Essential oils-proven benefits or expensive placebo?

For the last several years I have seen ads and posts inundating my Facebook feeds and google searches praising the amazing benefits of essential oils. Migraine relief, anxiety calming, muscle soothing, and even antimicrobial activity-seemingly there is nothing these magical oils cannot do. I do not doubt that people have found benefits from these compounds, but are anecdotal reports enough to support the price tag on these essential oils? What does the research really show?

antimicrobial activity

With flu season upon us, many will look to any natural remedy to fight this and any other contagious pathogens floating around. There have been literally thousands of publications looking at the bioactivity of essential oils as antimicrobial, antiinflammatory, antioxidant, and immunomodulating agents. However, does in vitro bioactivity translate into in vivo human benefits?

I have had many people ask me about OnGuard, a Doterra essential oil that is known to enhance immunity. It contains five essential oils-wild orange peel, clove bud, cinnamon bark, eucalyptus leaf, and rosemary leaf. A 2010 study showed influenza virus was suppressed by this essential oil treatment (1). Great right? Well the problem with this study was that it was in vitro, meaning it was done in a test tube. Additionally, it was done in canine kidney cells. So while the study is promising in that the essential oil could reduce infectivity, it is not possible to say if this actually translates in vivo in humans.

Another more recent in vitro study looked at two unique blends of Cinnamomum zeylanicum, Daucus carota, Eucalyptus globulus and Rosmarinus officinali and the activity against fungal, viral, and bacterial strains. It was found that these blends were active against the fourteen Gram‐positive and gram‐negative bacteria strains, including some antibiotic‐resistant strain. Additionally, one of the blends was active against H1N1 influenza strains and the pneumonia causing bacterial strains  S. aureus and S. pneumoniae. This is a potentially promising finding in those suffering both from influenza and post influenza pneumonia. In an era of antibiotic overuse and emerging resistance to both wide and narrow spectrum antibiotics this is a very promising finding that definitely deserves further research.

Tea tree oil is another essential oil that has been found to have activity against MRSA, an extremely pathogenic bacteria responsible for skin infections and respiratory infections. One study found that while not as effective as mupirocin cream for clearance of nasal carriage, tea tree oil was more active against MRSA skin lesions than chlorhexidine and silver sulfadiazene (3). This study was done in humans which was in contrast to the previous studies.

As noted above, there are hundreds of other bioactivity studies out there and I have only highlighted the above to show that there is promise in using essential oils as antimicrobial agents. Tea tree oil has been examined in human studies against MRSA skin infections, however the other research is mainly in laboratory testing. Will it hurt to use essential oils to help decrease possible viral or bacterial spread? No, unless you have an allergic reaction to the oil itself and it is used as recommended it is unlikely to cause any issues. If you forgo medical care because you believe an essential oil will cure you from a major illness that can also be an issue, so I do not recommend relying solely on these agents. Could essential oils theoretically reduce viral  or bacterial replication in humans? Maybe. More studies would need to be done in humans in  controlled studies to say conclusively. This is easier said than done as essential oils can be very unique in their chemistry depending on the plants that they are derived from, but I am hopeful that standardized studies may be able to be performed in the near future.

If you don’t mind spending the money, essential oils, especially those containing cinnamon, eucalyptus, clove, tea tree oil, and rosemary may have increased benefits in decreasing viral and bacterial spread of certain respiratory pathogens. And lets face it, we shell out money for many other unproven treatments or over the counter medications that probably don’t really do much in halting the spread of viruses or shortening the duration of illness. Also, we must remember that antibiotics do nothing to treat viral infections, which is the major cause of “colds” that people suffer from this time of year. From sinusitis to bronchitis, antibiotics typically are not needed despite the fact that I have patients requesting these on a daily basis. I would much rather be able to suggest something like essential oils to help combat these infections, rather than increasing the risk of antibiotic resistance and subjecting individuals to the many adverse side effects of inappropriate antibiotic use.

migraines

I have many patients that deal with migraines, and anyone that suffers from these headaches understands how debilitating they can be. There are many over the counter medications that are utilized-acetaminophen, aspirin, ibuprofen, naprosyn, and combinations with caffeine. Unfortunately, these are often unsuccessful in aborting migraines and often people have to turn to prescription triptans. Even then, those who frequently experience migraine headaches will find that no medications work, and even prophylactic treatment with beta blockers or Topamax does not stave off the episodes. (We will soon see how the new CGRP antibody-Aimovig-fares.) Time and again I have anecdotally heard about success stories with essential oils. So naturally I had to investigate.

