History and Origin
Chamomile is a well-known medicinal plant species from the Compositae (Asteraceae) family, often referred to as “the star among medicinal species”. Although Chamomile is native to southern and Eastern Europe, it is grown in Germany, Hungary, France, Russia, Yugoslavia, and Brazil. It also can be found in North Africa, Asia, North and South America, Australia, and New Zealand.
Chamomile has been used in herbal remedies for thousands of years, known in ancient Egypt, Greece, and Rome. This herb has been believed by Anglo-Saxons as 1 of 9 sacred herbs given to humans by the lord. (1) The name "chamomile" comes from two Greek words meaning “ground apple” for its apple-like smell. (3)
Its multitherapeutic, cosmetic, and nutritional values have been established through years of traditional and scientific use and research. It is included in the pharmacopoeia of 26 countries. Because of its extensive pharmaceutical properties, the plant possesses great economic value; German chamomile is the fifth top-selling herb in the world.
The flowers of M. chamomilla contain a blue essential oil possessing a variety of uses. The dry flowers of chamomile are also in great demand for use in herbal tea. Therefore, the plant is sold either as a flower head or as blue oil. “Blue oil” is the commercial trade name of chamomile oil in the international market. (1) Infusions and essential oils are used in a number of commercial products, including soaps, detergents, perfumes, lotions, ointments, hair products, baked goods, confections, and herbal teas. (2)
Chamomile Plant Structure
German chamomile is an annual plant, (1) which grows best in a light, sandy loam with abundant moisture at pH 6. (5) It has thin spindle-shaped roots only penetrating flatly into the soil. The stem is erect, heavily ramified, and grows to a height of 10–80 cm. The long and narrow leaves are bi- to tripinnate. (1) Its flowers are daisy-like, with yellow centers and white petals. (6) The golden yellow tubular florets with 5 teeth are 1.5–2.5 mm long. The 11–27 white plant flowers are 6–11 mm long, 3.5 mm wide, and arranged concentrically. The receptacle is 6–8 mm wide, flat in the beginning and conical, cone-shaped later, hollow (a very important distinctive characteristic of Matricaria including German chamomile), and without paleae. The fruit is a yellowish brown achene. (1)
The medicinal parts of German chamomile consist of the entire flowering herb or only the flowers. (4)
Fig. 1 The photo of Matricaria chamomilla
Chamomile Health Benefits
1. Calming Anxiety and Stress
In 2019, a study was conducted to investigate the effect of German chamomile flower tea on symptoms of anxiety in the elderly. The study was done on 54 patients (men and women aged 60-74) with generalized anxiety disorder (GAD) for 8 weeks. Based on the results, chamomile tea can significantly reduce the common symptoms of anxiety and it can be used for handling and improving anxiety. (7)
In 2016, a study was done to evaluate the effects of long-term use of German chamomile flowers on reducing the symptoms of generalized anxiety disorder (GAD). 179 patients with GAD were treated with German chamomile extract (500-mg capsule, 3 times a day) for 38 weeks. Extraction solvents were ethanol 70% and water. The results showed that long-term German chamomile use was safe and significantly reduced moderate-to-severe GAD symptoms. Furthermore, it might be effective in improving blood pressure and weight loss. (8)
2. Improving Digestive System Function
In 2014, a study was done to investigate the antidiarrheal properties of German chamomile flowers decoction extract in rats. The results showed that chamomile decoction produced a significant protection against diarrhea and intestinal fluid accumulation. These findings suggested that chamomile decoction is effective in the treatment and management of digestive system disorders as diarrhea. (9)
Dried chamomile flowers are one of the richest sources of apigenin. According to researchers, apigenin might hinder the ability of gastrointestinal cancers to progress and spread. (10) Chamomile tea contains quite low concentrations of apigenin but includes high levels of apigenin-7-O-glucoside. (11) Glycosides of apigenin are cleaved in the gastrointestinal tract to be absorbed and distributed as apigenin itself. For this reason, the gastrointestinal tract is exposed to higher concentrations of apigenin than tissues at other locations. (10)
The principal components of the essential oil extracted from the German chamomile flowers are the terpenoids α-bisabolol and chamazulene. (11) The chamomile extract that contains bisabolol and chamazulene is effective in reducing the symptoms of irritable bowel syndrome (IBS), including severe abdominal pain, bloating, nausea, stool consistency, and changes in bowel habits. (12) Also, apigenin and bisabolol in chamomile essential oil have spasmolytic effects on gastrointestinal smooth muscles. This effect is comparable to papaverine (an antispasmodic drug). (3)
STW5 is a commercially herbal preparation that contains hydroethanolic extract of German chamomile (20%). (13) According to studies, STW5 can prevent the development of gastric ulcers by reducing gastric acid secretion and lowering gastric acidity. (11)
3. Regulating Blood Glucose Levels
In 2008, researchers investigated the effects of chamomile tea and its major components on the prevention of hyperglycemia (high blood glucose) and the protection or improvement of diabetic complications in diabetics. The major components include coumarins (umbelliferone, herniarin, esculetin, isoscopoletin) flavonoids (apigenin, luteolin, and quercetin) and sesquiterpenes (bisabolol and farnesene).
