Modern Aromatic Medicine

Aromatic Medicine in the 21st Century: Essential Healthcare Alternatives by James L. Geiger MD

What does a musical wind instrument have to do with complementary alternative medicine?

Nothing really . . unless you’re suffering from sleep apnea.

Call it a new way of thinking, a revolution of sorts, if you will – an alternative to tradition, which is exactly the thinking associated with aromatic medicine.

Aromatic medicine, of course, is an element of holistic healing expressed in the clinical practice of integrative medicine.

The clinical definition goes like this: “Essential oils are the concentrated distillations of volatile aromatic compounds extracted from plants to yield apothecary-like compounds used to promote health and wellness as part of the vast field of complementary alternative medicine (CAM).”

“Complementary alternative medicine” thinking is exactly where the didjeridoo – the traditional Australian Aborigine musical wind instrument – fits in.

Let’s begin with our understanding of the sense of smell.

Your sense of smell isn’t just simply for detecting and differentiating the good, the bad, and the ugly aromas around you; and neither does your sense of smell simply happen.

Smelling is a learned process whereby your mind’s memory banks have inhaled, processed, and stored information over time through thought, language, neurogenesis, and genetics.

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 – midazolam and certain aromatic gases, for example – work through GABA receptors causing sedation and relief of anxiety and amnesia.

Anosmia:

Speaking of amnesia, anosmia literally happens when your nose literally forgets how to smell. The sense of smell can be affected by medications or a vitamin deficiency, causing anosmia. All classes of medications from A to Z, whether they are antibiotics, anti-inflammatory agents, anti-Parkinson drugs, antihistamines, antidepressants, or anticonvulsants can cause anosmia. Remember, these are just some of the drug families starting with the first letter of the alphabet.

We should also note that vitamin A deficiency is a leading cause of loss of sense of smell, though this is reversible with supplementation of vitamin A.

Sleep Apnea and the didjeridoo “A Noisy Airway Is an Obstructed Airway”

My father taught me that phrase.

Amazingly, there appears to be benefits in treating sleep apnea using a didjeridoo according to a report recently published in the British Journal of Medicine. The report concluded that sleep apnea symptoms decrease with progressive use of the didjeridoo (Puhan, 2006) as there is less obstructed breathing (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 also 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, however, to design a study in which essential oils are involved in this case. 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.

The results suggest a proof of principle in this work. 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.

Whatever the case, essential oils seem to be leading the charge in the Wellness Revolution of the 21st Century.

Essential oils: The Natural Alterative Medicine

The word essential, when discussing extracted oils from plants, refers to the aromatic, fragrant, adaptogenic, and phytomolecular essence of plants. Embodied in the chemical constituents found in these plant distillates are the energy and informational building blocks that produce complex emotional and intricate physiological effects in humans and animals.

The benefits of essential oils are many; the drawbacks seem few and far between:

• 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. Carrier oil used in an aromatherapy treatment does have minimal caloric value.

• Essential oils are rich in high-energy, double-bonded electron molecules, and as such are exceedingly high in oxygen radical absorbance capacity (ORAC) value to scavenge the free radicals associated with disease and aging.

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 bacteral infections and malodorous ulcerated lesions of diabetic gangrene, while promoting growth of new skin (Sherry, 2001, 2003, 2004).

● 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.

● Essential oils are also suggested to be instrumental in diseases such as dementia and Alzheimer’s. Melissa officinalis (lemon balm) and lavender has been described as an effective treatment in the management of severe, agitated dementia (Holmes, 2002; Ballard, 2002).

● Ginger oil effectively treats the three major components of nausea related to surgical interventions: general anesthetic agents, narcotics, and motion sickness. Application of 10% carbon dioxide-distilled essential oil of ginger root to the palms, wrists, soles, ears, and in the oxygen face-mask reduces the ill effects of anesthesia, as well as patient anxiety.

The inhalation and dermal application of ginger oil in general anesthesia patients, combined with the use of guided imagery, showed a more than 30% decrease in the incidence of nausea in patients at high risk for nausea during recovery from anesthesia (Geiger, 2005).

Oil of Ginger: Proof of Principle

Oil of ginger is a fine example of an essential oil that currently has proof of principle established. It also serves 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 postoperative nausea and vomiting (PONV).

