I was also impressed by the studies out of Germany on Silexan, which is a lavender extract taken orally. The clinical trials took it head-to-head with lorazepam, which is a benzodiazepine like Valium. It held up remarkably well, with similar levels of anxiety relief. So the effects are not limited to olfactory use.
I’m a psychiatrist, and I have prescribed it a few times for patients that I treat. There’s a version of it available in the US called CalmAid that is identified as the same isolate in Silexan.
International Journal of Psychiatry in Clinical Practice. 2013. 10.3109/13651501.2013.813555
Journal of Clinical Psychopharmacology. 2017. 10.1097/jcp.0000000000000615
Frontiers in Pharmacology. 2017. 10.3389/fphar.2017.00280
Edit: added info on an RCT, a meta-analysis, and some work on the mechanism of action
A neat fact is that you can put any DOI at the end of doi.org/ and it will (never has failed me) redirect you right to the landing page of the paper the the DOI is a reference for.
So a paper with a DOI of 10.3109/13651501.2013.813555 can be reached by going to: doi.org/10.3109/13651501.2013.813555
Re: Silexan, I'm noticing a lot of stuff that seems very off. "Kasper" seems to be the author of almost every study around silexan, like article #1 above (doi 10.3109/13651501.2013.813555) and this meta-analysis [0] where Kasper et al seems to be analyzing three of their own papers!
Article #2 (doi 10.1097/jcp.0000000000000615) is a meta-analysis that seems to not have Kasper in the author list, but then if you read the full article you'll see that every single one of the studies they analyze minus one are all Kasper's!
Isn't this super shady? How is any of this kosher????
----
And the Kasper meta-analysis I mention above was funded by the makers of Silexan:
> The research presented in this paper was funded by Dr. Willmar Schwabe GmbH & Co. KG, manufacturer of Silexan, who was also the sponsor of the trials included in the meta-analysis. The statistical analysis plan for the meta-analysis was conceived and the analyses were performed by the biostatistical department of Dr. Willmar Schwabe GmbH & Co. KG under the responsibility of co-author SS. The company also provided the raw data of the trials included into the analyses. A first draft of the manuscript was prepared by Andreas Völp, Ph.D., an independent medical writer who was reimbursed by Dr. Willmar Schwabe GmbH & Co. KG, who also independently performed the risk of bias assessments. Open access funding provided by Medical University of Vienna.
And of the other authors:
> Hans-Jürgen Möller has received grant/research support, consulting fees and honoraria within the last years from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen Cilag, Lundbeck, MSD, Novartis, Organon, Otsuka, Pfizer, Schwabe, Sepracor, Servier, and Wyeth. Hans-Peter Volz has served as a consultant or on advisory boards for Astra/Zeneca, Eli Lilly, Lundbeck, Pfizer, Schwabe, Janssen, Otsuka, Merz, Wyeth, neuraxpharm and has served on speakers’ bureaus for Astra/Zeneca, Eli Lilly, Lundbeck, Schwabe, Janssen, Merz, Wyeth, Lichtwer, Steigerwald, Hormosan, neuraxpharm and Bristol-Myers Squibb. Angelika Dienel and Sandra Schläfke are employees of Dr. Willmar Schwabe GmbH & Co. KG, manufacturer of Silexan. Siegfried Kasper received grants/research support, consulting fees and/or honoraria within the last 3 years from Angelini, AOP Orphan Pharmaceuticals AG, AstraZeneca, Eli Lilly, Janssen, KRKA-Pharma, Lundbeck, Neuraxpharm, Pfizer, Pierre Fabre, Schwabe and Servier.
Sadly that’s the state of the world - most research is funded by those who stand to gain from it. It’s not good, but the study designs are. Assuming they aren’t just falsifying data (which does happen, but is rare), then good study design limits the ability to influence results.
Also, this is an inexpensive, over-the-counter treatment for mild to moderate anxiety. So I am comfortable considering a treatment with more modest research support, particularly if the patient has tried and failed other better-supported interventions, or refuses to try them.
I was in the psych ward a little while back and had an absolute breakdown while I was there. They had security put me in the observation room behind the nurse's station, which is just like a room with thick glass on three sides and curtains on the outside and a mattress on the floor. I was losing my shit. When I finally calmed down around 2 AM, a nurse came in with a little bottle of lavender essential oil. She asked if she could put it on my pillow. I had the best sleep of my time spent on the ward, and started using it when I was discharged. I had wonderful dreams, I was calm in the morning, I was comforted, I felt safe.
