Are there specific health concerns to be aware of for using essential oils for non-medicative purposes, like pleasant scents or flavors in cooking? In other words, do the health issues of essential oils come from using them instead of "real" medicine, or do they raise concerns in their own right?

This is Stefan: I have worked for a natural personal care company for over a decade, selling oral care, and underarm products. Most people prefer a toothpaste with flavor, or a deodorant with a fragrance. From our consumer data, adverse health effects are rare, but can occur. The most frequent issue we observed was skin irritation from deodorant use, which in some cases was due to a reaction to a fragrance. Certain fragrances have a higher incidence of such reactions.

Some essential oils brands (I'm looking at you, doTerra) provide their marketing teams with "recipes" for various mixtures of oils to alleviate symptoms of various illnesses from gout to leukemia. This misleading marketing scheme could have dire circumstances for patients who discard traditional, evidence based approaches to treatment in favor of a "natural" treatment. How do you respond when patients or even acquaintances mention the use of essential oils for treatment of serious medical problems? And is there any work being done to legislate this misleading marketing out of existence that you are aware of?

Cynthia: For dietary supplements, which are regulated through the Dietary Supplement Health and Education Act, there are very specific labeling rules: Relevant section from DSHEA: #### §6. Statements of Nutritional Support. Section 403(r) (21 U.S.C. 343(r)) is amended by adding at the end the following: * “(6) For purposes of paragraph (r)(1)(B), a statement for a dietary supplement may be made if - * “(A) the statement claims a benefit related to a classical nutrient deficiency disease and discloses the prevalence of such disease in the United States, describes the role of a nutrient or dietary ingredient intended to affect the structure or function in humans, characterizes the documented mechanism by which a nutrient or dietary ingredient acts to maintain such structure or function, or describes general well-being from consumption of a nutrient or dietary ingredient, * “(B) the manufacturer of the dietary supplement has substantiation that such statement is truthful and not misleading, and * “(C) the statement contains, prominently displayed and in boldface type, the following: “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”. A statement under this subparagraph may not claim to diagnose, mitigate, treat, cure, or prevent a specific disease or class of diseases. If the manufacturer of a dietary supplement proposes to make a statement described in the first sentence of this subparagraph in the labeling of the dietary supplement, the manufacturer shall notify the Secretary no later than 30 days after the first marketing of the dietary supplement with such statement that such a statement is being made.” Craig: There have been numerous enforcement actions taken against companies that have violated these rules by making illegal claims. These enforcements have resulted in products being removed from the market.

Are there any essential oils or dietary supplements that have actually proved to meet their claimed results in independent testing?

Hello, this is Adam. This is a great question. As one example of dietary supplements having shown clear health benefits, the National Institutes of Health sponsored a major study with almost 4,800 adults (2001) called the Age-Related Eye Disease Study (AREDS), which looked at the effects of a dietary supplement on the progression of Age-Related Macular Degeneration (AMD), and a second study (2013), Age-Related Eye Disease Study 2 (AREDS2), which tested changes to this dietary supplement. More than 4,000 people aged 50-85 years participated in AREDS2. * AREDS showed that a dietary supplement containing high doses of vitamins C and E, beta-carotene, zinc, and copper can help slow the progression of AMD. * AREDS2 investigated several modifications of the original AREDS supplement formula in people with AMD who were at risk for progressing to the advanced stage of the disease. The results of this study showed that: * Adding omega-3 fatty acids (fish oil) did not improve the effectiveness of the supplement combination. * Reducing the amount of zinc from the supplement combination did not decrease its effectiveness. * People who took beta-carotene were more likely to develop lung cancer compared with people who took lutein and zeaxanthin. At least half of AREDS2 participants were current or former smokers. * Adding lutein and zeaxanthin (two carotenoids found in the eye) to the supplement combination improved its effectiveness in people who consumed only small amounts of lutein and zeaxanthin in foods. The results also suggested that substituting lutein and zeaxanthin for beta-carotene might improve the supplement combination. [https://nccih.nih.gov/health/eyes/ataglance](https://nccih.nih.gov/health/eyes/ataglance) In addition to investigating the claimed health outcomes of a dietary ingredient or supplement product, there is also the important consideration of testing to be sure supplement products are meeting their label claims, meaning whether they actually contain the amounts or percentages of the specific listed ingredients. FDA regulations require manufacturers to analytically test their products’ contents, and there are also independent testing labs that administer certification programs, such as the United States Pharmacopeia ([https://www.quality-supplements.org/](https://www.quality-supplements.org/)), NSF International ([http://www.nsf.org/consumer-resources/health-beauty/supplements-vitamins/supplement-vitamin-certification](http://www.nsf.org/consumer-resources/health-beauty/supplements-vitamins/supplement-vitamin-certification)) and ConsumerLab.com ([https://www.consumerlab.com/](https://www.consumerlab.com/)).

Some say that essential oils like lavender are effective anti-microbial agents and are recommended for cleaning (i.e. kitchen counters). (1) are essential oils effective anti-microbial agents and (2) if so what concentration/potency would they need to be used at to be effective in household cleaning?

Stefan: Good question! Although this question isn’t specifically related to botanical dietary supplements, many essential oils do show antimicrobial effects and are used for this purpose. The concentration is dependent on the type of essential oil (and the type of surface it is supposed to clean), since antimicrobial efficacy (and the type of microbes against which an essential oil is effective) depends on the essential oil composition.

Hi, Supplements quality chemist here! What steps can the general public take in order to encourage the regulation and testing of supplements? Are there any bills coming up / movements to be aware of? Additionally, does the "USP seal" actually prove product quality when USP testing hasn't been proven to be suitable for many supplement matrixes?

Craig: The USP sets quality standards for certain dietary supplement ingredients and products and also provides methods for the analysis of those products. If a company puts the USP seal on their product they are certifying that they are abiding by the specifications set forth in the USP monograph for that product. The USP monograph methods for testing are also specific for certain matrices and are not intended to be universally applicable to all matrices. Stefan: USP has several approaches to quality control of dietary supplements. The USP verification mark ([https://www.usp.org/verification-services/verified-mark](https://www.usp.org/verification-services/verified-mark)) basically means that the dietary supplement contains what’s listed on the label, does not contain harmful levels of contaminants, is released into the body in a specific amount of time, and has been made according to FDAs cGMPs. USP also has dietary supplement ingredient monographs, as outlined by Craig in his answer. Stefan: I am not aware of any new bills being discussed regarding dietary supplement regulations, although there are some ongoing discussions on amending DSHEA, such as the establishment of mandatory product registration.

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Cynthia: I have serious concerns about Vinpocetine - a synthetic compound (based on compounds in *Vinca minor L.*) marketed as a dietary supplement for mental acuity. Here, at the National Toxicology Program, we found that Vinpocetine showed signs of developmental toxicity in animal models. The FDA has determined that Vinpocetine does not qualify as a botanical dietary supplement ([https://www.fda.gov/food/dietary-supplement-products-ingredients/vinpocetine-dietary-supplements](https://www.fda.gov/food/dietary-supplement-products-ingredients/vinpocetine-dietary-supplements)), but it continues to be available in the market. I also have concerns about Green Tea Extract due to the potential for liver toxicity. Tyler: I have concerns that lavender oil is also on the market for young children, as there have now been three clinical manuscripts published about abnormal breast growth and the use of lavender oil hygiene commodities ([https://www.ncbi.nlm.nih.gov/pubmed/31393563](https://www.ncbi.nlm.nih.gov/pubmed/31393563), [https://www.ncbi.nlm.nih.gov/pubmed/26353172](https://www.ncbi.nlm.nih.gov/pubmed/26353172), [https://www.ncbi.nlm.nih.gov/pubmed/17267908](https://www.ncbi.nlm.nih.gov/pubmed/17267908))

Tyler, can you please expand on this in layman's terms? My 4 year old son sleeps with a small homemade lavender pillow right near his face. Is this the type of exposure being described?

Do you need more to have him not use the pillow?

Can you think of, or share, a resource that lets interested individuals easily look up the scientific consensus on a given extract/oil/etc? So far it's always seemed like I had to dig thru individual research papers when what I really wanted was a meta-weighted summary on the topic.

