Health: Can you pour oil on a problem?

Complementary medicine is growing in popularity all the time, and aromatherapy is by far the most common form. But are aromatherapists qualified? Is it safe to use oils at home? Our special health series is here to guide you. By Professor E Ernst

What is

Aromatherapy?

"THE WAY to health is to have an aromatic bath and scented massage every day" (Hippocrates).

Even though oils have been used for medicinal purposes for thousands of years, aromatherapy as we know it today only started in the 1930s in France. The story goes that an explosion happened in chemist Maurice Gattefosse's laboratory. He burnt his hand, and spontaneously plunged it into pure lavender oil. His wounds healed faster than expected, which triggered his interest in the healing properties of essential oils.

Aromatherapy is the use of "essential" oils extracted from the flowers, fruit, seeds, Ieaves and roots of plants for medicinal purposes. The oils are highly concentrated and contain numerous chemical constituents. The therapist selects oils according to the physical and emotional state of the client in a way that proponents view as holistic and critics might call esoteric or irrational. The selected oils may be blended together and must always be diluted with a carrier oil. The resulting mixture is then massaged into the skin. The application of oils by massage is by far the most common form of aromatherapy.

Its action could be explained by:

n the pharmacological effects of the absorbed substances

n the emotional and physiological effects of the scent

n the effects of the gentle stroking massage.

Sometimes the oils are administered by mouth or inhaled, used as additives to a bath or applied as a cold compress on to the skin. Thus aromatherapy can be a form of self-treatment. And aromatherapists claim that each oil has specific effects, for instance:

n Lavender; relaxation, healing of small wounds

n Niaouli: vitalising

n Palmarosa: anti-infectious

n Peppermint: an excellent stimulant for the liver

n Rosemary: good for activating skin metabolism

n Tea Tree: antiseptic, healing of small wounds

Some of these claims are supported by evidence from scientific investigations but the vast majority are not. The statements one finds in aromatherapy books are mostly adopted from previous books rather than based on proven facts. Aromatherapists would, of course, argue that their claims are based on years of experience. If this were true, one would expect a high level of agreement between key recommendations, eg condition X is best treated with therapy Y. This, unfortunately, is not the case.

This particular criticism does not apply just to aromatherapy but to most other treatment modalities of complementary medicine. Aromatherapists are not usually medically qualified and there is no mandatory training nor proper regulation of this profession. About 7,000 aromatherapists are registered within various professional organisations in the UK. Of all complementary medicine products, the market for aromatherapy oils is growing most rapidly. In 1996, the UK turnover was pounds 14m, a growth of 470 per cent in real terms since 1991.

One aromatherapy session will usually cost between pounds 30 and pounds 40. Aromatherapists tend to advise a series of about 6-10 weekly sessions that might be repeated at intervals.

What happens in

a session?

The therapist will usually take a short history, ask about current complaints and try to assess patients in an holistic way. This will lead to the choice of oil(s) thought to be particularly suited. The patient will then undress, lie down and enjoy the gentle stroking action of the therapist's hands. While the oil is rubbed into the skin, the patient has time to relax. A full body massage can take one hour or longer.

The therapist will often sell oils for use at home and give instructions on how to use them. Some oils command amazingly high prices. Many people simply buy the oils which are readily available in high street shops and use them for relaxation or pleasure. It is important to store the precious oils correctly; in closed containers out of the heat and sun.

it for?

Aromatherapists believe in the positive effects of their oils on the emotional well-being of their patients. Aromatherapy is often used for stress, anxiety, depression, premenstrual symptoms, insomnia, headache or asthma as well as in palliative care to ease the burden of suffering of terminally ill patients. Generally speaking, aromatherapists treat mild symptoms to increase well-being.Even though there is a considerable amount of research on the physiological effects of odour on humans, little scientific work has been carried out to objectively assess the effects of aromatherapy.