On the topic of traditional sleep aids, I found chamomile capsules [0] to be a safe and effective sleep aid. I previously worked exclusively overnight and tried many herbal supplements, finally settling on chamomile as my favourite.
Did the Psych Ward cause your breakdown or make it worse? I always that people were having the breakdown first, and then you would go to the ward after.
How long do they take to discharge you after a breakdown?
I was admitted before that, but while on the ward I had a few breakdowns (or "episodes"). I think the psych ward made it worse in some ways and better in others. It was safe, there was a routine, and other crazies to talk to, which made me feel like I had a community. But sometimes the nurses were condescending, rude, or lacking any empathy, and despite how safe it was I also didn't want to give up my freedom. I felt "bad" for being there, like the universe was punishing me because I didn't follow the "plan", so in that way it was even kind of traumatizing, especially considering that I witnessed other people on the ward having episodes and going through a really hard time. Sometimes it was like hell and sometimes it was the only place I ever wanted to be.
It depends on what kind of breakdown and what the problem was to begin with. Some people hurt themselves when they have an episode, and those people usually get another week or two tacked on, sometimes more. I didn't hurt myself so I was discharged on normal time (about three weeks). It also depends on how well you respond to treatment even after an episode. The main thing is showing signs of recovery and having an "action plan" that you draw up with your doctor and the nurses for figuring out your life after discharge.
My wife had a very stressful and painful delivery with our first. During her 3 day recovery at Kasier, our nurses provided a lavender treatment (oil on a cotton ball) to help reduce her stress and calm her heart-rate. Our nurses had provided us with a patient information sheet that Kaiser had prepared specifically for this situation.
The key here is this was a very targeted and prescribed treatment performed by trained professional staff with a lavender oil product intended for use in a hospital. Not some huckster MLM agent that selling good knows what.
Yes, I was posting this in the context of a clinical study. A good study will try to account for its controls, that was my point. The only problem is in the wide variability of the actual product to be used. There needs to be information on a manufacturer/producer and the form of the lavender oil/extract and application. Taking a bath, topical application, alcohol based mist etc..
The in-between shouldn't be health enthusiasts or exclude the scientific method. Upthread is someone linking research that lavender includes compounds which significantly impact endocrine function in a way that is just starting to be studied.
It is hard to tell which is worse, if these non-pharmaceuticals are completely ineffective or potent medicines.
Given lavender's known negative effects on developing boys, I think it should only be available in a medical environment, or extensively labeled and regulated.
If this destroys the oily-MLM huns, that would be a side benefit.
There are no known negative effects on developing boys. See my comments down-thread. The "studies" purporting to show hormonal effects were extremely low-quality, and have not been reproduced. Other more recent studies are only in-vitro, and in-vitro hormonal effects do not translate well in living humans.
Besides, lavender shares a chemical makeup with many other common herbs and foods, or combinations thereof, and nobody is claiming that those disrupt our hormones. The whole hypothesis doesn't pass the smell test.
>Not some huckster MLM agent that selling good knows what.
I'm just curious where you position naturalist stores? I can go and buy lavender essential oils for <$5 that will last a long time with using it multiple times a day.
I understand there's a hangup with science-oriented people on natural/holistic therapies, but I feel like you're misrepresenting things to support your biased mindset.
My position is that industry has a long and well documented history or over inflated claims and hyperbole. The FDA exists because of the danger of claims that get made. Even recently a product was recommended to treat dogs that was like 90 proof alcohol which was toxic. So yeah I have a hang-up with naturalist stores that I feel is well justified.
When i was working on a project in Tunisia, i saw lots of the locals walking around in the morning with little sprigs of rosemary (which grows everywhere there) and taking sniffs of it as they commuted.
When I asked about it, they mentioned it was like a morning coffee, they felt it woke them up, and "got their brain firing".
I gave it a go, and (n=1) it definitely felt like a pick me up. I grow rosemary in my garden now, and every morning as I am getting ready for work I will grab a bit and smell away.
AFAIK there is not yet any evidence showing hormone disruption from lavender in people. There is some recent research showing effects in vitro (including the report you cited), but nothing in actual humans.
