All the Benefits of Echinacea: A Popular Natural Remedy
What is Echinacea?
Echinacea is a genus of herbaceous flowering plants in the same family as chamomile and daisies. Also known as "purple coneflower," the herb grows naturally in prairies and open wooded areas across North America.
In total, there are nine species of echinacea, but only three are used medicinally for human consumption:
- E. purpurea
- E. angustifolia
- E. pallida
Although they all belong to the same subfamily, each one has different quantities of active compounds. E. purpurea, for example, is best for supporting the immune system, while E. angustifolia seems to be more effective at supporting mental health.
How Does It Work?
Echinacea's therapeutic compounds are spread throughout different parts of the plant. The roots, for example, have the highest concentrations of essential oils, while the upper parts of the plant (stem, leaves, and flowers) tend to contain more polysaccharides, which are known to affect the immune system.
Most echinacea extracts are made from the upper part of the plant. However, for E. angustifolia and E. pallida extracts, typically only the roots are used.
The main active compounds in echinacea plants include:
- Essential oils
- Vitamin C
- Caffeic acid
- Phenolic acids
The alkamides and polysaccharides in echinacea may have specific effects on white blood cells.
According to a study published in the journal International Immunopharmacology, alkamides may improve white blood cell activity in the lungs by acting on cannabinoid receptors and producing TNF-alpha and nitrous oxide (NO).
History of Echinacea
Echinacea plants were widely used by the North American Plains Indians for hundreds of years prior to the arrival of colonial settlers.
Tribes used it in many herbal remedies to treat bacterial infections, blood poisoning, headaches, pain, and cold symptoms. External application was used to treat wounds, burns, and insect bites, while the roots were chewed to treat toothaches and throat infections.
Up until the introduction of antibiotics in the 1950s, echinacea extract was used throughout the modern world as a treatment for the common cold and flu, although there is little clinical evidence to support this benefit.
A List of Health Benefits Associated with Echinacea
One of the biggest myths in the world of naturopathic medicine is that echinacea is a cure for the common cold, but this actually isn't true. Although there is strong evidence to suggest that echinacea can boost the immune system in various ways, there is little-to-no evidence to indicate that it is an effective cold remedy.
However, echinacea can support white blood cell function, fight inflammation, and treat infections.
Here are nine of the top health benefits of echinacea:
1. Support White Blood Cells and Strengthen Immunity
Although much about echinacea's effects on the body are not yet fully understood, it clearly supports the function of white blood cells. The herb supports white blood cells in two primary ways:
- Affects macrophages (a type of white blood cell)
- Activates dendritic cells (another type of white blood cell)
Macrophages are white blood cells that destroy forgeign substances and dead cells in the blood.
Once activated, they release inflammatory cytokines and recruit other white blood cells to eliminate infections.
By increasing macrophage activity, echinacea can boost natural killer cells in a way that minimizes irritation from inflammation.
Dendritic cells are white blood cells that help the body recognize foreign molecules. Echinacea may optimize dendritic function and increase the release of immune molecules like IL-1beta and TNF-alpha.
Plus, it also increases antioxidants and supports cell structure.
In a 2007 rodent study published in the Journal of Medicinal Food, mice were treated with echinacea extract for seven days before being immunized with the red blood cells of sheep.
Researchers found that echinacea effectively increased immune cell populations.
According to the study's authors, "These findings demonstrate that echinacea is a wide-spectrum immunomodulator that modulates both innate and adaptive immune responses."
In a similar rodent trial, echinacea significantly increased total white blood cell counts within the first two weeks of administration.
2. Fight Infection
Echinacea can fight viral, bacterial, and fungal infections.
In a 2014 study published in the journal Phytomedicine, researchers found that the alkamides in echinacea can treat fungal infections by destroying fungal cell walls.
Other infections that echinacea may be able to treat include:
- Vaginal yeast infections
- Urinary tract infections
- Gum disease
Here's what the research has to say about echinacea's ability to fight infections:
- In a meta-analysis of 14 clinical trials, researchers concluded that echinacea may cut the chance of catching a cold in half.
- On a similar note, a 2009 laboratory study concluded that echinacea can alleviate respiratory disorders by inhibiting viral growth and cytokine production.
- Similarly, a 2015 meta-analysis concluded that echinacea may reduce the risk of recurrent upper respiratory tract infections through its antiviral, anti-inflammatory, and immunomodulatory effects.
