A Christmas without mistletoe:
Jacob Schor, ND, FABNO
A drought this year in Texas has decimated that state’s wild mistletoe and made it so difficult to find that our country’s mistletoe industry has been effectively shut down.
This leaves me saddened as I have always treasured seeing the odd sprig of mistletoe displayed as part of the season’s decorations. It is a fitting reminder of how deeply our holiday celebrations are linked to the ancient traditions. Seeing it is also an excuse to look at the new journal articles that have been published over the preceding year.
Thinking about mistletoe’s history is also a welcome antidote to what are now referred to as the ‘Christmas Wars.’ As David Sirota writes in the Denver Post, there seems to be a yearly battle between the those who are offended by the blurry line between church and state and those who would want the line shifted closer to their way of thinking.
Mistletoe continues to play a role in our holiday celebrations and this is an interesting reminder of how deeply rooted our winter celebrations are in Druidic cultures.
Mistletoe is an odd plant, it is both winter fruiting and an evergreen; the leaves stay green as they produce berries in the dead of winter. Because of this trait, early cultures revered the plant as a symbol of immortality and rebirth. When every thing else in the world appears frozen and dead, mistletoe is full of life. For people deeply connected with the natural world, this winter rebirth stood out.
Though I am sitting here about to start reviewing the publications in the medical literature on mistletoe, we must digress and first acknowledge mistletoe’s historic and religious significance.
In an earlier world, the fifth day following the new moon that follows the winter solstice, was the day on which Druid priests harvested mistletoe. With ritual ceremony, they cut the mistletoe down from oak trees using a golden sickle while their attendants caught the branches in their robes before the mistletoe touched the ground.
Mistletoe (Viscum alba) is a parasitic plant that lives on trees. Although the leaves contain some chlorophyll, a mistletoe plant can’t make enough food to feed itself; it obtains most of its nutrition from the host tree. Birds eat mistletoe seeds and then carry them from tree to tree. The seeds will not sprout until the berries are digested. After birds digest the berries, they excrete the seeds as a gooey mass that sticks to whatever it lands on. This adhering mass of bird crap seed and mistletoe seed, which is also widely called a ‘viscum’, is the origin of our word, viscous. If this viscous Viscum seed excrement lands on a tree, the seed sprouts, sending roots through the bark and into the tree to draw water and nourishment. Mistletoe spends its entire life cycle never touching the earth, an attribute that gave it early mystic significance.
The association of mistletoe with an easing of the social norms on who one might kiss goes back to the Norse story of Frigga and Balder.
This is a story of overprotective motherhood. Frigga, the goddess of love and beauty and probably hovering motherhood, did her best for Balder, her favorite son. She went all through the world and secured promises from all beings and things that sprang from the four elements--fire, water, air, and earth, that they would not hurt her son Balder. The Achilles heel of this plan of course was mistletoe. Mistletoe it was thought came from nowhere. It sprang from none of the four elements. If it sprang from anything, it sprang from bird poop but at the time of the story, this route of seed transmission was overlooked. The story goes that Loki, the sly evil spirit of Norse mythology, made an arrow of mistletoe and tricked Balder’s blind brother Hoder into shootiing Balder through the heart with it.
Frigga does a lot of weeping in the story and in the cold winter, her tears turn into the white berries of mistletoe. The berries of this immortal plant wake Balder back to life and the plant becomes a symbol of undying love.
There is another and perhaps better explanation for this kissing under mistletoe tradition. Mistletoe is an abortifacient; it both prevents pregnancy from occurring or prevents a pregnancy from going to term. It no doubt acted as an early but effective form of birth control. Mistletoe was apparently consumed in adequate quantities during the early Druidic seasonal feasts to prevent pregnancies. People figured out that during the ‘mistletoe season’ promiscuous behavior did not lead to the expected consequences. We preserve this early Druidic pragmatism when we act out the belief that what happens under the mistletoe stays under the mistletoe, that is it allows promiscuity without repercussion.
Though this may seem irrelevant to the current science, this long prehistoric tradition of mistletoe having magical attributes is relevant in appreciating the modern cancer research on using mistletoe extracts. People expect magical results from mistletoe and it’s hard to filter out fact from belief when it comes to effectiveness. Mistletoe treatments cannot but have significant placebo effect.
Rudolf Steiner originated the modern use of mistletoe for cancer treatment. Steiner (1861-1925) was the Austrian philosopher behind a belief system called Anthroposophy, something Wikipedia describes as, “a movement based on the notion that there is a spiritual world accessible to pure thought through a path of self-development.” [Whatever exactly that means.] In modern terms, we might want to write this off as just another cult but that would do Steiner and his followers, of which there are still many, a great injustice. Steiner came up with many practical applications for his philosophy and worldview that are still with us, including biodynamic agriculture, anthroposophical medicine, eurythmy and the one we are probably the most familiar with, Waldorf Education.
