Wednesday, February 4, 2015

A Skeptical Look at Essential Oils

I'm pretty skeptical by nature. If something sounds too good to be true, I usually assume that it is. I am generally not a bandwagon jumper, so if something is really popular, I tend to run the other way, because that's just the kind of person I am. This way of looking at the world can make me a Debbie Downer to be around, but it does help me try to question everything and assume nothing.

I first started noticing the essential oil trend on Pinterest, where people started adding them to homemade cleaning products to make them smell good. I like to clean with vinegar, and my hubby isn't a huge fan of the smell of white vinegar, so I purchased three small bottles of essential oils-- lemon, lavender, and tea tree oil, all for their smelly-good properties only. I started adding a few drops to my floor cleaner and laundry. They smell nice!

In one of my previous blog posts, I tried adding tea tree oil to an oil treatment for my hair and to homemade face wipes. Because I didn't like the smell, I didn't continue it for very long. I then saw a Pinterest pin for making DIY baby wipes, and since this was just before our baby was due to be born, I thought I'd give it a try. It required using a few drops of tea tree oil with the promise that it was "anti-bacterial and anti-microbial" and thus would prevent the wipes from turning moldy. I made the wipes exactly to specifications, and in two weeks, my wipes had mold growing on them, before the baby was even born. So much for that, I thought, and I tossed the wipes. Then I did a bit more research and found that tea tree oil can be irritating to skin and could possibly cause other side effects. I realized I needed to do more research before I started slapping anything and everything I find on Pinterest onto my skin--or worse, onto my baby! So I went back to using my three essential oils only to make my cleaning supplies smell better.

I started noticing more and more pins on Pinterest and posts on Facebook about the healing and medicinal properties of essential oils. I didn't think much of it at first, thinking it was limited to the crunchy Moms of the world (with whom I occasionally identify!). But then seemingly overnight, I was reading anecdote after anecdote about the almost miraculous properties of essential oils. Friends were linking to blog posts that made some pretty hefty claims about what essential oils could do. Then people started trying to sell high priced versions of these oils with promises that it would transform my family's health, and that's when my skept-o-meter went off.

How can a concentrated distillation of a plant treat the common cold, prevent the flu, cure diabetes, reduce stress, improve sleep, lower cholesterol, cure ADD, prevent asthma attacks, prevent Ebola (!!), and a whole host of other things?  All scientific studies aside, just the claims in and of themselves are pretty outrageous. It hearkens back to the days of snake-oil sellers promising a miraculous panacea to cure all your ills. Then they take your money and run. Of course, we all want to be healthy, and we want our families to be healthy. We want simple, easy, and natural solutions too, which is why essential oils are so appealing. But are they truly as effective as their proponents claim, or are they modern day snake oil?

It can be confusing to sort out the fact from fiction, so while this blog post is in no way exhaustive, I've tried to condense some reasons why one should approach essential oils and their accompanying sales pitches with a healthy dose of skepticism.

What About Scientific Studies? In Vivo versus In Vitro
The links to studies given by essential oil proponents usually link to studies that are performed in vitro ("within the glass") not in vivo ("within the living"). What difference does that make? Well, in vitro basically means in a petri dish or a test tube, while in vivo means inside a real live animal or human. Some essential oils have been shown to have anti-bacterial and anti-microbial properties in a petri dish. They will kill some bacteria and microbes in a glass dish with a growth medium. But that doesn't tell us anything about what they do inside the human body. Bleach kills bacteria in a petri dish, but you sure aren't going to go swig bleach to get rid of an infection. (And to be fair, testing of pharmaceutical drugs have the same challenges in proving their efficacy; the difference is that they go on to do controlled studies and medicinal trials in vivo after extensive study in vitro).

Some studies suggest that aromatherapy may help with pain and anxiety when inhaled or used in conjunction with massage (although the results are by no means definitive).  But studies on the use of oils through inhalation do not address the use of oils topically or internally. More on that later.

