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Thursday, April 21, 2016

Evidence Based Essential Oil Therapy and Its Effects on Inflammation

Integrative medicine (IM) is healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies.[1] [2] This is why integrative medicine excels where mainstream medical practice fails because an integrative approach to health care best supports the body’s natural ability to combat a variety of illnesses and injuries that cause disease. In fact there are tens of thousands of studies supporting numerous natural remedies as valuable adjuncts for many health conditions and diseases the evidence for which can be accessed in the U.S. National Library of Medicine’s database PubMed.[3]

An integrative approach to healthcare combines the best of both allopathic (modern/Western) and complementary medicine and applies the safest, least invasive, and most effective remedies first and when utilized prudently can improve the lives of men and women from all walks of life.[3]

Evidence-based utilization of essential oils has existed since the sixteenth century when the Germans greatly advanced the knowledge of essential oil distillation. The German model of essential oil therapy focused on inhalation better known as aromatherapy which current studies suggest has a profound effect on psychophysiology. [4] [5]

In the early 20th century, French chemists and physicians began experimenting with and investigating the topical and oral administration of essential oils. The French model developed a deep understanding of the pharmacology, toxicology, and physiology regarding therapeutic administration of non-diluted (a.k.a. neat) essential oils.[4]

In the 1950s Marguerite Maury, an Austrian born biochemist and nurse, introduced the therapeutic application of essential oils in England via aromatherapy massage. Her life’s work was based solely on the principles that we can remain youthful in our attitude, energies and beliefs if we only take the time to look at how we take care of ourselves.[6] She advocated the heavy dilution of essential oils prior to topical application but because she was not a medical doctor she discouraged oral administration. Her methodology, which became the British model of essential oil therapy, was vital to a greater comprehension of the safety, possible drug interactions, and health contraindications of essential oils.[4]

The 21st century approach to essential oil therapy, the one I am advocating here, is an evidence-based model which has taken the best aspects of these aforementioned models and has established modern protocols based on the consensus of user testimonials and, most importantly, scientific evidence to determine safe therapeutic applications for numerous health issues.

The evidence-based model of essential oil therapy first takes into account current medical literature and clinical case reports because contraindications do exist, primarily with regard to drug interaction. Many essential oils could interact with certain medications and therefore it is important for the layperson to seek the advice of their health-care practitioner before integrating any of the recommended protocols because some medical conditions require a more cautious use of essential oils.

This model incorporates three methods of administration of essential oils: inhalation, topical, and oral.

Inhalation is the safest way to administer essential oils and provides several benefits which include soothing throat infections [7], overcoming mental fatigue and exhaustion, encouraging the expulsion of mucous, relieving stress, anxiety, and nervous tension, and purifying the air (removing toxins, killing airborne germs, altering mood, encouraging restful sleep).[8] In fact the medical field has utilized inhalation therapy of essential oils to treat acute and chronic bronchitis, acute sinusitis, and the reduction of asthmatic symptoms.[9] A study published in the March 2016 edition of Complementary Therapies in Medicine examined the use and effectiveness of essential oil therapeutic interventions on pain, nausea, and anxiety, when provided by nurses to patients in acute hospital settings across a large health system between February 1, 2012 and June 30, 2014.[10] During the course of the study a total of 10,372 essential oil therapy sessions were administered, 77.6% were inhaled, 19.0% were topical, and 3.3% were a combination of both. The most frequently used essential oil was lavender [Lavandula angustifolia] (49.5%) followed by ginger [Zingiber officinale] (21.2%), sweet marjoram [Origanum majorana] (12.3%), mandarin [Citrus reiculata] (9.4%), and a combination of oils (7.6%). 



 Nurses collected patients’ self-reported pain, nausea, and anxiety scores directly prior to and within 60 minutes of the aromatherapy session. The results of this study found that sweet marjoram resulted in the largest single oil average pain change while an unspecified combination of the four oils also showed a clinically relevant change in overall subjective pain change [NOTE: Tabular data from this study indicates that ginger, lavender, and sweet marjoram are indicated[11] for this particular outcome.] Lavender [12] and sweet marjoram followed by mandarin resulted in the most clinically relevant applications for anxiety while ginger and mandarin exhibited the most clinically relevant applications for nausea. While this study was not a randomized control trial it does suggest that patients who receive essential oil therapy in conjunction to standard medical care report, on average, statistically significant decreases in pain, anxiety, and nausea. [7] [13] There was also evidence that indicates these four essential oils may help with symptom relief beyond their indication(s) for use.[7]

