Aromatherapy and Essential oils James Geiger MD Your Wellness Specialist

AROMATIC MEDICINE IN THE TWENTY – FIRST CENTURY

Smell is a learned process shaped by the associations of thought with language, experiences, neurogenesis, and genetics (Geiger, 2004).

Essential oils are the concentrated distillations of volatile aromatic compounds extracted from plants to yield apothecary-like compounds.  Examples supplied here substantiate health and wellness aspects of the vast field of complementary alternative medicine (CAM).

Evidence-Based Aromatics

The word “essential”, when discussing extracted oils from plants, refers to the aromatic, fragrant, adaptogenic, and phytomolecular essence of plants.

• Essential oils have no glycemic index value since they are volatile aromatic organic chemical compounds. Essential oils are used in foods as flavorings and fragrances in the range of 30 parts per million (ppm), which is exceedingly small at 3 to 5 calories per gram.
• Essential oils are not sugars or fats, as opposed to foods that may have hundreds of calories per ounce and therefore have virtually no caloric value.  A typical aromatherapy treatment that uses 5 to 10 drops of essential oil is of virtually no direct caloric consequence.
• Essential oils are rich in high-energy, double-bonded electron molecules, and as such are exceedingly high in oxygen radical absorbance capacity.

The Molecular Biology of Aromatic Medicine

Our biological understanding of the intracellular molecular events evoked from clinical applications of essential oils is growing. Essential oil phytomolecules impact intracellular synthesis pathways. The NFkappa B (NF-KB) transcription factor regulates many genes that permit cells to respond to infection and inflammation. The inflammatory protein NFKB product expression is inhibited by sesquiterpenes, compounds that are commonly present in essential oils (Tipton, 2006).  The dreaded Trypanosoma cruzi of South America that causes Chagas cardiac disease is killed in-vitro by the thymols present in essential oil of thyme (Santoro, 2006).  Clinically, topically applied essential oil phytomolecules have been used to treat the inflammation and malodorous ulcerated lesions of diabetic gangrene and cancer, while promoting growth of new skin (Sherry, 2003, 2005).   Oil of Pepper (Piper nigra) enabled stroke patients with swallowing difficulties to swallow and resume eating, thus limiting the mortality and morbidities of aspiration and malnutrition (Ebihara, 2006).  Essential oil of black pepper also blocks substance P, which is a mediator of painful sensations pathways.

The olfactory bulbs of the paired cranial nerves in the brain have two types of receptors, which are well-known to anesthesiologists and scientists: NMDA and GABA.  Pain is mediated through the N-methyl-D asparate (NMDA) receptors.  Sedation and anesthesia are mediated through the gammaaminobutyric acid (GABA) receptors located in the same smell portion of the nose.  The benzodiazepines (e.g., midazolam and certain aromatic gases) work through GABA receptors causing sedation and relief of anxiety and amnesia.  Patients almost always receive the benzodiazepine drug midazolam intravenously, before entering into any surgery or medical procedure.

The NMDA pain and psychometric receptors are stimulated or blocked by medications such as dextromethorphan and amantadine (Namenda).  Essential oils are also suggested to be instrumental in diseases such as dementia and Alzheimer’s.  Melissa officinalis (lemon balm) and Lavender have been described as an effective treatment in the management of severe, agitated dementia (Holmes, 2002; Ballard, 2002).

Sense of smell can be affected by medications or vitamin deficiency, causing a loss of sense of smell known as anosmia.  All classes of medications from A to Z, whether they are antibiotics, anti-inflammatory agents, anti-Parkinsonian drugs, antihistamines, antidepressants or anticonvulsants (these are just some of the drug families starting with the first letter of the alphabet) can cause anosmia.  It is noteworthy that vitamin A deficiency is a leading cause of loss of sense of smell, though this is reversible with supplementation of vitamin A.

Essential Oils in the Sleep Laboratory

Everybody craves sleep.  Sleep rejuvenates the body-mind connection.  Sleep has very complex neurological, hormonal, and chemical physiology.  The sleep hormone melatonin works on GABA receptors as do several essential oils.

There are olfactory and circadian rhythm experiments done on humans and rats that are somewhat informative, although the folklore of aromatherapy and sleep far exceeds the scientific research.  Different essential oils have different effects on sleep patterns in men, women and animals.

Essential oil of Lavandula angustifolia increased the percentage of deep and restorative slow-wave sleep in men and women.  All subjects reported more morning vigor.  Oil of Lavender had opposite effects in men and women in terms of how long it took to reach a wakened state after falling asleep (Goel, 2004-2006).

