Monthly Archives: August 2014

The Vitex Dilemma: Heeding the Call

Vitex_agnus-castus_H.ZellIn the Fall 2014 issue (Volume 3, Issue 2) of the International Journal of Professional Holistic Aromatherapy, Barbara Lucks puts forth a provocative article entitled The Vitex agnus castus Dilemma: Ethical Management of a Double-Edged Oil. Vitex agnus castus (a.k.a. Chaste Tree or simply Vitex) is a relative newcomer to the field of clinical Aromatherapy. As Barbara Lucks points out, some research has been done showing both beneficial and adverse health effects with notable differences in the response to the oil from the leaf or the berry.

The article touches on a number of important issues. Foremost is the nature of the essential oil itself. Is Vitex being sourced from Vitex agnus castus or Vitex negundo, the latter being grown in China as Chinese Chaste Tree? Is Vitex originating from Turkey, Croatia, Italy, or Cypress? How much, if any, α-bisabolol or farnesene is present in the oil as these are known to inhibit the CYP2D6 enzyme responsible for metabolizing certain antidepressant drugs (Tisserand and Young, 2014)? This is especially critical as some menopausal women are taking these drugs to help with hormonal mood alterations. It is possible that some adverse effects noted could be a drug–essential oil interaction. This is one clinical situation that requires significant caution with concurrent use of Vitex and antidepressant medications. Contraindications to the use of Vitex are progesterone therapy, pregnancy and those attempting to conceive, and breastfeeding and prepubertal children. Caution must be exercised in women undergoing estrogen replacement therapy or who are using oral contraceptives (Tisserand and Young, 2014).

Lucks raises another issue all too prevalent in the Aromatherapy industry. Essential oils have become a highly marketable commodity, and there are many people stepping up to get their share of this multi-million dollar industry. Safety and toxicity are secondary to profitability in some circles. Essential oils should be viewed as a judicious natural tool for the promotion of health. If an essential oil might have a desired effect in relieving menopausal symptomatology, the increased demand drives up more indiscriminant sales. Where then, I ask, is the careful medical supervision necessary to avoid catastrophe? Hormone balancing, if you want to call it that, is not and never will be one-size-fits-all. Whether we are dealing with drugs, herbs, or essential oils, it is always an experiment of one. Selecting Vitex for use is best left to those practitioners with enough experience willing to take on the challenge. With drugs, this is not an easy task. It is all the more challenging with essential oils such as Vitex which can be sourced from diverse places with a significant variability of essential oil constituents. Further complicating the situation is the lack of research showing proper dosage in various subsets of symptomatic menopausal women.

In regard to the issue of this or any other essential oil becoming a controlled substance, we are crossing the fine line between a natural product and a regulated drug. Is it not the first rule of natural medicine to do no harm? We who enjoy the privilege of using essential oils on behalf of good health should be the first to recognize potential dangers and do our best to minimize them or avoid them. So the yoke of control rests upon us. Banning essential oils or highly restricting their use is a last-ditch effort to protect the public from harm. The oils themselves are not dangerous. It is their indiscriminate and uneducated use that is at fault. The practice of Aromatherapy in a clinical setting must embrace a standard of professional excellence and education thoroughly grounded in essential oil safety.

I would like to bring a final thought to this discussion. The concept of benefit versus risk is crucial to any undertaking in a clinical setting. You and your client want a particular beneficial outcome. It is essential to have a practical discussion in which the possible benefits are outlined and the potential risks are examined. This is no less important in essential oil therapies. Properly done, both parties will be up to the task of effective surveillance as the therapy goes forward. Aromatherapists have an ethical duty to follow their clients and if trouble is brewing, to make adjustments or refer to someone more knowledgeable.

Vitex agnus castus is a valuable essential oil. Therefore it should not be banned in my opinion. Since more research on this vital oil is needed, I suggest that those who purchase it for use with clients firmly agree to keep detailed records of the cases including client selection, dosing, and both positive and negative outcomes. This important data would be published to the benefit of all of us who would like a better understanding of where this essential oil fits into the natural approach to the menopausal woman.

References                                                                                               Tisserand R and Young R. (2014). Essential Oil Safety. 2nd ed. London, UK: Churchill Livingstone.

About the author:                                                                                                                     Raphael d’Angelo, MD, is a practicing clinical Aromatherapist, medical advisor to the Alliance of International Aromatherapists, and medical editor of the International Journal of Professional Holistic Aromatherapy.

Image: Vitex agnus castus – H.Zell, Wikimedia Commons

Use all health care options available

rosemary-essential-oil-5When we think of health care, we usually think of traditional medical care that involves the diagnosis and treatment of chronic illness, cancer, etc., which many people refer to as “Western medicine.”

