Wellness

Arnica Nation

How does a traditional folk remedy grow in popularity despite lingering questions about its safety and efficacy?


Thursday, February 03, 2011

When I fell skiing a few weeks ago, I wounded more than my pride. It was a full-blown face plant, with my arms outstretched and a ski pole in each hand. When I landed, I sprained my thumb.

It wasn't bad enough to keep me from skiing, but I made sure to get ice on it—a snowball, actually—right away.

When I told one of the people I was skiing with what I'd done, she glanced at the swollen thumb joint and said, flatly, "Arnica. I have some gel in my car."

I think she thought I was going to put up a fight. A look crossed her face that told me she was just about to start making a case for the anti-inflammatory herb when I promptly agreed to accept her offer. As we skied down to her car, she said a few things about how great arnica is for treating various sports-related injuries; I smiled and nodded and thanked her again for her kindness.

I squeezed about an inch of the gel out of the tube and onto my thumb and wrist and worked it into the area that hurt. We hit the lifts and I kept icing it throughout the day.

I think my friend might have been a little disappointed that I accepted her arnica so matter-of-factly, though surely she knows that, in places like the Valley, you're as likely to find people who know about and embrace holistic and complementary medicine in any or all of its many branches as you are to find people who hug tight to medicine's mainstream. Still, I explained that my wife had turned me onto the wonders of arnica, and a host of other healing plants, many years ago.

"Oh, right," she said, smiling the conspiratorial smile that's shared among cognoscenti.

If I'd lost a few points for my lack of grace on skis, I like to think my obvious faith in arnica gained me a few points back.

*

As I say, arnica montana is hardly a secret. The yellow-flowered, aromatic herbaceous perennial—you might call it an alpine daisy—has been used in folk medicine for centuries, particularly in its native Europe, where it is still a common remedy for aches and pains.

The plant is known by many names, including mountain tobacco or mountain snuff, wolfsbane and leopardsbane, but in the world marketplace, arnica is the name that matters, the brand.

Arnica products find wide distribution in Europe and in countries like New Zealand, where arnica-based ointments and gels, as well as tinctures and homeopathic pills, grace the shelves of nearly every grocery store, department store and drugstore, not just the so-called "health food" markets or vitamin and supplement boutiques.

In the U.S., despite a fair amount of favorable publicity—integrative medicine guru Dr. Andrew Weil has long promoted its use, as does Lance Armstrong's Livestrong foundation with the imprimatur of Memorial Sloan-Kettering Cancer Center—the botanical isn't quite as widely distributed as it is abroad, but that's changing.

Large homeopathic medicine companies such as Boiron and Weleda are household names in Europe, and both companies unabashedly promote homeopathic medicine and holistic agricultural philosophies.

Boiron, a $730 million public company in France with 4,000 employees and distribution in more than 80 countries, refers to itself as a "pharmaceutical company." It puts out press releases that describe the basic sales strategy—and growth opportunity in the U.S.—for products like its "Arnicare" arnica-based line of pain relievers. "Fifteen percent of the shoppers said they have used homeopathic medicines for themselves, and 14 percent said they have used homeopathic medicines for their children in the past 12 months," Boiron announced in May, 2009, based on a study from one of Washington D.C.'s top marketing firms. "This most recent study aligns with other Hartman Group studies that point to health and wellness no longer being a niche market dominated by a small group of consumers... a long-term change that reflects how consumers view their lives and the products they purchase. Symptomatic of this, 27 percent of shoppers have successfully used a natural/alternative OTC [over the counter] medicine in the past, and an additional 55 percent who have not tried these products are interested."

Weleda, established in 1921 in Switzerland, has a somewhat softer identity than Boiron's. It claims to draw on "the largest medicinal gardens worldwide [growing] over 300 species using the strictest of organic methods ... following Demeter certified biodynamic standards& working with fair trade farmers around the world ... protecting and developing these farming communities with respect for the environment and people."

