White Angelica Essential Oil by Young Living Essential Oils

POSSIBLY EFFECTIVE

• Hyperlipidemia. Oral bergamot seems to reduce levels of low-density lipoprotein (LDL) cholesterol in patients with hyperlipidemia. It is unclear if bergamot is beneficial for improving high-density lipoprotein (HDL) cholesterol or triglyceride levels. Details: Preliminary clinical research in patients with hyperlipidemia shows taking a bergamot polyphenol fraction 1000 mg orally daily for 30 days increases HDL cholesterol and decreases total cholesterol, LDL cholesterol, and triglycerides similarly to rosuvastatin 10 mg daily, but to a lesser extent than rosuvastatin 20 mg daily. Taking the bergamot polyphenol fraction 1000 mg daily in combination with rosuvastatin 10 mg daily appears to result in similar improvements as those seen with rosuvastatin 20 mg daily (96357). A meta-analysis of 5 clinical trials shows that taking bergamot 500-1300 mg daily reduces total cholesterol, LDL cholesterol, and triglyceride levels, and increases HDL cholesterol levels. However, the included studies had high heterogeneity (109982). Clinical research in overweight or obese patients with mild hypercholesterolemia shows that taking bergamot phytosome (Vazguard, Indena SpA) 500 mg twice daily for 12 weeks modestly decreases total and LDL cholesterol, but does not affect HDL cholesterol or triglyceride levels, when compared with placebo (105317). Also, preliminary clinical research in statin-intolerant patients with moderate hypercholesterolemia shows that taking a specific bergamot extract (Bergavit, Bionap) providing 150 mg flavonoids daily for 6 months reduces LDL cholesterol and triglycerides by 20% and 17%, respectively, and increases HDL cholesterol by 8%, when compared with baseline (102599). Bergamot has also been evaluated in combination with other ingredients, usually in lower doses than the studies with single-ingredient products, and with inconsistent results (109982). One product (Colber, Esserre Pharma srl), containing bergamot extract, phytosterols, vitamin C, and dry artichoke extract, was taken as 2 pills daily for 8 weeks (102596); another product (CitriCholess, GardaVita Inc.), containing bergamot extract 500 mg along with unspecified additional ingredients, was taken daily for 12 weeks (96366). Another specific product (Vazguard; Indena SpA), containing bergamot phytosome 600 mg and artichoke leaf extract (Indena SpA) 100 mg, has also shown benefit in patients with mild hypercholesterolemia when taken twice daily for 2 months (108712). However, it is unclear if any effects from these products are due to bergamot, other ingredients, or the combination.

