by Marion Mackonochie

When most people think of chamomile, they think of a relaxing hot drink, particularly before bed. However, chamomile has been used throughout Europe for thousands of years – as a tea, medicine, ingredient in cosmetics, and deodorising agent. There is some modern scientific evidence to support its use for skin inflammation, but more research is needed to prove the benefit of its use as a nervous system relaxant. As a herb with an excellent safety profile, its main benefits may be as part of a healthy, plant-filled diet.

Introduction

Chamomile is the common name for a number of different species in the daisy family. The British species include Roman chamomile (Chamaemelum nobile (L.) All. – formerly known as Anthemis nobilis – see image to the right), German chamomile (Matricaria chamomilla L. – see image below), corn chamomile (Anthemis arvensis L.), and foetid or dog’s chamomile (Anthemis cotula L.) (Mills & Bone, 2000; Grieve, 1978). Roman and German are the species most commonly used medicinally at the current time. While Roman chamomile creeps along the ground and grows no higher than 30 cm, German chamomile can grow up to 1 metre. Both have small discs of yellow florets surrounded by white ray florets, very similar to a daisy. The leaves are feathery and green or grey/green.

Chamomile plants are native to East and Southern Europe and parts of Western Asia, but as they are hardy little plants, they now grow throughout Europe and parts of the Middle East (Engels & Brinckmann, 2015).

In German one of the common names for chamomile is “Alles Zutraut”, meaning “capable of anything” (Engels & Brinckmann, 2015). This is perhaps too optimistic for the cynical Brits who have forsaken chamomile as a medicine and relegated it to the hot drinks aisle of supermarkets. Currently in the UK, chamomile is only found in food and cosmetic products, while across Europe, chamomile products are marketed to relieve stress, and treat digestive disorders or inflammation of skin, mouth, throat, and anal and genital areas (EMA, 2014).

Etymology

The name chamomile comes from the Greek words for ground (chamos) and apple (melos), which is thought to be due to the low-growing nature and apple-like scent from the flowers of Roman chamomile. Historically, the flowers of German chamomile were used to treat disorders of the female reproductive system, hence the name Matricaria, from matrix (the Greek for womb) (Engels & Brinckmann, 2015).

Different species, different uses? And where does it come from anyway?

Some authors have considered both Roman and German chamomile to have the same properties and be used interchangeably (Brook, 1854). Mrs Grieve, a herbalist and horticulturalist who published a herbal book to provide up to date knowledge on the uses of medicinal herbs in 1931, stated that Roman chamomile was used to relieve pain, to prevent muscle spasms, relieve hysteria and treat indigestion, while German chamomile was used as a sedative, a tonic to the digestion and to relieve earache and toothache (Grieve, 1978). In more modern times, German chamomile is the main species to be used medicinally and researched, perhaps because most of the medicinal use of chamomile now occurs in mainland Europe, where German chamomile is most common. The chemicals present in both species are very similar (a mixture of flavonoids and phenolic acids), with the main difference being in the composition of the essential oils extracted from each plant. German chamomile essential oil is deep blue in colour, therefore is often referred to as chamomile blue and contains the chemicals chamazulene and bisabolol among others (Mills & Bone, 2000).

It has been documented that there are variations in the chemicals present in chamomile depending on where the plants are grown (Raal et al, 2012), so it would be interesting to see how these variations affect different products worldwide, particularly as, in many reports of research, the source of the chamomile is not disclosed. One of the main issues with scientific research into medicinal plants is that often researchers don’t place enough importance on the source of the plant. Most chamomile is today grown in Egypt, however, Germany, Poland, Argentina and Slovakia also grow appreciable amounts; while Germany is the biggest consumer (Engels & Brinckmann, 2015).