What about all these stories from people who swear they work?

 1. Correlation does not equate causation

The problem with anecdotal evidence is that there are too many variables at play. Scientific studies seek to limit and isolate variables so they can be compared to a control. But when someone says, "I took this oil and it worked!", we have no way to prove their claim scientifically, because there is nothing to compare it to. There are too many unknown variables that could have factored in to the outcome they received. Just because they took an oil and received an outcome that was favorable to them doesn't mean the oil itself is the reason for that outcome. Correlation does not equate causation.

Let's look at a few examples. A couple weeks ago, my daughter had norovirus (aka stomach bug) and was up all night puking. I was up with her, comforting her and helping her clean up. I worried I might get the stomach bug too, since I literally had vomit on me, but thankfully I ended up not getting the tummy bug. And 24 hours later, my daughter was symptom-free and back to her happy self. No one else in the house got sick either.

Now, let's take the same scenario and assume we were regular users of essential oils. My daughter starts puking, and I take whatever formulation of essential oils the company that produces them recommends. I also give them to the members of my family. I also give my daughter whatever formulation the essential oil company recommends for norovirus.  Then, miraculously it seems, I don't get sick, nor does anyone else in the family. My daughter, rather than being sick for several days, is better than 24 hours. To what do I credit our seemingly lucky escape from prolonged illness? Well, the essential oils of course! They MUST be the reason no one else got sick and my daughter recovered quickly!

But how do I know that I wouldn't have gotten sick and my daughter would recover in 24 hours without the essential oils? Without a point of comparison, I couldn't really know. And in my case, we stayed healthy without essential oils. I could have easily credited drinking lots of water or getting enough sleep or watching Doctor Who marathons.

2. Changes in behavior
Another reason essential oils might appear to work is that their use leads the user to change or alter behavior, and that changed behavior is the reason for the desired outcome. Say a person has been feeling tired, sluggish, with a headache and a scratchy throat, so he takes an essential oil formulation for cold symptoms. The company says to take a few drops of oils in a big glass of water. The person drinks the water with the few drops of oil, then repeats the procedure numerous times throughout the day. By the end of the day, he notices he feels a bit better. He repeats the procedure the next day and what do you know, he doesn't think he's going to get that cold after all!  Yay for essential oils!

But there is at least one other new variable added to this person's routine. In addition to the essential oils, this person drank many glasses of water that he might not have otherwise consumed. Taking the oils made him change other behaviors that could also be the reason for the desired outcome. Proper hydration is vital for health and yet we don't always credit this simple solution to why a person feels better.

Another example of a change in behavior would be the ritualistic nature of some of the essential oil remedies. The directions call for the user to rub the oils on their feet or put them in a diffuser. Rubbing and massaging one's feet can be relaxing exercise, with or without oils, and that alone could make a person feel better. Putting oils in a diffuser requires a person to slow down, do a thoughtful activity, and breathe deeply. How do we know that those acts in and of themselves aren't effective? In the absent of a control, we don't. If a person with insomnia tries essential oils, perhaps she turns off the TV sooner in order to prepare the oils. She rubs her feet and takes time to reflect on her day. Then when she sleeps well that night, she thinks the oils have been effective. Perhaps if she had turned off the TV sooner and done some other relaxing, reflective activity before bed, she would have slept just as well.

3. Placebo Effect
Perhaps another reason we hear so many "success" stories for essential oils is that the placebo effect is real. The people taking the essential oils believe they will help, and so they seem to work. If we go to a class telling us how these oils will help and hear other people talk about how these oils help, we become conditioned to expect a certain outcome, and then our interpretation of the outcome mirrors our expectations.

Now, if essential oils work because they are acting as placebos, that isn't necessarily a bad thing. If someone gets relief using a seemingly "natural" product and they are happy, then that's fine. The trouble is that many of the essential oils are very expensive. And without scientific testing to guide users in proper dosage and usage, they could potentially be dangerous. Which leads me to my next point.