Most people perceive aromatherapy as relaxing and agreeable. But so far, only a very limited number of rigorous clinical trials have been carried out (Box 2). In some of these studies, patients with sleep problems were given lavender oil to inhale. Even though the trials are burdened with flaws, their results suggest that lavender oil improved the quality of daytime wakefulness and lead to a more sustained sleep. Other studies suggest that it can reduce anxiety.

Are there any

risks?

Because there is no reporting mechanism for adverse effects of essential oils, very little is known about side effects. This, however, does not mean that side-effects do not occur. Essential oils are powerful mixtures of plant chemicals. They are on general sale in the UK, often without any instructions. Essential oils should not be applied directly to the skin or taken orally in undiluted form. All oils can cause allergic reactions in predisposed individuals. Some oils, such as orange, lemon or bergamot, can sensitise the skin to sunlight so that burning can occur more easily. Some oils are also known to promote cancerous growths in laboratory tests, but there is no evidence that this also occurs in humans. It seems that such risks could also be relevant for therapists. Because the skin absorbs some of the chemicals from the oils, they should not be used during pregnancy and lactation. Some aromatherapists also caution against use in children, patients with hypertension or epilepsy and when suffering from sunburn. Chemical constituents of aromatherapy oils absorbed into the body could theoretically also interact with prescribed drugs but again there is little data. A set of simple rules will help to minimise the risks (Box 3).

Adulteration of essential oils seems to be a widespread problem, so it is worth buying from a reputable supplier. Many essential oils on the market have been contaminated by pesticides. Most oils do not have a sell- by date but will clearly deteriorate over time. The lack of rigorous quality control presents a considerable potential risk to consumers. (With the exception of medical herbalism, this is true throughout complementary medicine.)

Indirect risks of aromatherapy relate to the medical competence of the therapists. If they are not aware of the limitations of their treatment or interfere with prescribed medicines, the patient could be harmed.

Aromatherapy is popular, yet under-researched, and there is very limited evidence of its benefits.

Addresses of some important professional organisations:

Aromatherapy Organisations Council

3 Latymer Close

Braybrooke

Market Harborough

Leicester LE16 8LN;

International Federation of Aromatherapists (IFA)

Stamford House

2/4 Chiswick High Road

London W4 1TH;

International Society of Professional Aromatherapists (ISPA)

ISPA House

82 Abbey Road

Hinckley

Leics LE10 1SN;

Aromatherapy Trades Council (ATC)

P0 Box 52

Market Harborough

Leics. LE16 8ZX

If you'd like to find out more, try these books:

n for those with prior knowledge:

Vickers, A. `Massage and aromatherapy'. Chapman Hall, London 1996

Tisserand R, Balacs T. `Essential oil safety. A guide for healthcare professionals', Edinburgh: Churchill Livingstone, 1995

n for beginners:

Tisserand R. `Aromatherapy for everyone'. Penguin, London 1988.

Next week: healing

To Be On the Safe Side

To be on the safe side, follow these simple rules:

n If you have previously suffered from allergies, it is wise to take a patch test to make sure you are not allergic to aromatherapy oils

n Never use an oil in undiluted form

n Do not take essential oils orally unless under medical supervision

n Do not use oils during pregnancy and lactation

n Buy products from reputable manufacturers

n Distrust therapists who promise a `quick fix', interfere with prescribed medicines, continue treatment without you seeing a benefit

n Do not treat serious medical problems with aromatherapy without telling your doctor

clinical trials

Aromatherapy has been tested through controlled clinical trials in the following conditions:

Condition Oil Form of application Result

Insomnia Lavender Inhalation Positive

Anxiety Lavender Massage Positive

Pain of childbirth Lavender Bath Negative

Flowers

Plant

Clove

(Syzgium aromaticum)

Eucalyptus

(Eucalyptus globulus)

Lemon grass

(Cymbopogon citratus)

Peppermint

(Mentha x piperita)

Thyme

(Thymus vulgaris)

Main constituents

Eugenol

Eucalyptol

Citral

Menthol

Thymol