It was found that chamomile tea, esculetin, and quercetin are effective in lowering blood sugar levels. These results clearly suggest that daily consumption of chamomile tea with meals can contribute to the prevention of the progress of hyperglycemia and diabetic complications such as cataracts, retinopathy, neuropathy, and nephropathy. (14)
Moreover, in another 2008 study, the researchers investigated the effect of the aerial part of chamomile ethanolic extract on preventing high blood glucose in diabetic rats. The diabetic rats were treated with different doses of the extract (including 20, 50, and 100 mg/kg) for 14 days. It was observed that treatment with different doses of chamomile extract significantly reduced postprandial blood glucose levels and protected the pancreatic β-cells. (15) Pancreatic β-cells are responsible for insulin secretion and control of plasma glucose levels. (16)
4. Regulating Blood Cholesterol Levels
In 2015, a study aimed at assessing the effects of chamomile tea consumption on serum lipid profile (including blood total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels). The participants were 30-60-year-old patients with type 2 diabetes mellitus (T2DM) (males and females). The individuals consumed chamomile tea (3 g/150 mL hot water) three times per day immediately after meals for 8 weeks. It was observed that chamomile tea significantly decreased total cholesterol, triglyceride, and LDL cholesterol. No significant changes were shown in serum HDL cholesterol levels. Therefore, it can be concluded that chamomile tea has some beneficial effects on lowering blood cholesterol and triglycerides levels. (17)
In a 2018 study, the effects of consumption of chamomile hydroalcoholic extract (80% ethanol and 20% distilled water) on total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride levels, and hardening and narrowing of arteries due to the accumulation of fatty deposits on the inside of the arterial walls were evaluated on rats that received high cholesterol diet.
The effects of the chamomile extract on lowering blood cholesterol and triglycerides levels were compared with lovastatin. The chamomile extract prevented an increase in blood total cholesterol, LDL cholesterol, and triglycerides levels in a dose-dependent manner. Also, no symptom of accumulation of fatty deposits on the inside of the arterial walls was observed. These effects of chamomile were similar to Lovastatin effects. (18)
5. Anti-Pain
The most important dissatisfaction of post-operative orthopedic patients is severe and intolerable pain. In 2020, the researchers evaluated the effect of chamomile tea consumption on pain intensity and pain management in patients after orthopedic surgery. In this study, 1 tea bag containing 1 g of chamomile was put in 150 mL of boiling water and then prescribed to the patients 3 times a day for 3 days. It was observed that drinking chamomile tea significantly reduced pain intensity and increased satisfaction with pain management after orthopedic surgery. (19)
In addition, in 2017, the effect of chamomile tea consumption on inflammation and pain was studied among rheumatoid arthritis patients. Rheumatoid arthritis (RA) is a joint inflammatory disease. The patients received 6 g/day chamomile tea as 2 teabags twice a day for 42 days. This study showed that chamomile tea could decrease inflammation and alleviate pain. (20)
In 2015, the efficacy and safety of applying chamomile oil to the skin for the treatment of knee osteoarthritis were assessed. The patients were asked to apply the oil three times a day for three weeks. They were allowed to use acetaminophen as an analgesic. It was found that chamomile oil significantly reduced the patients' need for pain relief medication compared to the patients who didn’t use this treatment. (21)
What Are Chamomile Side Effects?
1. When Taken by Mouth
German chamomile is LIKELY SAFE when taken in amounts found in food. It is POSSIBLY SAFE when taken by mouth as a medicine for short periods of time.
2. When Applied to the Skin
German chamomile is POSSIBLY SAFE when applied to the skin.
However, it can cause allergic skin reactions. When applied to the skin near the eyes, German chamomile may cause eye irritation.
3. Pregnancy and Breast-Feeding
There isn't enough reliable information to know if German chamomile is safe to use when pregnant or breastfeeding. So, stay on the safe side and avoid it.