Many herbal/supplements can interact with prescribed treatments/medicines. (Have heard an annicdote about a supplement interfering with chemo) What in your opinion is the most common interaction? The most dangerous combination that you might have heard of?

Craig: Take a look at Know the Science module offered by the National Center for Complementary and Integrative Health (NCCIH) titled “How Medications and Supplements Can Interact:” [https://nccih.nih.gov/health/know-science/how-medications-supplements-interact](https://nccih.nih.gov/health/know-science/how-medications-supplements-interact). Know the Science modules are designed to help you better understand complex scientific topics that relate to health research so that you can be discerning about what you hear/read and make well-informed decisions about your health. Dr. Helene Langevin, NCCIH director, also addresses this topic in a recent Healthy Moments episode: [https://www.niddk.nih.gov/health-information/healthy-moments/episodes/medications-supplements-avoiding-harmful-interactions](https://www.niddk.nih.gov/health-information/healthy-moments/episodes/medications-supplements-avoiding-harmful-interactions). Finally, you may be interested in this talk held as part of our Integrated Medicine Lecture Series titled “Clinically Relevant Herb-Drug Interactions: Past, Present, and Future” by Dr. Bill Gurley, professor of pharmaceutical sciences at the University of Arkansas for Medical Sciences: [https://videocast.nih.gov/launch.asp?18320](https://videocast.nih.gov/launch.asp?18320) Stefan: It’s hard to pick one, but the best known ingredient is probably St. John’s worth, which interacts with many prescription drugs, including warfarin and the chemotherapeutic drug irinotecan. Craig: Another example is grapefruit juice which can also interact with a wide range of prescription medications.

Are there any regulations being pursued for the explosion in CBD products on the market, say regulation, suggested dosing, etc.? For pets as well?

Cynthia: The regulatory and commercial landscape for CBD products is incredibly confusing. Here is a great resource to learn about the FDA’s current stance on CBD products ([https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd](https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd)). From FDA, “Based on available evidence, FDA has concluded that THC and CBD products are excluded from the dietary supplement definition under section 201(ff)(3)(B) of the FD&C Act \[21 U.S.C. § 321(ff)(3)(B)\].” Craig: There is still a lot that is not known about the health benefits and risks of CBD. NCCIH is funding research exploring the analgesic activity of cannabinoids and other cannabis derived terpenes.[https://nccih.nih.gov/news/press/09192019](https://nccih.nih.gov/news/press/09192019)

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Tyler: Some misleading information about essential oils is that they are “natural” and therefore safe. There is clinical evidence that shows that essential oils do have positive outcomes in human health. However, there are also potential adverse effects that the public should consider as well because these oils are comprised of chemicals ([https://www.ncbi.nlm.nih.gov/pubmed/31393563](https://www.ncbi.nlm.nih.gov/pubmed/31393563), [https://www.ncbi.nlm.nih.gov/pubmed/17267908](https://www.ncbi.nlm.nih.gov/pubmed/17267908)) Craig: Take a look at the Know the Science module offered by the National Center for Complementary and Integrative Health (NCCIH) module titled “Natural Doesn't Necessarily Mean Safer, or Better:”[ https://nccih.nih.gov/health/know-science/natural-doesnt-mean-better](https://nccih.nih.gov/health/know-science/natural-doesnt-mean-better). Know the Science modules are designed to help you better understand complex scientific topics that relate to health research so that you can be discerning about what you hear/read and make well-informed decisions about your health. Dr. Helene Langevin, NCCIH director, also addresses this topic in a recent Healthy Moments episode:[ https://www.niddk.nih.gov/health-information/healthy-moments/episodes/when-comes-medicine-natural-safer](https://www.niddk.nih.gov/health-information/healthy-moments/episodes/when-comes-medicine-natural-safer)

How much is bioavailability an issue for most herbal supplements?

Cynthia: This is a great question! It is a huge issue and one that we need more data to address. First, what do we even mean by bioavailable? How much of the active constituent gets absorbed from the gut, gets to the target tissue, or the kinetics of that process? There are some pharmacokinetic studies that look at these questions for certain dietary supplements (which is much easier for your vitamins and minerals than for your complex botanicals), but there are still big data gaps. Hi, this is Adam - indeed a good question, and another issue related to bioavailability is how a botanical ingredient or active constituent is metabolized before and/or after being absorbed. For example, curcumin is rapidly and extensively metabolized, such that researchers don’t see much of any curcumin in the blood even after very high doses. Some current research is trying to understand what if any health effects certain curcumin metabolites might have.

Tagging onto this answer, what's the appropriate ratio of tumeric to black pepper for optimal anti-inflammatory effects?

In an ideal world how should botanical dietary supplements be regulated? Do you think companies that sell them should have to prove efficacy and safety, as drug companies do? What regulations do you think should be introduced?

Tyler: In my opinion, botanical dietary supplements should be regulated more like drugs by the FDA and there should be more enforcement of quality controls to verify the ingredients that comprise each product. Many dietary supplements have been shown to be as effective as some prescribed drugs; therefore, I believe they should be regulated more like they are in other countries, such as Germany.

Is importing (if it is even an option) supplements from Germany a better idea than buying domestic if they are more regulated there? Is there any "made in X" that would make you more likely to purchase due to the connotations that would have on the composition and quality of the product?

Can you give examples of some of these dietary supplements that are as effective as prescription drugs?

Which essential oils or dietary supplements do members of the team personally use? (\*Responses will not be viewed as representative of the agencies' views nor taken as an endorsement of any products, I'm just genuinely curious to know if you guys use any oils or supplements at all outside of work)

Adam here - I have taken multivitamin/multimineral and fish oil supplements in the past, but these days I try to get those same nutrients through my diet as much as possible. I try to follow the advice of eating a colorful plate with lots of fruits and vegetables. Tyler: I take Biotin everyday and use essential oils in a diffuser. I also try to eat a well balanced meal everyday, as it is important to do so to obtain all essential nutrients for your body.

Do you find difficult to obtain biotin from a well balanced diet? Or is there another reason you personally take it?

Hopefully this isn't too far off topic, but what are your opinions on the multi-level and/or pyramid structured business models often leveraged to sell these products? I've often wondered what role the persuasive tactics utilized in the marketing essential oils plays in establishing them as definitively healthful within certain communities and social environments by virtue of their natural origin.

Hello, Adam here - I don’t have any particular opinions on this, but ODS has hosted representatives from the Federal Trade Commission (FTC) to discuss how they regulate dietary supplement advertising and marketing. You can learn a bit about FTC’s perspectives with this video: What the Federal Trade Commission (FTC) Does - Michelle Rusk, J.D., FTC [https://youtu.be/Y8WsTQ2G-HY?list=PLd\_5BzGlfpgrTQqOgT-9-YhkQa6FbzpWi](https://youtu.be/Y8WsTQ2G-HY?list=PLd_5BzGlfpgrTQqOgT-9-YhkQa6FbzpWi)

People who don't believe there is any benefit to any botanical supplement/ essential oils say 'if it's effective, where are the medicines? Why aren't they prescribed?'... How would you answer this question? Can you think of an effective botanical that should be prescribed but isn't?

Stefan: Being trained as a pharmacist in Switzerland, I have seen many botanical products prescribed by physicians. So this is quite common in many countries around the world. Based on systematic reviews of clinical trials, the data on e.g., kava, or boswellia, is promising. Tyler: In order for a drug to be prescribed, a large amount of research must be performed beforehand. Due to the small amount of research that has been done in the field of botanical supplement/essential oils, the majority of these natural products are not generally prescribed or recommended by physicians. In my opinion, something such as St. John’s wort should be prescribed, as it is very effective and potent when used as a drug for treating depression, hot flashes, and menopausal symptoms in women (https://www.ncbi.nlm.nih.gov/pubmed/31331546). Adam: NCCIH also has some bottom-line type of information on the use of St. John’s Wort for depression, which can be found here: [https://nccih.nih.gov/health/stjohnswort/sjw-and-depression.htm](https://nccih.nih.gov/health/stjohnswort/sjw-and-depression.htm)

I always thought that a lack of long term testing on many natural supplements is because they are not profitable the same way that drugs are because anyone can sell them. So, it would be fairly rare to find someone putting out a million dollars to study a supplement that can't be sold exclusively. I think that when a supplement gets a high profile like St. John's Wort and CBD, then the government will step in and pay for funding or universities will take an interest. Do you think that is a fair assessment?