Topical application of essential oils is administered in a range of dilution from neat to highly diluted so that each person is able to customize his or her usage according to their current state of health, body physiology, skin sensitivity, and level of comfort. Dilution with carrier oil (i.e. coconut oil, olive oil, sesame seed oil, sweet almond oil) is ideal to avoid sensitization and irritation especially for “hot” oils like oregano, thyme, and cinnamon, however, maximum strength is recommended for serious injuries, burns, infections, wounds, or severe illnesses but should only be utilized in this way for short periods by those who are sensitive.[14] Additionally, carrier oils prolong the therapeutic verve of essential oils especially when administering to influence mood and emotions because the aroma is available for a longer period of time. Once applied to the skin, essential oil compounds rapidly penetrate the tissues and enter the bloodstream quickly.[12] Once in the bloodstream, essential oils are attracted to (due to its lipophilic [15] characteristics) and able to penetrate the phospholipid membrane [16] (a thin oil-like barrier) of the cell to deliver nutrients to the cell nucleus[17] [18] [19] [20] [21] hence why drug companies produce treatments (i.e. cancer drugs) that are encased by liposomes [22] [23] and why essential oils can affect cell function, behavior, and overall well-being. The terpenes [24] found in essential oils have a significant role in controlling the central nervous system as well as anti-inflammatory effects on the cells of the human body.[8] Essential oils and their individual aroma components have also shown cancer suppressive inactivity [25] [26] when tested on a number of human cancer cell lines including glioma [27] [28], tumors, breast cancer [29], leukemia and others.[30] [31]

Oral administration of essential oils allows for greater precision in dosing, increased convenience, as well as good degree and rate of uptake by the body in their physiologically active form. However, administered in this way increases the risk of drug interactions and stomach irritation hence why contraindications and safety precautions MUST be checked before administering essential oils orally.[32] Oral administration can be done four ways: in a vegetable capsule, in a beverage (water, almond milk, herbal tea), in honey, or directly on or under the tongue. In fact, sublingual (under the tongue) administration bypasses the digestive tract of the body due to the high concentration of capillaries under the tongue allowing essential oils to be absorbed directly into the bloodstream.[31] Adverse reactions to essential oils are considerably lower and less severe than those of prescribed medication and, based on current data, when utilized in reasonable doses for a practical period of time oral administration of essential oils can be a significant integrative adjunct to standard medical treatment.[31]

Method(s) of essential oil application is dependent on the condition, its severity, and the familiarity of the individual with a certain oil(s) and/or protocol. The effectiveness of essential oil therapy can be exponentially increased by utilizing more than one application method at a time but should always be diluted according to age, current state of health, and body size. Therefore, be prepared, have a supply of pure, authentic oils [not the fragrance-grade kind often sold for use as perfumes or as scents] before finding yourself in a situation where you need them especially if you know you have a specific health condition. Oil purity is paramount, many oils sold today (up to 98%) are used for perfumes and are manipulated for consistency of scent rather than use in aromatherapy applications.[33] Common adulterations of essential oils include synthetic menthol added to peppermint oil, synthetic phenyl ethyl alcohol added to rose otto, adding lavandin to lavender, diluting citronella with lemongrass, or using cinnamon leaf instead of bark.33 Synthetic/adulterated essential oils can cause significant harm and while they may elicit results in the short term over time can produce allergies, headaches, chemical sensitivities, and result in body toxicity.[33] Ensure using pure oil by purchasing from a manufacturer that has expertise in the distillation process, takes a clinical approach to essential oil development, personally involved in the farming and cultivation process, verifies purity with their own laboratories as well as third-party testing facilities and educated scientists. In closing keep one fact in mind, there is no autonomous level of quality or excellence that is accepted as the norm or by which actual attainments are judged for “Therapeutic Grade” and while many companies promote their own therapeutic grade standard, one should be aware that there is no universally accepted independent body that certifies essential oils as therapeutic grade. A fair and factually correct statement that nobody (i.e. marketing companies and traditional aromatherapists) can disagree with.[34]


*NOTE: The information provided in this article is not meant to be substituted for medical treatment when it is available nor to replace treatment prescribed by your physician or health-care practitioner. Do not attempt to diagnose or prescribe essential oils for conditions that require professional attention. Always consult a physician for any health condition, injury, or illness.