The research out there is scarce, although I did find a couple of studies. One from 2012 investigated the benefits of inhaled lavender essential oil in migraine sufferers. This was a placebo controlled trial with 47 participants where the case patients inhaled lavender essential oil for 15 min, and the placebo group inhaled liquid paraffin. The response to lavender in reducing headache severity and even aborting migraines was significantly greater in the lavender group (4). However, a 2017 study using topical rose oil did not show benefit over placebo (5).

Mechanistically, peppermint oil also has the potential to alleviate headaches.  Research has shown that local application of peppermint oil generates a long-lasting cooling effect on the skin, caused by alteration of the cold receptors. It has also been shown that peppermint oil inhibits serotonin and substance P induced smooth muscle contraction in animal models, and it is also induces a significant increase in blood flow to the skin (6). However, there are no random controlled trials in humans looking at peppermint oil specifically for migraine relief.

As there is minimal research out there, a clear conclusion cannot be drawn. Lavender may be beneficial in reducing migraine headaches, and who I am to argue with a long suffering migraine patient who tells me it works for them? The one thing to consider is that certain scents and perfumes can actually worsen or precipitate migraines in some, and in these people inhaled essential oils may actually worsen the symptoms. Other than that, its not something that is likely to cause any adverse reactions  so at this point there seems to be no harm in using essential oils for migraine relief. This is actually a product that would be much safer than chronic NSAID or acetaminophen use. For those with heart, kidney, and liver disease, using ibuprofen on a chronic basis is contraindicated. And of course those with a history of gastric ulcers or reflux cannot take NSAIDS on a consistent basis either. Individuals with hypertension and coronary artery disease are often advised to stay away from triptans as well. So if essential oils work and help to alleviate the symptoms of migraines, I think they are a great option for many people.

Anxiety and stress

One of the biggest touted benefits I see out there for essential oils is that it helps calm anxiety and reduce stress. In this fast paced and demanding world we live in, anxiety disorders are becoming more and more prevalent, and this can severely impair day to day functions. The vast majority of medications used to treat anxiety can be habit forming and have adverse effects, so having a more natural option for treatment would be extremely valuable. I have to admit, when I can relax and breathe in something aromatic it does help release some tension. However, is there any science behind this?

A 2013 study actually looked at EEG patterns to discern if essential oils can have relaxation effects on the brain. It compared inhaled lavender, rose, sandalwood, and peppermint. It found that rose had the best effect on stress relief in females, while peppermint provided better calming effects in males (7). Another study examined participants solving difficult math problems  (considered the stressed state). EEG recordings were taken prior to solving the math problem, during the stressed state, and then while receiving aromatherapy with essential oils. Lavender, rose, sandalwood, and lemongrass  were used and EEG patterns were measured. There did appear to be a significant reduction in stress with all four essential oils, and this occurred within about ten minutes of exposure (8). Another study showed that lavender, when compared to almond oil, had a more relaxing effect based on self reporting. In addition, blood pressure, heart rate, and skin temperature were reduced in the lavender group indicating decreased autonomic arousal. This was a small study that involved twenty healthy patients between the ages of 18-35 (9).