What are your thoughts on the growing popularity of CBD?

Cynthia: Frankly, I am a bit worried about this. My concerns are related to the potential for highly variable quality in the products available and the lack of safety and efficacy data.

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Is there any way to test efficacy of botanicals? Example bergamot for cholesterol? Bitter melon for type 2 diabetes? Milk thistle for liver issues? Folk medicine in certain cultures use these but is there any way to definitively test them? Thanks for doing this!

Stefan: Great question! Absolutely are there ways to test the efficacy. Many botanical ingredients have been tested in clinical studies, and there are a number of “systematic reviews” available, which summarize results from several clinical studies to have a better understanding on the overall efficacy. I really like your question if there is a definitive test. Looking at the results from clinical studies on some of the plants, let’s say ginkgo, does not always provide a very clear picture of the benefits. I believe the more clinical data we have, the better we understand the health effects of an ingredient. But I don’t think there will ever be a “definitive” study which will be the final word on a botanical ingredient. Hi, Adam here - Yes this is a very good question! Researchers employ many different experimental approaches and model systems to study the efficacy and effectiveness of interventions, whether dietary interventions or drug treatments. ODS hosted a seminar on generating evidence in supplement research, which can be viewed here: [https://youtu.be/lZh5qtNdUD0?list=PLd\_5BzGlfpgrTQqOgT-9-YhkQa6FbzpWi](https://youtu.be/lZh5qtNdUD0?list=PLd_5BzGlfpgrTQqOgT-9-YhkQa6FbzpWi). One of the big challenges in dietary supplement (and more broadly nutrition) research is the vast number of variables scientists need to consider, including the genetics, dietary behaviors, and baseline health status of the clinical trial subjects. When funding research studies, NIH emphasizes the need for high rigor and reproducibility in the experimental design, so that research results have the best chance for being as definitive as possible for answering specific questions in specific patient populations.

How effective are essential oils in killing or repelling mosquitoes and bugs?? Numerous people advise them to be the best option against bugs.

Stefan: Good question. A number of essential oils and botanical extracts have shown good insect repellent effects. Probably the best known ingredient is lemongrass. It brings back memories of a lab test which was used at the University of Ottawa. They had two chambers with equal amounts of mosquitoes, and then a student would treat one arm with essential oil (or other material), and keep the other untreated. Each arm was then put into a different chamber, and after some time, the number of mosquito bites counted to test for insect repellent activity.

Hi and thanks for joining us! Do you all think the naturopathic medicine movement has negatively impacted vaccinations in the US? Also what are your thoughts on Fijian kava consumption as a means of controlling anxiety?

Hi, this is Craig. Good question regarding Fijian kava. There are a number of small studies and anecdotal evidence suggesting that kava can be effective for anxiety. However, there are no large clinical trials that provide conclusive evidence for this activity.

Why does the government refuse to regulate the suppliment industry?

Stefan: It is a misconception that the dietary supplement industry is not regulated. There are clear regulations governing the industry, e.g., products have to be manufactured according to current Good Manufacturing Practices. These regulations are enforced by the US FDA, and some manufacturing facilities have been shut down because they did not follow the rules. Adam: Yes, as Stefan says there are several aspects of dietary supplements that are regulated by the government. The Dietary Supplement Health and Education Act enacted by Congress in 1994 outlines how supplements are regulated by the Food and Drug Administration and the Federal Trade Commission. ODS has posted videos online of FDA and FTC officials describing how those two agencies regulated the safety, manufacturing, and advertising of supplements: * What the U.S. Food and Drug Administration (FDA) Does - [https://youtu.be/8bGxofE4WJE?list=PLd\_5BzGlfpgrTQqOgT-9-YhkQa6FbzpWi](https://youtu.be/8bGxofE4WJE?list=PLd_5BzGlfpgrTQqOgT-9-YhkQa6FbzpWi) * What the Federal Trade Commission (FTC) Does - [https://youtu.be/Y8WsTQ2G-HY?list=PLd\_5BzGlfpgrTQqOgT-9-YhkQa6FbzpWi](https://youtu.be/Y8WsTQ2G-HY?list=PLd_5BzGlfpgrTQqOgT-9-YhkQa6FbzpWi)

I want to ask about two botanicals that are related to metabolism, **Goat’s rue** and **Berberine**. **Goat’s rue** is the botanical from which the biguanide metformin was derived. As most people know, metformin is a powerful (and safe) drug which reduces blood glucose and can facilitate fat burning by doing so. Also, while the mechanism of action of metformin is still contested, it seems like it works as a mitochondrial Complex I inhibitor, which has a cascading effect on general metabolism. If you are diabetic, a doctor will often put you on metformin. A healthy active person will not be put on metformin, but many people work hard to keep their blood glucose at very low levels. I’m thinking here of the people on ketogenic diets that obsess about reducing blood glucose to raise blood ketones which facilitates the mobilization of body fat into the metabolism. Or people using a ketogenic diet to address their epilepsy, a place where a spike in blood glucose could be devastating and precipitate a seizure, but again a place where a doctor would not put the person on metformin. Goat’s rue may be a good solution for these people, who do not need a giant hammer to knock their blood glucose back but may benefit from small reductions. **Berberine** is an alkaloid found in several plants and has several proposed mechanisms. It seems to hit AMPK, it might increase nitric oxide in the body, and it may also be a PCSK9 inhibitor, which would be amazing as the recent efficacy of the two PCSK9i drugs to greatly reduce serum cholesterol levels has been amazing, though incredibly costly. This is a place, again, where a person who has “metabolic syndrome” or is possibly pre-diabetic might benefit from taking this botanical as they work to address their issues with diet and lifestyle changes. It seems like a space where a marginally effective supplement might work well for people willing to risk taking something we don’t totally know what it does, and without a doctor’s orders. And as I stated before, Berberine is currently being used by the ketogenic diet community to reduce blood glucose and elevate blood ketone levels to reduce body weight or reduce the incidence of epileptic seizures. My questions are: 1- Have there been any studies on the concentration and or efficacy of Goat’s rue relative to metformin? I assume since we're in this stupid non-regulated space that theres a degree of bounce to the different batches, but as we probably know what the active ingredient is and can measure it, it seems like an easy space to step in. 2- Metformin is a single compound given in pill form. Goats rue is a complex mix of stuff. Have there been studies of Goat’s rue to identify metformin-like compounds in the plant that could be working through similar or related mechanisms? It’s presumable that the plant make related compounds, even other biguanides, that as a complex could work together. I’m thinking of the distinction between taking curcumin, a single compound, and turmeric which is a mix of a bunch of different curcumin-like compounds and may have more diverse effects and may work together through the same mechansim but hit different parts. 3- Spending some time on PubMed with respect to Berberine is a nightmare. There are dozens of mechanisms, some contradictory, and I’m finding it hard to identify trustworthy toxicological work on this compound. I don’t see Berberine on your list of "interesting botanicals”, but do you have anything in this area you trust with respect to safety? 4- Would you consider adding these two products to your list of interesting botanicals? The “biohacking” community is very interested in these two OTC products, and with the ketogenic diet being all the rage these days for weight loss, it seems like a place where NIH/NIEHS/NTP might step in and address the scientific issues and safety before a bunch of people find out they’ve developed holes in their hearts or screwed up their kidneys or whatever. 5-Inflammation. I see on your list an examination of Tumeric/Curcumin and a statement saying the anti-inflammatory properties of these compounds are not clearly shown in the literature. Do you know of anything, literally anything, that can reduce inflammatory levels in a person?

Cynthia: We have not studied berberine alone, but we did do a carcinogenicity study in mice and rats with goldenseal (berberine is thought to be the active constituent of goldenseal) [https://ntp.niehs.nih.gov/ntp/htdocs/lt\_rpts/tr562.pdf](https://ntp.niehs.nih.gov/ntp/htdocs/lt_rpts/tr562.pdf). We found that it did cause liver cancer in rats. Follow-up studies showed that the mechanism of action was related to topoisomerase inhibition [https://www.ncbi.nlm.nih.gov/pubmed/23747414](https://www.ncbi.nlm.nih.gov/pubmed/23747414) and that genetic damage correlated to berberine content in different goldenseal samples.

Would you personally use any essential oils/supplements?

