 2200-2211.

 

Ness J, Sherman F, & Pan CX. (1999).  Alternative Medicine: What the data say about common herbal therapies.  Geriatrics, 54(OCT): 33-43.

 

Park JS, Chew BP, Wong TS. (1998).  Dietary Lutein from Marigold Extract Inhibits Mammary Tumor Development in BALB/c Mice.  Journal of Nutrition, 128:1650-1656.

 

Ramos A, Edreira A, Vizoso A, Betancourt J, Lopez M, & Decalo M. (1998).  ABSTRACT: Genotoxicity of an extract of Calendula officinalis L.  Journal of Ethnopharmacology, 61(1): 49-55.

 

Vickers AJ, Fisher P, Smith C, Wyllie SE, & Rees R. (1998).  ABSTACT: Homeopathic Arnica is ineffective for muscle soreness after long distance running: a randomized, double-blind, placebo-controlled trial.  Clinical Journal of Pain, 14(3): 227-31.

 

Internet Cited Web Addresses/Links

 

www.choicemail.com/epicure

 

www.botanical.com/botanical/mgmh/d/daisyc03.html              

 

www.virtualciti.com/sushruta/pages/researcher.htm

 

www.medicinegarden.com/ne/bellis_perennis.html

 

www.mothernature.com/ency/Homeo/Athletic_Support_hm.asp

 

www.kcweb.com/herb/herbmain.htm

 

www.vineherbal.com.html

 

www.vineherbal.com.html

 

www.mothernature.com/ency/Herb/Calendula.asp

 

www.pharmor.com/index_vit_spec.html

 

www.mothernature.com/ency/Herb/Echinacea.asp

 

www.kcweb.com/herb/echin.htm

 

www.healthrise.com/pr/herb_cd.html

 

www.pharminfo.com/pubs/pnn/pnn37_3.html

 

www.wic.net/waltzark/herbencc.htm

 

www.medicinegarden.com/ne/aconite.html

 

www.kcweb.com/herb/arnica.htm

 

www.kcweb.com/herb/stjohn.htm

 

www.storeybooks.com/main/herb/he_pages/herb_ids/HG206A.html

 

www.herblink.net/herblink/124ru.htm

 

 

 

 

 

 

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