4. Children
German chamomile is POSSIBLY SAFE when taken by mouth or applied to the skin as a medicine, short-term.
Early research shows that:
- Several products containing German chamomile are safe in infants when taken by mouth for up to one week.
- Oil containing German chamomile is safe in children and teenagers when applied to the skin nightly for up to 6 weeks.
5. Hormone-Sensitive Condition such as Breast Cancer, Uterine Cancer, Ovarian Cancer, Endometriosis, or Uterine Fibroids
German chamomile might act like estrogen in the body. If you have any condition that might be made worse by exposure to estrogen, don't use German chamomile.
6. Surgery
German chamomile might interact with anesthesia for surgery. So, stop using it at least 2 weeks before a scheduled surgery.
7. Allergies to Ragweed or Related Plants
German chamomile may cause an allergic reaction in people who are sensitive to the Asteraceae/Compositae family of plants. Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many other herbs. (22)
A case report indicates chamomile may precipitate severe anaphylactic reactions in patients with hay fever and bronchial asthma caused by a variety of pollens. (4)
Generally, every person may be allergic to certain herbs and spices. This sensitivity must be first diagnosed by the person and secondarily by the physician. However, these allergic reactions do not cause chronic or acute side effects, and after identifying the allergenic plant and removing it from the diet, allergy-related complications will be eliminated.
No company or product can be aware of the allergic reactions of different bodies in advance. The body's incompatibility with one or more specific herbs rarely occurs, but consumers may encounter it anyway.
Nutritional Information
Nutritional analysis of chamomile dried flower powder showed that the powder contains moisture, fiber, ash, macronutrients (including protein, fat, carbohydrate), and Micronutrients (including vitamin C and minerals (iron, zinc, calcium)). (23)
Chamomile Daily Dosage
A single dose is approximately 3 gm as an infusion.
An infusion is prepared by pouring one cup (150 ml) of boiling water over 3 gm of chamomile. One cup of freshly-made tea is administered 3-4 times daily. (4)
Bioactive Compounds
One hundred twenty chemical constituents have been identified in chamomile, including terpenoids, flavonoids, and coumarins.
Active chemical constituents of German chamomile include:
Terpenoids: α-bisabolol, α-bisabolol oxide A and B, chamazulene, sesquiterpenes;
Flavonoids: apigenin, luteolin, quercetin;
Coumarins: umbelliferone;
Spiroethers: en-yn dicycloether;
Other constituents: anthemic acid, choline, tannin, polysaccharides. (3)
German chamomile flowers contain 0.24 to 2.0 percent volatile oil (essential oil) that is blue in color. Yield varies depending on the origin and age of the flowers. European Pharmacopoeia recommends chamomile contain no less than 4 mL/kg of blue essential oil.
The two key constituents, alpha-bisabolol and chamazulene, account for 50-65 percent of total volatile oil content. (6)
In another study, it was found that chamazulene and Bisabolol comprise about 5% and 50% of German chamomile’s essential oil, respectively. (3)
The chamazulene provides a blue color to the oil; chamazulene is not present in the raw flower head but forms during distillation from matricin. (5) Chamazulene and bisabolol are very unstable and are best preserved in an alcoholic tincture. (11)
Best Time to Consume
1-2 hours before or after meals.
As a mild tranquilizer and sleep-inducer: one cup of chamomile tea about 45 minutes before bed. (24)
For reducing blood glucose levels: one cup of chamomile tea immediately after meals. (25)
Possible Drug Interactions
1. Birth Control Pills (Contraceptive Drugs)
Some birth control pills contain estrogen. German chamomile might have some of the same effects as estrogen. But it isn't as strong as the estrogen in birth control pills. Taking German chamomile along with birth control pills might decrease the effectiveness of the pills.
Some birth control pills include ethinyl estradiol and levonorgestrel (Triphasil), ethinyl estradiol and norethindrone (Ortho-Novum 1/35, Ortho-Novum 7/7/7), and others.
2. Estrogens
Large amounts of German chamomile might have some of the same effects as estrogen, but it isn’t as strong as estrogen pills. Taking German chamomile along with estrogen pills might decrease the effects of these pills.
Some estrogen pills include conjugated estrogens (Premarin), ethinylestradiol, estradiol, and others.