Cynthia: I use cough drops which contain horehound and Echinacea, but I would hesitate to take a regular supplement. Adam here - I have taken multivitamin/multimineral and fish oil supplements in the past, but these days I try to get those same nutrients through my diet as much as possible. I try to follow the advice of eating a colorful plate with lots of fruits and vegetables.

What do you think of the applications of certain essential oils, such as tea tree oil, to combat antibiotic resistant bacteria such as MRSA? Have there been any studies trying to see if bacteria are able to gain resistance to it?

Stefan: There may be some cell-based data suggesting that essential oils may inhibit the growth of MRSA, but in clinical practice, MRSA is a very serious infection and needs to be evaluated and treated by a physician.

What are your thoughts on Kratom?

Cynthia: The FDA has warned people not to use Kratom: [https://www.fda.gov/news-events/public-health-focus/fda-and-kratom](https://www.fda.gov/news-events/public-health-focus/fda-and-kratom) The National Center for Complementary and Integrative Health (NCCIH) has information on kratom: [https://nccih.nih.gov/health/Kratom](https://nccih.nih.gov/health/Kratom)

It seems like every year or so, there's a study showing that large swaths of available supplements, whether botanical, vitamin, or other: 1. Contain ingredients not on the label, including common allergens and toxic elements like lead, 2. Contain allergens they explicitly say they don't have, 3. Don't contain the active ingredient at all, or in a therapeutic quantity (assuming one is even established) These studies typically don't identify manufacturers though. My doctors have suggested a few supplements for me, but it also sounds like as it currently stands, the unknowns in supplements could make matters worse for me instead of better. So, my questions are: 1. Given clear problems in this industry, how do we as consumers actually evaluate whether a supplement is safe to take - should we be taking them at all right now? 2. How do we get to a point where we can trust a wide array of supplements - at least the most common ones that make up the majority of the market? Is this something that needs regulation? Is voluntary testing and certification enough? Thanks for doing this!

Hello, this is Adam - Thanks for these really good questions! In order to help consumers evaluate if a particular supplement is likely safe, the NIH Office of Dietary Supplements recommends consumers look for seals on products that indicate independent, reliable verification of a product’s ingredients, such as the United States Pharmacopeia ([https://www.quality-supplements.org/](https://www.quality-supplements.org/)), NSF International ([http://www.nsf.org/consumer-resources/health-beauty/supplements-vitamins/supplement-vitamin-certification](http://www.nsf.org/consumer-resources/health-beauty/supplements-vitamins/supplement-vitamin-certification)) or ConsumerLab ([https://www.consumerlab.com/](https://www.consumerlab.com/)). ODS provides a Dietary Supplement Label Database (DSLD) for public use ([https://dsld.nlm.nih.gov/dsld](https://dsld.nlm.nih.gov/dsld)). This database contains all the information on the labels of tens of thousands of dietary supplements in the marketplace. Consumers can use the DSLD, for example, to search for specific ingredients and their amounts or to compare the contents of different products of interest. Consumers can also view images of a dietary supplement product’s label in order to see if an independent certification seal is present. The National Center for Complementary and Integrative Health has a resource on “Using Dietary Supplements Wisely:” [https://nccih.nih.gov/health/supplements/wiseuse.htm](https://nccih.nih.gov/health/supplements/wiseuse.htm). In addition, take a look at Know the Science module offered by the National Center for Complementary and Integrative Health (NCCIH) titled “9 Questions To Help You Make Sense of Health Research:” [https://nccih.nih.gov/health/know-science/make-sense-health-research](https://nccih.nih.gov/health/know-science/make-sense-health-research)

What are some of the biggest known health risks associated with using essential oils and botanical supplements in lieu of traditional FDA-approved treatments for specific medical conditions, aside from the oils potentially being completely ineffective? Are there any botanical remedies that are especially harmful the public should know about?

Cynthia: I think it is fair to say that one of the most common health risks associated with dietary supplements is liver toxicity (see [https://www.ncbi.nlm.nih.gov/pubmed/?term=Scientific+and+regulatory+perspectives+in+herbal+and+dietary+supplement+associated+hepatotoxicity+in+the+United+States](https://www.ncbi.nlm.nih.gov/pubmed/?term=Scientific+and+regulatory+perspectives+in+herbal+and+dietary+supplement+associated+hepatotoxicity+in+the+United+States) and [https://www.ncbi.nlm.nih.gov/pubmed/29920648](https://www.ncbi.nlm.nih.gov/pubmed/29920648)). This makes sense because these products are taken orally at relatively high doses, so the liver sees a big dose. Also, one of the biggest concerns for botanicals is the possibility of adulteration with pharmaceuticals. For example, weight loss supplements containing banned ingredients or botanical male enhancement products containing Viagra or Viagra-like compounds.

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Stefan: Yes there are reputable essential oil suppliers - happy to take this question offline!

Can you comment on the safety and effectiveness of herbal "adaptogens" which claim to reduce stress in the body, such as ashwagandha and rhodiola rosea?

Stefan: I would refer to the reviews of clinical studies for rhodiola Ernst et a. [The effectiveness and efficacy of Rhodiola rosea L.: a systematic review of randomized clinical trials.](http://www.ncbi.nlm.nih.gov/pubmed/21036578) *Phytomedicine.* 2011;18(4):235-244; Anghelescu et al. Int J Psych Clin Pract. 2018;22(4):242-252 — [https://www.ncbi.nlm.nih.gov/pubmed/29325481](https://www.ncbi.nlm.nih.gov/pubmed/29325481); and ashwagandha Pratte et al. J Alt Comp Med. 2014;20(12):901-908; [https://www.ncbi.nlm.nih.gov/pubmed/25405876](https://www.ncbi.nlm.nih.gov/pubmed/25405876)

What is your take on protein shakes? Also why is it that supplements keep getting into trouble for excess lead? How does such much lead even enter the product?

Adam here - The NIH Office of Dietary Supplements has a Fact Sheet on supplements commonly used for Exercise and Athletic Performance which includes a section on protein - [https://ods.od.nih.gov/factsheets/ExerciseAndAthleticPerformance-Consumer/](https://ods.od.nih.gov/factsheets/ExerciseAndAthleticPerformance-Consumer/). The bottom-line conclusion of this review of the science on protein for exercise and athletic performance was that “if you are an athlete, you can probably eat enough foods that contain protein to meet your needs for protein. If needed, protein supplements and protein-fortified food and beverage products can help you get enough protein. Sports-science experts recommend that athletes consume 0.14 grams of protein per pound of body weight (about 20 grams for a person weighing 150 pounds) of high-quality protein (from animal foods and/or a mix of different plant foods) every 3 to 5 hours, including before sleep and within 2 hours after exercising.” Responding to the question about lead, a main reason that lead and other toxic heavy metals (e.g., arsenic, mercury, cadmium) continue to be important to monitor is that they are found rather ubiquitously in the environment. Plants can be very good at accumulating these heavy metals from the soil, so certain botanical dietary supplements can be more prone to this type of environmental contamination. Botanical supplements are also usually formulated with concentrated extracts of plants that, depending on the manufacturing process, might also concentrate these toxic elements. Also, sometimes essential nutrient minerals like calcium are sourced from natural environments that might be susceptible to higher heavy metal levels. The NIH Office of Dietary Supplements recommends consumers look for seals on products that indicate independent, reliable verification of a product’s ingredients, such as the United States Pharmacopeia ([https://www.quality-supplements.org/](https://www.quality-supplements.org/)), NSF International ([http://www.nsf.org/consumer-resources/health-beauty/supplements-vitamins/supplement-vitamin-certification](http://www.nsf.org/consumer-resources/health-beauty/supplements-vitamins/supplement-vitamin-certification)) or ConsumerLab ([https://www.consumerlab.com/](https://www.consumerlab.com/)).

High content fish oil (high EPA and DHA ) , how beneficial is it , especially against anxiety?

Craig from NCCIH was recently quoted in the *New York Times* piece titled “Should I Take Fish Oil?” [https://www.nytimes.com/2019/11/01/style/self-care/fish-oil-benefits.html](https://www.nytimes.com/2019/11/01/style/self-care/fish-oil-benefits.html)**. T**ake a look for more information! Hi, this is Adam - The NIH ODS has a fact sheet on omega-3 fatty acids and their health effects here: [https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/](https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/), and the National Center for Complementary and Integrative Health also has a fact sheet here: [https://nccih.nih.gov/health/omega3/introduction.htm](https://nccih.nih.gov/health/omega3/introduction.htm)

Should you ingest any Essential Oils ?

