Herb of the Month – Mistletoe or Viscum Album L

🌿This month’s Herb of the Month is Mistletoe or Viscum album L
Family: Viscaceae/Santalaceae

🌿 Botanical name and description

Mistletoe (Viscum album L.) belongs to the Santalaceae family, formerly Viscaceae, and is native to Europe, Asia and Africa (5). Mistletoe is an evergreen woody shrub (perennial) with small leathery leaves with flowers that ripen into semi-transparent white berries, and grows on deciduous and coniferous trees (hemi-parasitic) (7).  It’s stems range from 40-100cm in length with long oval shaped leaves that are light-green/yellow in colour (6). The aerial tops of the plant are used for medicinal purposes, and can be found wrapped around the stems and leaves of their hosts at the crown of the tree (5). Common hosts in European regions are pines, oaks and maple trees, with kola nut, cocoa and cashew trees being hosts in Asia and Africa (5). Mistletoe enjoys a continental climate with cold winters and warm summers (5). 

🌿 History and traditional use:

In ancient times, the European Mistletoe was viewed as a mythical plant and a remedy for various diseases, and has been studied for more than 2000 years for its medicinal uses (4). Mistletoe has long been considered a pagan religious symbol of prosperity and good fortune, and was believed to have magical properties in the traditions and rituals of the Celtic Druids (4).  It is reported that the Druids collected the plant from oak trees and used it as a “panacea”  to cure any disease (4).  Historically, Hildegard von Bingen used Mistletoe for the treatment of the spleen and liver, Hippocrates used the plant for menstruation complaints, and Paracelsus recommended mistletoe for epilepsy, infertility and ulcers (5).  In the Middle Ages, Mistletoe was used for conditions of the lungs, labour pains, to deworm children, treat gout, leprosy, and hepatitis, and is documented in the Dioscorides De Materia Medica (7).  During the eighteenth and nineteenth century, Mistletoe was used predominantly for oedema associated with a weak heart, and to reduce blood pressure, and in 1920, Rudolf Steiner introduced Mistletoe as a treatment for cancer patients based on his anthroposophical medicine traditions (7).  In non European parts of the world, Mistletoe was used for hypertension, heart spasms, rheumatic pain, threatened abortion, and locally to treat frostbite (Japan) (4). In India, mistletoe leaves were used as a tea to treat diabetes and fevers with aching limbs. In Africa, Mistletoe was administered as an enema to treat diarrhoea and stomach infections, whilst in Israel, it was used to treat constipation in young children and adults alongside backaches and arthritis (4).  In Egyptian traditional medicine, Mistletoe was used to treat epilepsy, and diseases of the heart (7).

🌿 Actions and usage today

Mistletoe is a potent cardiovascular herb known for its hypotensive and vaso-relaxant effects via the up-regulation of the nitric oxide (NO) pathway which reduces both systolic and diastolic blood pressure (1).  As it’s mechanism of action is via the NO pathway, studies have shown that Mistletoe, alongside pharmaceutical medication can benefit patients with heart failure (1).  Furthermore, Mistletoe exhibits hypoglycaemic actions, thereby preventing many complications associated with insulin and non-insulin dependant Type-2 diabetes (6).  Additionally, Mistletoe has displayed renal protective actions in patients with diabetes induced kidney disease, and may normalise liver enzymes in patients with fatty liver caused by metabolic syndrome (6).  One of the most well known uses of Mistletoe today is as an anti-cancer, anti-tumour and cytotoxic agent, especially in breast cancer patients due to its anti-mutagenic and immunomodulatory mechanisms displayed in clinical trials (2).  Today, Mistletoe is used for its sedative, anxiolytic, anti-epileptic and anti-depressant actions to alleviate disorders such as nervous spasms, psychosis, dizziness and headaches (7).