POSSIBLY INEFFECTIVE

• Anxiety. Inhaled bergamot essential oil does not seem to be beneficial for anxiety associated with radiotherapy treatment. Details: Clinical research in patients receiving concurrent radiotherapy shows that using bergamot essential oil as aromatherapy does not reduce anxiety when compared with placebo (11452).
• Mental alertness. Inhaled bergamot essential oil does not seem to improve mental alertness. Details: Some clinical research shows that using bergamot essential oil as aromatherapy does not improve mental alertness and might actually impair mental alertness in healthy people due to its relaxing effects (34438,34440).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Antipsychotic-induced metabolic side effects. It is unclear if oral bergamot is beneficial for reducing antipsychotic-induced metabolic side effects. Details: Preliminary clinical research shows that taking bergamot extract (Bergamot Polyphenolic Fraction BPF, H&AD SRL) 500 mg orally daily for 60 days along with dietary advice does not affect body weight, body mass index, glucose, or lipid parameters when compared to baseline in patients taking second generation antipsychotics (96355). The lack of a comparator group limits the validity of these results.
• Aromatase inhibitor-induced arthralgia. Oral bergamot has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in postmenopausal adults with aromatase inhibitor-induced arthralgia shows that taking two tablets of a product containing bergamot juice flavonoids, phytosterols, artichoke leaf extract, and vitamin C (ColBer, Esserre Pharma SRL) orally daily for 6 months along with dieting and exercise modestly reduces joint pain when compared to baseline (96367). The lack of a comparator group limits the validity of these results.
• Autism spectrum disorder. It is unclear if inhaled bergamot essential oil is beneficial for reducing anxiety in children with autism spectrum disorder. Details: Preliminary clinical research in children aged 6-11 years with autism spectrum disorder shows that inhaling 5 drops of bergamot essential oil on a scent strip for 15 minutes while waiting in a medical office does not reduce anxiety when compared with no aromatherapy (102597).
• Depression. Inhaled bergamot essential oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in community-dwelling older adults shows that a combination of lavender, sweet orange, and bergamot essential oils in a 2:1:1 ratio, for a final combined concentration of 1% in sweet almond oil, administered via inhalation or aromatherapy massage to the upper body with 5 mL of the combination oil, twice weekly for 8 weeks improves symptoms of depression in 55% to 65% of patients when compared with control (98474). It is unclear if this benefit is associated with bergamot, other aromatherapy oils, or the combination.
• Impaired glucose tolerance (prediabetes). Oral bergamot has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in patients with prediabetes shows that taking a product containing fenugreek seed extract 200 mg, olive leaf extract 100 mg, and bergamot extract 500 mg for 6 months does not improve levels of glycated hemoglobin (HbA1c), fasting glucose or insulin, insulin resistance, or lipids, when compared with placebo (102251).
• Insomnia. Inhaled bergamot essential oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients hospitalized for cardiac rehabilitation shows that bedside aromatherapy with lavender, ylang ylang, and bergamot in a 1:1:1 ratio on a cotton ball for 5 nights moderately improves subjective sleep quality, but not sleep duration or sleep time, when compared with placebo (102594).
• Lice. Although there is interest in using topical bergamot oil for lice, there is insufficient reliable information about the clinical effects of bergamot for this purpose.
• Menopausal symptoms. Inhaled bergamot oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in postmenopausal adults with mild to moderate anxiety shows that inhaling bergamot oil 0.04% with lavender oil 5% as aromatherapy three times daily for 8 weeks reduces anxiety and depression symptom scores when compared with placebo (109981).
• Metabolic syndrome. Oral bergamot has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: In patients with both nonalcoholic fatty liver disease and metabolic syndrome, preliminary clinical research shows that taking a combination of a bergamot polyphenolic fraction 650 mg, oleuropein 20% 100 mg, and ascorbic acid 50 mg twice daily for 120 days modestly reduces levels of fasting blood glucose, low-density lipoprotein (LDL) cholesterol, and triglycerides and increases high-density lipoprotein (HDL) cholesterol levels when compared with baseline (105318). The validity of these findings is limited by the lack of a comparator group.
• Mycosis fungoides. Although there is interest in using topical bergamot oil for mycosis fungoides, there is insufficient reliable information about the clinical effects of bergamot for this condition.
• Nausea and vomiting. It is unclear if inhaled bergamot essential oil is beneficial for nausea and vomiting in children undergoing stem cell transplantation. Details: Preliminary clinical research shows that using bergamot essential oil (Elizabeth Van Buren) as aromatherapy does not reduce nausea when compared with an unscented control in children and adolescents undergoing stem cell transplantation (90508).
• Nonalcoholic fatty liver disease (NAFLD). Oral bergamot has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: In patients with both NAFLD and metabolic syndrome, preliminary clinical research shows that taking a combination of a bergamot polyphenolic fraction 650 mg, oleuropein 20% 100 mg, and ascorbic acid 50 mg twice daily for 120 days modestly reduces levels of fasting blood glucose, low-density lipoprotein (LDL) cholesterol, and triglycerides and increases high-density lipoprotein (HDL) cholesterol levels when compared to baseline. It also improves ultrasonographic markers of NAFLD (105318). The validity of these findings is limited by the lack of a comparator group. Bergamot polyphenolic fraction has also shown some benefit in combination with artichoke extract. In patients with NAFLD and type 2 diabetes, preliminary clinical research shows that taking a specific product (Bergacyn, Seris srl) containing 150 mg each of these ingredients, daily for 16 weeks, modestly improves levels of liver markers when compared with placebo; although bergamot polyphenolic fraction alone may have modest benefits, comparisons to the placebo group were lacking (105315). In patients with NAFLD without diabetes, clinical research shows that taking a similar combination for 12 weeks reduces liver fat by approximately 80% more than placebo. After controlling for a modest weight reduction in patients using this product, this benefit was limited to individuals over 50 years of age (105316).
• Obesity. It is unclear if oral bergamot is beneficial for weight loss or improving metabolic parameters in adults with obesity. Details: Clinical research in overweight or obese patients with mild hypercholesterolemia shows that taking bergamot phytosome (Vazguard, Indena SpA) 500 mg twice daily for 12 weeks modestly decreases visceral adipose tissue and levels of total and low-density lipoprotein cholesterol when compared with placebo. However, there was no effect on body weight, fat mass, high-density lipoprotein cholesterol, triglycerides, or glycemic indices (105317). A clinical study in adults with obesity following a reduced-calorie diet and performing 30-60 minutes of daily, light-intensity exercise, shows that a specific oral product (CitruSlim; NHR Science) containing bergamot extract 83% and Eurycoma longifolia root extract 17%, taken as 200 mg or 400 mg daily as three divided doses before meals for 112 days, decreases body mass index by 3.3% and 3.2%, respectively, but does not impact lipid parameters or waist-to-hip ratio, when compared with diet and exercise alone (108452). It is unclear if this effect is due to bergamot, Eurycoma longifolia, or the combination.
• Postpartum depression. It is unclear if inhaled bergamot essential oil is beneficial for reducing depressive symptoms in postpartum adults. Details: A small clinical trial in healthy adults voluntarily residing in a postpartum care center in Taiwan for 1 month shows that diffusing bergamot essential oil as aromatherapy daily for 15 minutes, beginning after childbirth and continuing for approximately 3 weeks, modestly reduces scores on the Edinburgh Postnatal Depression Scale, but not on the Postpartum Sleep Quality Scale, when compared with diffusing water. However, these patients did not have a diagnosis of postpartum depression at baseline, and depression scores improved in both groups (108992). The validity of these findings is limited by concerns with the study methodology.
• Psoriasis. It is unclear if topical bergamot is beneficial for chronic plaque psoriasis. Details: Preliminary clinical research shows that applying bergamot essential oil topically 30 minutes prior to ultraviolet B (UVB) therapy three times weekly is no more effective than UVB therapy alone for reducing plaque severity in patients with chronic plaque psoriasis. The duration of treatment varied according to plaque outcome, with discontinuation occurring either after plaque resolution, or after five consecutive procedures produced no observable effects (34381).
• Pre-procedural anxiety. It is unclear if inhaled bergamot essential oil is beneficial for reducing preoperative anxiety in adults or children. Details: In patients undergoing laparoscopic cholecystectomy, preliminary clinical research shows that bergamot essential oil as aromatherapy has a small beneficial effect on anxiety when compared with inhalation of grape seed oil (105319). However, bergamot essential oil (Elizabeth Van Buren) as aromatherapy does not appear to help reduce anxiety in children and adolescents undergoing stem cell transplantation (90508).
• Schizophrenia. It is unclear if oral bergamot is beneficial for improving executive functioning in patients with schizophrenia. Details: Preliminary clinical research in patients with schizophrenia taking second generation antipsychotics shows that taking a bergamot extract product (Bergamot Polyphenolic Fraction BPF, H&AD SRL) 500 mg orally twice daily for 8 weeks improves some, but not all, measures of executive functioning when compared to baseline (96356). The validity of these findings is limited by the lack of a comparator group.
• Vitiligo. Although there is interest in using topical bergamot oil for vitiligo, there is insufficient reliable information about the clinical effects of bergamot for this condition. More evidence is needed to rate bergamot for these uses.

(Read more about BERGAMOT)

There is insufficient reliable information available about the effectiveness of bois de rose oil.

(Read more about BOIS DE ROSE OIL)

There is insufficient reliable information available about the effectiveness of hyssop.

(Read more about HYSSOP)