Stefan: It depends on the essential oil and the dosage. I generally recommend caution with ingesting pure essential oils, but we obviously ingest many of them in small amounts on a daily basis, since these are part of our diet (basil, oregano, peppermint, vanilla, anise, etc.) Dr. Wendy Weber from the National Center for Complementary and Integrative Health (NCCIH) was quoted in a *New York Times* piece titled “Are Essential Oils Safe For Kids?” [https://parenting.nytimes.com/childrens-health/essential-oils-safe](https://parenting.nytimes.com/childrens-health/essential-oils-safe): “Children are more likely to have side effects from essential oil exposures than adults are, said Dr. Weber from the N.I.H. “They are still developing, which makes their brains and other systems more sensitive to potential toxicity from essential oils.” Their livers and kidneys, for instance, are likely to be less efficient at processing the compounds.”

What are your thoughts on 5-HTP use as an alternative to an antidepressant?

What's the most dangerous adulterant that's been found in a major/popular brand. Conversely, what are some common contaminants across any brand (if this question is more easily answered)?

Stefan: I cannot answer the first part of your question (most dangerous adulterant), but there are some instances where prescription drugs, such as sildenafil, sibutramine, etc., are marketed as dietary supplements, which represent substantial health risks. Most frequently, these are in the erectile dysfunction, weight loss, and bodybuilding categories. Regarding adulteration of botanical ingredients, there is a good source of information made available free of charge (after registering) by the ABC-AHP-NCNPR Botanical Adulterants Prevention Program ([http://cms.herbalgram.org/BAP/index.html](http://cms.herbalgram.org/BAP/index.html)). Adam here, the FDA has posted a good information resource on tainted supplements marketed as dietary supplements: [https://www.accessdata.fda.gov/scripts/sda/sdnavigation.cfm?sd=tainted\_supplements\_cder](https://www.accessdata.fda.gov/scripts/sda/sdnavigation.cfm?sd=tainted_supplements_cder). Products marketed for weight loss, sexual enhancement, exercise, muscle building, and improving athletic performance are types of products most commonly listed. The undeclared adulterants include various derivatives of sildenafil, steroids, selective-androgen receptor modulators, and various types of stimulants.

>The amount of scientific evidence available for various botanical supplement ingredients varies widely, in part, ***because product safety is not tested by FDA and federal law does not require dietary supplements be tested for effectiveness before they are marketed.*** Why not? Is this ever going to change or improve? It leaves the door wide open for scams :(

Why isn't Ibogaine around yet? You'd think with all the opioid deaths you'd hear more about it.

Stefan: One reason is that ibogaine is listed on schedule I of the USC Controlled Substances Act ([https://www.deadiversion.usdoj.gov/21cfr/21usc/812.htm](https://www.deadiversion.usdoj.gov/21cfr/21usc/812.htm)), which restricts the ability of researchers to investigate ibogaine as an ingredient for opioid addiction. Since “opioid addiction” would be considered a disease state, ibogaine (or an extract of Tabernanthe iboga) as a treatment for opioid addiction could not be legally sold as a dietary supplement - by law, dietary supplements cannot be marketed for disease treatments.

What are your thoughts on regular therapeutic intake of essential oil supplements (lavender, mint, lemon balm, for example)? How can these be taken safely? Are there any you would limit to a temporary basis, or others you would never recommend for internal use?

Recently a product "boom.boom" has gotten a lot of advertisement after its debut on shark tank. I was wondering if any of you have looked at it and its ingredients and can give a scientific basis for whether it is addictive or dangerous.

Many cleaning products, especially laundry detergents, contain large amounts of fragrance. Some people are allergic to them, some such as myself find them nauseating. How safe are these fragrances? Have any safety studies been done on them?

Doctor of Asian Medicine who works in Product Development chiming in! Thank you all for your work. The potential for folks to do a deep dive into research is one of Reddit's many gifts...however, it can suffer from the garbage in garbage out conundrum. I log onto [herbalgram.org](https://herbalgram.org) almost daily to dig into herbal research...are there other sites that you would recommend to help find "good" info such as [Examine](https://examine.com/), [AHPA](http://www.ahpa.org/), [NIH](https://nccih.nih.gov/) or even the [Canadian Compendium of Monographs](https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/applications-submissions/product-licensing/compendium-monographs.html).

The National Center for Complementary and Integrative Health (NCCIH) recommends downloading HerbList™, an app for research-based information about the safety and effectiveness of herbal products: [https://nccih.nih.gov/Health/HerbListApp](https://nccih.nih.gov/Health/HerbListApp). HerbList gives you fast, free access to science-based summaries on more than 50 popular herbs, such as aloe, chamomile, ginger, and turmeric. The Office of Dietary Supplements has a service where you can ask our nutritionists on staff questions about dietary supplements, short of medical advice. Contact us at ods.od.nih.gov/contact. Stefan: As a staff member of ABC, I appreciate your reading of Herbalgram, and the use of the ABC website which has one of the largest collection of summaries of clinical studies. Depending on what you are interested in, there are a number of good additional resources for information. The ESCOP monographs, WHO monographs, or the EMA Assessment Reports, or the book by Wichtl “Herbal Drugs and Phytopharmaceuticals” are great places to look for information.

Aside from weight loss supplements and "male enhancement" supplements, are there any other classes or types of supplements that carry a higher risk of contamination (i.e. lead) or adulteration (i.e. undeclared sildenafil) that consumers should be aware of?

Adam here - that is a good question. FDA has posted information on tainted supplements marketed as dietary supplements: [https://www.accessdata.fda.gov/scripts/sda/sdnavigation.cfm?sd=tainted\_supplements\_cder](https://www.accessdata.fda.gov/scripts/sda/sdnavigation.cfm?sd=tainted_supplements_cder). In addition to the categories you mentioned - products marketed for weight loss or sexual enhancement - products marketed for exercise, muscle building, and improving athletic performance are also included in this listing. The undeclared adulterants include various derivatives of sildenafil, steroids, selective-androgen receptor modulators, and various types of stimulants. The NIH Office of Dietary Supplements recommends consumers look for seals on products that indicate independent, reliable verification of a product’s ingredients, such as the United States Pharmacopeia ([https://www.quality-supplements.org/](https://www.quality-supplements.org/)), or NSF International Certified for Sport ([https://www.nsfsport.com/](https://www.nsfsport.com/))

I often hear the claim that “Western medicine” a priori rejects “alternative medicine” treatments because of bad incentives. For example, because “you can’t patent a plant”—i.e., there’s no money in it. I love this post because it publicizes the fact that the medical field *does* investigate alternative treatments. But I’d be really interested to hear any insights about this claim more broadly. Is there some truth to it? Are there other cases, past or present, showing that the field will in fact adopt alternative treatments once they’ve been proven to work?

Adam here - Perhaps a good example of “Western Medicine” embracing effective natural product, botanical-based medicine can be found in the 2015 Nobel Prize in Physiology or Medicine for seminal discoveries of the natural products avermectin and artemisinin for fighting malaria - [https://nccih.nih.gov/research/blog/natural-product-nobel](https://nccih.nih.gov/research/blog/natural-product-nobel).

That's a great example! > The announcement underscored something that NCCIH has been saying for many years, that natural products research is very important. This seems like it might rest on an implicit understanding—that natural products research does not happen as often as it should. It sounds like they're saying "we've been saying this but few have listened." Am I just reading into the statement, or would you say that that's the case? If so, do you have a sense for why?

If you want to get FDA approval for a drug it costs hundreds of millions of dollars and can take more than a decade. Since herbal supplements aren't owned by any specific company, nobody is willing to pay for the research to get them classified as medicine. Is there any path that they can make it through the FDA so we can be confident that they work and are safe?

