Chamomile (Matricaria recutita)

Commonly referred to as: chamomile, German chamomile, Hungarian chamomile, wild chamomile, blue chamomile, scented mayweed

Alton Adams Student pharmacist Spring 2023

Background/history: Chamomile flowers have been used since around 500 BCE by the ancient Greeks, Egyptians, and Romans to treat erythema (patchy red skin due to irritation) and xerosis (dry skin) caused by dry weather They also drank it in the form of a tea as a calming beverage. It is thought to have first been used by Hippocrates, or at least was first used in his time, the “father of medicine."

Pharmacology/Mechanism of Action: chamomile works by acting as a mild tranquilizer and sleep-inducer by its sedative effects. It is due to the flavonoid, apigenin that binds to benzodiazepine receptors in the brain. This flavonoid is also where chamomile gets its anxiety reducing effects. Apigenin also has potent anti-cancer effects.

Dosage forms: tea, powder, tablet, capsule, or essential oils (Dosage1 and Dosage2)

Dosing/serving: Tea (8 oz., 1-4 cups daily), tablet/capsule (900mg-1200mg), Powder (1 teaspoon with a cup of warm water, once or twice daily), essential oil (no info found on how to use)

Uses: hay fever, inflammation, muscle spasms, menstrual disorders, insomnia, wound healing, gastrointestinal disorders, rheumatic pain, hemorrhoids, anxiety, stress reduction and boosting your immune system.

Safety/Adverse Effects/Toxic Effects: nausea, dizziness, allergic reactions

Effectiveness: Relative to participants randomized to placebo, those who continued chamomile experienced a lesser increase in GAD-7 symptoms (P = 0.0032) and had overall better psychological well-being (P = 0.013), specifically in anxiety impacts on well-being (P = 0.0094).

Interactions (food/drug): could see interactions with sedatives, blood thinners (because it contains a small amount of coumarin, which can have small blood thinning effects), antiplatelet drugs, aspirin, NSAID painkillers such as Ibuprofen and naproxen. It could also interact with other supplements such as ginkgo biloba, garlic, saw palmetto, St. John’s wort and valerian. One should also stop taking chamomile two weeks before any surgery due to possible interactions with a nesthetic drugs

Summary of one article or study:

WebMD’s “What is Chamomile?” written by R Morgan Griffin, reviewed by Melinda Ratini, MS, DO on March 20th , 2021

The article talks about how chamomile has been used for thousands of years to calm anxiety and settle stomachs. It is most common in the United States as a form of herbal tea. Sections in the article include ‘why do people take chamomile?’ which talks about the different uses for chamomile such as upset stomach, mild sedative, heartburn, nausea, and vomiting. Other studies show that a mouth rinse might relieve mouth sores caused by cancer treatments and diarrhea, hemorrhoids, anxiety, and insomnia. When used topically, it’s also been shown to be as effective as hydrocortisone cream for eczema.

The next section is ‘how much chamomile should you take?’ which talks about the effective doses of chamomile. There is no standard dose of chamomile, but studies shown that between 900-1200mg in capsule form daily show desired effects. In tea form, people drink anywhere from 1-4 cups daily. The next section is ‘can you get chamomile naturally from foods?’ and the only information in this section is that chamomile flowers are common in teas, and they can be used as flavoring in other food and drinks.

The final section is ‘what are the risks of taking chamomile?’ which includes side effects, risks, and interactions. These include allergic reactions, complication with other drugs such as NSAIDs, blood thinners, antiplatelet medications, anesthetics, sedatives and other supplements like garlic, ginkgo biloba, St John’s wort, saw palmetto and valerian.

Personal/Professional opinion: After completing my research, I believe this supplement has many great benefits in reducing anxiety and improving sleep quality and is very low risk in the case of interactions with other drugs and side effects. Anyone taking this supplement should still talk to their doctor if they notice any side effects or suspect any adverse interactions that may be occurring because of taking chamomile and other medications or supplements. They should also mention their use of this supplement prior to any surgeries. ~A Adams

References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC564623 5/#:~:text=Relative%20to%20participants%20randomize d%20to,being%20(P%20%3D%200.0094). Published December 15, 2016. Accessed February 25, 2023. https://abc.herbalgram.org/site/DocServer/CRCPRESSCh amomile-Section_1.5978-1-4665-77596.pdf?docID=6362. Accessed February 25, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC299528 3/#:~:text=Chamomile%20preparations%20are%20com monly%20used,extensively%20in%20cosmetics%20and% 20aromatherapy. Published November 1, 2010. Accessed February 25, 2023. https://artfultea.com/blogs/wellness/chamomile-teabenefits#:~:text=Chamomile%20has%20been%20used% 20in,of%20chamomile%20tea%20can%20help. Published September 1, 2022. Accessed February 25, 2023.