The hypothesis is highly questionable to begin with, simply because the chemicals in lavender that show hormone disruption in vitro (almost all of them terpenes in the latest studies) are ubiquitous in nature, being present in hundreds of other widely consumed foods and herbs, often in high concentrations. Nature has surrounded us with these chemicals, and we've evolved in their presence. It would be really odd for lavender to cause problems, and not any of the other plants that contain the same substances.
The 2007 report (by Henley et al) that kicked off the whole panic over lavender and tea tree oil is a textbook case of poor quality pseudo-research that should never have been published. It had a sample size of three. That's right, three. It was neither blinded nor controlled in any way. It was simply a doctor who thought he noticed a decrease in gynecomastia among three kids after they stopped using some products that might have contained lavender or tea tree oil. If you want to know what's wrong with scientific publishing and reporting nowadays, reading about this case is a great place to start [1].
Does the 2013 rebuttal study in that link tell us anything about the safety of ingesting lavender extract (e.g. like the Silexan studies given above)? Wouldn't that involve much higher absorption than topical application?
Update: OK, weirdly enough, Tisserand seems to be highly involved in the aromatherapy industry per their own website, and the study [0] seems to involve researchers from the "Research Institute for Fragrance Materials" which sounds suspiciously like an industry-related group - is this reputable at all??
I think this is one of those situations where most of the people who care enough to debate are those with an economic interest. Like perfumers. Conflict of interest is possible I suppose, but Tisserand's rebuttal seems well reasoned regardless, and he provides a list of other rebuttals from other people.
> Does the 2013 rebuttal study in that link tell us anything about the safety of ingesting lavender extract?
No, only topical application, albeit in far greater quantities than is seen in typical usage.
> Wouldn't that involve much higher absorption than topical application?
No, not necessarily. Silexan is delivered in 80mg doses. Higher levels of the same chemicals can easily be delivered by common foods. For example, a dish that's well seasoned with thyme or coriander can easily contain far more than 80 mg of linalool, and a few other ingredients would easily provide the same terpenoid profile as found in lavender, just as if you were to eat a large amount of lavender oil. Lavender really isn't anything special.
I was a little disappointed not to see that mentioned in the NYT article. I fear to think how many overactive little boys are going to start getting dosed with lavender to calm them down.
The dose from aromatherapy ought to be much lower than that from topical or oral exposure. Several studies mention gynecomastia after rubbing lavender oil on the skin or drinking tea:
Only one of the reports in your search results purports to show gynecomastia in vivo. That's the report I mentioned in my earlier comment, and it's possibly the poorest quality "study" that I see cited with any regularity. Sample size of three, no controls, no blinding, no analysis of the products used. It's functionally equivalent to an old wive's tale.
The authors try to bolster their credibility by including some in-vitro evidence of estrogenic activity, which is extra-credit bullshit because there are plenty of common (and natural) substances that can disrupt hormones in a test tube, but show no such ability in actual humans. This is cheap research that the authors sensationalized with three completely uncontrolled and unblinded anecdotes. It blows my mind that this thing got published.
Notice how many other studies in your list cite that the Henley report. Also notice how many more recent studies list the same authors, namely Henley and Korach. Given the poor quality of their work and the overall implausibility of the proposed effect in vivo, I'd recommend taking their reports with a large amount of salt, at least until actual in-vivo effects are demonstrated in a higher quality study.
>That's the report I mentioned in my earlier comment, and it's possibly the poorest quality "study" that I see cited with any regularity. Sample size of three, no controls, no blinding, no analysis of the products used. It's functionally equivalent to an old wive's tale.
Case studies are widely used in medicine. But thanks for the downvote.
>Notice how many other studies in your list cite that the Henley report.
Here is a different report (early puberty in a girl):
>Given the poor quality of their work and the overall implausibility of the proposed effect in vivo, I'd recommend taking their reports with a large amount of salt, at least until actual in-vivo effects are demonstrated in a higher quality study.
The cautious option is to avoid systemic use of lavender in populations where xenoestrogenic activity may be undesirable. Particularly in light of the fact that the “refutation” you linked was written by someone with an obvious conflict of interest.
> Case studies are widely used in medicine. But thanks for the downvote.