POSSIBLY EFFECTIVE

• Depression. Small clinical trials show that oral lemon balm may improve depression when used short-term; the long-term effects are unclear. It is also unclear if lemon balm aromatherapy is beneficial for depression. Details: A meta-analysis of randomized controlled trials in adults with depression and/or anxiety shows that using lemon balm, usually orally, daily for 3-56 days moderately improves depression scores when compared with control. Lemon balm was used orally as 1200-3000 mg daily or as aromatherapy for 30 minutes daily (110136). Other individual studies also show that oral lemon balm may modestly improve depression. A small clinical study in patients with mild or moderate depression shows that taking lemon balm 600 mg with fertilized egg powder (Young Tissue Extract) 1,680 mg daily for 12 weeks improves symptoms when compared with placebo, but not when compared with taking fertilized egg powder alone (19534). Another small clinical study in adults with mostly mild depression shows that taking lemon balm 2 grams daily for 8 weeks moderately improves depressive symptoms when compared with baseline. The improvement appears to be similar to taking lavender powder 2 grams daily or fluoxetine 20 mg daily (104433). However, this study was inadequately powered to detect differences between groups. A small clinical study in adults with type 2 diabetes and mild to moderate depression conducted in Iran shows that taking lemon balm extract capsules 350 mg twice daily for 12 weeks modestly reduces the severity of depression and anxiety based on validated patient-reported questionnaires when compared with placebo (111741). However, the interpretation of these findings is limited by methodological flaws in outcome analysis.
• Herpes labialis (cold sores). Topical lemon balm 1% lotion seems to be beneficial for the healing of recurrent cold sores. Details: Clinical research in patients with recurring cold sores shows that applying a cream containing 1% lemon balm dried leaf extract (LomaHerpan, Infectopharm) at the early stages seems to shorten healing time and reduce symptoms of recurring cold sores when compared with placebo (790,9995).
• Stress. Oral lemon balm seems to be beneficial for improving experimentally-induced stress in some patients. Details: A small study in healthy adults suggests that a single dose of lemon balm extract 600 mg increases calmness and alertness during laboratory-induced psychological stress when compared with placebo (19524). Another small study in healthy adults shows that a single dose of lemon balm extract (Bluenesse, Vital Solutions) 300 mg added to food or drink reduces anxiety and improves memory and alertness during multi-task cognitive testing when compared with placebo (91733). Lemon balm has also shown benefit when used in combination with other ingredients for stress. Lemon balm 240 mg has been used in combination with valerian 360 mg (Songha Night, Pharmaton Natural Health Products) (19405). Lemon balm 50 mg has been used in combination with valerian root 90 mg, passion flower 90 mg, and butterbur 90 mg (Relaxane, Max Zeller Sӧhne AG) (97276).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Age-related cognitive decline. It is unclear if oral lemon balm is beneficial for improving cognitive function. Details: Preliminary clinical research in adults with age-related cognitive impairment shows that taking lemon balm leaf extract, standardized to contain 500 mg rosmarinic acid, orally daily for 96 weeks does not improve cognitive function scores when compared with placebo (110142).
• Alzheimer disease. It is unclear if oral lemon balm is beneficial for improving cognitive function. Details: A small clinical study in elderly patients with mild to moderate Alzheimer disease shows that taking a leaf extract of lemon balm (standardized to citral 500 mcg/mL) 60 drops daily for 4 months seems to reduce agitation and improve cognitive function when compared with placebo (9993). This study was limited by a large number of drop-outs in the placebo group. An even smaller clinical study in patients with mild Alzheimer disease shows that taking lemon balm extract containing 500 mg rosmarinic acid daily for 24 weeks does not seem to improve cognition, but might modestly improve neuropsychiatric symptoms, when compared with placebo (104435). The validity of these findings is limited because the study was not powered to evaluate cognition and neuropsychiatric symptoms.
• Anxiety. It is unclear if oral lemon balm or lemon balm aromatherapy is beneficial for reducing anxiety in most patients. Details: A meta-analysis of randomized controlled trials in adults with depression and/or anxiety shows that using lemon balm daily for 3-56 days moderately improves anxiety scores when compared with control. Lemon balm was used orally as 1200-3000 mg daily or as aromatherapy for 30 minutes daily (110136). The validity of this result is limited by high heterogeneity. Also, a small clinical study in patients with mild or moderate anxiety disorders shows that taking a specific standardized lemon balm extract (Cyracos, Naturex SA) 300 mg twice daily reduces anxiety-associated symptoms and improves sleep when compared with baseline (104425). The validity of this finding is limited by the lack of a comparator group. Another small clinical study in adults with type 2 diabetes and mild to moderate depression conducted in Iran shows that taking lemon balm extract capsules 350 mg twice daily for 12 weeks modestly reduces the severity of depression and anxiety based on validated patient-reported questionnaires when compared with placebo (111741).
• Attention deficit-hyperactivity disorder (ADHD). Although there is interest in using oral lemon balm for ADHD, there is insufficient reliable information about the clinical effects of lemon balm for this condition.
• Chronic bronchitis. Although there is interest in using oral lemon balm for bronchitis, there is insufficient reliable information about the clinical effects of lemon balm for this condition.
• Cognitive function. It is unclear if oral lemon balm is beneficial for improving memory and response time in healthy patients. Details: A small study in healthy young adults shows that taking a single dose of lemon balm 1600 mg increases memory accuracy, but may slow performance on timed memory tasks, when compared with placebo (19530). Another small study shows that taking a combination product containing equal parts lemon balm, sage, and rosemary, 5 grams of plant material per 10 mL solution, twice daily for 2 weeks might modestly improve delayed, but not immediate, word recall when compared with placebo in healthy adults 62 years of age or younger. No benefits were seen in adults 63 years of age and older (97277). It is not clear if this effect is due to lemon balm, the other ingredients, or the combination.
• Colic. Oral lemon balm has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical studies in breast-fed or formula-fed infants with colic show that giving specific multi-ingredient products containing lemon balm 65-97 mg and German chamomile 9-178 mg, with or without fennel 164 mg and inactivated Lactobacillus acidophilus (ColiMil; ColiMil Plus, Milte Italia SPA), orally twice daily for 1-4 weeks reduces crying times when compared with either placebo or simethicone (16735,96278). Another small clinical study in infants shows that giving 150 mL of a specific herbal tea preparation (Calma-Bebi, Bonomelli), containing German chamomile, vervain, licorice, fennel, and lemon balm, up to three times daily after an episode of colic for one week, modestly reduces colic when compared with placebo water without herbs (19715). It is not known if the benefits of these multi-ingredient preparations are due to lemon balm, other ingredients, or the combination.
• Delirium. Oral lemon balm has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults in the intensive care unit with agitation and delirium who are receiving quetiapine 50-200 mg every 12 hours shows that taking 5 mL of a syrup containing lemon balm leaf extract 50 mg and valerian root 625 mg orally every 12 hours improves agitation when compared to baseline. Although the improvement appeared to similar to that seen in those taking placebo, no statistical comparison was conducted between groups (106627).