🌿 Science and clinical trials:

The research on Viscum album primarily focuses on its anticancer properties with clinical studies demonstrating that Mistletoe therapy may enhance quality of life, prolong survival, and induce tumour regression (2). The key phyto-chemicals in Mistletoe include lectins and viscotoxins, known for their apoptotic and cytotoxic effects in cancer treatment (2). Additionally, phenolic acids, phenyl-propanoids, and flavonoids possess antioxidant and anti-inflammatory properties (1,5). Mistletoe also contains triterpenes, phytosterols and oligo/polysaccharides which also display cytotoxic, apoptotic, and hepatoprotective actions in vitro (4,6)In breast cancer patients, Mistletoe has been shown to induce the release of immune related cytokines, protect DNA, and inhibit the COX-2 pathways (2,5). Furthermore, Mistletoe reduces neutropenia, fatigue and insomnia in cancer patients, and releases beta-endorphins which improve mood, pain levels, appetite, and a tolerance to the adverse effects experienced during oncological therapies (3). Qualitative studies have also reported that patients taking therapeutic doses of Mistletoe experience increased vitality, warming sensations, and a reduced susceptibility to infections (6).

Recent studies have investigated the neuropharmacological potential of Mistletoe extracts, particularly for Alzheimer’s disease treatment in in vitro experiments (7).  Mistletoe’s inhibitory effects on amyloid-β protein and hydrogen peroxide-induced neurotoxicity, as well as its neuro-protective properties via the stimulation of brain-derived neurotrophic factor (BDNF) in the brain are believed to be the mechanisms involved (7).  Additionally, there is evidence that Mistletoe could be used as a complementary therapy for epilepsy patients alongside pharmaceutical treatment to improve overall therapeutic outcomes (7).

🌿 References:

  1. Karagöz A, Kesici S, Vural A, Usta M, Tezcan B, Semerci T, Teker E. Cardioprotective effects of Viscum album L. ssp. album (Loranthaceae) on isoproterenol-induced heart failure via regulation of the nitric oxide pathway in rats. Anatol J Cardiol. 2016 Dec;16(12):923-930. doi: 10.14744/AnatolJCardiol.2016.6780. Epub 2016 Jun 29. PMID: 27443473; PMCID: PMC5324911.
  2. Marvibaigi M, Supriyanto E, Amini N, Abdul Majid FA, Jaganathan SK. Preclinical and clinical effects of mistletoe against breast cancer. Biomed Res Int. 2014;2014:785479. doi: 10.1155/2014/785479. Epub 2014 Jul 20. PMID: 25136622; PMCID: PMC4127267.
  3. Mascher A, Pelzer F, Duncan LJ, Martin DD, Baumgartner S, Berger B. The Introspective Patient Experience of Mistletoe Therapy in Cancer: A Qualitative Study. Integr Cancer Ther. 2023 Jan-Dec;22:15347354231198474. doi: 10.1177/15347354231198474. PMID: 37731253; PMCID: PMC10515602.
  4. Nazaruk J, Orlikowski P. Phytochemical profile and therapeutic potential of Viscum album L. Nat Prod Res. 2016;30(4):373-85. doi: 10.1080/14786419.2015.1022776. Epub 2015 Mar 27. PMID: 25813519.
  5. Nicoletti M. The Anti-Inflammatory Activity of Viscum album. Plants (Basel). 2023 Mar 27;12(7):1460. doi: 10.3390/plants12071460. PMID: 37050086; PMCID: PMC10096603.
  6. Szurpnicka A, Kowalczuk A, Szterk A. Biological activity of mistletoe: in vitro and in vivo studies and mechanisms of action. Arch Pharm Res. 2020 Jun;43(6):593-629. doi: 10.1007/s12272-020-01247-w. Epub 2020 Jul 3. PMID: 32621089; PMCID: PMC7340679.
  7. Szurpnicka A, Zjawiony JK, Szterk A. Therapeutic potential of mistletoe in CNS-related neurological disorders and the chemical composition of Viscum species. J Ethnopharmacol. 2019 Mar 1;231:241-252. doi: 10.1016/j.jep.2018.11.025. Epub 2018 Nov 17. PMID: 30458281.