The Importance of Mindfullness

According to the Washington Post, one doesn't need anti-anxiety medication. New research suggests you may not need them. Mindfulness-based interventions (think breathing, stretching, and attention exercises) are as effective as escitalopram, an anti-anxiety pill, according to a study in JAMA Psychiatry that tracked 208 participants for eight weeks.

A recent study published in JAMA Psychiatry showed that people who received eight weeks of mindfulness-based interventions experienced a decrease in anxiety that matched those who were prescribed escitalopram, a common anti-anxiety medication that is often prescribed under the brand name Lexapro.

A seven-point scale was used to assess anxiety among 208 participants, with a score of seven representing extreme anxiety and a score of one being normal. In both the medication and the mindfulness groups, the average score after treatment dropped from a moderate level of anxiety to a mild level of anxiety.

Both groups began the study with similar baseline scores (4.44 in the mindfulness group and 4.51 in the medication group.) By the end of the study, anxiety scores in both groups had declined to an average of 3.09 on the anxiety scale, a statistically similar change that showed the treatments to be equally effective.

Mindfulness practices such as breathing exercises have been used to treat anxiety for a long time, but this is the first study showing how effective they can be in comparison with standard treatments for anxiety disorders, said the study’s lead author, Elizabeth Hoge, who is a psychiatrist and director of the Anxiety Disorders Research Program at Georgetown University.

Mindfulness treatments used in the study included breath awareness exercises, which involve paying attention to your breath as you allow thoughts to rise, then pass through your mind before letting them go. Importantly, the practice isn’t about trying to change your breath, Hoge said, but about focusing on your breath as a way to ground yourself if any anxious thoughts arise.

Some Essential Oils Have Science-Backed Health Benefits

According to an article in the Washington Post by Dr. Trisha Pasricha, there are some essential oils like peppermint, lavender and tea tree oils that can medically treat certain health conditions while others like citronella and rose, are lacking in evidence.

I’ve heard essential oils can help treat stress, insomnia and other health conditions. Is that true? What does the research say?

From a purely medical perspective, it’s hard to say that many essential oils are doing anything profound. The health claims linked to most varieties, such as citronella, bergamot, rose and sandalwood, are lacking in convincing data from clinical studies.

But there is reasonable medical evidence for a few uses, including:

• Peppermint oil capsules for irritable bowel syndrome
• Lavender oil capsules or aromatherapy for sleep and anxiety
• Tea tree oil applied topically for acne

Essential oils are often extracted through distillation methods that use steam to extract the oils from plants. You should never ingest pure essential oils, such as those from the vial, as this may be toxic. Instead, look for products containing essential oils that are meant for ingestion, as is the case of IBgard, an over-the-counter peppermint-containing product for irritable bowel syndrome.

Likewise, avoid applying pure essential oils directly on the skin. Instead, dilute them to 1-5 percent concentration using your favorite lotion or another carrier oil, such as olive oil. This helps lower the risk of contact dermatitis.

Peppermint oil

The active ingredient in peppermint is menthol, which relaxes the muscles of the human gastrointestinal tract. A 2022 meta-analysis of 10 randomized controlled trials looking at ingestion of peppermint oil in treating irritable bowel syndrome symptoms found it to be more effective than a placebo (many of the studies were industry-funded).

Peppermint may be especially helpful for abdominal pain, though as a caution, it can aggravate heartburn symptoms. Peppermint is recommended by the American College of Gastroenterology, and I find it reasonable to try for mild symptoms, though many patients with irritable bowel syndrome and similar disorders may ultimately benefit more from other therapies. I generally recommend trying one peppermint oil capsule three times a day.

Lavender oil

Lavender is thought to exert its effects on sleep and anxiety in our central nervous system in a somewhat similar fashion to the medication pregabalin, an analgesic.

In Germany, a medication containing lavender oil, silexan, is approved for anxiety-related symptoms. Several randomized controlled trials have shown lavender capsules to improve anxiety symptoms both compared to a placebo and, in the case of high-dose silexan, compared to paroxetine, a medication commonly used to treat depression. These studies were predominantly done in women, and many were funded by the manufacturer.

