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What is mistletoe therapy?

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Mistletoe has come into the medical focus over the last 100 years. The Celtic druids had revered it as the “all-healing one”. In the Middle Ages it was used to treat liver complaints, and later, to lower blood pressure. At the beginning of the 20th century, a new interest in mistletoe arose: Around 1907, the Munich-based botanist Karl von Tubeuf began to collect all the knowledge that was available on mistletoe at that time with relation to the natural sciences, mythology and cultural history. In 1923, he published the “Monograph of Mistletoe”.

In 1904, Dr Rudolf Steiner, the founder of Anthroposophy, had already begun to talk about mistletoe as part of his teaching and research activities in the humanities. His ideas were taken up by the physician Dr Ita Wegman who, together with pharmacist Adolf Hauser, developed the first mistletoe preparation for injection. As early as 1917, she used it to treat cancer patients in her gynaecological practice in Zurich and achieved some promising outcomes. In 1920, the first experiences with mistletoe therapy had been worked out and were presented at the first anthroposophical course for medical practitioners in Dornach, Switzerland.

In 1935, Dr Ita Wegman and colleagues founded the Association for Cancer Research in Arlesheim, Switzerland, dedicated to the ongoing research and development of mistletoe therapy. Today, mistletoe preparations are the most prescribed remedies in complementary or integrative cancer therapy.

The primary aim of mistletoe therapy is to improve the patient’s quality of life. During mistletoe therapy, many patients experience a rapid improvement in their general well-being, a normalisation of their sleeping patterns, and an increase of appetite and every-day performance. Tumour-related pain may be alleviated, the immune system strengthened and side effects of chemotherapy and radiotherapy may be reduced.

Botany of mistletoe

The myths surrounding mistletoe can partly be explained by its botanical properties. Mistletoe is indeed a peculiar plant. It grows as a semi-parasite on other trees and shrubs, but cannot take root in the soil. The berries do not contain a seed, but a nutrient tissue core with one or two plant embryos, which must be exposed to light throughout the winter in order to retain their ability to germinate. Bird species such as the mistletoe thrush and the waxwing will eat the white berries and excrete the seeds again, whereupon they stick to a branch. The blackcap sticks the seed directly onto the branch using its beak. The embryos then form so-called sinkers, which are slowly overgrown by the wood and thus anchor the mistletoe seedling in the tree. The sinkers provide the germinating mistletoe with water and nutrients.

Mistletoe grows very slowly and only acquires its typical spherical shape after years. It flowers for the first time at age five to seven. At the age of 10 to 15 years, it can be harvested and processed. In cancer therapy, only the white berried mistletoe (Viscum album L.) is used. It owes its name to its white, translucent berries.

In Central Europe, mistletoe occurs in three subspecies: deciduous mistletoe, pine mistletoe and fir mistletoe. Deciduous tree mistletoe grows particularly frequently on apple trees and poplars, but it can also be found on maple, birch, lime, almond, robinia, willow, hawthorn and very rarely on oak and elm.

Ingredients and their effects

Mistletoe extracts have many different effects. They can stimulate the immune system, damage tumour cells and in turn protect the genetic material of healthy cells from damage. In addition, mistletoe therapy can reduce the side effects of chemotherapy or radiotherapy and thus improve the patient’s quality of life. The tumour-related exhaustion syndrome (fatigue) can also be significantly reduced by mistletoe therapy. In addition, mood-lifting and pain-reducing effects may also be observed due to an increased release of the body’s own beta-endorphins.

The observed effects are based on a variety of different substances. Mistletoe extracts contain over 600 proteins, with mistletoe lectins and viscotoxins being the most important pharmacological constituents. The content of the various constituents depends on the season, the stage of development of the plant, the time of harvest, the location and the host tree on which it grows .

Mistletoe lectins are sugar-containing protein compounds that inhibit the growth of cancer cells or kill them under experimental conditions, i.e. they have cytostatic and cytotoxic effects. One of the possible ways to impair certain cancer cells is the programmed cell death triggered by mistletoe lectins, the so-called apoptosis. In addition, mistletoe lectins influence the immune system (immune modulation).

Viscotoxins (from viscum) are small protein molecules whose effects have (so far) been researched in less detail than those of lectins. In experiments, viscotoxins were able to destroy the cell wall of cancer cells (cytolytic effect, necrosis). Furthermore, like lectins, they can stimulate the immune system by increasing the activity of natural killer cells and granulocytes.

In summer, the mistletoe plant has a high viscotoxin content, whereas in winter the content of mistletoe lectins is particularly high. This is one of the reasons why the mistletoe plant is harvested twice a year, in June and December, and processed into plant juices by means of lactic acid fermentation. These extracts are then blended in a special process.

The phrase “The whole is more than the sum of its parts” (Aristotle, 384 – 322 B.C.) is especially true for mistletoe therapy: Only the total extract from equal parts of summer and winter mistletoe juice unfolds the full spectrum of effects in complementary cancer therapy. Since mistletoe therapy has an “immunomodulating” effect, cells of the immune system are activated.

This may represent a triple benefit in cancer therapy:

  • A functional immunodeficiency can be counteracted, in turn contributing to an improvement in general well-being.
  • Surgery, radiation and/or chemotherapy weaken the immune system considerably. By strengthening it with mistletoe therapy, the body will be less prone to infections, and patients can recover more quickly.
  • An intact immune system may help to prevent relapses in the aftercare phase. That is why mistletoe therapy can be continued even after cancer therapy has concluded.

Holistic effect of mistletoe preparations

It has often been observed that mistletoe activates mind and soul and may help the individual to shake off the paralyzing fear that often dominates life after a cancer diagnosis. It may help the patient to overcome the initial shock after diagnosis, to actively contribute to one’s own wellbeing and thus, to face life positively again.

Furthermore, mistletoe therapy also has a “warming” effect, normalizing the body temperature that is closely connected to the function of the immune system. As their regulation of body temperature may become impaired due to illness and as a side effect of oncological therapies, many cancer patients find this observation particularly pleasant.

It simultaneously facilitates wellbeing and indicates mistletoe’s beneficial effect on the immune system. Through mistletoe therapy, patients can also find more comfort within their own bodies.They learn to attend and listen to it, to perceive and understand its signals. Even in cases of severe illness, mistletoe therapy may help to support the quality of life.


Mistletoe extract is administered as subcutaneous injection. Similar to an insulin or heparin injection, the mistletoe extract is injected into the subcutaneous tissue, which patients can also do themselves. It should be noted that at least the first injection should be carried out together with the attending doctor or a nurse. He or she may also demonstrate the injection and explain how it is done. As a rule, the mistletoe preparation is injected two to three times a week, preferably in the morning.

What should be observed during the injection?
Mistletoe preparations should be stored in the refrigerator. It is therefore advisable to warm the required ampoule with the mistletoe extract briefly in your hand before use. When injecting, it is important to use a strictly subcutaneous injection technique, i.e. the needle is inserted into the skin at an angle of between 30 and 45°. Suitable sites for this are the abdominal region and the outer side of the thigh.

Reddening around the injection site (up to a maximum of 5 cm in diameter) may occur temporarily and is no cause for alarm, but rather an indication of a normal reaction to the mistletoe extract, signifying immunoresponse. As a rule, this local reaction subsides again by the time of the next injection. It is important to change the injection site regularly to avoid additional skin reactions. It is also important not to inject into inflamed skin areas, radiation fields, or surgical fields.