The chamomile that is used in food products, such as non-medicinal teas or for flavourings, is generally of lower quality – it may be the fine parts left over once the flower heads have been removed for medicinal preparations, or could be the whole plant with leaves and flowers present (the flowers are the part used medicinally) (Engels & Brinckmann, 2015). The different parts of the plant will contain different chemicals and therefore are likely to have different effects. Therefore, in the UK if you want to ensure medicinal quality for your chamomile tea, it is best to use the whole flowers loose.
History

Chamomile has been considered a panacea for thousands of years. Hippocrates describes it as a medicine in the 5th Century bc, and there are reports of its uses by Dioscorides in the 1st Century ad and Palladius in the 5th Century ad, as well as the Middle Ages (Franke, 2005). Shakespeare was familiar with chamomile and makes reference to the hardy nature of this weed in King Henry IV, Part I – “chamomile, the more it is trodden the faster it grows”. The bard wasn’t discussing the therapeutic uses of chamomile; however, its appearance in popular literature indicates how well integrated it has been into culture. In the Middle Ages, Roman chamomile was commonly planted along walkways, as the apple-like scent would be released when walked on (this was of benefit in an age when baths were rare) and the plant seems to thrive when being trodden

on (Grieve, 1978). In more modern cultural references, Beatrix Potter’s Peter Rabbit was given chamomile tea – “one table-spoonful to be taken at bedtime” – when he wasn’t feeling well. Mrs Grieve refers to chamomile as the “plant’s physician”, as planting a chamomile next to a “drooping and sickly” plant was said to revive it (Grieve, 1978). It was always well respected throughout Europe and in Slovakia, people were supposed to bow to the plant when they saw it (Engels & Brinckmann, 2015).

Chamomile was known in ancient Greece, Egypt and Rome, and was one of nine sacred Anglo-Saxon herbs (Singh et al, 2011). The traditional uses of chamomile in Europe are mainly for nervous and gastrointestinal problems such as, anxiety, restlessness and sleep disorders, and flatulent and nervous dyspepsia, travel sickness and nervous diarrhoea; however, nasal catarrh, painful periods and lack of periods are also listed as uses (Singh et al, 2011). Ancient texts from Greece, Rome and Egypt describe the use of the infusion for very similar indications as today – sedation, skin redness and dry skin. Some uses changed over time and by the 16th and 17th centuries it was also used to treat fever (Engels & Brinckmann, 2015).

How could chamomile be working?

Anti-inflammatory

The main effect of chamomile that has been researched is its anti-inflammatory activity. This contributes to the effect of the herb in the treatment of both inflamed skin and inflammatory digestive conditions. The exact mechanism by which chamomile reduces inflammation is not known, but research to find out what goes on at a molecular level has indicated some possibilities.

Inflammation is a process that has been linked to numerous chronic health conditions, from cardiovascular problems to cancer, and multiple sclerosis to Alzheimer’s disease. Following an injury, inflammation is a helpful occurrence; the area around the wound swells up and is painful to encourage us to protect the affected body part, blood rushes to the area to bring important wound-healing substances, and immune cells flock to the scene to make sure infectious agents don’t take over. Unfortunately, in some disease processes, the inflammation is unhelpful and contributes to the problem. Pain relievers and anti-inflammatory agents such as ibuprofen and paracetamol target cyclooxygenases (or COXs), which are key molecules that take part in the inflammation series of events. One of these, COX-2, is found to be increased only in inflammatory disorders (i.e., when there is a problem), so is a useful target. Unfortunately, COX-2 specific inhibitors available currently have been found to have cardiovascular side effects, so there is a need for better anti-inflammatories.

Chamomile infusion was found to reduce the release of the inflammatory chemical prostaglandin E2 from macrophages stimulated with lipopolysaccharide (as a model of inflammation) via a reduction in COX-2, indicating a potential mechanism to justify the traditional use of chamomile for treating inflammation (Srivastava et al, 2009). This activity may be due to inhibition by bisabolol and matricine, which are chemicals found in chamomile blue (German chamomile) essential oil, or the flavonoid apigenin, which is found in both Roman and German chamomile (Mills & Bone, 2000).
Animal testing has been used to demonstrate that swelling and inflammation of the skin are reduced when chamomile is applied to the skin. Pre-treatment with an alcohol and water extract of chamomile was able to prevent the formation of stomach ulcers in rats. This was thought to be due to antioxidant effects from chamomile. Additionally, the healing of wounds in rats was found to be faster when they were fed chamomile tea (120mg/kg/day) (EMA, 2014).