A 2022 meta-analysis looking at essential oil aromatherapy on sleep quality among cancer patients found lavender oil was moderately effective and performed better than other essential oils, like chamomile or orange. In the studies analyzed, lavender oil in aromatherapy was done through massage or directly inhaled after dilution — for example, putting the oil on a cotton ball that was kept around the patient’s collar for 20 minutes.

It bears noting the studies tend to follow patients for only a few weeks at most so lavender oil is more likely to help as a short-term aid.

Tea tree oil

With tea tree oil, which has some antimicrobial properties when applied to the skin, two trials are worth noting: One was a study of 5 percent tea tree oil from 1990 that found it equally effective as 5 percent benzoyl peroxide for treating acne, though the oil was slower to act. The second was a 2007 double-blind trial that found a 5 percent tea tree oil gel to be more effective than a placebo in reducing acne severity. For some, tea tree oil irritates the skin, but for others with acne who prefer a more natural option, the data are encouraging.

To try it for acne, apply a thin layer of 5 percent tea tree oil to the affected area twice daily and leave it on for 20 minutes. Afterward, wash the area thoroughly with water.

Does it matter where you buy essential oils from?

Essential oils are generally not regulated as medications by the Food and Drug Administration in the United States, so it can be hard to know what exactly you’re getting when you buy these over-the-counter or online. Look for essential oils that come from a reputable company and have few, if any, additives that may irritate the skin.

What are the risks of using essential oils?

In 2007, there was a small case series published in the New England Journal of Medicine linking gynecomastia — an enlargement of breast tissue — in young boys to exposure to tea tree and lavender essential oils. It got some buzz in the press at the time, but larger peer-reviewed studies since then have failed to show a connection.

There are a few caveats still worth noting: Many essential oils can make your skin more sensitive to sun damage, so I would not rub any in before heading outside. Several essential oils, including tea tree oil, are toxic to dogs and cats.

Avoid vaping essential oils and keep your exposure short: Limited human data suggests that inhaling essential oil vapors for longer than one hour can be harmful to cardiovascular health. Because of their possible irritating effects on the lungs, the American Lung Association does not recommend people with asthma or COPD use essential oils.

In general, it’s best to discuss with your health care provider before using essential oils, especially if you’re pregnant or have young children.

What I want my patients to know

Essential oils have been used for millennia in healing and bathing rituals across many cultures. I have no problem with my patients incorporating the oils in a personal care routine if doing so makes them feel luxurious. But to me, the more important question if you suffer from poor sleep is not whether lavender essential oil will help your symptoms, but whether we can address the underlying issue causing it. Similarly, for anxiety, we still need to find a long-term solution.

Tell Me Something I Don't Know

Did you know that honey never spoils? Archaeologists have found pots of honey in ancient Egyptian tombs that are over 3,000 years old and still perfectly edible. The unique composition of honey, with its low moisture content and acidic pH, creates an environment that prevents the growth of bacteria and fungi, making it one of the few foods that never spoils.

A Very Zen Video

A friend shared this with me for those times when I have trouble sleeping.

How to Turn Plants Into Tinctures, Like an Ancient Alchemist

Jessica Leigh Hester of AtlasObscura offers a beginner’s guide to extracting flavors from herbs and flowers.

Hieronymus Brunschwig had a cure for whatever ailed you, and it all came down to plants. More specifically, it hinged on coaxing things from them.

In the early 1500s, the German surgeon-alchemist was sure that distillation could do some very heavy lifting when it came to human health. Brunschwig believed that distillation—one method of extracting flavors from flowers, herbs, and other plants, by boiling and condensing water—could calibrate the body, which was frustratingly prone to falling out of whack.

A tall order, but Brunschwig was not one to shy away from an encyclopedic effort. In his book one of the first printed distillation manuals, he arranged plants alphabetically, and noted their sneaky synonyms. He tallied the afflictions that various plants could defeat, and annotated which portions of flowers, stalks, and leaves were especially potent. He even indicated the months when each plant species were at their most formidable.