In addition to the type of medical care we have all grown up with, there are several other approaches to health care that are known as “complementary” and “alternative.” Other areas of nontraditional health care include “integrative medicine” as well as “functional medicine.” So, what do all these terms mean and why should we think about using these types of health care?

In general, these are different approaches to health care with a history of use and origins outside of mainstream medicine; and although the term CAM uses the words complementary and alternative together and often interchangeably, these two words refer to somewhat different concepts of health care.

“Complementary” refers to using non-mainstream health care together with traditional or conventional medical care. The term “alternative” refers to using non-mainstream health care in place of traditional health care.

Another term we hear is “integrative medicine.” Think of the use of massage therapy or guided imagery. These are ways of treating a person using nontraditional means to help them heal. They integrate traditional medical care with alternative therapies. As an example, some cancer treatment centers use integrative health care programs which offer acupuncture or meditation to help manage symptoms and side effects of the cancer along with its traditional treatments (chemotherapy, radiation therapy, etc.).

It is interesting to see that “integrative health care” is happening now and is a growing trend among people who understand the benefits. For these individuals it is important to utilize any and all means of health care that will help them treat their illness or, in the case when a person does not have a defined illness, simply stay healthy. The National Center for Complementary & Alternative Medicine (NCCAM) uses the term “complementary health approaches” when discussing natural products or, mind and body health care practices.

“Natural” products include herbs and botanicals, vitamins, minerals and probiotics which are often marketed as dietary supplements. Evidence shows that the value of these alternative products is significantly underestimated. When you look at the research and the scientific evidence for the use of botanicals (herbs and plants) for the treatment and prevention of illness and disease, the evidence is overwhelming. There are hundreds if not thousands of research reports that support the use of natural products for treatment and prevention. Examples include fish oil, echinacea, and mineral supplements. It is interesting to remember that penicillin comes from a fungus; and digoxin, a heart medication, comes from the foxglove plant. When we talk about using anti-oxidants to lower the risk of cardiovascular disease, we need to understand that most of these come from plants.

NCCAM also includes “mind and body practices” as other forms of alternative health care. These include acupuncture, massage therapy, meditation, relaxation techniques, spinal manipulation, osteopathic manipulation, chiropractic therapies, tai chi, yoga, hypnotherapy, to name a few. NCCAM is the government’s lead agency for scientific research on health care practices outside of mainstream medicine. Its mission is to define through scientific investigation the usefulness and safety of complementary health care approaches and to understand their roles in improving health. This scientific evidence will help people make informed decisions about their health care. More information about this organization can be found at

Another area of complementary medicine is called “functional medicine,” which focuses on alternative treatments emphasizing the interaction between the environment and the gastrointestinal, endocrine and immune systems. Knowing the function of these systems within the body helps to understand the approach of functional medicine. The gastrointestinal (GI) system is the first line of defense the body has to bacteria, viruses, toxins, chemical, and other potentially harmful substances. Maintaining a healthy GI tract is necessary if we are going to be able to ward off these invaders. The endocrine system is the chemical system of the body which contains and controls the hundreds of hormones that keep us healthy. Knowing that there are so many environmental, health and life factors that affect our hormones is a no-brainer to understand why it is so important to keep this system healthy. The immune system allows us to fight infections and probably also helps us to deal with cancer cells and other illnesses.

Keeping the body functional should be one of the most important goals for health care. How do you do this? The answer to this is what I like to refer to as lifestyle management. This is a daily approach to life that allows you to maintain good health:

• a functional GI, endocrine and immune system;

• a sound and productive brain;

• a musculoskeletal system that allows you to move around and do all the physical things you want to do every day;

• a social and spiritual personality that brings you happiness and fulfillment and enables you to give back, pay it forward and to be grateful for all the blessings you have.

I can tell you from personal and professional experience that one of the most rewarding things you can do is to practice lifestyle management. I do this in my medical practice and in my personal life. It is so enjoyable to see a person take control of their health by taking control of their life. When they realize the power they have over their health, and all the benefits they get from keeping good health practices as the No. 1 priority in life, it is amazing to see what a person can accomplish and what a wonderful life they can enjoy!

Functional medicine is practiced by many physicians who find it important to not only treat a person’s illness but also to prevent illness, disease and disability. The American Board of Functional Medicine (ABFM) is an independent organization that certifies physicians who practice functional medicine.

I believe in and have practiced traditional medical care as a board certified internist for 20 years so I can attest to the significant benefits of this approach. With the addition of complementary health care products and services, we add another dimension to our health care and make available many other prevention and treatment approaches. Therefore, the recommendation would be to continue to rely on traditional medical/health care and add on complementary products, services and treatment approaches as necessary. This will enable you to take full advantage of all that is offered from Western and Eastern philosophies.

Dr. Salvatore Lacagnina is vice president of health and wellness for Lee Memorial Health System.

This was first published July 17, 2014 by and is republished here with the author’s permission.