- A 2010 study published in Phytomedicine found that echinacea may exert antibacterial properties against C. difficile, S pyogenes, H. influenzae, and P. acne.
- In a separate 2010 study, researchers determined that echinacea can kill parasites in human cells.
3. Reduce Inflammation
Echinacea may also reduce certain types of inflammation. For example, a 2009 laboratory study in the journal Phytotherapy Research found that echinacea consumption can alleviate inflammation caused by a viral infection.
According to a 2002 study, echinacea extracts can reduce inflammation in rats through oral and topical use.
Human studies have also been promising. In a small pilot study, a three-day echinacea treatment effectively reduced inflammation in six patients exhibiting cold and flu symptoms.
4. Support Mental Health
Echinacea may reduce anxiety and depression.
In a 2013 study published in the journal Phytotherapy Research, researchers tested the anxiolytic (anti-anxiety) potential of Echinacea angustifolia extract on rats and humans.
The herb effectively decreased anxiety-related behaviors in rats at doses ranging from 1000 to 3000 mg/kg of body weight.
At the same time, healthy adults with mild anxiety were given 20-40 mg of echinacea extract once-a-day for a week. The higher dose of 40 mg effectively reduced anxiety after just three days of treatment. The lower 20 mg dose, however, did not have any significant effects on anxiety.
According to a 2015 report, echinacea may achieve its anti-anxiety effects by acting on cannabinoid receptors in the body.
This same study concluded that echinacea extract may exert antidepressant effects in rats by stimulating L-DOPA (the amino acid precursor to dopamine).
5. Heal the Skin
Echinacea purpurea cream may protect the skin from oxidative stress and reduce signs of aging by hydrating the skin and reducing wrinkles.
Here's what the research has to say about echinacea and skin health:
- In a 2010 human study, echinacea cream was tested on 10 healthy volunteers aged 25-40 years. After one month of daily treatment, wrinkles decreased between 9.47% and 14.92%.
- Another study found that echinacea can inhibit the breakdown of hyaluronic acid (an important part of skin cells). When hyaluronic acid breaks down, it causes the tissue to loosen and become inflamed.
- According to a study published in the journal Planta Medica, echinacea can protect collagen from free radical damage caused by UVA/UVB radiation. In other words, echinacea may help protect your skin from the sun.
- In a 2011 study published in the journal Phytotherapy Research, echinacea reversed inflammation induced by the bacteria P. acnes.
- According to a 2017 study, echinacea may treat atopic eczema. In the study, 49 patients were treated with topical echinacea for three months. Echinacea significantly reduced redness and swelling by interacting with cannabinoid receptors in the skin.
6. May Relieve Asthma
Echinacea's effects on the immune system may also relieve asthma.
Recent studies indicate that echinacea preparations can reverse the secretions of asthma-related cytokines in bronchial cells.
In a 2015 animal study published in the Journal of Ethnopharmacology, researchers treated guinea pigs suffering from ovalbumin-induced allergic asthma with an oral echinacea complex for 14 days.
Echinacea proved to be equally effective at reducing symptoms as the corticosteroid medication budesonide.
According to the study's authors, "Pharmacodynamic studies have confirmed significant bronchodilatory and anti-inflammatory effects of echinacea complex that was similar to effects of classic synthetic drugs. These results provide a scientific basis for the application of this herb in traditional medicine as a supplementary treatment of allergic disorders of the airways, such as asthma."
7. May Reduce Pain
Many Native American tribes, including the Lakota, used echinacea as a pain remedy.
It appears to be most effective at reducing pain associated with intestinal issues, herpes, measles, headaches, toothaches, tonsillitis, and sore throats.
A 2008 study published in the American Journal of Clinical Nutrition indicates that echinacea extract may influence the perception of pain by inhibiting the TRPV1 receptor: a receptor that's the prime target of many over-the-counter analgesic and anti-inflammatory drugs.
E. purpurea extracts seem to have the strongest anti-inflammatory and pain-relieving effects, with E. angustifolia having somewhat less.
Side Effects of Echinacea
Although rare, high doses of echinacea may lead to side effects like:
- Stomach aches
Side effects are more common among people who have seasonal allergies.
Patients with autoimmune diseases may also be more likely to experience side effects.