Other studies have looked at an orally administered lavender containing capsule marketed as Silexan. A 2010 trial showed that the lavender oil preparation significantly improved the quality and duration of sleep and improved mental and physical health without major adverse side effects(10). Another larger study compared this oral lavender preparation not just to placebo but also to the antidepressant paroxetine in participants with generalized anxiety disorder. The end-point looked at the reduction in the Hamilton Anxiety scale score. The lavender preparation decreased this score significantly compared to placebo. There was only a trend toward significance when compared to paroxetine, however there were fewer adverse effects in those receiving the lavender supplement compared to paroxetine (11). A different study compared Silexan to lorazepam, or better known to many as Ativan. This was a six week study that again used the Hamilton Anxiety rating scale as an end point to measure improvement in the subjects anxiety. The lavender preparation was comparable to the lorazepam in this study in ameliorating anxiety, with the advantage of not having sedating properties like those seen with lorazepam (12).

These are just a few of the many studies that have shown promise for the use of essential oils to reduce the symptoms of anxiety. It should be noted that it is difficult to do blinded studies with aromatherapy due to-you guessed it-the aroma. So in some cases it is hard to say if it is more of an expectation bias that leads to subjective reporting of improved mood. The lavender oil capsule preparation, marketed as Silexan, has also shown to decrease symptoms of stress and anxiety not only when compared to placebo, but also had similar effects when compared to lorazepam and paroxetine. For some, this may mean being able to avoid habit forming medications for symptom relief. For others, essential oils, notably lavender, could be a great add on for individuals with anxiety that may not be fully resolved with pharmacologic therapy.

sleep

We all need it, and the majority of us don’t get enough of our favorite “S” word-Sleep. Seriously, when was the last time you got the full recommended eight hours of sleep? Getting enough shut eye at night allows our bodies to recover and is crucial in maintaining our health and wellness. Sleep affects our mood, cognitive function, and stress levels. It allows our bodies to recover after a hard workout, and it helps maintain our immune systems to fight off all those nasty microbes that surround us. However, a great deal of people suffer from sleep deprivation for numerous reasons. I’ve found the number of patients I have had requesting sleep aids has grown substantially in the past few years. Most of this seems to stem from stress and anxiety, which was addressed above. Many just cannot seem to unwind from the day and end up caught in a vicious cycle of poor sleep and increased stress, which then circles back to poor sleep the following night. There have been a number of pharmacologic agents developed over the years to combat insomnia, however these can be habit forming and have numerous side effects. I have found myself trying to find more natural ways to help individuals with their sleep issues despite the fact that many are requesting Ambien by name. There are plenty of anecdotal tales about the benefits of aromatherapy and sleep, and it turns out some controlled trials as well.

A study from 2010 investigated the effects of a lavender, roman chamomile, and neroli oil blend aromatherapy on anxiety, sleep, and blood pressure in patients who were admitted to the ICU after stent placement for coronary artery disease. It was found that those in the aromatherapy group experienced reduced anxiety, increased sleep, and stabilized blood pressure compared to the control group who received standard nursing care without aromatherapy (13). Another study looked at inhalation of lavender by healthy male and female subjects prior to sleep. There was an increase in deep wave sleep in both sexes as well as increased energy the subsequent morning (14). These are just examples of some of the studies out there looking at essential oils and sleep, but again does show promise that there is more than just a placebo effect from aromatherapy and essential oil use.

Pain

Everyday we hear about the opiate crisis and the addictive nature of prescription pain medications. I have not stumbled across research directly comparing essential oils to narcotic pain medications, although there are studies that do examine the the role of essential oils and pain relief. One review and meta-analysis showed that aromatherapy decreased pain  among subjects based on a visual analog scale. This meta-analysis looked at a variety of studies, ranging from chronic back and knee pain to post-operative and cancer pain. Studies looking at neck and knee pain showed improvement in range of motion when essential oils and massage were combined with conventional treatment. In a randomized trial following total knee replacement surgery, those treated with eucalyptus aromatherapy, along with standard pain medication treatment, had lower pain levels and blood pressure levels. Studies looking at postpartum pain, cancer pain, and pain related to dialysis also showed benefits using essential oils (15). In these studies, essential oils were mainly used as a complementary treatment in addition to pain medications or other usual care. However, it is promising in that this could help decrease the reliance on addictive narcotic pain medications.

in summary

This is not an all inclusive list of studies done on essential oils, but serves to highlight the fact that their is more than just anecdotal tales that support the benefits of essential oils. These are overall safe as well, although individuals using essential oils need to make sure they are using the oils as directed. There is the potential for skin irritation if directly applying the oils to the skin. Theoretically there is the potential for exacerbating respiratory symptoms when diffusing the oils, however there are also studies showing benefits of essential oils in patients with asthma. So use needs to be individualized and monitored.

