Aromatherapy- Aromatherapy is the use of essential oils derived from fragrant plants (such as peppermint, sweet marjoram, bay, caraway, peppermint, chamomile, rose and others) to "help relieve health problems and improve the quality of life in general".  These oils are derived from flowers, and are available for use as an inhaled agent, topically applied, in association with massage or acupressure, or taken internally.    Inhaled essential oils must be diffused into the air in order to enter the alveoli of the lungs. 

Essential oils- oils derived from fragrant plants, flowers, herbs, leaves, grasses, roots, woods, barks, spices, fruits or gum using steam distillation.  This method of oil extraction destroys some of the components of the oils. 

Pure essential oils- these are expensive, labor intensive oils that do not have additives.  Some products labeled only "essential oil" may be synthetic or adulterated.  "Pure essential oils" theoretically is a higher quality oil that will be more expensive, but since the FDA does not regulate the industry, and there are no standards for lot analysis (most are not analyzed at all), therefore it is not possible to trust the labels. Analysis certificates may easily be fabricated, and since there is no one to check the analysis, it is possible that even those oils labeled "Pure essential oils" may be fake or adulterated.

Absolutes- these are oils derived from fragrant plants using a solvent based extraction of oils.  The solvent is then later removed from the extracted oil. Whereas steam distillation removes some of the components of the oils, the absolutes usually do not.  The same product, essential oil or absolute will therefore have different properties and sometimes different fragrances.

Aromatherapy oil- is a very diluted form of essential oils used for massage. When used as a massage therapy, the essential oils are administered as a very dilute product, typically containing less than 2% of essential oils with the balance being 98% almond or grape oil.  Aromatherapy oil is only useful for massage, and aside from the faint scent associated with the oil, the contents are not concentrated enough to have any significant medical healing effect.

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ESSENTIAL OIL HARMS

Internal use of most of the essential oils is completely untested for safety and inhaled essential oils also have very few studies demonstrating safety.  Slick marketing causes naïve practitioners to believe “therapeutic grade” oils are the only ones that can be used internally, when in reality there is no evidence use of these oils is safe.  The Alliance of International Aromatherapists gives this statement on the internal use of essential oils: “AIA does not endorse internal therapeutic use (oral, vaginal or rectal) of essential oils unless recommended by a health care practitioner trained at an appropriate clinical level. An appropriate level of training must include chemistry, anatomy, diagnostics, physiology, formulation guidelines and safety issues regarding each specific internal route (oral, vaginal or rectal). Please refer to the AIA Safety Guidelines for essential oil use.”  Most practitioners suggesting such oils have not had the requisite training, however in the absence of safety studies, there is no amount of training that can insure safety.  Historical use of these substances internally is also not evidence of proof of safety.  There are a few studies demonstrating capsules of peppermint can improve the pain from inflammatory bowel diseases by altering gut flora but inhaled  has little proof of efficacy nor safety.  Many aromatherapists using or promoting essential oils are not medically or nursing trained, and have neither devoted enough time nor effort into proving the safety or efficacy of their therapies. There are several essential oils that should not be taken internally due to risks of liver damage include buchu, cassia, aniseed, basil, bay, clove, fennel, and tarragon. Other essential oils that may cause toxicity taken internally include camphor, mugwort, nightshade, pennyroyal, rue, savin, southernwood, stinging nettles, tansy, thuja, wintergreen, wormseed, and wormwood. 

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STORAGE OF ESSENTIAL OILS

1. Store away from children

2. Do not store in direct sunlight since the UV rays will oxidize and decompose the oils, and cause the more volatile components to vaporize

3. Store in bottles that are not clear to avoid light oxidation.  Amber is best, green is next, violet does not protect from UV light, and clear is the worst. 

4. Store in a refrigerator to prolong the life of the oil, especially in the summer.  This lowers the temperature so the volatile components do not vaporize as quickly, however essential oils of Rose Otto, Aniseed, Star Anise and Fennel may solidify at this temperature. This just means you will need to allow them to warm up before use, and in the case of Rose Otto just holding it in your hand for a few minutes produces enough heat to dissolve the natural waxes which solidify just below room temperature. Other oils may need to stand for a few hours to return to normal. Certain oils should be removed from the fridge 12 hours before you need to use them to allow them to naturally adjust to room temperature, because when stored at low temperatures some carrier oils form fatty particles which will need to be dissolved again before you can use them. A quick shake of the bottle is all that is needed to ensure that waxy/fatty particles are dissolved back to their normal state. Jojoba oil will set into a solid, butter-like consistency at cool temperatures, and this is an indication that the oil has not been 'extended' with a cheaper carrier oil. Unrefined Avocado may also react in a similar way, although the refined oil will remain liquid since most of the essential fatty acids have been removed during the processing of the oil.

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ESSENTIAL OILS AS A TREATMENT-  

Some of those manufacturing, selling or using essential oils in treatments tout essential oils being "holistic", treating the whole body instead of just the disease.  They claim essential oils "regulate, balance, heal and maintain your entire being by working with nature, and not against it- a far cry from allopathic medicine, which tends to take a 'sledgehammer to crack a nut' approach."  Of course this is simply hype without any scientific evidence that oils treat "the whole body" in any positive way, and is often a desperate attempt to sway the naive towards abandonment of traditional medicine, replacing it with essential oils and other alternative medicine.  It is common to find alternative practitioners banding together to share office space and "holistic treatment centers", and sharing a common message that organized medicine is bad while alternative medicine is good because it is "safe" and "natural".  Nothing is further from the truth- the safety of alternative therapies is often unknown because the practitioners have never studied the safety of these treatments in large scale studies, and some are completely un-natural, such as the supplement industry.   