[1] Arizona Center for Integrative Medicine. "What Is Integrative Medicine?"Arizona Center for Integrative Medicine. The University of Arizona, n.d. Web. 13 Apr. 2016. http://integrativemedicine.arizona.edu/about/definition.html>.
[2] Dossey B, Keegan L. Holistic Nursing: A Handbook for Practice. 6th ed. United States: Jones & Bartlett Learning: 2013
[3] Johnson, Scott A. Surviving When Modern Medicine Fails: A Definitive Guide to Essential Oils That Could save Your Life during a Crisis. 3rd ed. North Charleston, SC: CreateSpace, 2014. 8-9. Print.
[4] Johnson, Scott A. Surviving When Modern Medicine Fails: A Definitive Guide to Essential Oils That Could save Your Life during a Crisis. 3rd ed. North Charleston, SC: CreateSpace, 2014. 14-16. Print.
[5] physiological psychology: a branch of psychology that studies the interactions between physical or chemical processes in the body and mental states or behavior
[6] Austin, Ken. "Marguerite Maury." Oils and Plants~ The Aromatherapy and Herbal Health Website. Http://www.magiwebs.com/, n.d. Web. 13 Apr. 2016. <http://www.oilsandplants.com/maury.htm>. Madame Marguerite Maury (1895-1968) was an Austrian born biochemist who became interested in what was to become aromatherapy.