• Dementia. It is unclear if oral lemon balm is beneficial for reducing neuropsychiatric symptoms of dementia, such as agitation. Details: A small clinical study in patients with severe dementia and agitation shows that applying a lotion containing essential oil of lemon balm to the faces and hands of patients for 4 weeks reduces agitation based on the Cohen-Mansfield Agitation Inventory (CMAI) scale when compared with applying a placebo lotion (19523). However, another small clinical study in patients with Alzheimer disease and prolonged agitation shows that applying lemon balm oil by gentle massage for 1-2 minutes twice daily for 12 weeks does not reduce agitation when compared with applying placebo oil (19522). The validity of these results is limited by the notable improvement observed in the placebo group, which may have been due to the regular physical touch and increased social interaction that occurred in this group. A small clinical study in patients with dementia shows that inhaling lemon balm oil from a small pad attached to the collar of clothing for 2 hours once daily for 2 weeks does not reduce agitation based on the Neuropsychiatric Inventory (NPI) and CMAI scales when compared with placebo (99710).
• Dysmenorrhea. Although there is interest in using oral lemon balm for dysmenorrhea, there is insufficient reliable information about the clinical effects of lemon balm for this condition.
• Dyspepsia. Oral lemon balm has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A meta-analysis of four small clinical studies in patients with IBS shows that using a specific combination product containing lemon balm (Iberogast, Steigerwald Arzneimittelwerk GmbH) 1 mL orally three times daily over a period of 4 weeks reduces severity of acid reflux, epigastric pain, cramping, nausea, and vomiting when compared with placebo. The combination includes lemon balm, peppermint leaf, German chamomile, caraway, licorice, clown's mustard plant, celandine, angelica, and milk thistle (13089). In another clinical study, taking a similar combination product containing extracts from peppermint leaf, clown's mustard plant, German chamomile flower, caraway, licorice root, and lemon balm (STW 5-II, Steigerwald Arzneimittelwerk GmbH), 1 mL orally three times daily for up to 8 weeks eliminates gastrointestinal symptoms in 40% more dyspepsia patients when compared with placebo (12724).
• Headache. Although there is interest in using oral lemon balm for headache, there is insufficient reliable information about the clinical effects of lemon balm for this condition.
• Hypertension. It is unclear if oral lemon balm is beneficial for hypertension. Details: Preliminary clinical research in adults with uncontrolled hypertension while on 1-3 active treatments shows that taking lemon balm extract 400 mg, standardized to contain 8 mg rosmarinic acid, orally daily for 4 weeks reduces systolic and diastolic blood pressure by 8% to 14% and 11% to 16%, respectively, when compared with baseline. These improvements were significant when compared with placebo (110138).
• Hyperthyroidism. Although there is interest in using oral lemon balm for hyperthyroidism, there is insufficient reliable information about the clinical effects of lemon balm for this condition.
• Insect repellent. Although there is interest in using topical lemon balm as insect repellant, there is insufficient reliable information about the clinical effects of lemon balm for this condition.
• Insomnia. Oral lemon balm has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Taking a specific combination product providing lemon balm leaf extract 80 mg and valerian root extract 160 mg (Euvegal forte, Dr. Willmar Schwabe Pharmaceuticals) 2-3 times daily appears to improve the quality and quantity of sleep in healthy people and those diagnosed with insomnia or sleeping disorders (10423,19528,19536). However, lower daily doses may not improve sleep (10421). Other clinical research in healthy adults with insomnia shows that using a combination product containing ground lemon balm herb 1000 mg and aqueous extract of Nepeta menthoides 400 mg at bedtime for 4 weeks improves sleep quality and sleep duration and reduces sleep disturbance, sleep latency, and daytime dysfunction when compared with placebo (97278). A clinical study in children 12 years and younger shows that a specific combination product containing lemon balm leaf extract 80 mg and valerian root extract 160 mg (Euvegal forte, Dr. Willmar Schwabe Pharmaceuticals) 1-2 tablets once or twice daily might decrease symptoms of restlessness and dyssomnia when compared to baseline (14416). It is unclear if these effects are due to lemon balm, other ingredients, or the combinations.
• Irritable bowel syndrome (IBS). Oral lemon balm has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients with IBS shows that using 30 drops of a combination product providing lemon balm, spearmint, and coriander (Carmint, PurSina Pharmacy) three times daily after meals for 8 weeks reduces abdominal pain and discomfort when added to standard treatment with loperamide or psyllium, compared to standard treatment alone (19535). It is not known if the effect is due to lemon balm, the other ingredients, or the combination.
• Menopausal symptoms. Oral lemon balm has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in postmenopausal adults with sleep disturbances shows that taking lemon balm leaf 250 mg and fennel fruit 250 mg orally once daily for 8 weeks improves menopausal symptoms including vasomotor, psychomotor-social, physical, and sexual symptoms, by 24% to 38% when compared with baseline. These improvements were significant when compared with placebo (110137).
• Pain (acute). It is unclear if lemon balm aromatherapy is beneficial for reducing pain in patients with acute coronary syndrome. Details: A small clinical study in patients with acute coronary syndrome presenting to the emergency department shows that aromatherapy with lemon balm leaf and stem essential oil 1% for 10 minutes twice on the day of presentation modestly reduces chest pain scores when compared with placebo. However, pain was no longer different between groups within 15 minutes after the second aromatherapy session (110139).
• Postpartum complications. Oral lemon balm might reduce postpartum pain in some patients; however, it's not clear if it is beneficial for other postpartum complications. Details: A small clinical study shows that taking lemon balm leaf extract 395 mg every 6 hours for 24 hours following childbirth is slightly more effective for reducing postpartum pain when compared with taking mefenamic acid 250 mg using the same dosing schedule (101763).
• Psoriasis. Oral lemon balm has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adults with mild to moderate psoriasis shows that taking an oral combination product containing lemon balm, rose hip, and fennel as 10 mL three times daily for 12 weeks improves pruritus and psoriasis scores by 45% and 49%, respectively, when compared with baseline. In contrast, these scores worsened in the placebo group (110141). The validity of this finding is limited by the lack of statistical comparison between groups.
• Somatic symptom disorder. Oral lemon balm has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A clinical study in individuals with somatic symptom disorder shows that taking one tablet of a combination product three times daily for 2 weeks seems to improve symptoms of depression and anxiety when compared with placebo. Each tablet of this product contains lemon balm leaf extract 60 mg, valerian root extract 90 mg, and passionflower herb extract 90 mg (19701). It is not known if the effect is due to lemon balm, other ingredients, or the combination.
• Ventricular arrhythmias. It is unclear if oral lemon balm leaf tea is beneficial for patients with premature ventricular contraction (PVC). Details: Preliminary clinical research in adults with low to moderate PVCs shows that drinking lemon balm leaf tea twice daily for 12 weeks reduces the frequency of PVCs by 32% when compared with baseline. This improvement was significant when compared with no treatment. Lemon balm tea also modestly improved heart rate, but not left ventricular ejection fraction, when compared with no treatment. The tea was prepared by steeping lemon balm leaf 2 grams in 250 mL of boiling water (110140). More evidence is needed to rate lemon balm for these uses.