Different essential oils have different effects on sleep patterns in men, women and animals.  Therefore, choosing a particular essential oil as a sleep aid is difficult.  The inhaled essence of essential oil of cedar in humans significantly shortened the daytime napping non-rapid eye movement stage 2 sleep latency. The shortened napping cycle could possibly be due to the stimulation of neural or humoral mechanisms in humans by the cedrol in the essential oil of Cedar. The Cedar oil had the opposite effect in rats, (Sano, 1998).  Lemon may worsen insomnia (Komori, 2006).

Essential oils can have specific stimulating or inhibiting effects on the parasympathetic and sympathetic nervous systems of the human body modifying the balance of the autonomic nervous system.  Essential oil of Rose, for example, decreases adrenal cortisol release, which is a sympathetic response to stress, by greater than 30% (Haze, 2002).

The following essential oils have been suggested to be safe sleep aids to test and see what works:

Bergamot, Lavandula angustifolia, Ravensara aromatica, Mandarin, Neroli, Sweet orange, Melissa officinalis, Sandalwood, Roman chamomile, and Valerian.

Sleep Apnea: “A Noisy Airway Is an Obstructed Airway”

My father taught me that phrase. I read an online report about treating sleep apnea syndrome using a Didjeridoo. The Didjeridoo is a traditional Australian Aborigine musical wind instrument.  A study published in the British Journal of Medicine, concluded that sleep apnea symptoms decrease with progressive use of the Didjeridoo (Puhan, 2006).

There is less obstructed breathing (i.e. snoring) when sleeping at night. It is possible that this decrease is a result of the breathing exercise required by playing the instrument, which strengthens the throat muscles.  I found it curious that traditionally, the Didjeridoo’s beeswax mouthpiece is cleaned with two essential oils, Lavender and Eucalyptus (species not mentioned).  It is difficult to design a study in which essential oils are involved.  What caused the benefit is not perfectly clear in this study, because the authors do not mention whether essential oils were used by the test or control group to clean the Didjeridoo as traditionally recommended.

Plausible mechanisms to explain the reversal of the sleep apnea problem suggest that, if traditional essential oils were used to clean the instrument, the oils may have acted as astringents to decongest the airways, possibly working in conjunction with the “workout” to strengthen the throat muscles.  This example of a medical study making the news, sounds fun and appears promising.  Playing the Didjeridoo might even relieve a person of having to wear a sleep apnea CPAP or BIPAP mask at night, or eliminate the need for corrective surgery.

Proof of Principle for Ginger oil and Anesthesia

Ginger is a food, and as such, has been used in many forms as a traditional remedy.  Obstetrics-gynecology journal articles in the last several years have verified the safety and efficacy of ginger during pregnancy (Smith et al., 2004).

Oil of ginger is a fine example of an essential oil that currently has proof of principle established serving as an example of the successful entry of essential oil of ginger into surgical pre-op and anesthesia recovery in surgery centers and hospitals to decrease the incidence of PONV.  Application of 10% carbon dioxide-distilled essential oil of ginger root to the palms, wrists, ears, soles of feet in children, and in the oxygen face-mask reduces the ill effects of anesthesia, as well as patient anxiety.

The potential for complications from the herb-drug interactions between traditional Chinese medicine (TCM) and anesthesia was studied in “Herbal Medicines and Perioperative Care.”   This study verifies the

relative safety of ginger among surgical patients in regard to blood coagulation parameters such as platelet aggregation and international normal ratios, INR values (Lee, 2006).  The overall morbidity due to interactions between TCM prescriptions and anesthesia was negligible.  However, a two-week hiatus from all TCM prescriptions and herbals was recommended prior to surgery based on rare but possible minor interactions (Lee, 2006).

The inhalation and dermal application of 10% CO2 ginger oil for general anesthesia patients, combined with the use of guided imagery, has shown a more than 30% decrease in the incidence of nausea in patients at high risk for nausea during recovery from anesthesia.

Increased Client Satisfaction

Prophylaxis with ginger increases patient satisfaction significantly, is very inexpensive, extremely low risk, and potentially of use in procedural situations that might induce vaso-vagal or gastrointestinal distress such as bowel preparations, endoscopy, and to decrease “gagging” during dental procedures. Ginger oil effectively treats the three major components of nausea related to surgical interventions: general anesthetic agents, narcotics, and motion sickness.

Aromatic medicine with essential oils is one element of holistic healing expressed in the clinical practice of integrative medicine.

James Geiger MD Your Wellness Specialist