 

Essential oils are used in massage (aromatherapy), with at least temporary proven health benefits.  Part of the benefit of massage with essential oils is the time spent with and being counseled by the essential oil "therapist".  The effect of physical relaxation with massage and the psychological relaxation with counseling cannot be underestimated. 

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But the essential oil "therapist" may have adopted an unusual belief system that effectively is an ersatz pseudo-medical system.  They believe many physical manifestations of disease are simply due to "stress", and will attempt to relieve the stress by using body mind techniques that use the essential oil as a schtick rather than as part of a cure.  There is much placebo effect and much fabricated information passed down from oil manufacturers about the advantages of essential oils.  Certainly, spending time with a "therapist" (indeed the psychological component cannot be underestimated) and having a massage is relaxing, producing temporary reduction in stress and anxiety. 

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So how do essential oils stack up in treating disease?  Using the highest levels of evidence based medicine (that which medicine is held to by insurers and governments), essential oil treatments have virtually no evidence of effectiveness, primarily because valid studies have not been performed. Most of the essential oil treatments do not use a "control" or a placebo, therefore it is impossible to determine whether the touted effects are real or imagined.  Furthermore, essential oils themselves are part of a psychological and massage treatment, and cannot be separated.  Only by blinding the essential oil therapist to what is a real and what is placebo is it possible to determine the effect of an oil.  Most essential oil studies are of poor quality, have significant bias built into the study when graded using scientific methods, use small numbers of patients, and do not employ controls.  The follow up from these studies is poor.  Essential oil therapists have largely created their own pseudo-medical system with fundamental concepts that are unproven.  The therapists accept these concepts without ever demanding proof- frequently concepts that have been handed down through the ages, but have never been subjected to scientific scrutiny.  While in general, essential oil therapists are harmless in their treatments (with the exception of recommending internally consumed oils), the greatest danger is their attitude towards traditional medicine, causing patients with serious diseases to forgo medical treatment, instead relying on essential oils and aromatherapy.  Cancer certainly can manifest itself as "fatigue" or "stress", and a delay in diagnosis and treatment for the cancer while being treated with essential oils by therapists who castigate the medical profession, can be disastrous.  Many essential oil therapists see aromatherapy as a true alternative to the traditional medical system.  Of course there is no culpability of these therapists since the legal system has not yet turned their focus onto these practitioners that are leading to delay in diagnosis and perpetuation of disease through non-treatment.  We will examine the medical evidence of effectiveness of essential oils, keeping in mind essential oil practitioners do not believe their craft should be subjected to this type of scrutiny. 

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EVIDENCE BASED ANALYSIS OF AROMATHERAPY

Evidence Based Medicine Reviews of Aromatherapy (AT) Alone, not combined with other therapies:

• Burns. 2017 Nov 20.  Insufficient evidence to support AT in burn patients

• J Perianesth Nurs. 2017 Dec;32(6):530-541  Insufficient evidence to support AT use for post-operative pain management.

• Pain Res Treat. 2016;2016:8158693  Aromatherapy is useful in post operative and labor pain, but less effective with inflammatory pain, and almost ineffective in chronic intractable pain

• Cochrane Database Syst Rev. 2016 Jun 3;(6):CD009873  Not enough quality data to answer the questions whether aromatherapy is effective in pain control, or nausea or vomiting

• Evid Based Complement Alternat Med. 2016;2016:9147974  Cochrane- Aromatherapy does not reduce pain in cancer patients

• Neuromodulation. 2014 Oct;17 Suppl 2:24-30  Little to no evidence aromatherapy is useful in the treatment of chronic low back pain

• Cochrane Database Syst Rev. 2014 Feb 25;(2):CD003150  Benefits of aromatherapy for patients with dementia are equivocal

• There is moderate evidence gamma linolenic acid (GLA) from evening primrose oil, borage seed oil, or black current seed oil, in terms of reduced pain intensity in those with rheumatoid arthritis Cochrane Database Syst Rev. 2011 Feb 16;(2):CD002948.

• Cochrane Database Syst Rev. 2012 Apr 18;(4):CD007598. There is no valid medical evidence peppermint reduces post operative nausea and vomiting, although isopropyl alcohol does.

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RCTs

• Laryngoscope Investig Otolaryngol. 2017 Nov 8;2(6):437-441. Lavender modestly reduces preoperative anxiety 

• Holist Nurs Pract. 2018 Jan/Feb;32(1):8-16.  Lavender oil inhalation significantly improves sleep quality in nursing home patients

• J Ethnopharmacol. 2016 Dec 24;194:937-946  Anise capsules given orally is effective 75% of the time in the treatment of irritable bowel syndrome compared to 35% with placebo and 53% with Colpermin standard treatment

• http://www.jabfm.org/content/16/1/47.long  Evening primrose oil taken orally at a dosage of 6,000 mg a day for 6-12 months may improve symptoms mild to moderate diabetic neuropathy.  Contraindicated if the patient is taking anticoagulants or if severe neuropathy. 2 out of 3 trials were positive.  There was no change in blood sugar.

• BMC Complement Altern Med. 2016 Nov 9;16(1):450  No significant differences in aromatherapy (lavender, mint, spearmint, ginger) vs. saline placebo in the treatment of post op nausea and vomiting although 3 times as many continued using aromatherapy despite it being ineffective

 

Assessment:  no significant evidence of efficacy for pain but no real harms data for topical use.  There are some oils that are consumed internally and this is potentially overtly dangerous. However, used as a complementary rather than an alternative medical system, essential oils treatments may be relaxing and have some stress reduction health benefits.  Finally, a 21st century use of “aromatherapy” especially offered as “relaxation”  or "stress reduction" are code words for some sex trade offerings.