Steiner’s followers who practice Anthroposophical Medicine developed a fermented preparation of mistletoe called Iscador.
Iscador is well accepted in Germany, Switzerland and Northern Europe as an approved cancer treatment. Today, mistletoe extracts are the most frequently prescribed unconventional cancer therapies in Germany and in some other European countries. In Europe, approximately 60 to 70 percent of cancer patients use some form of mistletoe. Whether or not mistletoe is actually effective for treating cancer has been debated for years. A number of positive studies appeared in the German medical literature in the late 1980’s and early 1990s.
Yet while well accepted in Europe, mistletoe is uncommon in the United States. The American Cancer Society has long condemned it and for years warned against people against using it. Their website is a reliable source of negative research on Iscador.
The most important of these negative studies is from Eggermont and his colleagues, who compared Iscador to interferon in treating melanoma. Between 1988 and 1996, the European Organization for Research and Treatment of Cancer Melanoma Group performed a prospective, randomized phase III trial that compared the effects of several types of interferon or Iscador against an untreated control group. High-risk patients were randomized and followed until their first progression or death. In the end, there was no apparent difference in either disease free survival or overall survival in any of the interferon groups or the Iscador patients over the control group. In other words, taking Iscador didn’t do these patients any good.  Of course, one has to keep this in perspective. Pretty much nothing works well for treating melanoma. While Iscador was no miracle cure but this should not be a great surprise, nothing else is either.
There are reports in the literature of cases that appear to respond to Iscador. A 1989 article in Thorax describes a case of small cell lung cancer that got better with Iscador treatment.  Still for the most part, we don’t hear much about Iscador in the United States, except for a small flurry of interest when Suzanne Summers admitted she was using it.
In 2006, was a big year for Iscador research with quite a few interesting studies published. In January, an Israeli group reported reviewing 15 different prospective studies on Iscador and finding that most reported positive results.  The same researchers published a paper in Anticancer Research in February describing their success at using Iscador to treat fluid build up in the abdomen of patients with advanced cancer. In March, a Russian study reported that Iscador improved quality of life measurements of patients undergoing chemotherapy and radiation for breast cancer. In June, French researchers published a paper comparing Iscador (made from oak mistletoe) against mistletoe extracts prepared from apple or pine grown mistletoes. They suggested that, at least in part, the effect of mistletoe involves mediation of nitric oxide production. 
A June 2006 paper compared the genetic characteristics of various breast cancer cell lines and their response to various mistletoe extracts. Another June study, described the characteristics of cell death caused by mistletoe in multiple myeloma and lymphoma. The faster growing the tumor cells were, the more effective mistletoe was at killing them.  Still another June study comparing the effect of mistletoe on various types of cancer cells, found that colon and rectal cancer cells had the least response.  In July a paper published in the International Journal of Immunology described the effects of Iscador on immune function and theorized how these changes could fight cancer. 
In September, Anticancer Research published a paper authored by Swiss doctors comparing various mistletoe extracts to see which was most effective against pediatric brain tumor cells.
Despite the popularity of Iscador in Europe, it is still rare to see it used in the United States, even among alternative providers. The American Cancer Society opposes its use and routinely posts warnings that it is ineffective or even dangerous on their website. The intensity of this opposition is what reminds me of the annual ‘Christmas Wars.’ People have strong opinions. Much of the intensity in this debate on the merits of mistletoe could possibly stem back to its association with pagan religions and with Steiner’s ‘philosophical cult.’ Thus it is no wonder that it is difficult to sort through the pros and cons. Both the proponents and the opponents to its use may be swayed by unacknowledged beliefs unrelated to its potential for therapeutic benefit. Let us hope that time and unbiased researchers will soon sort this out.
A meta-analysis published in December 2009 provides what would appear to be strong objective evidence that mistletoe lengthens survival times in cancer patients. Data from 49 studies on the clinical effects of Iscador were combined and the effect on survival times of cancer patients calculated. These outcomes were expressed as hazard ratios (HR). The combined data yielded a ‘meta-study’ of 3,388 patents treated with Iscador and 7,253 untreated controls. The conclusion was that, “…treatment of cancer patients with the mistletoe extract Iscador is associated with a better survival…”
Mathhes et al described using Iscador in combination with chemotherapy for treating pancreatic cancer in June 2010. Keep in mind though that they looked at using Iscador to enhance the effect of chemotherapy. There are some readers who will misinterpret these kinds of studies and think that Iscador might be effective instead of chemotherapy.
Eisenbraun et al reported in January 2011 that Iscador used in conjunction with chemotherapy for breast cancer reduced side effects and improved quality of life. In their study 89% of the patients reported benefit.
We will miss mistletoe this holiday season. It is a symbol that our modern holiday celebrations transcend our current religious beliefs and come to us from far back in a pre-history that traces its roots to a world view that predates our current religions.