Essential oils can be used in a diffuser as aromatherapy, and some can be applied to the skin. If being used on the skin (even if you’re just adding the essential oils to a bath), you’ll need a carrier oil—a neutral, plant-based oil that can act as a base. Common carrier oils include sweet almond, jojoba, olive, sunflower seed, avocado, and grapeseed. This really serves two purposes. Mainly it protects against skin irritation and skin reactions. But dilution also extends how long your essential oils will last as well.

The next question is: What is the best essential oil brand to buy? The market is saturated with so many options, it is difficult to know exactly what you are getting. This is not an article comparing brands, but during my research I did find a great review site that looks at some of the most popular brands: Essential Oil Haven. There is an overview of each brand, and individual reviews that follow. There is great information here about how these oils are labeled and what to look for when comparing brands. Obviously, purity and testing are of utmost importance, and this breaks it down nicely. Essential oils are not FDA approved or monitored.  Labels like “100% therapeutic grade”, “100% pure”, and others are just marketing tools that companies use. Some companies have even stopped using these terms as they find the labels misleading. I am only trying to point out that there is a lot of marketing jargon and ploys that companies use to try to say that their products are superior to others, and it is important to do your own research when deciding what brands to use.

Young Living and Doterra seem to be two of the more popular brands and I have heard great things about these companies. I personally have been using NOW, Thrive Market, and Aura Caucia essential oils. Full disclaimer, my main reason for this is that I have a subscription to Thrive Market (which I highly recommend not just for essential oils but for their whole marketplace), and all of these brands are sold on this online marketplace at incredible prices. You can get 25% off your first purchase using the link below.

Overall I think essential oils are a great tool in combating different health issues as noted above. I am not saying they are a substitute for good medical evaluation and care. But they can be used as an add on to the treatments we are currently using in the medical field and should not be completely written off. I am hoping to see more research in the future on these products, especially in the area of antiviral/antimicrobial activity and pain relief.  Having another option other than misused antibiotics and prescription opiates could be a game changer in healthcare.