Nervous system relaxant

One of the most common home uses of chamomile tea is as a relaxant and to help with restful sleep, but does the research support this?

Some of the chemicals in chamomile have been found to bind to a receptor known as the benzodiazepine receptor found throughout the nervous system. It is known as the benzodiazepine receptor, as this is how benzodiazepines such as Valium have their sedating effects (Mills & Bone, 2000; Chang & Chen, 2015). This may explain how chamomile could have a relaxing effect.

Sleep inducing and de-stress effects in rats were shown following either ingestion of chamomile extract (300mg/kg) or inhalation of the essential oil, respectively. These effects were prevented in both cases when the benzodiazepine receptor was blocked by a known inhibitor, indicating that this receptor was responsible for the activity (EMA, 2014).

Is there evidence to prove the actions of chamomile in humans?

Anti-inflammatory

Tests have been carried out to confirm that the chemicals present in chamomile are absorbed into the skin of human volunteers, which is the first step towards proving that chamomile could have an effect when applied to the skin. Clinical trials have found chamomile to be effective in eczema and wound healing when applied to the skin. In one trial, chamomile cream had 70% of the anti-inflammatory activity of hydrocortisone ointment. A survey of 2477 GPs and a trial comparing chamomile cream to hydrocortisone found chamomile to be beneficial in eczema (Mills & Bone, 2000).
A fairly recent trial of the use of chamomile extract to treat recurrent mouth ulcers found it to be as effective as the current standard corticosteroid treatment, triamcinolone, at reducing ulcer size after 3 days. Triamcinolone was more effective at reducing the time taken for complete resolution of ulcers, but users were equally satisfied with the results from chamomile and triamcinolone at the end of the trial, and both treatments were more effective than placebo (Andishe Tadbir et al, 2015).

Relaxing effects

Initial reports from a trial to determine whether German chamomile is helpful in anxiety indicate that the majority of participants experienced a reduction in their anxiety levels over 2 months when taking 1.5g daily (Mao et al, 2012).

A trial carried out in Taiwan found that a cup of chamomile tea at bedtime improved the sleep quality and lowered depression levels in women with 6-week old babies. The researchers devised a questionnaire to separate out sleep interference due to care for the baby and sleep “inefficiency” due to physical reasons unrelated to being a mother.

Although, whether these two different hindrances to sleep in new mothers can be separated is debatable. Additionally, the control group were not given any intervention, so it is difficult to assess whether the beneficial effects were due to chamomile or just the act of having a warm drink before bed and feeling supported (Chang & Chen, 2015).
Another small trial to test the effect of chamomile capsules (540mg/day) in people with chronic insomnia found no significant benefit. The trial only included 34 people, so it was rather small to draw any conclusions from, and the authors pointed out that they excluded anyone with anxiety from the study (Zick et al, 2011). Therefore, it is possible that chamomile has a mild anxiety reducing effect that may help people who have sleep problems due to anxiety. The study also used smaller doses than other studies, which may have affected the efficacy.

Could there be a potential for new medicinal uses of chamomile in the future?

A double blind trial of 118 women in Iran compared the effects of the anti-inflammatory drug mefenamic acid and 100mg of German chamomile extract on PMS (pre-menstrual syndrome). Both treatments improved physical symptoms such as breast tenderness, abdominal pain, headache and fatigue, in addition to psychological symptoms such as anxiety and changes in sleep. Chamomile was found to be more effective for most symptoms (Sharifi et al, 2014). However, it is likely that there was considerable placebo effect in play, as mefenamic acid is a non-steroidal anti-inflammatory that is prescribed for pain, so it is unlikely that it was responsible for the significant reduction in symptoms such as depression, anxiety and lack of interest in daily routine that was found in all participants. As there was no placebo pill to compare to in this study and all the participants were from the same dormitory in a university (leading to a likely increase in group placebo effects), it is impossible to attribute any of the positive effects seen to either mefenamic acid or chamomile.