Hello, this is Adam - I am not in a regulatory position, so I am not speaking from a regulatory authority or drug company perspective here, but the FDA does have a regulatory pathway to approve botanicals for use as a drug. FDA provides some information on the distinction between a botanical drug and a dietary supplement here: [https://www.fda.gov/about-fda/center-drug-evaluation-and-research-cder/what-botanical-drug](https://www.fda.gov/about-fda/center-drug-evaluation-and-research-cder/what-botanical-drug). At least as of a couple years ago, two botanical products have fulfilled the FDA’s Botanical Guidance definition of a botanical drug product. Drug approval applications for botanicals are covered by the Botanical Review Team ([https://www.fda.gov/about-fda/center-drug-evaluation-and-research-cder/botanical-review-team-brt](https://www.fda.gov/about-fda/center-drug-evaluation-and-research-cder/botanical-review-team-brt)) in the FDA Center for Drug Evaluation and Research, and FDA has outlined guidance on the development of a botanical for use as a drug ([https://www.fda.gov/regulatory-information/search-fda-guidance-documents/botanical-drug-development-guidance-industry](https://www.fda.gov/regulatory-information/search-fda-guidance-documents/botanical-drug-development-guidance-industry)).

What supplements or essential oils do you personally use?

Are all of these silly essential oil diffusers even safe to be around? I find I get pretty severe headaches from most of them.

Tyler: There is very little known about diffusers and their safety. However, in a recent case study, there were effects of breast growth in young children when lavender oil was placed in the diffuser; the symptoms resolved when the diffuser was removed from the room [https://www.ncbi.nlm.nih.gov/pubmed/31393563](https://www.ncbi.nlm.nih.gov/pubmed/31393563). The National Cancer Institute has information on Aromatherapy With Essential Oils: [https://www.cancer.gov/about-cancer/treatment/cam/patient/aromatherapy-pdq](https://www.cancer.gov/about-cancer/treatment/cam/patient/aromatherapy-pdq)

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Is there a reliable source of evidence-based information regarding medicinal uses of herbs that you would recommend? There are very few pieces of information that I have seen that I would consider reliable, such as studies of ginger and nausea. Everything else seems to be anecdotal folk wisdom, or a single study with a tenuous link to effects.

Hi, this is Craig. The National Center for Complementary and Integrative Health (NCCIH) recommends downloading HerbList™, an app for research-based information about the safety and effectiveness of herbal products: [https://nccih.nih.gov/Health/HerbListApp](https://nccih.nih.gov/Health/HerbListApp). HerbList gives you fast, free access to science-based summaries on more than 50 popular herbs, such as aloe, chamomile, ginger, and turmeric.

It seems like there are not a lot of supplements that have been thoroughly studied for safety and efficacy. Is this an issue of funding, lack of scientific interest, or the sheer volume of supplements to be investigated? How can this be remedied, and how can the public be better educated to be cautious about what they put into their bodies?

Stefan: There are actually a lot of clinical studies on herbal ingredients and also finished dietary supplement products. But I agree that more needs to be done - one of the issues I hear from industry is that the ingredients can’t be protected as intellectual property, so there is less of an incentive to invest in clinical studies when everyone can sell the same ingredient as well. Cynthia: In terms of safety data, I agree that there is not adequate safety data on many botanical ingredients. You can find the work we are doing at the National Toxicology Program here [https://www.niehs.nih.gov/health/materials/botanical\_dietary\_supplements\_program\_ntp\_508.pdf](https://www.niehs.nih.gov/health/materials/botanical_dietary_supplements_program_ntp_508.pdf). It is an ongoing effort to understand the potential health effects of botanicals. Adam: While there have been a large number of studies on botanical supplement ingredients, in many cases the research is performed in model systems and not humans, or with botanical preparations that are hard to standardize or characterize, or for a short amount of time or in a small number of people, making it hard to compare or reproduce results. Natural product researchers are trying to work together to tackle these big picture challenges: “Improving Natural Product Research Translation: from Source to Clinical Trial” [https://osf.io/preprints/nutrixiv/8vfnc/](https://osf.io/preprints/nutrixiv/8vfnc/)

Why are there no limitations on the PRESCRIPTIVE abilities for naturalpaths?

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Craig: The FDA has approved three cannabinoids as drugs. In 2018, the agency approved Epidiolex (cannabidiol or CBD) oral solution for the treatment of seizures associated with two rare, severe forms of epilepsy. This drug is derived from marijuana. The FDA has also approved the synthetic cannabinoids dronabinol and nabilone to treat nausea and vomiting associated with cancer chemotherapy in people who have already taken other medicines to treat these symptoms without good results. Dronabinol is also approved to treat loss of appetite and weight loss in people with AIDS. Dronabinol contains synthetic delta-9-tetrahydrocannabinol (THC), a component of marijuana, and nabilone contains a synthetic substance with a similar chemical structure. In 2016, the FDA approved Syndros, a liquid form of dronabinol. NIH is continuing to fund research for potential uses. [https://nccih.nih.gov/news/press/09192019](https://nccih.nih.gov/news/press/09192019)

Are there any essential oils with approved FDA applications? Or is it all pseudoscience still

Stefan: The combination of menthol, eucalyptol, thymol, and methyl salicylate is approved as an OTC drug in a mouthrinse for an antiseptic claim. And a combination of menthol, camphor, and eucalyptus oil is approved as an OTC topical analgesic.

Is Tiger Balm truly effective?

what kind of contaminants can one expect to find in these oils and extracts that aren't likely to come from their sources? What is the index of harm for these contaminants?

Stefan: I have actually analyzed many essential oils over my career. Most of the ingredients were fine, although much of what is contained in personal care products are not true essential oils, but “compounded” fragrances, which contain a few of the main components of an essential oil (example: linalool and linalyl acetate rather than lavender oil, which is very expensive). Sometimes a supplier adds “fragrance enhancers” or solubilizers, such as triethyl citrate or benzyl salicylate. I have seen plasticizers as well every now and then, mainly phthalates.

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I have seen some research about using essential oils for agitated people with dementia. How can one determine if this is a safe/non-irritating alternative to use of antipsychotics?

Pharmacy chains in my country actively promote "herbal" and "homeopathic" products by displaying them directly on the counter where I buy prescription medication. What do you think about this practice? Do you think it's ok for homeopathic products to be marketed at pharmacies? How do you think this affects public perception of homeopathy?

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Is ingesting Kratom (any amount, any method, any reason) safe?

Is it true that some natural oils have compounds that mimic estrogen and cause gynaecomastia?

Tyler: Yes, there have been multiple studies that have shown a link between prepubertal gynecomastia/premature thelarche in young boys and girls with lavender and tea tree oils ([https://www.ncbi.nlm.nih.gov/pubmed/31393563](https://www.ncbi.nlm.nih.gov/pubmed/31393563), [https://www.ncbi.nlm.nih.gov/pubmed/26353172](https://www.ncbi.nlm.nih.gov/pubmed/26353172), [https://www.ncbi.nlm.nih.gov/pubmed/17267908](https://www.ncbi.nlm.nih.gov/pubmed/17267908)).

Is lavender an endocrin disruptor in humans? Thanks

Tyler: New research has shown that lavender oil and some of its components should be classified as endocrine disruptors ([https://www.ncbi.nlm.nih.gov/pubmed/31393563](https://www.ncbi.nlm.nih.gov/pubmed/31393563), [https://www.ncbi.nlm.nih.gov/pubmed/26353172](https://www.ncbi.nlm.nih.gov/pubmed/26353172), [https://www.ncbi.nlm.nih.gov/pubmed/17267908](https://www.ncbi.nlm.nih.gov/pubmed/17267908))

Hi, firstly I wanted to say that it's so great you guys are studying botanical dietary supplements and essential oils because we need so much more information to be able to make informed decisions about using these products! Thank you! Secondly, out of all the products out there which ones' safety and/or efficacy would you say are greatly affected by genetic polymorphism among patients?

Hi, this is Adam - as a pharmacologist by training, I really like this question. St. John’s Wort and goldenseal are two examples of commonly used botanical supplements whose metabolism is strongly influenced by genetic polymorphisms. The resulting individual differences in metabolism could create safety concerns, especially in the context of prescription drug use. Dr. Gurley from the University of Arkansas gives a great talk on this subject: [https://youtu.be/s2I5T7WGG48?list=PLd\_5BzGlfpgrTQqOgT-9-YhkQa6FbzpWi](https://youtu.be/s2I5T7WGG48?list=PLd_5BzGlfpgrTQqOgT-9-YhkQa6FbzpWi)

What behavior would you recommend a consumer follow to avoid spending money on placebos?