Thrive Market

    1. Wu S, Patel KB, Booth LJ, Metcalf JP, Lin HK, Wu W. Protective essential oil attenuates influenza virus infection: an in vitro study in MDCK cells. BMC Complement Altern Med. 2010;10:69. Published 2010 Nov 15. doi:10.1186/1472-6882-10-69
    2. Brochot A, Guilbot A, Haddioui L, Roques C. Antibacterial, antifungal, and antiviral effects of three essential oil blends. Microbiologyopen. 2017;6(4):e00459.
    3. Dryden, MS et al. A randomized, controlled trial of tea tree topical preparations versus a standard topical regimen for the clearance of MRSA colonization. Journal of Hospital Infection. 2004. 56:4.
    4. Sasannejad P, Saeedi M, Shoeibi A, Gorji A, Abbasi M, Foroughipour M: Lavender Essential Oil in the Treatment of Migraine Headache: A Placebo-Controlled Clinical Trial. Eur Neurol 2012;67:288-291. doi: 10.1159/000335249
    5.  Maria, N, Mohammad HH,  Mohsen T, Mojtaba H,  Abdolhamid S. Efficacy of topical Rose (Rosa damascena Mill.) oil for migraine headache: A randomized double-blinded placebo-controlled cross-over trial. Complement Ther Med.  2017 Oct;34:35-41. doi: 10.1016/j.ctim.2017.07.009. Epub 2017 Jul 25.
    6.  Göbel H, Schmidt G, Dworschak M, Stolze HHeuss D. Essential Plant Oils and Headache Mechanisms. Phytomedicine. 1995 Oct; 93-102.
    7. Liu, CW et al., Electroencephalographic Study of Essential Oils for Stress Relief. Applied Mechanics and Materials. 2013;1085-1088
    8. Hema, CR, Revathi, S. A Preliminary Study on Aromatherapy as a Stress Buster Using EEG Signal Analysis. Emerging Trends in Engineering Research. 2012; 211-219.
    9. Sayorwan, W., Siripornpanich, V., Piriyapunyaporn, T., Hongratanaworakit, T., Kotchabhakdi, N., & Ruangrungsi, N. The effects of lavender oil inhalation on emotional states, autonomic nervous system, and brain electrical activity. Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2012 95 4, 598-606.
    10. Kasper S, Gastpar M, Müller WE, Volz HP, Möller HJ, Dienel A, Schläfke S. Silexan, an orally administered Lavandula oil preparation, is effective in the treatment of ‘subsyndromal’ anxiety disorder: a randomized, double-blind, placebo controlled trial. International Clinical Psychopharmacology. 2010 Sep;25(5):277-287.
    11. Kasper S, Gastpar M, Müller WE, Volz HP, Möller, Sandra HJ, Schläfke S, Dienel A.  Lavender oil preparation Silexan is effective in generalized anxiety disorder – a randomized, double-blind comparison to placebo and paroxetine, International Journal of Neuropsychopharmacology, 2014 June;17:859–869.
    12. Woelk HSchläfke S. 2010A multi-center, double-blind, randomized study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine. 17:9499
    13. Cho MY, Min ES, Hur MH, Lee MS. Effects of aromatherapy on the anxiety, vital signs, and sleep quality of percutaneous coronary intervention patients in intensive care units. Evid Based Complement Alternat Med. 2013;2013:381381.
    14. Namni Goel PhD, Hyungsoo Kim & Raymund P. Lao (2005) An Olfactory Stimulus Modifies Nighttime Sleep in Young Men and Women, Chronobiology International, 22:5, 889-904.
    15. Lakhan, S. E., Sheafer, H., & Tepper, D. (2016). The Effectiveness of Aromatherapy in Reducing Pain: A Systematic Review and Meta-Analysis. Pain research and treatment2016, 8158693.

flu is no joke


Prevention is the best treatment.

No matter how much real evidence is out there, many refuse to believe the benefit of vaccinations. Some will claim that doctors “push” vaccines because we receive kickbacks. Well, if you consider not having a bunch of people with a horrible, life threatening virus breathing on me, then yes I guess that is a kickback. But no, I will receive no monetary compensation by trying to protect your life. It just happens to be my job. I still remember several years ago when we had the Ebola scare and people were pleading for a vaccine for this extremely rare disease. Yet these were the same people that would refuse a flu vaccine. Blows my mind. Last year, over 80,000 people died from complications related to influenza. 80,000!! I know that there are a lot of questions out there about the flu vaccine and a lot of myths have been perpetuated. While there is a small group of people for whom this vaccine may not be appropriate, for the majority of people this is not something that should be skipped. Let’s break it down based on the most common reasons patients give for wanting to forgo the flu vaccine. 

“The flu vaccine gave me the flu”


This is probably the most frequent reason I hear when someone tells me they do not want the flu vaccination. No, you will not get the flu from the flu shot. The vaccine contains weakened or inactivated virus that stimulates your body to make antibodies to fight the real influenza virus. Now there are a couple caveats to this. One is that it takes about two weeks to build up these antibodies, so if you are exposed to the flu in this time period you can still develop symptoms. In addition, the flu vaccine is developed every year based on what strains are believed to be most prevalent in the upcoming year. It is not 100% effective every year and there may be strains out there that were not included in the vaccine. Luckily, though, by receiving the flu shot your body will still respond to a slightly different strain which usually will minimize the symptoms and shorten the duration of the illness if you do contract influenza. And for anyone that has suffered with influenza this can be critical. Also, many people will get a common cold or another infection that is not actually due to the influenza virus but people will assume that it is the flu. Every illness during the winter is not, in fact, influenza, and you can still contract a number of different bacterial and viral infections that unfortunately not all vaccines can protect against. 

