Comfrey

• How It Works

  Bottom Line: Comfrey has not been shown to treat or prevent cancer. Several cases of liver toxicity have been reported with its use.

  Comfrey leaves and roots have been used for many centuries to treat several ailments. Comfrey contains two substances that have been found to be biologically active in laboratory tests: allantoin causes cells to increase the rate at which they divide, and rosmarinic acid reduces inflammation and prevents injury to the small blood vessels in the lungs. However, these effects have not been confirmed in humans through clinical trials.
  Many cases of liver toxicity have been reported with use of comfrey.

• Purported Uses
  • To treat bronchitis
    There is no scientific evidence to support this claim.
  • To treat cancer
    This claim is not backed by research.
  • To treat peptic ulcers
    There is no scientific evidence to support this.
  • To improve wound healing
    Laboratory studies show that comfrey leaves have wound-healing effects. Human data are lacking.
• Patient Warnings
  • On July 6, 2001 the U.S. Food and Drug Administration, along with the Center for Food Safety and Applied Nutrition, advised all dietary supplement manufacturers to remove products containing comfrey from the market.
  • Comfrey contains compounds that are toxic to the liver and can cause liver cancer.
• Side Effects
  • Liver damage
• Scientific Name

  Symphytum officinale

• Clinical Summary

  Comfrey is a fast-growing plant whose leaves and roots have been used for centuries to treat many ailments, especially for wound healing.
  A study done in mice indicated that oral comfrey has antiproliferative effects ⁽¹³⁾; the leaves showed wound healing properties ⁽¹⁶⁾; and the root extract was useful in relieving acute back pain ^(14) (17) and osteoarthritis of the knee ⁽¹⁸⁾. However, comfrey contains pyrrolizidine alkaloids that are hepatotoxic and carcinogenic ⁽¹³⁾.
  There is extensive literature concerning hepatotoxicity with use of comfrey ^{(5) (6) (7) (8) (9) (10)}. However, the risk of systemic absorption following the use of topical comfrey preparations is not known.

  Comfrey was used since the 1930s for animal feed, but has been prohibited in Australia and New Zealand. In June 2001, the FDA asked all manufacturers to remove products containing comfrey from the market ⁽¹²⁾.
  Comfrey herbal tea use resulted in several cases of cardiac glycoside poisoning due to misidentification with foxglove as the leaves of both plants look similar ⁽¹⁵⁾.

• Purported Uses
  • Bronchitis
  • Cancer treatment
  • Inflammation
  • Peptic ulcers
  • Rheumatoid arthritis
  • Wound healing
• Constituents
  • Alkaloids (pyrrolizidine-type): Symphytine, symlandine, echimidine, intermidine, lycopsamine, myoscorpine, acetyllycopsamine, acetylintermidine, lasiocarpine, heliosupine, viridiflorine, and echiumine
  • Carbohydrates: Gums (arabinose, glucuronic acid, mannose, rhamnose, xylose), glucose, and fructose
  • Tannins (pyrocatechol-type) 2.4%
  • Triterpenes: Sitosterol and stigmasterol (phytosterols), steroidal saponins, and isobauerenol
  • Other constituents: Allantoin, caffeic acid, carotene, chlorogenic acid, choline, lithospermic acid, rosmarinic acid, and silicic acid
    ⁽¹⁹⁾
• Mechanism of Action

  The mechanism of action has not been elucidated, but the therapeutic properties of comfrey are thought to be based on its anti-inflammatory and analgesic properties.
  Comfrey was shown to stimulate granulation and tissue regeneration, and support callus formation ⁽¹⁸⁾. Allantoin and rosmarinic acid, two important components, are believed responsible for cell proliferation and anti-inflammatory effects ⁽²⁰⁾.