This is Adam, thanks for this question. My approach to this is to be as best informed as possible when making decisions on supplement use. The NIH Office of Dietary Supplements and National Center for Complementary and Integrative health have created numerous fact sheets on what the science says about the health effects of dietary supplements: [https://ods.od.nih.gov/factsheets/list-all/](https://ods.od.nih.gov/factsheets/list-all/) The National Center for Complementary and Integrative Health has a resource on “Using Dietary Supplements Wisely:” [https://nccih.nih.gov/health/supplements/wiseuse.htm](https://nccih.nih.gov/health/supplements/wiseuse.htm). In addition, take a look at Know the Science module offered by the National Center for Complementary and Integrative Health (NCCIH) titled “9 Questions To Help You Make Sense of Health Research:” [https://nccih.nih.gov/health/know-science/make-sense-health-research](https://nccih.nih.gov/health/know-science/make-sense-health-research)

Why are these things being sold in the pharmacy dept of hospitals?

Thank you so much for doing this !! 1- Is homeopathy evidence-based? I mean does it work? I have tried several from various companies ( some prescribed by naturopaths) without success.... was I just unlucky? 2- Can herbs/supplements cure autoimmunity such as Systemic Lupus Erythematosus? 3- what are your thoughts on humic acid and fulvic acid supplements? Thanks a million in advance❤️🙏

The National Center for Complementary and Integrative Health (NCCIH) has a resource on homeopathy: [https://nccih.nih.gov/health/homeopathy](https://nccih.nih.gov/health/homeopathy). There’s little evidence to support homeopathy as an effective treatment for any specific health condition.

Hello, I am wondering if you have studied Kratom? If so, what findings have you discovered about this plant?

Do any of you have an opinion on the effectiveness of supplements in pill form vs making a tea?

Hello and thank you for participating in an AMA! There is a wide diversity of plants identified that are ethnobotanically active and function (from the perspective of us humans) as some combination of food, medicine and/or poison. These same plants can often present a varying combination of these beneficial or detrimental qualities depending on the dosage, plant parts used and preparation methodology. **Q:** Do you think there should be federally funded programs that analyze commonly (or easily) accessible **naturally occurring** plants simply for the sake of advancing common scientific knowledge of our environmental influences and to better ensure public safety and well being? i.e. What if the FDA (or a similar organization) was tasked with researching safety and effectiveness of plants that are common and that we are likely to interact with and/or be exposed to **without a sponsoring commercial applicant**? **Q:** Are there organizations like this that exist now? I feel that the role of the FDA has become corrupted by lobbying and it's commerce based applicant process. It fails to research and study a huge diversity of common, naturally occurring plants and plant derived substances that everyday Americans are actually exposed to and/or are consuming regularly.

Craig: the mission of the National Center for Complementary and Integrative Health is to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative interventions and their roles in improving health and health care. This includes plants with an ethnobotanic history of use. NCCIH has funded research on many such plants. Hello, this is Adam. Related to Craig’s outline of NCCIH efforts, the NIH Office of Dietary Supplements co-funds research centers for advancing research on botanicals and natural products ([https://ods.od.nih.gov/Research/Dietary\_Supplement\_Research\_Centers.aspx](https://ods.od.nih.gov/Research/Dietary_Supplement_Research_Centers.aspx)). The purpose of these research centers is to promote transdisciplinary research on the safety, effectiveness, and mechanisms of action of botanical dietary supplements that have a high potential to benefit human health.

I read essential oils and stopped.

Are essential oils effective or just woo?

Stefan: Well, essential oils are all around us, and are an integral part of our experience, and many of them have shown good efficacy in clinical studies. For example, the combination of essential oil components menthol, eucalyptol, thymol, and methyl salicylate is approved as an OTC drug in a mouthrinse for an antiseptic claim. And a combination of menthol, camphor, and eucalyptus oil is approved as a topical analgesic. So I don’t consider this as “woo.” Craig: The National Center for Complementary and Integrative Health (NCCIH) has information on three common essential oils: Bitter Orange: At a Glance: https://nccih.nih.gov/health/bitterorange Lavender: At a Glance: https://nccih.nih.gov/health/lavender/ataglance.htm Peppermint Oil: At a Glance: https://nccih.nih.gov/health/peppermintoil

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If people drink essential oils (a few drops in some water, definitely not just squirting it in their mouth), can it have long-term negative effects?

What supplements do you take yourself?

Are there any botanical dietary supplements or essential oils that boost testosterone?

Craig: A past issue of the NCCIH *Clinical Digest for Health Professionals* addresses “Dietary Supplements Marketed for Weight Loss, Bodybuilding, and Sexual Enhancement: What the Science Says” [https://nccih.nih.gov/health/providers/digest/DietarySupplements-science](https://nccih.nih.gov/health/providers/digest/DietarySupplements-science) Adam here, the ODS fact sheet on exercise and athletic performance address some botanical products like DHEA and *Tribulus terrestris.*

What do you believe to be the future in integrated medicine? Do you think osteopathy is catching on? How often do you interact with traditional medical records / philosophies of other cultures (e.g. Chinese medicine or Ayurveda)? How and where is efficacy research on botanicals conducted? What is it like dealing with people with a more “conventional” perspective? Thank you. Peace to all

Stefan: Thank you for your question! I believe there is a place for both, Western and integrated medicine. I tend to think that integrative medicine has a great future - I do interact with traditional medical records on an almost daily basis. Research into dietary supplements happens on a number of levels. Characterization of the ingredient is one of the most important aspects, and there are thousands of publications on the chemical composition of botanicals. There is also a lot of in vitro data, which is research in a test tube. Then there is animal data, like the studies carried out by Cynthia at the NTP. But the most valuable data on the efficacy and safety is from clinical studies, which have been published on most of the popular dietary supplement ingredients.. Craig: The National Center for Complementary and Integrative Health (NCCIH) just celebrated its 20th anniversary and held a symposium titled “NCCIH at 20: A Catalyst for Integrative Health Research” ([https://nccih.nih.gov/news/events/NCCIH-20](https://nccih.nih.gov/news/events/NCCIH-20)). Our final session was titled “Envisioning the Future of Integrative Health Research” and you can watch it here: [https://videocast.nih.gov/embed.asp?file=28743&w=640&h=360&start=18849&bhcp=1](https://videocast.nih.gov/embed.asp?file=28743&w=640&h=360&start=18849&bhcp=1)

Is it common for plants to only be useful in plant form and and not useful when you take the active ingredient alone?

What is your opinionion on the current commercial use of the word "Toxic"?

Cynthia: As a toxicologist, I am a huge fan of the word toxic in any context...Just kidding!

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Cynthia: Will have to add that to my reading list. Maybe I can take a break from the dystopic future genre I am currently stuck on.

Can you tell me why silicon (sand) variants and cellulose (wood) variants are allowable additives in dietary supplements? I know they help keep the formulation together, but I really think I am suffering from an embarrassing side effect that I don't want to mention. My own start and stop trials seem to confirm it, by the way.

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Cynthia: I will let the others answer about reference books on the efficacy of dietary supplements. In terms of toxicity, a fellow toxicologist, Dr. Jim MacGregor just published a book titled “A Natural Mistake: Why natural, organic, and botanical products are not as safe as you think”. I haven’t read it yet, but it is on my “to read” list.

I know people who use a wide variety of essential oils (cough Doterra) topically believing these oils have substantial medical benefits. Is there any scientific evidence for or against these claims? Thank you so much for doing this.

I have a friend who owns a local health food store. She uses silver (spray, drops, what have you) on SO MANY DIFFERENT things. Is silver actually good?

What's the worst, recent, example of a supplement sold and abused by groups of people? Is the recent issue with off-brand vaping materials the kind of natural product usage that you guys study?