Why are you saying I downvoted you? I'm not trying to be adversarial, just trying to provide counterpoints to what I believe is poor-quality reporting. Case studies are indeed often used in research. However in this situation we have an n=3 sampling without even a semblance of scientific control or analysis. They apparently didn't even bother to confirm whether the products that the kids were using actually contained lavender, much less characterize the quantity or composition. This isn't scientific by any stretch of the imagination. It's pure anecdote. It's no better than a facebook rumor.
> Here is a different report (early puberty in a girl)
Okay, another single case report, and again no analysis of the product being used, and no analysis of the "other CAM remedies" that the mother was reportedly using, nor any attempt to isolate other coincident changes in diet, treatment, chemical exposure, etc. Not sure how this helps anything.
> The cautious option is to avoid systemic use of lavender in populations where xenoestrogenic activity may be undesirable.
I disagree. You are of course free to be as cautious as you like, but IMO it's a paranoia that isn't justified by the research we've seen so far.
And as I said, the whole thing doen't really make sense. If we really do have to worry about lavender, then we're pretty fucked, because the chemicals of interest (such as the eight studied in the report you cited) are everywhere. Eucalyptus, basil, coriander, pine oil, mints of all kinds, citrus of all kinds... all of these and many more contain estrogenic terpenes in quantities similar to (or greater than) lavender. Are you going to be cautious of these as well if someone starts a rumor that they can disrupt your hormones?
> Particularly in light of the fact that the “refutation” you linked was written by someone with an obvious conflict of interest.
Tisserand's monetary interest in the industry could well lead to a conflict of interest. I don't know anything about him, but I'll grant that. But be careful about discounting him out of hand; it's easy to cross over into ad-hominem attacks. That he may have a dog in this fight doesn't necessarily make him wrong, and it doesn't make Henley's report more legit. Do you have a specific quarrel with Tisserand's reasoning? Do you have a rebuttal to his rebuttal, so to speak?
I can tell you that cutting lavender, bowing with a blade under a flaming sun, isn't soothing at all :) Ditto throwing tons of lavender with a fork in the distillation tank next to the blazing fire :)
Soothing? I have a disgust of all things lavender, and I don't appreciate being subjected to the aroma when colleagues use lavender products. I wonder if there's a connection between my visceral reaction and my general lack of ability to relax.
Entirely possible. Think of cilantro that tastes and smells like soap for some people. Contrary to popular belief, we do not all perceive the world in the same ways.
"This may be traced to the OR6A2 gene, an olfactory receptor able to bind many of the aldehydes implicated in the herb's very particular smell. Perhaps those with a specific variation in the gene are particularly sensitive to its soapiness."
Same here, can not stand the smell of lavender. Never found it relaxing. Do not know why. At the same time I can not smell fish-sauce at all which many people do find revolting.
Another +1 here. Intense visceral disgust of lavender. I don't think I'm "smell-sensitive" in any other way. I can tolerate all manner of, e.g., dank cheese, pungent fish, fragrant smoke, any other plant oil, etc. I just can't stand lavender.
While I’m not particularly hopeful for actual positive outcome of a larger study I must ask: isn’t this how studies are supposed to be done?
You devise a hypothesis, you confirm it as good as you can in an experiment and document the procedure. Someone else then peer reviews your study and finds any potential mistakes, if the research looks promising enough an independent research team will devise a larger study with more funding to verify the claims, repeat this X times until some sort of conclusion can be made.
Again, I’m partial against this study but at least it’s a study.
being dismissive of basic research is counter-productive. Would you like to suggest that their methodology or that their conclusions are suspect? Would you prefer a large-n tracking study of experiments on humans over many years?
Yeah, so would we all, but studies like this are how researchers build up a hypothesis and funding to do larger more powerful studies.
This Hacker News meme of being dismissive of research is pointless and should stop. Cynicism and snark don't add to the discussion.
I’m a psychiatrist, and I have prescribed it a few times for patients that I treat. There’s a version of it available in the US called CalmAid that is identified as the same isolate in Silexan.
International Journal of Psychiatry in Clinical Practice. 2013. 10.3109/13651501.2013.813555
Journal of Clinical Psychopharmacology. 2017. 10.1097/jcp.0000000000000615
Frontiers in Pharmacology. 2017. 10.3389/fphar.2017.00280
Edit: added info on an RCT, a meta-analysis, and some work on the mechanism of action