MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

This study aimed to evaluate the efficacy of Persian barley water in controlling the clinical outcomes of hospitalized COVID-19 patients. It was designed as a single-blind, add-on therapy, randomized controlled clinical trial and conducted in Shiraz, Iran, from January to March 2021. One hundred hospitalized COVID-19 patients with moderate disease severity were randomly allocated to receive routine treatment (per local protocols) with or without 250 ml of Persian barley water (PBW) daily for two weeks. Clinical outcomes and blood tests were recorded before and after the study period. Multivariable modeling was applied using Stata software for data analysis.

The length of hospital stay (LHS) was 4.5 days shorter in the intervention group than the control group regardless of history of cigarette smoking (95% confidence interval: -7.22, -1.79 days). Also, body temperature, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and creatinine significantly dropped in the intervention group compared to the control group. No adverse events related to PBW occurred.

The authors from the Department of Traditional Medicine, Shiraz University of Medical Sciences, Shiraz, Iran, concluded that this clinical trial demonstrated the efficacy of PBW in minimizing the LHS, fever, and levels of ESR, CRP, and creatinine among hospitalized COVID-19 patients with moderate disease severity. More robust trials can help find safe and effective herbal formulations as treatments for COVID-19.

I must admit, I did not know about PBW. The authors explain that PBW is manufactured from Hordeum vulgare via a specific procedure. According to recent studies, barley is rich in constituents such as selenium, tocotrienols, phytic acid, catechin, lutein, vitamin E, and vitamin C; these compounds are responsible for their antioxidant and anti-inflammatory properties. Barley grains also have immune-stimulating effects, antioxidant properties, protective effects on the liver and digestive systems, anti-cancer effects, and act to reduce uric acid levels.

But even if these effects would constitute a plausible mechanism for explaining the observed effects (which I do not think they do), the study itself is more than flimsy.

I do not understand why researchers investigating an important issue do not make sure that their study is as rigorous as possible.

  • Why not use an adequately large sample size?
  • Why not employ a placebo?
  • Why not double-blind?
  • Why not report the most important outcome, i.e. mortality?

As it stands, nobody will take this study seriously. Perhaps this is a good thing – but perhaps PBW does have positive effects (I know it’s a long shot) and, in this case, a poor-quality study would only prevent an effective therapy come to light.

5 Responses to Efficacy of Persian barley water on clinical outcomes of hospitalized moderate-severity COVID-19 patients

  • Edzard said: “As it stands, nobody will take this study seriously”…
    Notice the word – “NOBODY.” You seem to spend a great deal of your (valuable?) time Edzard discrediting any phytonutrient that may offer positive support to the complex workings of the human body. Just another SCAM you are inferring. Do you really think that the whole world will disregard this albeit limited but interesting study just because Edzard has dismissed it? Move on everyone – nothing to see here, as they say in the movies.

    • That’s ridiculous. Professor Ernst spends his time discrediting, by exposing and commenting upon, shoddy science and bad studies.

      This helps to protect the public from possible harm arising out of putting faith in spurious claims.

      Mike Grant, if you know of any credible evidence that Persian Barley Water can positively affect the clinical outcomes of any health condition to an extent greater than placebo, please share it.

    • why don’t you also quote me with this:
      “but perhaps PBW does have positive effects”

    • @Mike Grant
      I think it is vitally important that researchers should strive for the best possible quality in their scientific studies. And to that aim, it is equally important that other scientists can be overt in their criticism. And the latter may again lead to criticism of those critters critics … and so on. Sloppy or meaningless studies, errors and wrongdoing should not be simply accepted – regardless of the subject, and regardless of the researchers involved.

      The ‘problem’ here is that Edzard not only chooses to exclusively evaluate alternative modalities (which have a very high chance of being problematic in one or more aspects(*)), but is also one of the world’s leading experts in this particular subject matter. So yes, from the onset, chances are pretty slim that his appraisal of a particular study or treatment will be positive. But that does NOT mean that he is prejudiced or just tries to denounce alternative treatments without good reason. It means that most alternative modalities are not very effective, and that a lot of research in this area is not very good either.
      From what I see, he really tries to look for positive things – IIRC, at the start of his tenure at Exeter University, he actually expected to find a fair amount of positive outcomes. Unfortunately, those did not materialize, and he dutifully documented his findings in a manner that was as neutral and unbiased as possible, but without mincing words: if he found that something was useless, then he would say so. Which of course is not appreciated by proponents of alternative modalities.

      Just compare it to the work of police detectives: most of the people they investigate are not very nice (to put it mildly). This does not mean that they deem everyone they meet to be guilty of a crime by default.

      *: And these problems are unfortunately increasing. Up until two or three decades ago, most proponents of alternative modalities would simply ignore science, or denied that it had any bearing on what they were doing. At worst, they would falsely that their SCAM had been ‘scientifically proven’.
      Unfortunately, fake ‘scientific research’ touting the virtues of alternative treatments seems to be on the rise, with a deluge of papers from Asia, claiming to find almost exclusively positive results for acupuncture, TCM, homeopathy and ayurveda – completely contradicting the existing body of scientific literature. This poisoning of the body of scientific literature increasingly happens here as well: more and more papers and even complete journals with ‘fairy tale’ research are out there, with ‘scientists’ sprinkling those papers with references to chakras, energy fields, homeopathic nanobubbles and quantum whatever as if those were real, accepted parts of science.
      So it is critical to stay critical 🙂

  • Google was not helpful to me in finding out what Persian Barley Water is. If it’s made from ripe barley grain, that would appear to contribute no vitamin C or D at all. If it has lemon or other citrus juice added, as is common for European recipes, than that will contribute vitamin C, of course.
    https://en.wikipedia.org/wiki/Barley#Nutrition

    If I make the barley water by first malting the barley, adding yeast to the mix with water and some hops for flavouring, will that work as well as PBW? 😉

    My Google efforts turned up this reference to the PBW study, as a McMaster University Health Information Research Unit Covid-19 Evidence Alert. It gives the study 6/7 star rating for “Relevance to practice”, which I think might be unwarranted.
    https://plus.mcmaster.ca/COVID-19/Article/Details/35179770

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