The potential contribution of herbal medicine and home remedies strategies as part of the response to the crisis of anti-biotic resistance.

When he received the Nobel Peace Prize on 1933 Alexander Fleming warned that the newly uncovered anti-microbial activity of mould against bacteria, became diminished over time. In the flush of excitement over the potential of these new and genuinely wonderful drugs, the early observations were ignored as the medical profession, the pharmaceutical industry and agri-business promoted prophylactic use patterns that accelerated the growth of bacterial resistance to them. In subsequent years, many have warned of the potential catastrophe of a post anti-biotic era. In 2012 Dr Margaret Chan Director of the World Health Organisation, made this call for action:

“A post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill. Some sophisticated interventions, like hip replacements, organ transplants, cancer chemotherapy, and care of preterm infants, would become far more difficult or even too dangerous to undertake. At a time of multiple calamities in the world, we cannot allow the loss of essential antimicrobials, essential cures for many millions of people, to become the next global crisis.”

Although the implications of the growth of antibiotic resistance has been understood and anticipated for many years, the global response to date, has been slow and ambivalent. Co-ordinated efforts to put in place policy to address the crisis at a global community level have begun, but remain embryonic and only partially effective. (1)

The drive to find solutions from within a market led pharmaceutical industry may be curbed by the lack of return inherent from investing to develop products that will likely be obsolete within a relatively short time frame.

On the other hand science continues to uncover extra-ordinary and wondrous insights into the world of micro-biology that may well lead to medium and longer term solutions or part solutions. We cannot be sure yet how this will evolve, but for example recent understanding of bacterial communication systems shows exciting promise. (2)

As with all complicated problems, it may well be that the solutions also need to be complex and multifaceted. In this context, this article sets out to explore the possible contribution of herbal medicine, and home remedies in particular to this crisis.

The impetus to do so does not flow from an ideological attachment to high tech over low tech, or ‘natural over ‘pharmaceutical’ but from the following four assertions:

Most of us will have cause to be grateful for the existence of effective pharmaceutical antibiotics at some point in our lives – either for ourselves of for serious ill loved ones. Given this, it becomes our collective responsibility to develop behaviours and strategies that preserve their use and subsequent efficacy for the times when we really need them.
We have at least four thousand years of medical writings, case histories and anecdotal record of various culture’s struggle against infection. To compliment this we have contemporary scientific tools to examine this evidence further. It is some kind of arrogant and illogical madness not to take advantage of this knowledge.
We have learnt the bacteria quickly evolve strategies to counteract initially deadly single compound antibiotics and have responded to this by introducing multi-compound drugs. In addition it may be time to consider the possibility that employing a shifting target of constantly evolving complex combinations of chemical compounds ( i.e a whole plant extract) may confound resistance and offer acceptable efficacy in some circumstances.
Modern insights into the role of bacteria in the function of human physiology have begun to shape a paradigm shift away from silver bullet solution/conflict and colonisation metaphor - germ theory, towards a more ecological perspective. (3,4) In this context and with complex whole plant extracts it may not always be necessary to wipe out every single pathogen in a colony. To use a gardening/agricultural analogy, we are moving away from the impetus to attain sterile monocultures and beginning to understand the strength and potential sustainability of - for example – a forest garden where interconnection is valued and effort is focussed on nourishing the growing environment to nurture and promote the establishment of useful/desirable plants, with occasional weeding when one species becomes dominant and begins to threaten diversity.

What can we do as Individuals

The first step is to educate ourselves about the problem. A second may be to re learn/re define protocols for taking responsibility for our own health and understanding what is safe to treat home, and when it is that we need to seek skilled help. A third may be to explore the role of home remedies as alternative strategies to combat infection.

Understanding the problem

We have understood for some time that prophylactic (just in case) use of antibiotics by the medical profession along with routine daily medication of livestock contributed to the current problem. Policies are beginning to be put in place to address this with in at an international, national and local level eg. restrictions to livestock feeding, prescription guidelines to GPs etc. (5,6, 7)

For the individual, it may be important to distinguish between when antibiotics may have a role, and when their deployment is pointless, counterproductive, anti-social, or all of the above.

A very simple first rule is that antibiotics (when they remain effective) work against some bacteria, but are ineffective, and always have been, to all viruses. Many of the everyday infections we deal with at home are caused by viruses - for example flu, colds, most sore throats. Certainly a body weakened by a viral infection can be susceptible to a secondary bacterial infection – especially if that body is weak or vulnerable. But this is exactly why we need the antibiotics to remain effective, so as to be of use in these scenarios. Bacteria replicate rapidly; using antibiotics against them selects for resistant species. Continually exposing bacteria to antibiotics enables them to develop and communicate avoidance strategies. From the point of view of the individual, a course of antibiotics may disrupt the finely balanced internal ecologies that form part of our protection against infection/domination by one particular species – bear in mind we host more individual bacteria than we have cells in our bodies.

So three questions arise in the presence of infection:

Is the infection viral or bacterial?
If viral, how can the body be supported to resolve without developing a bacterial infection?
If bacterial, then can it be dealt with effectively in some other way than through antibiotics. (Is the individual otherwise strong and healthy, is it the kind of infection one that can initially respond well to herbs – ear infections, urinary tract infections etc.)

This answer to this may be sought with the support of skilled help eg. a GP, a herbalist, another health professional etc.

Home remedy solutions

Part of the point of this article is to argue that antibiotics can be so crucially life saving that we need to look for ways of taking action to preserve their function. However this does not preclude the premise that alternative strategies to combat infection may sometimes also be preferable from an individual perspective as well as a collective one.