Due to their pharmacological similarities, if you're allergic to chamomile, you may also be allergic to echinacea.
Because of echinacea's effects on the immune system, it's best to consult a medical professional before taking echinacea if you have a history of systemic diseases like multiple sclerosis, AIDS, or tuberculosis.
However, for the vast majority of individuals, echinacea products can be a safe and effective way to stimulate the immune system and enhance your health.
Echinacea is commercially available in several forms, including alcohol tinctures, water-based liquid extracts, teas, tablets, and capsules.
Always inspect your dietary supplements thoroughly, as many do not disclose which type of echinacea they use.
For the most part, herbal supplements made from E. purpurea are typically your best bet for potential health and wellness benefits.
By Frank La Sorte and Kyle Horton
Millions of birds travel between their breeding and wintering grounds during spring and autumn migration, creating one of the greatest spectacles of the natural world. These journeys often span incredible distances. For example, the Blackpoll warbler, which weighs less than half an ounce, may travel up to 1,500 miles between its nesting grounds in Canada and its wintering grounds in the Caribbean and South America.
Blackpoll warbler. PJTurgeon / Wikipedia<p>We used this information to determine how the number of migratory bird species varies based on each city's level of <a href="https://www.britannica.com/science/light-pollution" target="_blank" rel="noopener noreferrer">light pollution</a> – brightening of the night sky caused by artificial light sources, such as buildings and streetlights. We also explored how species numbers vary based on the quantity of tree canopy cover and impervious surface, such as concrete and asphalt, within each city. Our findings show that cities can help migrating birds by planting more trees and reducing light pollution, especially during spring and autumn migration.</p>
Declining Bird Populations<p>Urban areas contain numerous dangers for migratory birds. The biggest threat is the risk of <a href="https://doi.org/10.1650/CONDOR-13-090.1" target="_blank">colliding with buildings or communication towers</a>. Many migratory bird populations have <a href="http://dx.doi.org/10.1126/science.aaw1313" target="_blank">declined over the past 50 years</a>, and it is possible that light pollution from cities is contributing to these losses.</p><p>Scientists widely agree that light pollution can <a href="https://doi.org/10.1073/pnas.1708574114" target="_blank">severely disorient migratory birds</a> and make it hard for them to navigate. Studies have shown that birds will cluster around brightly lit structures, much like insects flying around a porch light at night. Cities are the <a href="https://doi.org/10.1002/fee.2029" target="_blank" rel="noopener noreferrer">primary source of light pollution for migratory birds</a>, and these species tend to be more abundant within cities <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/gcb.13792" target="_blank" rel="noopener noreferrer">during migration</a>, especially in <a href="https://doi.org/10.1016/j.landurbplan.2020.103892" target="_blank" rel="noopener noreferrer">city parks</a>.</p>
Composite image of the continental U.S. at night from satellite photos. NASA Earth Observatory images by Joshua Stevens, using Suomi NPP VIIRS data from Miguel Román, NASA's Goddard Space Flight Center
The Power of Citizen Science<p>It's not easy to observe and document bird migration, especially for species that migrate at night. The main challenge is that many of these species are very small, which limits scientists' ability to use electronic tracking devices.</p><p>With the growth of the internet and other information technologies, new data resources are becoming available that are making it possible to overcome some of these challenges. <a href="https://doi.org/10.1038/d41586-018-07106-5" target="_blank">Citizen science initiatives</a> in which volunteers use online portals to enter their observations of the natural world have become an important resource for researchers.</p><p>One such initiative, <a href="https://ebird.org/home" target="_blank" rel="noopener noreferrer">eBird</a>, allows bird-watchers around the globe to share their observations from any location and time. This has produced one of the <a href="https://doi.org/10.1111/ecog.04632" target="_blank" rel="noopener noreferrer">largest ecological citizen-science databases in the world</a>. To date, eBird contains over 922 million bird observations compiled by over 617,000 participants.</p>