(Read more about LEMON BALM)

LIKELY INEFFECTIVE

• Schistosomiasis. Most research suggests that oral myrrh extract is not effective for treating schistosomiasis. Details: Although one manufacturer-sponsored study shows that taking a specific myrrh extract (Mirazid, Pharco Pharmaceuticals) 600 mg once daily for 6 days cures schistosomiasis in about 90% of patients, multiple clinical studies show that taking this myrrh extract does not treat schistosomiasis in children or adults. In one study, only about 9% of adults and children treated with this myrrh extract at a dose of 600 mg every 3 weeks for 2 doses were cured compared to about 76% of patients treated with praziquantel (95541). A similar lack of benefit was shown in another clinical trial in which children were given a higher dose of 300 mg daily for 3 days or 600 mg daily for 6 days (95542,95545). A systematic review of the available literature concludes that praziquantel continues to be the treatment of choice for schistosomiasis, and that myrrh appears ineffective for parasitological cure (95544).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Back pain. It is unclear if oral myrrh is beneficial in patients with back pain, and topical myrrh has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults with chronic low back pain shows that two 15-minute sessions of lumbar massage weekly with 5 mL of myrrh 2% and frankincense 2% essential oils for 3 weeks reduces measures of pain and disability when compared with placebo (111504). An observational study in adults with chronic lower back pain and sciatica suggests that taking a combination of myrrh 200 mg, palmitoylethanolamide 600 mg, and alpha-lipoic acid 800 mg daily for 30 days, along with periradicular infiltrations of oxygen-ozone, is associated with resolution of pain in 17% more patients when compared with periradicular steroid infiltrations at 60 days (111308). However, it is unclear if the effects in these studies are due to myrrh, other ingredients, or the combinations. Additionally, observational research in adults with chronic low back pain of varying intensity has found that taking a specific myrrh extract (MyrliMax, Sundyota Numandis Pharmaceuticals) 100 mg twice daily for 20 days is associated with reductions in pain and the need for rescue analgesics when compared to baseline (111112). The validity of these findings is limited by the lack of a control group.
• Cancer. Although there has been interest in using oral myrrh for cancer, there is insufficient reliable information about the clinical effects of myrrh for this purpose.
• Canker sores. Although there has been interest in using topical myrrh for canker sores, there is insufficient reliable information about the clinical effects of myrrh for this purpose.
• Common cold. Although there has been interest in using oral myrrh for the common cold, there is insufficient reliable information about the clinical effects of myrrh for this purpose.
• Cough. Although there has been interest in using oral myrrh for cough, there is insufficient reliable information about the clinical effects of myrrh for this purpose.
• Crohn disease. Oral myrrh has only been evaluated in combination with other ingredients, its effect when used alone is unclear. Details: Observational research over a period of 24-28 days in a small group of patients with active inflammatory bowel disease (50% ulcerative colitis and 50% Crohn disease) has found that taking a specific combination product containing myrrh 100 mg, coffee charcoal 50 mg, and chamomile extract 70 mg per tablet (MYRRHINIL-INTEST, Repha GmbH) results in symptom resolution in 16-26 days. The probability of being free of symptoms did not differ between patients using other treatments, the myrrh combination product alone, or a combination of the myrrh product with other treatments. Overall efficacy was rated as good to very good by patients and physicians (104593). The validity of these findings is limited by the observational nature of the study. Also, it is unclear if these findings are due to myrrh, other ingredients, or the combination.
• Dental peri-implantitis. It is unclear if rinsing with myrrh mouthwash solution is effective for the prevention of dental peri-implantitis. Details: A small clinical study in adults undergoing dental implant placement shows that rinsing with myrrh 1% mouthwash solution twice daily for 2 weeks leads to similar rates of postoperative bleeding, pain, redness, and swelling when compared with chlorhexidine 0.12% mouthwash (111114).
• Diarrhea. Oral myrrh has only been evaluated in combination with other ingredients, its effect when used alone is unclear. Details: Observational research over a period of 7-14 days in a group of patients with active diarrhea related to an acute inflammatory disorder has found that taking a specific combination product containing myrrh 100 mg, coffee charcoal 50 mg, and chamomile extract 70 mg per tablet (MYRRHINIL-INTEST, Repha GmbH), alone or in combination with other therapies, improves overall symptoms of diarrhea. The median time to symptom resolution was 4 days. The probability of symptom resolution with use of the myrrh combination product was similar to that observed when other treatments were used. Overall efficacy was rated as good to very good by patients and physicians (104593). The validity of these findings is limited by the observational nature of the study. Also, it is unclear if these findings are due to myrrh, other ingredients, or the combination.
• Fasciolosis. It is unclear if oral myrrh extract is beneficial in patients with fasciolosis. Details: A small clinical study in adults and children with fasciolosis shows that taking a specific myrrh extract (Mirazid, Pharco Pharmaceuticals) 600 mg daily for 6 days leads to a cure rate of about 94% at 3 months. However, the lack of standardized stool sample evaluation and absence of a control group limit the validity of this finding (95543). Furthermore, another small study in adults and children with fasciolosis shows that taking this same product, 600 mg daily for 6 days, leads to a 0% cure rate at both 1 and 2 months (95545).
• Gingivitis. Although there has been interest in using topical myrrh for gingivitis, there is insufficient reliable information about the clinical effects of myrrh for this purpose.
• Herniated disc. Oral myrrh has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small observational study in adults with acute lumbosacral radiculopathy secondary to lumbar disc herniation suggests that taking a combination supplement containing myrrh 100 mg, alpha-lipoic acid 404 mg, and palmitoylethanolamide (PEA) 306 mg (Tiobec Dol, Uriach Italy Srl) twice daily for 4 weeks, along with steroids and as needed opioids, is associated with reduced pain and disability and improved physical but not mental health as it pertains to quality of life when compared with steroids and as needed opioids alone (111711). However, it is unclear if these effects are due to alpha-lipoic acid, other ingredients, or the combination.
• Intestinal parasite infection. It is unclear if oral myrrh extract is beneficial in children with intestinal parasite infections. Details: A small clinical study in immunocompetent children shows that taking a specific myrrh extract (Mirazid, Pharco Pharmaceuticals) 10 mg/kg daily in combination with paromomycin 500 mg four times daily for 2 weeks improves symptoms such as abdominal pain, diarrhea, nausea, and vomiting when compared with paromomycin or myrrh extract alone. However, no differences in oocyst elimination were observed across groups (95546).
• Irritable bowel syndrome (IBS). Oral myrrh has only been evaluated in combination with other ingredients, its effect when used alone is unclear. Details: Observational research over a period of 24-28 days in a group of patients with IBS has found that taking a specific combination product containing myrrh 100 mg, coffee charcoal 50 mg, and chamomile extract 70 mg per tablet (MYRRHINIL-INTEST, Repha GmbH), alone or in combination with other therapies, improves overall symptoms of diarrhea. The probability of being free of symptoms did not differ between patients using other treatments or when the myrrh combination product was used in combination with other treatments. Overall efficacy was rated as good to very good by patients and physicians (104593). The validity of these findings is limited by the observational nature of the study. Also, it is unclear if these findings are due to myrrh, other ingredients, or the combination.
• Miscarriage. It is unclear if oral myrrh is beneficial in patients with incomplete miscarriage. Details: A small clinical study in adults with incomplete miscarriage (incomplete abortion) shows that taking myrrh 500 mg three times a day for 2 weeks increases the proportion of patients with successful complete abortion, defined as no retained products of conception, to 83%, compared to only 54% of those taking placebo (104840).
• Muscle cramps. Although there has been interest in using oral myrrh for muscle cramps, there is insufficient reliable information about the clinical effects of myrrh for this purpose.
• Oral mucositis. Although there has been interest in using topical myrrh for oral mucositis, there is insufficient reliable information about the clinical effects of myrrh for this purpose.
• Pain (acute). It is unclear if oral myrrh extract is beneficial in patients with acute pain. Details: A small clinical study shows that taking a specific, standardized myrrh extract (MyrLiq, Biosfered S.r.l.) 200-400 mg daily for 20 days can improve various types of acute pain, including headache, fever-associated pain, joint or muscle pain, lower back pain, and menstrual cramps, when compared with placebo (98224).
• Pain (chronic). It is unclear if oral myrrh extract is beneficial in patients with chronic pain. Details: A small clinical study shows that taking a specific, standardized myrrh extract (MyrLiq, Biosfered S.r.l.) 200-400 mg daily for 20 days can improve various types of chronic pain, including joint or muscle pain and lower back pain, when compared with placebo (98224).
• Peptic ulcers. Although there has been interest in using oral myrrh for peptic ulcers, there is insufficient reliable information about the clinical effects of myrrh for this purpose.
• Sciatica. Oral myrrh has only been evaluated in combination with other ingredients, its effect when used alone is unclear. Details: Observational research in patients with sciatic pain due to herniated discs has found that taking a combination of myrrh extract 200 mg, alpha-lipoic acid 800 mg, and palmitoylethanolamide 600 mg daily for 20 days along with 3 sessions of oxygen-ozone therapy over 30 days is associated with slight improvements in pain when compared with oxygen-ozone therapy alone (111113). The validity of these findings is limited by the observational nature of the study. Additionally, it is unclear if these findings are due to myrrh, other ingredients, or the combination.
• Tooth extraction. It is unclear if rinsing with myrrh extract solution is beneficial in patients undergoing tooth extraction. Details: A small clinical study in healthy, non-smoking adults shows that using a mouthwash containing myrrh extract 0.5% twice daily for 7 days following simple tooth extraction decreases the socket size in 90% of patients compared with 40% in the control group. Swelling and tenderness also decreased when compared with control (105846).
• Trichomoniasis. It is unclear if oral myrrh extract is beneficial in patients with trichomoniasis. Details: A small clinical study in patients with resistant Trichomonas vaginalis shows that taking a specific myrrh extract (Mirazid, Pharco Pharmaceuticals) 600 mg daily for 6-8 days cures infections in most patients. In this small study, 85% (11/13) of patients who did not respond to combination therapy with metronidazole and tinidazole were cured after receiving this myrrh extract (93652). A lack of control group limits the validity of these findings.
• Ulcerative colitis. Oral myrrh has only been evaluated in combination with other ingredients, its effect when used alone is unclear. Details: A small clinical study in patients with ulcerative colitis shows that taking a specific combination product containing myrrh 100 mg, chamomile extract 70 mg, and coffee charcoal 50 mg per tablet (MYRRHINIL-INTEST, Repha GmbH), four tablets three times daily for 12 months, is non-inferior to mesalamine therapy for maintaining remission (93653). In addition, observational research over a period of 24-28 days in a small group of patients with active inflammatory bowel disease (50% ulcerative colitis and 50% Crohn disease) has found that taking this same product results in symptom resolution in 16-26 days. The probability of being free of symptoms did not differ between patients using other treatments, the myrrh combination product alone, or the myrrh combination product with other treatments. Overall efficacy was rated as good to very good by physicians (104593). It is unclear if these findings are due to myrrh, other ingredients, or the combination.
• Urinary tract infections (UTIs). Oral myrrh has only been evaluated in combination with other ingredients, its effect when used alone is unclear. Details: A small clinical study in patients with at least 2 recurrent UTIs in the past 6 months or more than 3 UTIs in the past year shows that taking a combination of myrrh, hibiscus, and vegetable proteases (Aviur Retard ) for 6 months might reduce the risk of UTI recurrence. A UTI episode was not reported by 49% of females over the 6-month period, with an additional 35% reporting fewer than 2 UTIs (101115). The validity of these findings is limited by the lack of comparator group. Additionally, it unclear if this benefit is due to myrrh, other ingredients, or the combination.
• Wound healing. It is unclear if topical myrrh extract is beneficial for wound healing. Details: Two small clinical studies in patients requiring episiotomy during childbirth shows that using myrrh 1:5 tincture 10 mL or myrrh extract 20 mL, diluted in 5 L of water as a sitz bath, twice daily for 7 days, modestly improves ecchymosis, discharge, and wound healing scores when compared with either placebo, frankincense extract 20 mL, or betadine 10% solution 20 mL (104838,104839). It is unclear if these modest effects are clinically relevant. More evidence is needed to rate myrrh for these uses.