In order to explore this, we may need to re-appraise some ingrained assumptions about the nature if infection and germ theory.

It has already been asserted in the introduction, that it is possible, likely even, that the use of whole plant extracts, made up as they are of thousands of chemicals and chemical compounds that that exist in a constantly dynamic cocktail that shift according to the season, the climate, the aspect, the soil type, maybe the phase of the moon, will confound the capacity of bacteria to easily develop resistance.

In the past it has been assumed that resistance notwithstanding, a single compound is stronger, more focussed, more deadly in relation to pathogenic microbes. This may be true in the short term, but the perceived advantage of this capacity relies on the assumption that it is necessary to obliterate the whole of a pathogenic community. In some instances this may be a definite advantage – for example when the host (ie the sick person) is weak or their immune system is functioning poorly; when the host’s immune system does not recognise the pathogen so has not built in specific immunity and the pathogen is virulent and quick to replicate; when these or circumstances conspire so that one pathogen overwhelms the immune system rapidly and a fast acting intervention means the difference between life and death (for example septicaemia). Furthermore in relation to the development of antibiotic resistance it is imperative that no bacteria are left to limp away, regroup and re-turn forewarned and forearmed.

However there are other circumstances when it may not be necessary or even desirable to wipe out an entire apparently pathogenic community of microbes. It may be that some bacteria that would be hostile or pathogenic in large numbers deliver the function or competing against and consequently restricting the numbers of other bacteria that otherwise be hostile or ‘pathogenic’ in large numbers. It is possible that they may be delivering some other function. ( 8)

It is seldom possible to precisely target a specific community of microbes and collateral damage of other species may leave gaps in the ecology that may be readily filled by other opportunistic pathogens.

What this means in practice is that while powerful targeted anti-microbial (be they single or multi-compound) have their uses, they may not always be the tool of preference. Or, that they may sometimes be more effective in conjunction with other strategies.

Herein lies the realm of home remedy interventions.

Herbal Home remedies tools to support the body against infection

Home remedy strategies of course start with diet and nutrition; many of the plants highlighted below are commonly used as foods and flavourings.

Medicinal plants that are useful as home remedies to combat infection and deliver anti-microbial outcomes have properties can be divided in to four categories:

Support the individual
Support/nourish or add to the body’s ‘passive immunity’ and mechanical barriers
Stimulate or activate the body’s ‘active’ or cell mediated immunity
They are targeted antimicrobials in the sense that they are directly bactericidal, fungicidal, or viracidal

Most herbs will contain compounds that have more than one of the above actions; many will contain many compounds that deliver all four.

Herbs that support the Individual

An individual’s susceptibility to infection will relate partly to their own specific circumstances, their weaknesses and fault lines. For example a stressed person will manifest raised cortisol levels that will impact on their immunity; an anxious person may not be digesting their food efficiently so missing out on nutrients; an atopic or allergic individual may be experiencing symptoms that pre-dispose them to infection. Gut health, alcohol consumption, glycaemic index of diet, exercise, smoking, sleep etc. will all be factors. (9, 10,) To some extent theses can be counter-acted by constitutional herbs and a holistic approach. Individual appraisal may best be achieved with skilled help, but perhaps it is all of our responsibility - and a step away from the culture of expert paternalism – to ‘know thyself’, and learn about the herbs that support digestive function, adrenal function, liver function; allay anxiety, promote sleep - or relate to whatever specific issue it is that we is relevant to our own particular individual circumstances.

Herbs to support our mechanical defence systems

Our passive immune system starts with our skin, which acts as barrier to the outside universe. It continues with the mucous membrane that lines our orifices, cavities. And includes the ecologies of micro-flora that inhabit both. Herbs to help here may include those that tone and sooth – plantain (Plantago lanceolata), mallow (Althea officionalis), corn silk (Zea mays), raspberry leaf (Rubus idaeus), and the foods and plants that are pro and prebiotic.

Also the prophalactyc herbs that are consumed ‘just in case herbs’ or because they are delicious in food or drink, that act by promoting an environment that is hostile to pathogens that would otherwise aim to settle in. Examples might include Elderberry (11) (Sambucus nigra) which discourages flu and cold viral adhesion to the mucous membrane of the upper respiratory tract and cranberry (Vaccinium oxycoccos) that does a similar thing in the Urinary tract. (12)

Herbs to support our active or cell mediated immune system

Our active immune system includes of the cascade of inflammatory response; the immune cells that mop up debris after injury or infection; and the specialised cells that learn to recognise and respond to specific pathogenic microbes. The capacity to support active immunity may be unique to herbal medicine. For example herbs such as Samucus nigra, Astragalas species and Echinacea species have been demonstrated to stimulate cytokine production and/or modulate immune response. (13,14,15)

Anti-microbial or microcidal herbs

There is a body of evidence into the anti-microbial properties of plants and plant extracts has been building for decades. Each region and tradition has its own examples. (16, 17, 18) Among them are kitchen staples like garlic, ginger and turmeric. (19, 20, 21)

Many, herbs with promising in vitro (in a test tube) results have yet to be tested clinically (in people). Many scientific papers reviewing the exciting and potentially lifesaving anti-microbial activity of legion plant remedies conclude with the inevitable ‘more research needed’ mantra. (22, 23)

Time to act?

So what is holding things back? Why is the vast resource of traditional herbal knowledge and experience not being exploited effectively to help meet the current crisis. The sometimes spurious, sometimes relevant argument regarding lack of evidence base, masks an intransigency related to ideology and paternalism as well as an inability to move beyond the current paradigm in a genuinely neutral and scientific way. It may be time to seek a community led drive to explore, test and promote our own solutions.

References