3. Medications Changed by the Liver (Cytochrome P450 3A4 (CYP3A4) Substrates) / (Cytochrome P450 1A2 (CYP1A2) Substrates)
Some medications are changed and broken down by the liver. German chamomile might decrease how quickly the liver breaks down these medications. Taking it along with some of these medications can increase their effects and side effects. So, if you are taking any medications that are changed by the liver, talk to your healthcare provider before taking German chamomile.
Some medications changed by the liver include:
- CYP3A4 substrates: lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and many others.
- CYP1A2 substrates: amitriptyline (Elavil), haloperidol (Haldol), ondansetron (Zofran), propranolol (Inderal), theophylline (Theo-Dur, others), verapamil (Calan, Isoptin, others), and others.
4. Sedative Medications (CNS Depressants / Benzodiazepines)
German chamomile might cause sleepiness and drowsiness. Medications that cause sleepiness are called sedatives. So, taking German chamomile along with sedative medications might cause too much sleepiness.
Some CNS depressants include pentobarbital (Nembutal), phenobarbital (Luminal), secobarbital (Seconal), fentanyl (Duragesic, Sublimaze), morphine, zolpidem (Ambien), and others. Some benzodiazepines include alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), midazolam (Versed), temazepam (Restoril), triazolam (Halcion), and others.
5. Tamoxifen (Nolvadex)
Some types of cancer are affected by hormones in the body. Estrogen-sensitive cancers are cancers affected by estrogen levels in the body. Tamoxifen (Nolvadex) is used to help treat and prevent these types of cancer. German chamomile seems to affect estrogen levels in the body too. Therefore, it might decrease the effectiveness of tamoxifen (Nolvadex).
So, do not take German chamomile if you are taking tamoxifen (Nolvadex).
6. Warfarin (Coumadin)
Warfarin (Coumadin) is used to slow blood clotting. German chamomile might increase its effects. So, taking German chamomile and warfarin (Coumadin) together might slow blood clotting too much and cause bruising and bleeding. (22)
Traditional Use
Chamomile is extensively consumed as a tea or tonic. It is used internally to treat anxiety, hysteria, convulsions, nightmares, insomnia, and other sleep problems.
One of chamomile’s main roles is as a multipurpose digestive aid to treat gastrointestinal disturbances, including flatulence, indigestion, diarrhea, anorexia, motion sickness, nausea, and vomiting.
It is used to treat colic, croup, and fevers of children and as an emmenagogue and a uterine tonic in women. (3)
In the sixth century, it was used to treat back pain, neuralgia (pain in a nerve pathway), rheumatism, skin conditions, headaches, and gout. (4)
Some Questions about Chamomile
How many times a day can you drink chamomile tea?
One cup of freshly-made chamomile tea (3 gm /150 ml) is administered 3-4 times daily. (4)
Does chamomile cause drowsiness?
Chamomile has calming effects and improves sleep quality. (26) Sedative effects may be due to the flavonoid, apigenin, which binds to benzodiazepine (BDZ) receptors in the brain. Compounds, other than apigenin, present in extracts of chamomile can also bind BDZ and GABA receptors in the brain and might be responsible for some sedative effects; however, many of these compounds are as yet unidentified. (11)
Is chamomile good for PCOS?
According to the studies, chamomile consumption decreases serum testosterone levels in women with PCOS. (27)
References
1. https://www.ncbi.nlm.nih.gov/
2. https://www.researchgate.net/
3. https://tratamientocelular.com/
4. PDR for herbal medicines. (2000). 2nd ed. Montvale, NJ: Medical Economics Company
5. Tucker, A. O., DeBaggio, T. (2009). The Encyclopedia of Herbs: A Comprehensive Reference to Herbs of Flavor and Fragrance. United States: Timber Press.
6. https://www.researchgate.net/
7. https://www.scitepress.org/
8. https://www.ncbi.nlm.nih.gov/
9. https://www.researchgate.net/
10. https://onlinelibrary.wiley.com/
11. https://www.ncbi.nlm.nih.gov/
12. https://www.researchgate.net/
13. https://link.springer.com/
14. http://www.pkdiet.com/
15. https://link.springer.com/
16. https://www.sciencedirect.com/
17. https://pubmed.ncbi.nlm.nih.gov/25194428/
18. http://www.bmrat.org/
19. https://pdfs.semanticscholar.org/
20. https://www.mattioli1885journals.com/
21. https://www.researchgate.net/
22. https://www.webmd.com/
23. https://www.researchgate.net/
24. https://www.insider.com/
25. https://www.bbcgoodfood.com/
26. https://www.ncbi.nlm.nih.gov/
27. https://iranjournals.nlai.ir/