[8] Johnson, Scott A. Surviving When Modern Medicine Fails: A Definitive Guide to Essential Oils That Could save Your Life during a Crisis. 3rd ed. North Charleston, SC: CreateSpace, 2014. 90. Print.
[9] Rajendran, Mini Priya, Blessed Beautlin Pallaiyan, and Nija Selvaraj. "Chemical Composition, Antibacterial and Antioxidant Profile of Essential Oil from Murraya Koenigii (L.) Leaves." Avicenna Journal of Phytomedicine. Mashhad University of Medical Sciences, n.d. Web. 16 Apr. 2016. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104627/>.
[10] Johnson, Jill R., Rachael L. Rivard, Kristen H. Griffin, Alison K. Kolste, Denise Joswiak, Mary Ellen Kinney, and Jeffery A. Dusek. "The Effectiveness of Nurse-delivered Aromatherapy in an Acute Care Setting." Complementary Therapies in Medicine 25 (2016): 164-69. Web.
[11] Ou, Ming-Chiu, Tsung-Fu Hsu, Andrew C. Lai, Yu-Ting Lin, and Chia-Ching Lin. "Pain Relief Assessment by Aromatic Essential Oil Massage on Outpatients with Primary Dysmenorrhea: A Randomized, Double-blind Clinical Trial." Journal of Obstetrics and Gynaecology Research 38.5 (2012): 817-22. Web.
[12] Najafi, Zahra, Mohsen Taghadosi, Khadijeh Sharifi, Alireza Farrokhian, and Zahra Tagharrobi. "The Effects of Inhalation Aromatherapy on Anxiety in Patients With Myocardial Infarction: Randomized Clinical Trial."Iranian Red Crescent Medical Journal Iran Red Crescent Med J 16.8 (2014): n. pag. Web.
[13] The single arm observational design is appropriate for exploring the aromatherapy program in a real-world hospital setting which is indicated by the following: Black N. Why we need observational studies to evaluate the effectiveness of health care. BMJ. 1996;312(7040):1215-1218 - Atkins D. Creating and synthesizing evidence with decision makers in mind: integrating evidence from clinical trials and other study designs. Med Care. 2007;45(10 Supl. 2):S16-22
[14] Johnson, Scott A. Evidence- Based Essential Oil Therapy: The Ultimate Guide to the Therapeutic and Clinical Application of Essential Oils. Middletown, De.: CreateSpace Independent, 2015. 30-31. Print.
[15] lipophilic: having a chemical affinity for lipids
[16] lipid: a biological compound that is not soluble in water, e.g. a fat. The group also includes waxes, oils, sterols, triglycerides, phosphatides, and phospholipids.
[17] Cox, SD, Mann CM, Markham JL, et al. The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil). J Appl Microbiol. 2000 Jan;88(1): 170-5.
[18] Bakkali F, Averbeck S, Averbeck D, et al. Biological effects of essential oils - A review. Food Chem Toxicol. 2008 Feb;46: 466-475.
[19] Cristani M, D’Arrigo M, Mandalari G, et al. Interaction of four monoterpenes contained in essential oils with model membranes: Implications for their antibacterial activity. J Agric Food Chem. 2007 Jul 25;55(15):6300-8
[20] Buchbauer G, Jirovetz L, Jager W, et al. Fragrance compounds and essential oils with sedative effects upon inhalation. J Pharm Sci. 1993 Jun;82(6):660-4
[22] "What Is a Liposome?" News-Medical.net. Https://plus.google.com/+News-medicalNet/posts, 17 Feb. 2010. Web. 16 Apr. 2016. <http://www.news-medical.net/life-sciences/What-is-a-Liposome.aspx>
[23] Detoni, Cassia B., Diêgo Madureira De Oliveirac, Islane E. Santo, André São Pedro, Ramon El-Bachac, Eudes Da Silva Velozoa, Domingos Ferreirad, Bruno Sarmentod, and Elaine C. De Magalhães Cabral-Albuquerque. "Evaluation of Thermal-oxidative Stability and Antiglioma Activity of Zanthoxylum Tingoassuiba Essential Oil Entrapped into Multi- and Unilamellar Liposomes." National Center for Biotechnology Information. U.S. National Library of Medicine, 6 May 2011. Web. 20 Apr. 2016. < http://www.ncbi.nlm.nih.gov/pubmed/21548711/ >.
[24] terpene: an aromatic hydrocarbon obtained from plant oils
[25] inactivity: describes a disease that, though present in the body, is not developing or producing any symptoms
[26] Bayala, Bagora, Imaël HN Bassole, Riccardo Scifo, Charlemagne Gnoula, Laurent Morel, Jean-Marc A. Lobaccaro, and Jacques Simpore. "Anticancer Activity of Essential Oils and Their Chemical Components - a Review." American Journal of Cancer Research. E-Century Publishing Corporation, 19 Nov. 2014. Web. 20 Apr. 2016. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266698/>.
[27] Quassinti, Luana, Giulio Lupidi, Filippo Maggi, Gianni Sagratini, Fabrizio Papa, Sauro Vittori, Armandodoriano Bianco, and Massimo Bramucci. "Antioxidant and Antiproliferative Activity of Hypericum Hircinum L. Subsp. Majus (Aiton) N. Robson Essential Oil." National Center for Biotechnology Information. U.S. National Library of Medicine, 5 Apr. 2012. Web. 20 Apr. 2016. <http://www.ncbi.nlm.nih.gov/pubmed/22480321/>.
[28] Hsu, Shu-Shong, Ko-Long Lin, Chiang-Ting Chou, An-Jen Chiang, Wei-Zhe Liang, Hong-Tai Chang, Jeng-Yu Tsai, Wei-Chuan Liao, Fong-Dee Huang, Jong Khing Huang, I-Shu Chen, Shuih-Inn Liu, Chun-Chi Kuo, and Chung-Ren Jan. "Effect of Thymol on Ca2+ Homeostasis and Viability in Human Glioblastoma Cells." National Center for Biotechnology Information. U.S. National Library of Medicine, 2 Sept. 2011. Web. 20 Apr. 2016. <http://www.ncbi.nlm.nih.gov/pubmed/21914442/>.
[29] Suhail, Mahmoud M., Weijuan Wu, Fadee G. Mondalek, Kar-Ming Fung, Pin-Tsen Shih, Yu-Ting Fang, Cole Woolley, Gary Young, and Hsueh-Kung Lin. "Boswellia Sacra Essential Oil Induces Tumor Cell-specific Apoptosis and Suppresses Tumor Aggressiveness in Cultured Human Breast Cancer Cells." BMC Complementary and Alternative Medicine. BioMed Central Ltd, 15 Dec. 2011. Web. 20 Apr. 2016. <http://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-11-129>.
[30] Iyer D, Uma DP. Phyto-pharmacology of Murraya koenigii. Pharmacognosy Reviews. 2008;2:180–184.
[31] Ni, Xiao, Mahmoud M. Suhail, Qing Yang, Amy Cao, Kar-Ming Fung, Russell G. Postier, Cole Woolley, Gary Young, Jingzhe Zhang, and Hsueh-Kung Lin. "Frankincense Essential Oil Prepared from Hydrodistillation ofBoswellia Sacra Gum Resins Induces Human Pancreatic Cancer Cell Death in Cultures and in a Xenograft Murine Model." BMC Complementary and Alternative Medicine. BioMed Central, 13 Dec. 2012. Web. 20 Apr. 2016. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538159/>.
[32] Johnson, Scott A. Evidence- Based Essential Oil Therapy: The Ultimate Guide to the Therapeutic and Clinical Application of Essential Oils. Middletown, De.: CreateSpace Independent, 2015. 44-47. Print.
[33] Johnson, Scott A. Evidence- Based Essential Oil Therapy: The Ultimate Guide to the Therapeutic and Clinical Application of Essential Oils. Middletown, De.: CreateSpace Independent, 2015. 16-18. Print.
[34] Pappas, Robert. "Essential Oil Myths." Essential Oil University (EOU). Essential Oil University, LLC, n.d. Web. 21 Apr. 2016. <https://essentialoils.org/news/eo_myths>. https://www.facebook.com/EssentialOilUniversity

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