1. Kleeberg UR, Suciu S, Brocker EB, Ruiter DJ, Chartier C, Lienard D, Marsden J,
Final results of the EORTC 18871/DKG 80-1 randomised phase III trial. rIFN-alpha2b versus rIFN-gamma versus ISCADOR M versus observation after surgery in melanoma patients with either high-risk primary (thickness >3 mm) or regional lymph node metastasis. Eur J Cancer. 2004 Feb;40(3):390-402.
2. Bradley GW,Clover A.Apparent response of small cell lung cancer to an extract of mistletoe and homoeopathic treatment.Thorax. 1989 Dec;44(12):1047-8.
3. Bar-Sela G, Gershony A, Haim N.Harefuah. [Mistletoe (Viscum album) preparations: an optional drug for cancer patients?] 2006 Jan;145(1):42-6, 77.
4. Bar-Sela G, Goldberg H, Beck D, Amit A, Kuten A. Reducing malignant ascites accumulation by repeated intraperitoneal administrations of a Viscum album extract. Anticancer Res. 2006 Jan-Feb;26(1B):709-13
5. Semiglazov VF, Stepula VV, Dudov A, Schnitker J, Mengs U. Quality of life is improved in breast cancer patients by Standardised Mistletoe Extract PS76A2 during chemotherapy and follow-up: a randomised, placebo-controlled, double-blind, multicentre clinical trial. Anticancer Res. 2006 Mar-Apr;26(2B):1519-29
6. Mossalayi MD, Alkharrat A, Malvy D. Nitric oxide involvement in the anti-tumor effect of mistletoe (Viscum album L.) extracts Iscador on human macrophages. Arzneimittelforschung. 2006 Jun;56(6A):457-60
7. Eggenschwiler J,Patrignani A,Wagner U, Rehrauer H, Schlapbach R,Rist L,et al. Gene expression profiles of different breast cancer cells compared with their responsiveness to fermented mistletoe (Viscum album L.) extracts Iscador from oak (Quercus), pine (Pinus), white fir (Abies) and apple tree (Malus) in vitro. Arzneimittelforschung. 2006 Jun;56(6A):483-96.
8. Kovacs E, Link S, Toffol-Schmidt U. Cytostatic and cytocidal effects of mistletoe (Viscum album L.) quercus extract Iscador. Arzneimittelforschung. 2006 Jun;56(6A):467-73.
9. Harmsma M,Ummelen M, Dignef W,Tusenius KJ,Ramaekers FC. Effects of mistletoe (Viscum album L.) extracts Iscador on cell cycle and survival of tumor cells. Arzneimittelforschung. 2006 Jun;56(6A):474-82.
10. Heinzerling L, von Baehr V, Liebenthal C, von Baehr R, Volk HD. Immunologic effector mechanisms of a standardized mistletoe extract on the function of human monocytes and lymphocytes in vitro, ex vivo, and in vivo. J Clin Immunol. 2006 Jul;26(4):347-59. Epub 2006 May 17.
11. Zuzak TJ, Rist L, Eggenschwiler J, Grotzer MA, Viviani A. Paediatric medulloblastoma cells are susceptible to Viscum album (Mistletoe). Anticancer Res. 2006 Sep-Oct;26(5A):3485-92.
12. Ostermann T, Raak C, Bussing A. Survival of cancer patients treated with mistletoe extract (Iscador): a systematic literature review. BMC Cancer. 2009 Dec 18;9(1):451.
13. Matthes H, Friedel WE, Bock PR, Zänker KS. Molecular mistletoe therapy: friend or foe in established anti-tumor protocols? A multicenter, controlled, retrospective pharmaco-epidemiological study in pancreas cancer. Curr Mol Med. 2010 Jun;10(4):430-9.
14. Eisenbraun J, Scheer R, Kröz M, Schad F, Huber R. Quality of life in breast cancer patients during chemotherapy and concurrent therapy with a mistletoe extract. Phytomedicine. 2011 Jan 15;18(2-3):151-7.
"Here we must mention the reverence felt for this plant by the Gauls. The Druids -- for thusly are their priests named - hold nothing more sacred than the mistletoe and the tree that bears it, as long as that tree be an oak.... Mistletoe is very rarely encountered; but when they do find some, they gather it, in a solemn ritual....
"After preparing for a sacrifice and a feast under the oak, they hail the mistletoe as a cure-all and bring two white bulls there, whose horns have never been bound before. A priest dressed in a white robe climbs the oak and with a golden sickle cuts the mistletoe, which is caught in a white cloak. Then they sacrifice the victims, begging the god, who gave them the mistletoe as a gift, to make it propitious for them. They believe that a potion prepared from mistletoe will make sterile animals fertile, and that the plant is an antidote for any poison. Such is the supernatural power with which peoples often invest even the most trifling things"
Pliny the Elder (23-79 AD)