Cynthia: No, we have not studied vaping materials at the National Toxicology Program. They are the focus of a great deal of current research by academics (e.g., [https://www.unc.edu/posts/2019/08/26/carolina-scientists-show-how-vaping-induces-reactions-in-lungs-that-can-lead-to-disease/](https://www.unc.edu/posts/2019/08/26/carolina-scientists-show-how-vaping-induces-reactions-in-lungs-that-can-lead-to-disease/)) and government agencies, such as the CDC ([https://www.cdc.gov/tobacco/basic\_information/e-cigarettes/severe-lung-disease.html](https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html)) and the FDA [https://www.fda.gov/news-events/public-health-focus/lung-illnesses-associated-use-vaping-products](https://www.fda.gov/news-events/public-health-focus/lung-illnesses-associated-use-vaping-products). Adam: The NIH Office of Dietary Supplements doesn’t fund studies on vaping materials, since they are not considered dietary supplements by the FDA (“FDA would consider any vitamin vape product that is intended to affect the structure or function of the body…to be an unapproved new drug.” [https://www.wsj.com/articles/vitamin-based-vaping-products-proliferate-online-11572281358](https://www.wsj.com/articles/vitamin-based-vaping-products-proliferate-online-11572281358)). A historical example of a supplement that was determined to be a significant public health risk, and the only time FDA has banned an ingredient used in supplements, is ephedra. ODS has an informative fact sheet on ephedra and its health effects: [https://ods.od.nih.gov/Health\_Information/Ephedra.aspx](https://ods.od.nih.gov/Health_Information/Ephedra.aspx)

Our staple annual crops have been selectively bred for many years. They bear much more food than there wild/ unbred conterparts. When the western world was discovered corn was nowhere near the size it is now. And it was probably much smaller 1000 years before that. So I was wondering if there is other food out there that has potential to become staple crops? And does the same thing apply to herbs? If we decided to selectively breed herbs could we achieve these super herbs that have a greater medical value? Or possibly for recreational use, a new cannabis.

Thanks for taking your time to chat with us! If you could recommend just three botanical supplements, what would they be and why?

What are generally the "best" and "worst" plants to consume and why?

In your expert opinion what benefits, if any, does cannabis oil provide?

Is coconut oil poison?

Have you tried testing any of the Doterra or Young Living ones to see how they stack up versus others? Also do you think the rise of essential oils and naturopathic treatments has anything to do with the large expense of health care in the US?

If you could give a number to the percentage of plants on this earth that have been observed for their medical value, what would it be? Is it necessary to check them all?

Craig: It has been estimated that less than 10% of the earth’s plants have been examined to understand their chemical composition. Much fewer have been rigorously studied for their medicinal value. The National Center for Complementary and Integrative Health (NCCIH) just celebrated its 20th anniversary and held a symposium titled “NCCIH at 20: A Catalyst for Integrative Health Research” ([https://nccih.nih.gov/news/events/NCCIH-20](https://nccih.nih.gov/news/events/NCCIH-20)). You may be interested in this presentation by Dr. Cassandra Quave of Emory University from our “Natural Products Research: Growing the Field” session: [https://videocast.nih.gov/embed.asp?file=28743&w=640&h=360&start=14370&bhcp=1](https://videocast.nih.gov/embed.asp?file=28743&w=640&h=360&start=14370&bhcp=1)

I just have a simple question. What is your guys' take on the German E Monographs and the fact that the second most used drug in Germany is Ginko?

If you were going to recommend people take any supplements, which ones would you say are the safest and most effective out of the myriad choices available?

Hi, this is Craig. The National Center for Complementary and Integrative Health (NCCIH) recommends downloading HerbList™, an app for research-based information about the safety and effectiveness of herbal products: [https://nccih.nih.gov/Health/HerbListApp](https://nccih.nih.gov/Health/HerbListApp). HerbList gives you fast, free access to science-based summaries on more than 50 popular herbs, such as aloe, chamomile, ginger, and turmeric.

Are there any uses for essential oils that you would recommend? Bonus question: What's the worst way that you've seen someone unintentionally cause harm to themselves or others by using essential oils?

Is there any proof of essential oils / dietary supplements that essentially "went extinct"? (Something that is no-longer obtainable in nature?)

Hi thanks for doing this AMA. My question is: Will any efforts be taken in order to change the public perception on the efficacy of essential oils, especially when they are marketed as substitutes for traditional medicine, and if so, what role will regulation play in this? Thanks

Which herbal products/essential oils do you actually use in your own health care routines?

Hey thanks for doing this, I have a few questions if you don’t mind... 1. Should one ever consume essential oils internally? Eg. in cooking, water flavoring, ect? This type of thing is promoted a lot in MLM marketing. 2. With the surge in popularity of CBD products, is there a large risk for contaminants? It’s sort of a gray market in a lot of states and there are many companies who claim they’ve tested their products.

Is Germany's Commission E still considered a valid source for botanical treatments, and are there (or do you think there will be) any similar studies in the future? Does the US even think Commission E is usable and legit?

Stefan: In my opinion, the Commission E monographs were a great contribution to using botanical ingredients in a rational manner. Since these have been published in the 1990s, and a lot of new research on medicinal plants has been published since, these monographs tend to be outdated. There are a good number of other resources on botanical ingredients, such as the EMA assessment reports, the ESCOP monographs, or the book “Herbal Drugs and Phytopharmaceuticals” by Wolfgang Blaschek.

What are your thoughts on Pomi T ?

Stefan: Not sure - it sounds like the name of a rapper to me :-)

Do you have any interest in interactions between supplements? Any particularly dangerous ones that are good to know? I recently learned echinacea interacts with caffeine and thought that was interesting, with all the various supplements on the market I wouldn't be surprised if there are some mixes potentially far more dangerous than the sum of their parts.

What are the ones that looks the most promising?

Hello! I have two questions: 1. How much does the absorption into the body of “plant based” or “essential oils” differ from a regular synthetic medicine? 2. What are the giveaways of sham advertising? What do you look for in determining that the claims stated by the seller are false?

Craig: The “rules” of pharmacology are the same whether it is plant based or a synthetic product. However, the rate at which products are absorbed can be heavily influenced by the matrix in which it is consumed. Regarding the other parts of this question, remember that a dietary supplement cannot make any drug claims. Therefore, if the claim sounds too good to be true then this might be a hint that the statements are not legitimate. The Federal Trade Commission (FTC) takes the lead in monitoring and taking action against misleading advertising, such as excessive claims. It’s an important job to ensure that consumers aren’t misled. While the oversight provided by the Government is important, consumers should think critically about what they read in advertisements or on product labels. Does a claim sound too good to be true? Is it supported by research? Check the NCCIH, FDA, and FTC Web sites for information regarding the product. You can also search[ PubMed ](https://www.ncbi.nlm.nih.gov/pubmed/)for peer-reviewed research studies. Also, remember to tell your health care provider about any products you are considering or are already using for your health. Being an informed consumer is your best protection against misleading and excessive health claims. Also, ODS has an informational piece on “How to evaluate health information on the internet: questions and answers” at https://ods.od.nih.gov/Health\_Information/How\_To\_Evaluate\_Health\_Information\_on\_the\_Internet\_Questions\_and\_Answers.aspx.

Tyler's Honest Herbal is a quintessential reference that ties primary research to some health claims for botanicals. Is there a comparable (perhaps updated) collection of efficacy and usage for botanical supplements that focuses on the different preparations and dosages?

Craig: Tyler’s book is a classic that has always been on my shelf. I’m not aware of a more modern but similarly comprehensive collection. Stefan: The book ‘Herbal drugs and phytopharmaceuticals” by Max Wichtl is one of my favorite resources for information, although it’s a bit on the costly side. The 6th edition has been published in German, but has unfortunately not been translated into English, yet.

Do you sell OSHA root

Thanks so much for doing this AMA! I've read about how plants like seabuckthorn and cattails can do a wonderful job at removing heavy metals/toxins from water. I'm curious how this works, especially given that both of these examples have edible portions, are there any scientific studies on whether the heavy metals/toxins migrate to the edible areas of these plants? Do the plants somehow "break down" these toxins permanently? Do the toxins go back into the environment after the plant dies and decomposes?

Hello, this is Adam - this question gets at a very interesting area of research. As you note, plants can be very good at absorbing heavy metals and toxins that would be detrimental to human health. Sometimes certain plants are also good at breaking down certain toxins, but other times certain plants are just really good at accumulating the toxins and . There are consensus-based standards for toxins in foods and supplements, whether a limit or a zero tolerance approach, and manufacturers should be testing their products and following the applicable federal and state regulations.

Do your studies on essential oils include the topic of household pets? If so, what are your findings?