(Read more about MYRRH)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Pain (acute). Although there has been interest in using oral and topical Norway spruce for acute pain, there is insufficient reliable information about the clinical effects of Norway spruce for this purpose.
• Respiratory tract infections. Although there has been interest in using oral Norway spruce for respiratory tract infections, including bronchitis, the common cold, and tuberculosis, there is insufficient reliable information about the clinical effects of Norway spruce for this purpose. More evidence is needed to rate Norway spruce for these uses.

(Read more about NORWAY SPRUCE)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Hereditary hemorrhagic telangiectasia (HHT). It is unclear if topical rose geranium oil is beneficial for epistaxis in patients with HHT. Details: A small clinical study in patients with HHT shows that applying 3-4 drops of a topical formulation containing rose geranium essential oil 0.17% in sesame oil into the nose twice daily for at least 3 months reduces the severity of epistaxis by 34% when compared to baseline (93881). The validity of this finding is limited by a lack of control group.
• Neuropathic pain. Although there has been interest in using oral and topical rose geranium oil for neuropathic pain, there is insufficient reliable information about the clinical effects of rose geranium oil for this purpose.
• Postherpetic neuralgia. It is unclear if topical rose geranium oil is beneficial in patients with postherpetic neuralgia. Details: A small clinical study in patients with postherpetic neuralgia shows that a single topical application of rose geranium oil 50% or 100% can significantly reduce pain when compared with placebo. Pain relief appears to be concentration-dependent. Rose geranium oil in a concentration of 100% appears to be about twice as effective as a 50% concentration (16653).
• Wound healing. Although there has been interest in using topical rose geranium oil for wound healing, there is insufficient reliable information about the clinical effects of rose geranium oil for this purpose. More evidence is needed to rate rose geranium oil for these uses.

(Read more about ROSE GERANIUM OIL)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Mental alertness. Preliminary clinical research suggests that inhaling fragrance from white sandalwood oil for 20 minutes or applying white sandalwood oil to the skin does not increase alertness or attentiveness compared to placebo in healthy individuals (73076,73080).
• Vaginitis. Preliminary clinical research shows that taking 10 grams of a combination of white sandalwood, tamarind, and neem twice daily for 21 days improves some symptoms of discharge, lower abdominal pain, and back pain when compared with baseline in females with bacterial or yeast vaginitis (99290). More evidence is needed to rate white sandalwood for these uses.

(Read more about WHITE SANDALWOOD)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Cognitive function. It is unclear if ylang ylang oil aromatherapy is beneficial in improving cognitive function. Details: Preliminary clinical research in healthy adults shows that aromatherapy with ylang ylang oil once for 5 minutes before and during a cognitive test does not improve working memory or attention, and may actually worsen speed of memory, when compared with no aromatherapy (98616).
• Hypertension. Although there has been interest in using topical ylang ylang oil for hypertension, there is insufficient reliable information about the clinical effects of ylang ylang oil for this purpose.
• Lice. Topical ylang ylang oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in children aged 6-14 years shows that applying a topical spray containing ylang ylang oil, anise oil, and coconut three times at 15 minute intervals every 5 days is 92% effective at eradicating head lice. These results were similar to a control spray containing permethrin, malathion, piperonyl butoxide, and isododecane (13483).
• Suicidal ideation. It is unclear if ylang ylang oil aromatherapy is beneficial in patients with suicidal ideation. Details: Low-quality clinical research in patients with a history of suicidal ideation or attempts shows that 1-5 sessions of either spiritual support or a massage with ylang ylang oil 10% aromatherapy over 4 months reduces the rate of suicide or suicide attempts by 75% when compared with a control group (109499). The validity of these results is limited by lack of randomization. More evidence is needed to rate ylang ylang oil for these uses.

(Read more about YLANG YLANG OIL)

LIKELY SAFE ...when bergamot essential oil is used orally in amounts commonly found in foods. Bergamot oil has Generally Recognized As Safe (GRAS) status for use in foods in the US (4912).