• Griffin RM. What is Chamomile? WebMD. https://www.webmd.com/diet/supplement-guidechamomile#091e9c5e8066ce66-1-4. Published March 20, 2021. Accessed February 25, 2023.

• Mao JJ, Xie SX, Keefe JR, Soeller I, Li QS, Amsterdam JD. Long-term chamomile (Matricaria Chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial. Phytomedicine : international journal of phytotherapy and phytopharmacology.

• Introduction to chamomile - herbalgram. Introduction to Chamomile.

• Srivastava JK, Shankar E, Gupta S. Chamomile: A herbal medicine of the past with bright future. Molecular medicine reports.

• Wack M. Top 8 chamomile tea benefits: Sleep, relaxation, and more. ArtfulTea.

• Patel K. Apigenin health benefits, dosage, safety, sideeffects, and more: Supplements. Examine. https://examine.com/supplements/apigenin/. Published October 4, 2022. Accessed February 25, 2023.

Ceylon Cinnamon (cinnamomum verum)

-"true" cinnamon -found in most supplements

Background & History

Cassia Cinnamon (cinnamomum aromaticum)

-stronger and sweeter flavor profile

-Historically used as an aromatic or as a flavoring agent

-Cinnamon has a long history of use in traditional medicine in the Middle East and parts of Asia Its bark being used as a spice and the flowers, leaves, and roots for their medicinal properties

--> This actually becomes a barrier for accurate research and result comparisons, due to the differing cinnamon products and their purported uses Chemical composition and therefore properties differing depending on what part of the cinnamon tree the product was extracted from

-Ancient Romans and Egyptians used cinnamon for digestive and respiratory ailments, as well as an aromatic to make embalming and funerals of the deceased more pleasant

Purported Uses

Lower blood glucose levels in patients with Type II Diabetes

Lowering of blood lipids and total cholesterol

Antioxidant and anti-inflammatory agent

Irritable Bowel Syndrome or other Gastrointestinal issues

Topically, as an insect repellent

Pharmacology

Cinnamaldehyde:

--------Polyphenol that regulates IL1, IL6, and TNFα release= anti-inflammatory & antioxidant properties

--------Regulation of insulin signaling pathways by activating intracellular cascades

Stimulation of GLUT 4 for increasing glucose uptake into muscle and adipose tissue promoting glycogen synthesis in the liver

Decreasing gene expression of regulators of gluconeogenesis

--------Inactivation of receptors on enterocytes that decreases the absorption of free cholesterol

Dosage Forms

1-3 grams/day

Max= 6 g/day

Adverse Effects

increased heart rate intestinal motility increased respiratory rate perspiration

(in large amounts)

Safety & Toxicity

Considered safe when consumed in quantities found in food (GRAS)

Contains coumarin may cause liver toxicity in large & prolonged amounts

Allergic reactions-- contact dermatitis

Interactions

Patients with liver disease

Anticoagulants (warfarin) coumarin contributes to liver toxicity and anticoagulatory effect

Effectiveness

Most recent studies have found that the most significant decline in blood glucose levels was after 40 days of taking 6 mg of cinnamon daily. There are a limited number of relevant studies available on the effect cinnamon has on controlling Type II Diabetes Mellitus.

A 2003 study------ summarized below

A 2012 study showing lowered A1c levels after 3 months

A 2013 meta-analysis displaying positive results, but was not controlled in the amount or kind of cinnamon used

A 2019 study finding its positive effects on several blood parameters

Study Summary

The purpose of the 2003 study was to determine cinnamon's effect on blood glucose, triglycerides, and cholesterol levels in patients with Type II Diabetes Mellitus.

There were 6 groups of individuals; 3 were given a placebo and the other 3 groups were given increasing doses (1,3, or 6 grams) of cinnamon for 40 days Fasting serum glucose levels were reduced 18-29%, triglycerides reduced 2330%, and total cholesterol reduced 12-26% at all 3 dosages of cinnamon given.

Limitations: all participants were taking sulfonylurea drugs it was not established how much of that almost this study is only suggesting cinnamon's positive effects 30% decrease in blood parameters was solely due to the cinnamon an an addition to an already established diabetes medication.

References:

In My Opinion...

I would not rely on cinnamon as the primary way to reduce blood glucose and/or cholesterol levels. Because the studies that have been done have been promising, I think adding a low to medium dose with a prescription medication could be a helpful asset. ~ A Mack