Light Pollution Both Attracts and Repels Migratory Birds<p>Migratory bird species have evolved to use certain migration routes and types of habitat, such as forests, grasslands or marshes. While humans may enjoy seeing migratory birds appear in urban areas, it's generally not good for bird populations. In addition to the many hazards that exist in urban areas, cities typically lack the food resources and cover that birds need during migration or when raising their young. As scientists, we're concerned when we see evidence that migratory birds are being drawn away from their traditional migration routes and natural habitats.</p><p>Through our analysis of eBird data, we found that cities contained the greatest numbers of migratory bird species during spring and autumn migration. Higher levels of light pollution were associated with more species during migration – evidence that light pollution attracts migratory birds to cities across the U.S. This is cause for concern, as it shows that the influence of light pollution on migratory behavior is strong enough to increase the number of species that would normally be found in urban areas.</p><p>In contrast, we found that higher levels of light pollution were associated with fewer migratory bird species during the summer and winter. This is likely due to the scarcity of suitable habitat in cities, such as large forest patches, in combination with the adverse affects of light pollution on bird behavior and health. In addition, during these seasons, migratory birds are active only during the day and their populations are largely stationary, creating few opportunities for light pollution to attract them to urban areas.</p>
Trees and Pavement<p>We found that tree canopy cover was associated with more migratory bird species during spring migration and the summer. Trees provide important habitat for migratory birds during migration and the breeding season, so the presence of trees can have a strong effect on the number of migratory bird species that occur in cities.</p><p>Finally, we found that higher levels of impervious surface were associated with more migratory bird species during the winter. This result is somewhat surprising. It could be a product of the <a href="https://www.epa.gov/heatislands" target="_blank">urban heat island effect</a> – the fact that structures and paved surfaces in cities absorb and reemit more of the sun's heat than natural surfaces. Replacing vegetation with buildings, roads and parking lots can therefore make cities significantly warmer than surrounding lands. This effect could reduce cold stress on birds and increase food resources, such as insect populations, during the winter.</p><p>Our research adds to our understanding of how conditions in cities can both help and hurt migratory bird populations. We hope that our findings will inform urban planning initiatives and strategies to reduce the harmful effects of cities on migratory birds through such measures as <a href="https://www.arborday.org/programs/treecityusa/index.cfm" target="_blank" rel="noopener noreferrer">planting more trees</a> and initiating <a href="https://aeroecolab.com/uslights" target="_blank" rel="noopener noreferrer">lights-out programs</a>. Efforts to make it easier for migratory birds to complete their incredible journeys will help maintain their populations into the future.</p><p><em><span style="background-color: initial;"><a href="https://theconversation.com/profiles/frank-la-sorte-1191494" target="_blank">Frank La Sorte</a> is a r</span>esearch associate at the </em><em>Cornell Lab of Ornithology, Cornell University. <a href="https://theconversation.com/profiles/kyle-horton-1191498" target="_blank">Kyle Horton</a> is an assistant professor of Fish, Wildlife, and Conservation Biology at the Colorado State University.</em></p><p><em></em><em>Disclosure statement: Frank La Sorte receives funding from The Wolf Creek Charitable Foundation and the National Science Foundation (DBI-1939187). K</em><em>yle Horton does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</em></p><p><em>Reposted with permission from <a href="https://theconversation.com/cities-can-help-migrating-birds-on-their-way-by-planting-more-trees-and-turning-lights-off-at-night-152573" target="_blank">The Conversation</a>. </em></p>
EcoWatch Daily Newsletter
By Lynne Peeples
Editor's note: This story is part of a nine-month investigation of drinking water contamination across the U.S. The series is supported by funding from the Park Foundation and Water Foundation. Read the launch story, "Thirsting for Solutions," here.
In late September 2020, officials in Wrangell, Alaska, warned residents who were elderly, pregnant or had health problems to avoid drinking the city's tap water — unless they could filter it on their own.