POSSIBLY SAFE ...when bergamot extract is used orally, short-term. A bergamot extract (Bergamot Polyphenolic Fraction BPF, H&AD SRL) has been used with apparent safety at a dose of 650 mg daily for up to 120 days (96355,105318). Another bergamot extract providing 150 mg of flavonoids (Bergavit, Bionap) daily has been used with apparent safety for up to 6 months (102599). Bergamot phytosome (Vazguard, Indena SpA) has been used with apparent safety at a dose of 500 mg twice daily for 12 weeks (105317). ...when inhaled as aromatherapy, short-term. Bergamot oil 3% has been used with apparent safety as 2 drops poured on a cotton ball, attached to the collar, and breathed in for 20 minutes (105319).

POSSIBLY UNSAFE ...when used topically. Bergamot essential oil that is not free of furocoumarins or psoralens can act as a photosensitizer and can induce malignant changes (6,96370).

CHILDREN: LIKELY SAFE
when bergamot essential oil is used orally in amounts commonly found in foods. Bergamot oil has Generally Recognized As Safe (GRAS) status for use in foods in the US (4912).

CHILDREN: POSSIBLY UNSAFE
when large amounts of the oil are ingested. Bergamot essential oil can cause intestinal colic, convulsions, and death (12). There is insufficient reliable information available about the safety of bergamot extract when used orally.

PREGNANCY AND LACTATION: POSSIBLY UNSAFE
when the oil is used topically (6). There is insufficient reliable information available about the safety of bergamot when taken by mouth in medicinal amounts; avoid use.

(Read more about BERGAMOT)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Bois de rose oil has Generally Recognized as Safe (GRAS) status in the US (4912). ...when used topically as a cosmetic ingredient; it is reported to be nontoxic (11). There is insufficient reliable information available about the safety of bois de rose oil when used orally or topically as medicine.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about BOIS DE ROSE OIL)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Hyssop, hyssop oil, and hyssop extract have Generally Recognized as Safe (GRAS) status in the US (4912). There is insufficient reliable information available about the safety of hyssop when used in medicinal amounts.

PREGNANCY: LIKELY UNSAFE
when used orally because it might cause uterine stimulant and menstrual stimulant effects (12).

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about HYSSOP)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Lemon balm has Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when used orally and appropriately, short-term. Lemon balm extract has been used with apparent safety at a dose of 500 mg daily for 6 months or at a dose of 3000 mg daily for 2 months (9993,9994,104435,104435,110136). ...when used topically and appropriately, short-term. Lemon balm 1% dried leaf extract has been used up to 4 times daily with apparent safety for a few days (790,9995).

CHILDREN: POSSIBLY SAFE
when used orally and appropriate, short-term. A single dose of lemon balm extract 3-6 mg/kg has been safely used in children aged 6-7 years (19525). A specific combination product providing lemon balm leaf extract 80 mg and valerian root extract 160 mg (Euvegal forte, Dr. Willmar Schwabe Pharmaceuticals) 1-2 tablets once or twice daily has been safely used in children under 12 years of age for 30 days (14416). In infants up to 4 weeks old, multi-ingredient products (ColiMil, ColiMil Plus) containing lemon balm 64-97 mg daily have been used with apparent safety for up to 7 days (16735,96278).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about LEMON BALM)

LIKELY SAFE ...when consumed in amounts commonly found in food. Myrrh is approved for use in foods as a flavoring agent in the US (11).

POSSIBLY SAFE ...when used orally and appropriately in medicinal amounts, short-term. Myrrh 400 mg three times daily has been safely used for up to 12 months (93653,104593). Myrrh 500 mg three times daily has been used with apparent safety for 2 weeks (104840). ...when used topically and appropriately (2,4,5,11,18). As a diluted bath, myrrh has been used with apparent safety for up to 7 days (104838,104839).

POSSIBLY UNSAFE ...when used orally in excessive doses. Myrrh may cause kidney irritation and diarrhea when used in doses of 2-4 grams (12).

PREGNANCY: LIKELY UNSAFE
when used orally. Myrrh stimulates uterine tone and blood flow and may have an abortifacient effect (4,12,19,93645). There is insufficient reliable information available about the safety of the topical use of myrrh during pregnancy.

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about MYRRH)

There is insufficient reliable information available about the safety of hemlock spruce.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about NORWAY SPRUCE)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Rose geranium oil has Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when used topically and appropriately, short-term. A single application of rose geranium oil in concentrations up to 100% has been safely used in a clinical trial (16653). ...when used intranasally and appropriately, short-term. Rose geranium oil has been applied with sesame oil in the nose safely (93881). There is insufficient reliable information available about using rose geranium oil orally for medicinal purposes.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid amounts greater than those found in foods.

(Read more about ROSE GERANIUM OIL)

LIKELY SAFE ...when used orally in amounts commonly found in foods. White sandalwood oil has Generally Recognized As Safe (GRAS) status for use in foods in the US (4912).

POSSIBLY UNSAFE ...when used orally for longer than 6 weeks. Use for more than 6 weeks is associated with kidney damage (12,19). There is insufficient reliable information available about the safety of white sandalwood when inhaled or when used topically in amounts greater than those found in cosmetics.

PREGNANCY: LIKELY UNSAFE
when used orally in medicinal amounts; sandalwood is reported to have abortifacient effects (19); avoid using.

LACTATION:
Insufficient reliable information available; avoid using amounts greater than those found in foods.

(Read more about WHITE SANDALWOOD)

LIKELY SAFE ...when used in amounts commonly found in foods. Ylang ylang oil has Generally Recognized as Safe (GRAS) status in the US (4912). There is insufficient reliable information available about the safety of ylang ylang oil when used orally or topically in medicinal amounts.

CHILDREN: LIKELY SAFE
when used orally in amounts commonly found in food. Ylang ylang oil has Generally Recognized as Safe (GRAS) status in the US (4912).

CHILDREN: POSSIBLY SAFE
when used topically. Ylang ylang oil has been used with apparent safety as three applications to the scalp at 5-day intervals (13483). There is insufficient reliable information available about the safety of ylang ylang oil when used orally in medicinal amounts in children.

PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in amounts commonly found in food. Ylang ylang oil has Generally Recognized as Safe (GRAS) status in the US (4912). There is insufficient reliable information available about the safety of using ylang ylang oil in medicinal amounts.

(Read more about YLANG YLANG OIL)

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking bergamot with antidiabetes drugs might increase the risk of hypoglycemia.  Details Animal research suggests that bergamot juice has hypoglycemic effects (34407).

PHOTOSENSITIZING DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, topical bergamot essential oil might increase the risk of side effects when used along with photosensitizing drugs.  Details Bergamot contains bergapten, which has photosensitizing effects (11019,34343,34350,34363,34377,34408,34410,34417,34421,34422,34426,34428).

(Read more about BERGAMOT)

(Read more about BOIS DE ROSE OIL)

(Read more about HYSSOP)

CNS DEPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = B Theoretically, concomitant use of lemon balm might have additive effects with CNS depressant drugs.  Details Lemon balm seems to have CNS depressant activity in animals and in humans (9994,19725).

THYROID HORMONE Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, lemon balm might interfere with thyroid hormone replacement therapy.  Details In vitro, constituents of lemon balm extract bind to thyroid stimulating hormone (TSH), preventing TSH receptor-binding and leading to the inhibition of TSH-stimulated adenylate cyclase activity (19727,19728). In animals, lemon balm extract has been shown to decrease levels of circulating TSH and inhibit thyroid secretion (19726).