• Warnings
  • On July 6, 2001 the U.S. Food and Drug Administration, along with the Center for Food Safety and Applied Nutrition, advised all dietary supplement manufacturers to remove products containing comfrey from the market.
  • Comfrey contains unsaturated pyrrolizidine alkaloids, which are hepatotoxic and hepatocarcinogenic.
    ⁽¹²⁾
• Adverse Reactions

  Reported: Hepatotoxicity ^{(6) (7) (8) (9) (10)}

• References

  1. Newall C, et al. Herbal Medicines: A Guide for Health-Care Professionals. London: Pharmaceutical Press; 1996.

  2. Schulz V, et al. Rational Phytotherapy: A Physicians Guide to the Use of Herbs and Related Remedies, 3^rd ed. Berlin (Germany): Springer; 1998.

  3. Awang DVC. Comfrey. Can Pharm J 1987;120:101-4.

  4. Tyler V. Herbs of Choice: The Therapeutic use of Phytomedicinals. Binghamton: Pharmaceutical Products Press; 1994.

  5. Ridker PN, McDermott WV. Hepatotoxicity due to comfrey herb tea. Am J Med 1989;87:701.

  6. Ridker PN, McDermott WV. Comfrey herb tea and hepatic veno-occlusive disease. Lancet 1989;1:657-8.

  7. Ridker PM, et al. Hepatic veno-occlusive disease associated with the consumption of pyrrolizidine-containing dietary supplements. Gastroenterology 1985;88:1050-4.

  8. Yeong ML, et al. Hepatic veno-occlusive disease associated with comfrey ingestion. J Gastroenterol Hepatol 1990;5:211-4.

  9. Weston CFM, et al. Veno-occlusive disease of the liver secondary to ingestion of comfrey. Br Med J 1987;295:183.

  10. Roitman JN. Comfrey and liver damage (letter). Lancet 1981;1:944.

  11. Foster S, et al. Tyler’s Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies, 3^rd ed. Binghamton: Haworth Herbal Press; 1993.

  12. FDA advises dietary supplement manufacturers to remove products containing comfrey from the market. Available from http://www.fda.gov/Food/DietarySupplements/Alerts/ucm111219.htm. Accessed April 24, 2014.

  13. Gomes MF, de Oliveira Massoco C, Xavier JG, Bonamin LV. Comfrey (Symphytum Officinale. L.) and Experimental Hepatic Carcinogenesis: A Short-term Carcinogenesis Model Study. Evid Based Complement Alternat Med. 2010 Jun;7(2):197-202.

  14. Giannetti BM, Staiger C, Bulitta M, Predel HG. Efficacy and safety of a Comfrey root extract ointment in the treatment of acute upper or low back pain: results of a double-blind, randomised, placebo-controlled, multi-centre trial. Br J Sports Med. 2009;44(9):637-41.

  15. Lin CC, Yang CC, Phua DH, Deng JF, Lu LH. An outbreak of foxglove leaf poisoning. J Chin Med Assoc. 2010 Feb;73(2):97-100.

  16. Araújo LU, Reis PG, Barbosa LC, et al. In vivo wound healing effects of Symphytum officinale L. leaves extract in different topical formulations. Pharmazie. 2012 Apr;67(4):355-60.

  17. Pabst H, Schaefer A, Staiger C, Junker-Samek M, Predel HG. Combination of comfrey root extract plus methyl nicotinate in patients with conditions of acute upper or low back pain: a multicentre randomised controlled trial. Phytother Res. 2013 Jun;27(6):811-7.

  18. Laslett LL, Quinn SJ, Darian-Smith E, et al. Treatment with 4Jointz reduces knee pain over 12 weeks of treatment in patients with clinical knee osteoarthritis: a randomised controlled trial. Osteoarthritis Cartilage. 2012 Nov;20(11):1209-16.

  19. Staiger C. Comfrey: a clinical overview. Phytother Res. 2012 Oct;26(10):1441-8.

  20. Andres P, Brenneisen R, Clerc JT. Relating antiphlogistic efficacy of dermatics containing extracts of Symphytum officinale to chemical profiles. Planta Med. 1989;55:66–67.