Unintended Consequences<p>Chemists first discovered disinfection by-products in treated drinking water in the 1970s. The trihalomethanes they found, they determined, had resulted from the reaction of chlorine with natural organic matter. Since then, scientists have identified more than 700 additional disinfection by-products. "And those only represent a portion. We still don't know half of them," says Richardson, whose lab has identified hundreds of disinfection by-products. </p>
What’s Regulated and What’s Not?<p>The U.S. Environmental Protection Agency (EPA) currently regulates 11 disinfection by-products — including a handful of trihalomethanes (THM) and haloacetic acids (HAA). While these represent only a small fraction of all disinfection by-products, EPA aims to use their presence to indicate the presence of other disinfection by-products. "The general idea is if you control THMs and HAAs, you implicitly or by default control everything else as well," says Korshin.</p><p>EPA also requires drinking water facilities to use techniques to reduce the concentration of organic materials before applying disinfectants, and regulates the quantity of disinfectants that systems use. These rules ultimately can help control levels of disinfection by-products in drinking water.</p>
Click the image for an interactive version of this chart on the Environmental Working Group website.<p>Still, some scientists and advocates argue that current regulations do not go far enough to protect the public. Many question whether the government is regulating the right disinfection by-products, and if water systems are doing enough to reduce disinfection by-products. EPA is now seeking public input as it considers potential revisions to regulations, including the possibility of regulating additional by-products. The agency held a <a href="https://www.epa.gov/dwsixyearreview/potential-revisions-microbial-and-disinfection-byproducts-rules" target="_blank">two-day public meeting</a> in October 2020 and plans to hold additional public meetings throughout 2021.</p><p>When EPA set regulations on disinfection by-products between the 1970s and early 2000s, the agency, as well as the scientific community, was primarily focused on by-products of reactions between organics and chlorine — historically the most common drinking water disinfectant. But the science has become increasingly clear that these chlorinated chemicals represent a fraction of the by-product problem.</p><p>For example, bromide or iodide can get caught up in the reaction, too. This is common where seawater penetrates a drinking water source. By itself, bromide is innocuous, says Korshin. "But it is extremely [reactive] with organics," he says. "As bromide levels increase with normal treatment, then concentrations of brominated disinfection by-products will increase quite rapidly."</p><p><a href="https://pubmed.ncbi.nlm.nih.gov/15487777/" target="_blank">Emerging</a> <a href="https://pubs.acs.org/doi/10.1021/acs.est.7b05440" target="_blank" rel="noopener noreferrer">data</a> indicate that brominated and iodinated by-products are potentially more harmful than the regulated by-products.</p><p>Almost half of the U.S. population lives within 50 miles of either the Atlantic or Pacific coasts, where saltwater intrusion can be a problem for drinking water supplies. "In the U.S., the rule of thumb is the closer to the sea, the more bromide you have," says Korshin, noting there are also places where bromide naturally leaches out from the soil. Still, some coastal areas tend to be spared. For example, the city of Seattle's water comes from the mountains, never making contact with seawater and tending to pick up minimal organic matter.</p><p>Hazardous disinfection by-products can also be an issue with desalination for drinking water. "As <a href="https://ensia.com/features/can-saltwater-quench-our-growing-thirst/" target="_blank" rel="noopener noreferrer">desalination</a> practices become more economical, then the issue of controlling bromide becomes quite important," adds Korshin.</p>
Other Hot Spots<p>Coastal areas represent just one type of hot spot for disinfection by-products. Agricultural regions tend to send organic matter — such as fertilizer and animal waste — into waterways. Areas with warmer climates generally have higher levels of natural organic matter. And nearly any urban area can be prone to stormwater runoff or combined sewer overflows, which can contain rainwater as well as untreated human waste, industrial wastewater, hazardous materials and organic debris. These events are especially common along the East Coast, notes Sydney Evans, a science analyst with the nonprofit Environmental Working Group (EWG, a collaborator on <a href="https://ensia.com/ensia-collections/troubled-waters/" target="_blank">this reporting project</a>).</p><p>The only drinking water sources that might be altogether free of disinfection by-products, suggests Richardson, are private wells that are not treated with disinfectants. She used to drink water from her own well. "It was always cold, coming from great depth through clay and granite," she says. "It was fabulous."</p><p>Today, Richardson gets her water from a city system that uses chloramine.</p>