Some studies have found that chamomile extracts suppress the growth of cancer cells in laboratory conditions (Srivastava & Gupta, 2007; Guimaraes et al, 2013); with an extraction using alcohol of Roman chamomile having the most pronounced activity (Guimaraes et al 2013b). This is thought to be due to a particular type of chemical present known as flavonoids, which are also present in many plants that we use as food (Sharma et al, 2014). However, the doses needed for significant cancer fighting activity are unlikely to be achieved in the body and the most likely benefit is a cumulative cancer preventative activity alongside a diet rich in fruit and vegetables.

Safety

Chamomile is a very safe medicinal plant unless people are allergic to it. The number of people who are allergic to chamomile and other daisy family plants is not very well documented. However, when daisy family plants were added to patch testing by a dermatologist for a year, 4.5% of the 686 patients responded positively, with 75% of these responses being due to chamomile (Mills & Bone, 2000, Edwards et al 2015), indicating that it is possible that 3 to 4% of the population could be allergic to chamomile; although this seems rather high given how frequently chamomile is consumed by the general population and that allergic reactions are very rare. Accurate identification of the correct species is important when it comes to allergy, as Anthemis cotula or dog’s chamomile is highly allergenic (i.e. causative of allergic reactions) and would be much more likely to cause an allergic reaction (Engels & Brinckmann, 2015).

Final word and recommendations

There appears to be good evidence to support the anti-inflammatory effects of chamomile and therefore its use on inflamed skin. Justifying its use for sleep problems and anxiety is less clearcut; however, given its excellent safety record, there are no problems recommending someone to try chamomile for these conditions to see if it helps. The medicinal effects are much more likely to be seen when high-quality, standardised extracts (as are found in countries such as Germany, Poland and France) are used, to maximise the concentrations of the particular chemicals that have the effects demonstrated in studies.

This fragrant little herb skirts the boundaries between medicines and food. Given our growing awareness that health is better attained and maintained through a combination of diet, lifestyle and medical intervention, than just a magic pill if you feel unwell, we would be wise to incorporate more healthy foods, or nutritional medicines into our lives.

Disclaimer:  In this essay we do not advise or recommend herbs for medicinal or health use. This information is intended for educational purposes only and should not be considered as a recommendation or an endorsement of any particular medical or health treatment. The use of any such product should be based on the appropriate advice of a health care professional or based on the information available in the patient information leaflets (i.e. for THR products).

© Marion Mackonochie 2016. All rights reserved

Marion Mackonochie is a medical herbalist practising in Brighton and an MSc. student in Medicinal Natural Products and Phytochemistry at the UCL School of Pharmacy.
To contact Marion please use the contact form on this website, or visit her website http://www.fieldremedies.com