(Read more about LEMON BALM)

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, myrrh might increase the risk of hypoglycemia when taken with antidiabetes drugs.  Details In vitro and animal research suggests that myrrh has hypoglycemic effects (4,104841).

WARFARIN (Coumadin) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, myrrh might decrease the effectiveness of warfarin.  Details In one case, a patient who was previously stable on warfarin had a significant decline in international normalized ratio (INR) following consumption of an aqueous extract of myrrh (14425).

(Read more about MYRRH)

(Read more about NORWAY SPRUCE)

(Read more about ROSE GERANIUM OIL)

(Read more about WHITE SANDALWOOD)

(Read more about YLANG YLANG OIL)

General ...Orally or as aromatherapy, bergamot seems to be well tolerated when used short-term. Topically, bergamot is possibly unsafe.
Most Common Adverse Effects:
Topically: Blisters, erythema, photosensitivity, pigment spots, pustules, and skin lesions.

Dermatologic ...Frequent contact with the peel or oil of bergamot can cause erythema, blisters, pustules, dermatoses leading to scab formation, and pigment spots (18).
Topically, photosensitivity can also occur, especially in fair-skinned people (11019).

Gastrointestinal ...Orally, bergamot extract has been associated with one case of heartburn in clinical research (96356).

Musculoskeletal ...Orally, muscle cramps have been reported for a patient starting one week after switching from drinking 4 liters of black tea to drinking 4 liters of Earl Grey tea daily. The muscle cramps were attributed bergapten, a constituent of bergamot essential oil in Earl Grey tea. The patient's symptoms subsided after discontinuing Earl Grey tea intake and remained absent upon re-initiation of Earl Grey tea intake 1 liter daily (34344).

(Read more about BERGAMOT)

General ...Bois de rose oil is well tolerated when used orally in amounts commonly found in foods or when used topically as an ingredient in cosmetic products (11,4912). When used as medicine, no adverse effects have been reported. However, a thorough evaluation of safety outcomes has not been conducted.

(Read more about BOIS DE ROSE OIL)

General ...No adverse effects have been reported. However, a thorough evaluation of safety outcomes has not been conducted. There is some concern that hyssop oil has demonstrated toxicity at very low doses when administered orally in animal studies (1304).

(Read more about HYSSOP)

General ...Orally, lemon balm seems to be well tolerated in food amounts and larger, medicinal amounts. Topically, lemon balm seems to be well tolerated.
Serious Adverse Effects (Rare):
Orally: Wheezing has been rarely reported.

Cardiovascular ...Orally, a case of transient complete atrioventricular block and QT prolongation is reported in a 25-year-old female following the post-workout use of a specific product (Muscle Eze Advanced) containing lemon balm and several other ingredients. Symptoms of fatigue and lightheadedness started 1 week into use of the product. Product discontinuation led to restoration of normal sinus rhythm within 24 hours and normalization of the electrocardiogram within 2 weeks (112556). It is unclear whether this occurrence is due to lemon balm, other ingredients, or the combination.

Dermatologic ...Topically, lemon balm 1% cream applied 5 times daily to cold sores has been associated with two cases of irritation and one case of cold sore exacerbation. However, these effects do not appear to occur more often with lemon balm than with placebo (790).

Gastrointestinal ...Orally, lemon balm might increase appetite in some patients (91732,104433). Nausea, vomiting, and abdominal pain have been reported rarely and do not seem to occur more often than in patients taking placebo (9993).

Neurologic/CNS ...Orally, lemon balm has been reported to cause dizziness and sedation; however, it does not seem to occur more often with lemon balm than placebo (9993,104433). Additionally, other clinical research shows that using lemon balm in conjunction with alcohol does not affect reaction time or influence cognitive performance (19427,19723).

Pulmonary/Respiratory ...Orally, lemon balm has been associated with rare cases of wheezing (9993).

(Read more about LEMON BALM)

General ...Orally, myrrh seems to be well tolerated.
Serious Adverse Effects (Rare):
Orally: Kidney impairment and heart rate changes at high doses.

Cardiovascular ...Orally, myrrh taken at doses of 2-4 grams may cause heart rate changes in some patients (12,19).

Dermatologic ...Topically, myrrh has been reported to cause dermatitis (6).

Gastrointestinal ...Orally, myrrh may cause diarrhea in some patients when taken at doses of 2-4 grams (12,19).

Genitourinary ...Severe lower abdominal pain has been reported in a pregnant woman drinking myrrh resin dissolved in 500 mL of water twice daily as prescribed by a traditional practitioner. This adverse effect resolved one day after discontinuing myrrh. The investigators suggest that this acute abdominal pain was related to myrrh's activity as a uterine stimulant (93645).

Immunologic ...Orally, myrrh has been reported to cause severe allergic skin reactions, with redness, swelling, and itching, in two case reports of individuals using oral traditional Chinese medicines containing myrrh (101114).

Renal ...Orally, myrrh may cause kidney impairment in some patients when taken at doses of 2-4 grams (12,19).

(Read more about MYRRH)

General ...None reported; however, a thorough evaluation of safety outcomes has not been conducted.

(Read more about NORWAY SPRUCE)

General ...Orally, rose geranium oil is well tolerated when used in food amounts. Topically, rose geranium oil seems to be well tolerated, short-term.

Dermatologic ...Topically, rose geranium oil has been associated with reports of dermatitis in hypersensitive individuals and burning sensations when applied to the face (16653).

Gastrointestinal ...When applied with droppers in the nose, rose geranium oil has been reported to cause a bad taste (93881).

Neurologic/CNS ...Topically, rose geranium oil has been associated with reports of lightheadedness and eye irritation when applied to the face (16653).

Ocular/Otic ...Topically, rose geranium oil has been associated with reports of eye irritation when applied to the face (16653).

(Read more about ROSE GERANIUM OIL)

General ...Orally, white sandalwood may cause itching, nausea, gastrointestinal complaints, and blood in the urine (18). Use of large doses or for more than 6 weeks is associated with kidney damage (12,19). Topically, contact dermatitis can occur in sensitive individuals (73081,73082,99292).

Dermatologic ...Orally, white sandalwood may cause itching (18).

Gastrointestinal ...Orally, white sandalwood may cause nausea and gastrointestinal complaints (18).

Immunologic ...Topically or when inhaled, there are case reports of white sandalwood paste or oil causing contact and photoallergic contact dermatitis (73081,73082,99292).

Renal ...Orally, use of large doses of white sandalwood or for more than 6 weeks is associated with kidney damage, with blood in the urine (12,18,19).

(Read more about WHITE SANDALWOOD)

General ...There is currently a limited amount of information on the adverse effects of ylang ylang oil. A thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Topically: Dermatitis, pruritus.

Dermatologic ...Topically, ylang ylang oil in combination with other herbs can cause localized pruritus (13483).

Immunologic ...Topically, ylang ylang oil in combination with other herbs has caused contact dermatitis in various case reports (98615).

(Read more about YLANG YLANG OIL)