“Water of lekes,” distilled from roots in June, may be a balm “after the byrth of a chylde,” he wrote. “Water of lettys,” swallowed at “mornynge and nyght,” could comfort the “lyver.” The book promises drinkable salves for nearly any malady from head to toe, however ineffable. You could distill a remedy for headaches, marital discord, or bad dreams. You might chug some water of dill, or dab a bit on your temples.

There’s a long history here. Ancient Arabic alchemists made tinctures by macerating flowers and herbs, accenting them with spices, and setting them to boil and condense in glass vials over wood fires. By the Middle Ages, distillation was widely practiced by physicians, botanists, and apothecaries. The Victorians were enamored with tinctures, and during the Prohibition era in the United States, when alcohol was hard to come by, moonshiners applied the principles of distillation to make high-octane booze. (In the U.S., it’s still very much illegal to craft your own hard liquor at home, though Americans are permitted to buy and use distillation paraphernalia for other purposes.)

We asked Sarah Lohman, a historic gastronomist and the author of Eight Flavors: The Untold Story of American Cuisine, to lay out a recipe for making simple infusions at home.

1. Collect your materials

No need to overthink this—most any herb or flower will do. “Lavender, thyme, basil, you can create whatever you want to add into baked goods, dinner, ice cream, whatever you’re thinking,” Lohman says.

“I guess if you’re really foolish, you could infuse something that’s poison—but just don’t do that,” Lohman adds. Only use plants you recognize. If you’re scouting for wild edibles, use a guidebook or go with a seasoned pro. “If you stick to herbs you find in the grocery store, you should be in good shape,” Lohman adds. You’ll also need a container. Plastic, snap-top takeout containers work nicely for the initial infusion.

The process is pretty, and fairly hands-off.

2. Measure out the ingredients

Besides your plant material, you only need high-proof alcohol. The higher the proof, the faster the infusion happens, Lohman says—and if it’s really high, around 180-proof (meaning it’s 90 percent alcohol and 10 percent water), you’ll likely need to cut it with water in order to douse the burn. Vanilla extract, for instance, is 70-proof, so it’s 35 percent alcohol. “You make the infusion at a higher proof, and then you usually add water to bring down the proof to a comestible level,” Lohman says.

If you have a cup of Everclear and a cup of water, for instance, you’ve slashed the proof in half—from roughly 90 percent to 45 percent. For flavored spirits, such as things you’d add to cocktails, you’d want to hover around 20 or 25 percent. Keep on adding splashes of water until you get there.

3. Walk away

Place the plastic container in a sunny windowsill, and then leave it alone for at least 24 hours.

4. Sample and adjust

Since high-proof alcohol kills whatever microbes cross its path, you don’t have to worry about things getting funky the longer you leave your concoction stewing. “The worst-case scenario is that you make something you don’t like the taste of and you throw it out,” Lohman says. That said, you’ll want to test your infusion daily so that the flavor doesn’t get stronger than you like.

A little clove goes a long way, while something like basil or thyme will be more subtle. To get a punchy flavor, you’ll either need to begin with more plant material or let the infusion sit around longer.

This is where tasting is crucial. A delicate flavor, such as wheatgrass, might take a few weeks to develop, while a more-aggressive lavender comes through in just two or three days—anything beyond that might be overbearing. On the other hand, if the flavor is too toothless, you can keep adding more of the ingredients—one vanilla pod here, a clove there. “It’s a little bit of trial and error,” Lohman says.

As you experiment, keep a log of the tweaks you make. This makes the whole thing replicable, if things go well—and if they don’t, you know what to change in the next go-around.

5. Decant it

Once you’ve arrived at the flavor you want, you’ll need to fish out or strain the plant material so that the flavor doesn’t keep evolving.

After that, you might want to pour it into a pretty glass jar. (There are lots of apothecary-aesthetic shops online.

The finished product makes a creative, inexpensive gift. “At this point, you’ve bought a bottle of vodka, plucked some stuff from the garden, and that’s it,” Lohman says. “It’s a very low-risk at-home hobby.” Not to mention a delicious way to tap into an ancient practice, with a modern twist.