References:
Amsterdam J, Shults J, Soeller I, Mao J, Rockwell K. (2012) Chamomile (Matricaria recutita) may provide antidepressant activity in anxious, depressed humans: An exploratory study. Alternative Therapies in Health and Medicine, 18(5), 44-9.
Andishe Tadbir A, Pourshahidi S, Ebrahimi H, Hajipour Z, Memarzade MR, Shiraziah S. (2015) The effect of Matricaria chamomilla (chamomile) extract in Orabase on minor aphthous stomatitis, a randomized clinical trial. Journal of Herbal Medicine, 5(2), 71-6.
Brook R. (1854) The cyclopaedia of botany, or a history and description of all plants British or foreign forming a complete book of herbs and family herbal. London, W.M. Clark.
Edwards, S., I. da Costa-Rocha, E.M. Williamson and M. Heinrich (2015) Phytopharmacy – an evidence-based guide to herbal medicines. Wiley, Chichester.
EMA. (2014) Draft assessment report on Matricaria recutita L., flos and Matricaria recutita L. aetheroleum. Available from: http://www.ema.europa.eu/docs/en_GB/document_library/Herbal_-_HMPC_assessment_report/2014/07/WC500170079.pdf [accessed online 05/02/2016].
Engels G, Brinckmann J. (2015) Chamomile. Matricaria chamomilla (syn. M. recutita, Chamomilla recutita). HerbalGram, 108, 8-17.
Franke R. (2005) Introduction. In: Franke R & Schilcher H (Eds). Chamomile Industrial Profiles. Boca Raton, FL, Taylor & Francis Group LLC.
Grieve M. (1978) A Modern Herbal. Middlesex, Penguin Books Ltd.
Guimaraes R, Barros L, Duenas M, Calhelha RC, Carvalho AM, Santos-Buelga C, Queiroz MJRP, Ferreira ICFR. (2013) Infusion and decoction of wild German chamomile: Bioactivity and characterization of organic acids and phenolic compounds. Food Chemistry 136, 947-54.
Guimaraes R, Barros L, Duenas M, Calhelha RC, Carvalho AM, Santos-Buelga C, Queiroz MJRP, Ferreira ICFR. (2013b) Nutrients, phytochemicals and bioactivity of wild Roman chamomile: A comparison between the herb and its preparations. Food Chemistry 136, 718-25.
Mao J, Derubeis R, Li Q, Baier J, Cristancho D, Hollm J, Minkel J, Amsterdam J. (2012) Oral chamomile (Matricaria recutita) extract therapy of generalized anxiety disorder (GAD): Trial in progress. BMC Complementary and Alternative Medicine 12(1), P02.118.
Raal A, Orav A, Pussa T, Valner C, Malmiste B, Arak E. (2012) Content of essential oil, terpenoids and polyphenols in commercial chamomile (Chamomilla recutita L. RAuschert) teas from different countries. Food Chemistry 131, 632-38.
Sharifi F, Simbar M, Mojab F, Alavi Majd H. (2014) Comparison of the effects of Matricaria chamomile (chamomile) extract and mefenamic acid on the intensity of premenstrual syndrome. Complementary Therapies in Clinical Practice 20(1), 81-8.
Sharma H, Kanwal R, Bhaskaran N, Gupta S. (2014) Plant flavone apigenin binds to nucleic acid bases and reduces oxidative DNA damage in prostate epithelial cells. PLoS One 9(3), e91588.

Singh O, Khanam Z, Misra N, Srivastava MK. (2011) Chamomile (Matricaria chamomilla L.): An overview. Pharmacognosy Review 5(9), 82-95.
Srivastava JA & Gupta S. (2007) Antiproliferative and apoptotic effects of chamomile extract in various human cancer cells. Journal of Agricultural & Food Chemistry 55(23), 9470-8.
Srivastava JK, Pandey M, & Gupta S. (2009) Chamomile, a novel and selective COX-2 inhibitor with anti-inflammatory activity. Life Sciences 85, 663-9.
Zamestani M, Rafraf M, & Asghari-Jafarabadi M. (2016) Chamomile tea improves glycemic indices and antioxidants status in patients with type 2 diabetes mellitus. Nutrition 32, 66-72.
Zargaran A, Borhani-Haghighi A, Faridi P, Daneshamouz S, Kordafshari G, Mohagheghzadeh A. (2014) Potential effect and mechanism of action of topical chamomile (Matricaria chamomilla L.) oil on migraine headache: A medical hypothesis. Medical hypotheses 83, 566-9.
Zick SM, Wright BD, Sen A, Arnedt JT. (2011) Preliminary examination of the efficacy and safety of a standardized chamomile extract for chronic primary insomnia: A randomized, placebo-controlled pilot study. BMC Complementary and Alternative Medicine 11, 78.