In marketing, Weleda and its distributors promote a lifestyle as much as a medicine. "An alpine flower that's much valued for winter sports is Arnica montana. After a demanding day on the slopes, Weleda's biodynamic Massage Balm with Arnica will soothe tired, aching muscles," reads an ad in the U.K. "This gorgeously silky massage oil has remained Weleda's all-time top selling natural remedy since the company, the original green pioneers, began in the 1920s. It's made with organic arnica grown in the Scottish Black Isle where the strong light and long midsummer days (up to 21 hours) aid the constant formation of very prolific flowers."

The biggest U.S.-based homeopathic remedy company, Hyland's, makers of a popular natural pain reliever for teething infants—a homeopathic product widely available in regular supermarkets, surprisingly enough—made a big push into arnica-based products two years ago. "Arnica is one of the most renowned remedies for trauma when there is soreness and tenderness involved," said J.P. Borneman, CEO of Hyland's, Inc. in May, 2009. Hyland's clearly sees arnica as a growth market, Borneman said, not just in the United States but worldwide, thanks to changing public attitudes and behaviors: "We know that our customers lead busy, active lives and feel confident that our new muscle therapy product line will help them maintain their physical health while doing so."

From big, publicly traded companies to the plant and soil science departments of some of the world's greatest universities, arnica is big, serious business internationally, supported by an agricultural industry in which farmers and plant scientists work constantly to improve the yield of arnica and the extraction of its active ingredient: helenalin.

The sesquiterpene lactone known as helenalin, the substance found in arnica that (and this much is pretty much beyond dispute) gives the plant its anti-inflammatory properties, is also the main source of controversy surrounding its use as a homeopathic remedy—at least in the U.S., where scant reports of a lethal arnica poisoning and warnings attributed to the Food and Drug Administration have even the plant's biggest boosters hedging with disclaimers of their own.

*

There's something schizophrenic about a lot of medical information available to the public, so devotees of arnica probably shouldn't take it personally, but even publications, like The Vitamins and Supplements Guide, that enthusiastically promote arnica's use offer the starkest of warnings: "When used frequently or for long periods, arnica can cause contact dermatitis or eczema. Some people may experience stomach discomfort, including nausea and vomiting. Liver and kidney damage has also been reported. Other side effects may include muscle weakness, organ damage, coma and death. Overdose of arnica extract has resulted in poisoning, with toxic symptoms, such as vomiting, diarrhea, and hemorrhage, even death. Use externally with caution, and only in dilute preparations. Arnica should not be used on broken skin, such as leg ulcers. Also, people who are hypersensitive or allergic to the herb should avoid it. Oral use of arnica and topical use of arnica on broken skin and open wounds is considered unsafe because sesquiterpenoid lactones in arnica, such as helenalin, are intensely poisonous and cardiotoxic."

Lance Armstrong's Livestrong site also promotes arnica: "Arnica may help treat bruises and contusions from traumatic injuries caused by blunt objects, according to the University of Michigan Health System. Arnica may also help relieve soreness and bleeding from surgery, dental work, sprains, strains and physical exertion. Arnica is commonly recommended for promoting wound healing and as a treatment for minor injuries." But Livestrong also warns: "Little medical research has evaluated arnica's safety and efficacy for treating bruises, so you must consult your doctor before using arnica. You should also seek a licensed professional homeopath to administer arnica remedies... The U.S. Food and Drug Administration has deemed arnica an unsafe herb for internal use because it has caused negative effects on the uterus, lungs and hearts of some users... Ingesting arnica in oral remedies might cause gastrointestinal distress, difficulty breathing, heart problems, coma and even death."

Andrew Weil's warning sounds only slightly less like a disclaimer: "Some people are sensitive to the compound helenalin found in arnica. If you develop a mild rash, then you are probably helenalin-sensitive and should stop using arnica. ...Arnica is toxic if it gets inside the body. Never apply arnica in any form on broken skin or on an open wound. Never take arnica internally unless it's in the form of homeopathic pills that contain too little arnica to cause harm."

Despite such warnings and some apparent concern registered by the FDA, however, the popular view of arnica—even the view of critics— isn't overly hysterical.