 

 

“i don’t like vaccines in general. they are dangerous and cause health issues.”

That Lancet article by Dr. Andrew Wakefield will just not go away. The 1998 article linked the MMR vaccine with autism and has had people worried ever since.  However the children that Wakefield studied were carefully selected and some of Wakefield’s research was actually funded by lawyers that were involved in lawsuits against vaccine manufacturers. The paper was retracted 12 years after it was originally published due to these inconsistencies and the finding that there really was no consistent link between the MMR vaccine and autism. This has not stopped many from skipping vaccines altogether, and unfortunately this has lead to an increase in childhood diseases that had all but been eliminated. Measles, whooping cough, and mumps are just a few that have been trying to make a comeback, along with influenza in the winter. Now that does not mean that you may not experience some mild side effects from the flu vaccine. You may have a sore arm at the inoculation site for a day or so after receiving the shot. Others may develop a low grade fever and mild muscle aches which is typically just the body’s physiologic response as it is building up antibodies. The majority of individuals do not experience these side effects, but even if you do, isn’t a day of mild discomfort worth not having a week or more of misery with the flu? Or the possibility of even ending up in the hospital?

Very rarely a vaccine can cause a hypersensitivity or allergic reaction. If you have ever experienced severe anaphylaxis (difficulty breathing or airway swelling) after receiving a vaccine this would be a contraindication. Guillain-Barre Syndrome is another very rare occurrence that has been reported following administration of the flu vaccine, although the CDC reports that safety monitoring over the years has not detected a clear link between Guillain-Barre and the influenza vaccine. Studies suggest that the risk of developing GBS after actual influenza is higher than the potential risk of GBS following vaccination. Every year 1-2 people per 100,000 develop GBS regardless of flu vaccination status. (1)

“i’m healthy, I don’t need a flu shot”


There are clearly individuals that are more susceptible to the flu and who will suffer more serious health consequences if they contract this deadly virus. However, anyone can get the flu, even young healthy people. Everyone over 6 months is advised to receive the flu vaccine, including pregnant women. And trust me, if you’ve ever had the real honest to goodness influenza virus, you do not want it again. Dealing with fevers, body aches, debilitating cough, and just overall weakness and malaise is no way to spend your days, especially for the health conscious person that wants to keep up with their fitness and training regimen. The flu will set you back a couple weeks. Also, you can prevent the spread of the virus to those that are more susceptible by getting vaccinated. 

“the flu is just a really bad cold”


According to the CDC, 80,000 people died from complications from influenza last winter

Nope, influenza is a very serious virus. Young children, those over 65 years of age, and individuals with medical comorbidities such as COPD, diabetes, and immunosuppressed states are especially susceptible. The flu can predispose the body to developing concomitant bacterial pneumonia and can even progress to septicemia (infection in the bloodstream). The infection can progress rapidly and the signs and symptoms need to be recognized and addressed by a medical professional immediately. PEOPLE DIE EVERY YEAR FROM THE FLU. It is not an illness to take lightly.

surviving flu season


There are a number of ways to be proactive in preventing the flu. This of course includes the flu vaccine as noted above, but there are other easy preventive measures you can take. Wash your hands with soap and water on a regular basis especially after making contact with others that are sick or after coughing or sneezing. Avoid sharing utensils and glasses and wipe down surfaces at home with an antibacterial cleaner. Despite your best efforts, unfortunately you may still develop symptoms consistent with influenza. Fevers, chills, muscle aches, fatigue,  and persistent cough are possible indicators that you have the flu. Your doctor can perform a flu swab to determine if you do indeed have the flu. If you catch the symptoms early you can be started on an antiviral medication. However, this is only beneficial within the first 48 hours of symptoms, which is why it is important to be proactive. Let’s be safe this flu season. Remember, prevention is the best treatment.

 

 

  1. Vellozzi, C, Igbal S, Broder K.  “Guillian-Barre syndrome, influenza, and influenza vaccination: the epidemiologic evidence. Clin Infect Dis. 2014 Apr; 58 (8):1149-55.
  2. https://www.cdc.gov/flu/index.htm