Toxic Treadmill<p>Most community water systems in the U.S. use chlorine for disinfection in their treatment plant. Because disinfectants are needed to prevent bacteria growth as the water travels to the homes at the ends of the distribution lines, sometimes a second round of disinfection is also added in the pipes.</p><p>Here, systems usually opt for either chlorine or chloramine. "Chloramination is more long-lasting and does not form as many disinfection by-products through the system," says Steve Via, director of federal relations at the American Water Works Association. "Some studies show that chloramination may be more protective against organisms that inhabit biofilms such as Legionella."</p>
Alternative Approaches<p>When he moved to the U.S. from Germany, Prasse says he immediately noticed the bad taste of the water. "You can taste the chlorine here. That's not the case in Germany," he says.</p><p>In his home country, water systems use chlorine — if at all — at lower concentrations and at the very end of treatment. In the Netherlands, <a href="https://dwes.copernicus.org/articles/2/1/2009/dwes-2-1-2009.pdf" target="_blank">chlorine isn't used at all</a> as the risks are considered to outweigh the benefits, says Prasse. He notes the challenge in making a convincing connection between exposure to low concentrations of disinfection by-products and health effects, such as cancer, that can occur decades later. In contrast, exposure to a pathogen can make someone sick very quickly.</p><p>But many countries in Europe have not waited for proof and have taken a precautionary approach to reduce potential risk. The emphasis there is on alternative approaches for primary disinfection such as ozone or <a href="https://www.pbs.org/wgbh/nova/article/eco-friendly-way-disinfect-water-using-light/" target="_blank" rel="noopener noreferrer">ultraviolet light</a>. Reverse osmosis is among the "high-end" options, used to remove organic and inorganics from the water. While expensive, says Prasse, the method of forcing water through a semipermeable membrane is growing in popularity for systems that want to reuse wastewater for drinking water purposes.</p><p>Remucal notes that some treatment technologies may be good at removing a particular type of contaminant while being ineffective at removing another. "We need to think about the whole soup when we think about treatment," she says. What's more, Remucal explains, the mixture of contaminants may impact the body differently than any one chemical on its own. </p><p>Richardson's preferred treatment method is filtering the water with granulated activated carbon, followed by a low dose of chlorine.</p><p>Granulated activated carbon is essentially the same stuff that's in a household filter. (EWG recommends that consumers use a <a href="https://www.ewg.org/tapwater/reviewed-disinfection-byproducts.php#:~:text=EWG%20recommends%20using%20a%20home,as%20trihalomethanes%20and%20haloacetic%20acids." target="_blank" rel="noopener noreferrer">countertop carbon filter</a> to reduce levels of disinfection by-products.) While such a filter "would remove disinfection by-products after they're formed, in the plant they remove precursors before they form by-products," explains Richardson. She coauthored a <a href="https://pubs.acs.org/doi/10.1021/acs.est.9b00023" target="_blank" rel="noopener noreferrer">2019 paper</a> that concluded the treatment method is effective in reducing a wide range of regulated and unregulated disinfection by-products.</p><br>
Greater Cincinnati Water Works installed a granulated activated carbon system in 1992, and is still one of relatively few full-scale plants that uses the technology. Courtesy of Greater Cincinnati Water Works.<p>Despite the technology and its benefits being known for decades, relatively few full-scale plants use granulated active carbon. They often cite its high cost, Richardson says. "They say that, but the city of Cincinnati [Ohio] has not gone bankrupt using it," she says. "So, I'm not buying that argument anymore."</p><p>Greater Cincinnati Water Works installed a granulated activated carbon system in 1992. On a video call in December, Jeff Swertfeger, the superintendent of Greater Cincinnati Water Works, poured grains of what looks like black sand out of a glass tube and into his hand. It was actually crushed coal that has been baked in a furnace. Under a microscope, each grain looks like a sponge, said Swertfeger. When water passes over the carbon grains, he explained, open tunnels and pores provide extensive surface area to absorb contaminants.</p><p>While the granulated activated carbon initially was installed to address chemical spills and other industrial contamination concerns in the Ohio River, Cincinnati's main drinking water source, Swertfeger notes that the substance has turned out to "remove a lot of other stuff, too," including <a href="https://ensia.com/features/drinking-water-contamination-pfas-health/" target="_blank" rel="noopener noreferrer">PFAS</a> and disinfection by-product precursors.</p><p>"We use about one-third the amount of chlorine as we did before. It smells and tastes a lot better," he says. "The use of granulated activated carbon has resulted in lower disinfection by-products across the board."</p><p>Richardson is optimistic about being able to reduce risks from disinfection by-products in the future. "If we're smart, we can still kill those pathogens and lower our chemical disinfection by-product exposure at the same time," she says.</p><p><em>Reposted with permission from </em><em><a href="https://ensia.com/features/drinking-water-disinfection-byproducts-pathogens/" target="_blank">Ensia</a>. </em><a href="https://www.ecowatch.com/r/entryeditor/2649953730#/" target="_self"></a></p>
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