In an article in the Daily Mirror just last week, British physician Dr. Miriam Stoppard lumped arnica into a diatribe against "alternative remedies" as "dangerous for children—and even fatal." Stoppard listed arnica, however, as one of only two remedies that are safe for babies, "but they have the drawback of not being effective at all. ... Quality studies have shown that arnica is totally ineffective for bruises and swelling."

*

For those of us who believe—or maybe just want to believe—in folk remedies like arnica, the rising awareness and prolific use of the plant medicinally hasn't done much to clear up the longstanding debate between adherents of homeopathy and those who'd call it quackery. A wide complaint among medical practitioners, one frequently seconded by the industry that supplies arnica and other homeopathic medicines, is a dearth of "quality studies" to ultimately prove or disprove that homeopathic treatments work.

As an avid recreational athlete, I live for "quality studies." And as a 30-year habitual reader of recreational sports publications like Runner's World and Skiing Magazine, I've read about a lot of studies, scientific investigations pertaining to matters of athletic performance, optimized health and fitness, and prevention and treatment of injuries. There has been some research into arnica, but the stories about research that have filtered into sports magazines over the years, like the research itself, reach no more dramatic conclusion than this: arnica may be mildly effective at reducing inflammation.

A 2003 study of marathon runners in Norway, probably the most dramatic of the studies so far, concludes that a small dose of homeopathic arnica—five pills administered orally twice, before and after the race—worked better than a placebo for relieving muscle soreness immediately after marathon running. The study, however, found no increase in the rate of repair of "cell damage as measured by enzymes."

An earlier study of arnica and long-distance running concluded that arnica was ineffective as a remedy for soreness. Information about the efficacy of gels and ointments remains largely inconclusive at this point.

*

So, given warnings about not getting arnica into an open wound, about the risk of lethal toxicity or, at the very least, a case of dermatitis, why not just take Ibuprofen and call it a day?

In the 30 years that I've been receiving medical care in Massachusetts for sports-related maladies, I have never encountered a physician who pushed hard for or against arnica—or any other homeopathic medicine, for that matter. At some point, most massage therapists and physical therapists have at least mentioned arnica to me, along with a host of herbs, essential oils and other natural health products. Such recommendations have always been offered not in a prescriptive tone, but in the spirit of, "Hey, this might work for you."

Never, ever in my long history have I encountered a physician, a massage therapist, physical therapist, EMT, ski patroller or any other person who deals with injured athletes who failed to remind me to take Ibuprofen to reduce inflammation.

For many of us who seem to gravitate easily toward alternative, some might say faddish remedies, the use of arnica and Ibuprofen and other anti-inflammatories isn't necessarily an either-or question. Nor does the possibility that arnica is mainly a placebo necessarily discount its use.

The minute I got home from skiing and bashing my thumb that day, I took three 200-milligram tablets of Ibuprofen. I continued to use Ibuprofen for several days while also frequently massaging the injured area with arnica.

RICE: Rest, Ice, Compression (oh, and I wrapped my thumb and wrist in an ace bandage) and Elevation (kept my arm up)—this is the injured athlete's mantra.

Arnica is just one more arrow in the quiver, effective or not.

Clearly, whatever the outcome, my anecdotal evidence is just that: anecdotal. Moreover, I pretty much trampled the idea of experimental controls when I introduced the Ibuprofen into the equation.

But for me, the only real goal was to heal my hand up enough to make a proper pole plant without wincing, and whether it was the arnica, the Ibuprofen, the snowball or the half-hour I spent running the virtual slalom on my daughter's video game, my hand got better. The swelling and discoloration never got too bad and my range of motion returned to normal in a few days. If I had to stand firmly on any point about my recovery, it would be this: the massage, with or without arnica, did as much to speed recovery as anything. I think the arnica helped, but who knows?

Of course, since then, I've taken another pretty good spill. When the woman who gave me arnica for my thumb found out I'd hurt my shoulder falling into fresh powder snow—I thought it was supposed to be soft!—she sent me a one-line email that shows that those of us in Arnica Nation often think alike: "I hope you hit the arnica and Ibuprofen!"

What else would I use?

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