What's the harm?

Many people are choosing essential oils because they want a natural alternative to medicine and pharmaceutical drugs. I understand that. I too am skeptical of the pharmaceutical industry, and the FDA has applied uneven standards to the approval and marketing of drugs. But just because we are skeptical of "big pharma" doesn't mean we should run with open arms to the essential oil companies. They too are out to make money, and they are making a ton of it. More than that, they rely on the trusting relationships between family, friends, and neighbors to market their products. And therein lies greater danger--who decides how these oils are used? For what ailments? How much of each oil? How much is too much? Too little? How often should you use them? For how long? Because they are not tested and regulated like regular medicine, there is no standard dosage and dispensation of essential oils. With regular medicine, people rely on their doctors and pharmacists, who have gone through years of highly advanced schooling with ongoing continuing education to maintain their licenses. The medicines prescribed have gone through extensive testing for dosage and efficacy and have continuous oversight by the FDA and will be recalled if necessary. With essential oils, people are trusting blogs, Pinterest, hearsay, and their own experimentation. They have no controlled trial testing, no double blind studies, and no approval or regulation by the FDA. It boggles my mind that people are skeptical of highly trained scientists and yet take their friend's second cousin's neighbor's opinion as medical advice.

Last fall, the FDA issued warnings to doTERRA and Young Living Essential oils because of the way they were labeling and marketing their oils for "use in the cure, mitigation, treatment, or prevention of disease"-- which is a violation of the law, since that would make the oils a drug and thus require FDA regulation and oversight. The doTERRA "wellness advocates" were promoting their oils for "conditions including, but not limited to, viral infections (including ebola), bacterial infections, cancer, brain injury, autism, endometriosis, Grave’s Disease, Alzheimer’s Disease, tumor reduction, ADD/ADHD,  and other conditions that are not amenable to self-diagnosis and treatment by individuals who are not medical practitioners."  The Young Living product guide marketed their oils as drugs and thus also violated the Federal Food, Drug, and Cosmetic act. Furthermore, Young Living Consultants were marketing the oils for "conditions such as, but not limited to, viral infections (including ebola), Parkinson’s disease, autism, diabetes, hypertension, cancer, insomnia, heart disease, post-traumatic stress disorder (PTSD), dementia, and multiple sclerosis, that are not amenable to self-diagnosis and treatment by individuals who are not medical practitioners."

The FDA exists for a reason-- to protect consumers from fraud and dangerous products. People cannot sell oils by making extravagant claims and not be held accountable for it. And how do we know that each bottle of oil contains what it says it contains? Recently in the news, we've seen headlines about supplements being pulled off the shelves because investigations revealed they didn't even contain the main ingredient they advertised. Just like herbal supplements, essential oils do not undergo the level of FDA oversight and rigorous standards to ensure quality, uniformity, and truth in labeling that regular medicines undergo.

It is frightening that people internally ingest these oils and/or rub them on their skin and even give them to their children, not knowing the potency or the side effects of the oils. Just because something is "natural" does not mean it is safe. Poison ivy is natural. Castor seeds are also natural. They can make castor oil, which is sometimes used as a carrier oil for essential oils... but castor seeds contain ricin, a substance so toxic even a tiny amount can kill an adult human. The National Association for Holistic Aromatherapy--which promotes the use of essential oils for aromatherapy--gives a pretty transparent list of some of the dangers of oils used improperly.  As mentioned before, there are studies that support aromatherapy as a possible option for stress and pain relief, but this does not then mean that those oils are then safe for topical or internal use. And with so many non-medically trained people dishing out essential oil formulations and advice on the internet, how do you know the directions you are following are safe? 

And even if they are safe, how can you be sure they are effective without adequate scientific studies and clinical trials?

And if you can't be sure they are effective, how can you be sure you aren't just spending your money on snake oil?

Just a few things to consider before you jump on the bandwagon.

Skeptically yours,
MulliganMama (aka Debbie Downer)