Powdered ginger – or oil-depleted ginger – has also been shown to reduce morning sickness in pregnant women as well as having varying degrees of success treating PONV during laparoscopic gynecological surgical procedures that are high risk for PONV. It should be noted that obstetrics-gynecology journal articles in the last several years have verified the safety and efficacy of ginger during pregnancy (Smith, 2004).

Also, 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, and 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.

Prophylaxis with ginger increases patient satisfaction significantly, is very inexpensive, extremely low risk, and potentially useful in procedural situations that might induce vaso-vagal or gastrointestinal distress, such as: bowel preparations; endoscopy; and decreasing gag reflex during dental procedures.

Therapeutic success may be attributed to the learned smell associated with ginger aromatherapy, utilizing the mind-body suggestion and guided imagery perioperatively.

Welcome to the 21st Century of complementary alternative medicine, an exciting new world of discoveries where essential oils and, yes, even a didjeridoo can be on the same team in the field of Aromatic Medicine.

Puhan, M.A., Suarez, A., Lo Cascio, C., Zahn, A., Heitz, M., & Braendli, O., (2006). Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ. Feb 4; 332(7536):266-70.

Tipton, D.A., & Hamman, N.R., Dabbous MK. (2006). Effect of Myrrh Oil on IL-1beta Stimulation of NF-kappaB Activation and PGE(2) Production in Human Gingival Fibroblasts and Epithelial Cells. Toxicol In Vitro. Mar; 20(2):248-55.

Santoro, G.F., das Gracas Cardoso, M., Guimaraes, L.G., Salgado, A.P., Menna-Barreto, R.F., & Soares, M.J., (2007). Effect of Oregano (Origanum vulgare L.) and Thyme (Thymus vulgaris L.) Essential Oils on Trypanosoma Cruzi (Protozoa: Kinetoplastida) Growth and Ultrastructure. Parasitol Res. Mar; 100(4):783-90.

Sherry, E., Boeck, H., & Warnke, P.H., (2001). Percutaneous Treatment of Chronic MRSA Osteomyelitis with a Novel Plant-Derived Antiseptic. BMC Surg.; 1:1. 2001 May 16.

Sherry, E., Reynolds, M., Sivananthan, S., Mainawalala, S., & Warnke, P.H., (2004). Inhalational Phytochemicals as Possible Treatment for Pulmonary Tuberculosis: Two Case Reports. Am J Infect Control. Oct; 32(6):369-70.

Sherry. E., Sivananthan, S., Warnke, P.H., & Eslick, G.D., (2003). Topical Phytochemicals Used to Salvage the Gangrenous Lower Limbs of Type 1 Diabetic Patients. Diabetes Res Clin Pract.Oct; 62(1):65-6.

Ebihara, T., Ebihara, S., Maruyama, M., Kobayashi, M., Itou, A., Arai, H., & Sasaki, H., (2006). A randomized trial of olfactory stimulation using black pepper oil in older people with swallowing dysfunction. J Am Geriatr Soc. 2006 Sep; 54(9):1401-6.

Ballard, C.G., O’Brien, J.T., Reichelt, K., & Perry, E.K., (2002). Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: the results of a doubleblind, placebo-controlled trial with Melissa. J Clin Psychiatry. Jul; 63(7):553-8.

Holmes, C., Hopkins, V., Hensford C, MacLaughlin V, Wilkinson D, & Rosenvinge H. (2002). Lavender oil as a treatment for agitated behaviour in severe dementia: a placebo controlled study. Int J Geriatr Psychiatry. Apr; 17(4):305-8.

Geiger, J.L., (2005). The Essential Oil of Ginger, Zingiber officinale, and Anesthesia. The International Journal of Aromatherapy 15, 7-14.

Lee, A., Chui, P.T., Aun, C.S., Lau, A.S., & Gin, T., (2006). Incidence and Risk of Adverse Perioperative Events Among Surgical Patients Taking Traditional Chinese Herbal Medicines. Anesthesiology. Sep; 105(3):454-61.

Smith, C., Crowther, C., Willson, K., Hotham, N., & McMillian, V., (2004). A Randomized Controlled Trial of Ginger to Treat Nausea and Vomiting in Pregnancy. Obstet Gynecol. Apr; 103(4):639-45.