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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Asthma. Although there has been interest in using oral bay leaf for asthma, there is insufficient reliable information about the clinical effects of bay leaf for this purpose.
• Cardiovascular disease (CVD). Although there has been interest in using oral bay leaf for CVD, there is insufficient reliable information about the clinical effects of bay leaf for this purpose.
• Common cold. Although there has been interest in using oral bay leaf for the common cold, there is insufficient reliable information about the clinical effects of bay leaf for this purpose.
• Dandruff. Although there has been interest in using topical bay leaf for dandruff, there is insufficient reliable information about the clinical effects of bay leaf for this purpose.
• Diabetes. It is unclear if oral bay leaf is beneficial in patients with diabetes. Details: Preliminary clinical research in patients with type 2 diabetes shows that adding bay leaf powder, 0.5-1.5 grams twice daily after meals, to oral hypoglycemic medications for 30 days reduces fasting blood glucose levels by 21% to 26% when compared with baseline. In addition, bay leaf reduced total cholesterol levels by 21% to 24% and low-density lipoprotein (LDL) cholesterol levels by 32% to 40% when compared with baseline. Bay leaf also inconsistently improved high-density lipoprotein (HDL) and triglyceride levels (33849). The validity of these results is limited by the lack of a control group.
• Diarrhea. Although there has been interest in using oral bay leaf for diarrhea, there is insufficient reliable information about the clinical effects of bay leaf for this purpose.
• Dyslipidemia. It is unclear if oral bay leaf is beneficial in patients with dyslipidemia. Details: Preliminary clinical research in healthy adults shows that drinking tea made with 5 grams of bay leaves once a day for 10 days increases high-density lipoprotein (HDL) cholesterol levels by 6%, but does not affect triglyceride or low-density lipoprotein (LDL) cholesterol levels, when compared with baseline (104766). The validity of the study is limited by its small size, short duration, and the lack of a comparator group.
• Dysmenorrhea. Although there has been interest in using oral bay leaf for dysmenorrhea, there is insufficient reliable information about the clinical effects of bay leaf for this purpose.
• Epilepsy. Although there has been interest in using oral bay leaf for epilepsy, there is insufficient reliable information about the clinical effects of bay leaf for this purpose.
• Furuncles (boils). Although there has been interest in using topical bay leaf for furuncles, there is insufficient reliable information about the clinical effects of bay leaf for this purpose. More evidence is needed to rate bay leaf for these uses.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Acne. It is unclear if topical myrtle is beneficial in patients with acne. Details: Preliminary clinical research in adults and adolescents with mild to moderate acne shows that applying myrtle leaf extract topically to the face twice daily for 16 weeks reduces facial lesion count and acne severity scores by 23% to 45% when compared to baseline. Improvements were similar to clindamycin 1% topical solution (106777). Also, a small, single-blind trial in females whose mild-to-moderate acne resolved after receiving conventional acne therapy shows that applying a lotion containing myrtle extract and azelaic acid twice daily for 16 weeks reduces the risk of acne relapse, decreases the number of acne lesions, and improves post-inflammatory hyperpigmentation when compared with a placebo cream (111733). It is unclear if these effects are to myrtle, azelaic acid, or the combination.
• Bacterial vaginosis. Although there has been interest in using topical myrtle for bacterial vaginosis, there is insufficient reliable information about the clinical effects of myrtle for this purpose.
• Canker sores. It is unclear if topical myrtle is beneficial in patients with canker sores. Details: A small clinical study in patients with recurring canker sores shows that applying a paste containing myrtle leaf extract 5% to canker sores four times daily for 6 days decreases ulcer size, pain, and redness when compared with placebo (98643).
• Diarrhea. Although there has been interest in using oral myrtle for diarrhea, there is insufficient reliable information about the clinical effects of myrtle for this purpose.
• Gastroesophageal reflux disease (GERD). It is unclear if oral myrtle is beneficial in patients with GERD. Details: Preliminary clinical research in adults with GERD shows that taking myrtle berry or myrtle berry extract 1000 mg orally daily for 4 weeks improves GERD symptom scores and frequency when compared with baseline. The improvements were similar to taking omeprazole 20 mg daily. However, the study may have been inadequately powered to detect a difference between groups (98641). Preliminary clinical research in children 1-7 years of age with GERD shows that taking myrtle berry extract syrup 0.21 mL/kg orally three times daily and with meals along with omeprazole 1 mg/kg daily orally for 8 weeks does not reduce GERD scores or symptoms, including vomiting and regurgitation, when compared with taking placebo along with omeprazole. However, the study may have been inadequately powered to detect a difference between groups. (106781).
• Gingivitis. It is unclear if topical myrtle is beneficial in patients with gingivitis. Details: A small cross-over trial in young adults with plaque-induced gingivitis shows that rinsing with an herbal mouth rinse containing fresh plant extracts of myrtle, pomegranate, Quercus brantii, Portulaca oleracea, and Boswellia serrata twice daily after brushing for 2 weeks improves gingivitis indices when compared with placebo, with similar improvements when compared with chlorhexidine 0.2% mouth rinse (111734). Information on the specific plant parts used for each species was lacking. Further, it is unclear if these findings are due to myrtle, other ingredients, or the combination.
• Human papillomavirus (HPV). It is unclear if intravaginal myrtle is beneficial in patients with HPV. Details: Clinical research in adults with cervicovaginal HPV infection shows that insertion of vaginal suppositories containing myrtle leaf extract 10% and essential oil 0.5% daily on non-menstruating days for up to three menstrual cycles reduces positive HPV tests by an additional 30% when compared with placebo suppositories. The myrtle leaf suppository also reduces symptoms of vaginal itching and burning when compared with placebo (98644).
• Intestinal parasite infection. Although there has been interest in using oral myrtle for intestinal parasite infection, there is insufficient reliable information about the clinical effects of myrtle for this purpose.
• Menorrhagia. It is unclear if oral myrtle is beneficial in patients with menorrhagia. Details: Preliminary clinical research in adults with menorrhagia shows that taking myrtle fruit syrup 5 mL three times daily for 7 days, starting on the first day of bleeding and repeating for three consecutive menstrual cycles, reduces the duration of bleeding by 2.4 days when compared to baseline. The validity of this study is limited by the lack of a comparator group (98642). Other preliminary clinical research in adults with menorrhagia shows that taking myrtle berry powder 750 mg orally three times daily for 5 days during menses for 2 cycles improves blood loss assessment scores by 58% and hemoglobin levels by 17% when compared to baseline. Improvements were similar to tranexamic acid 500 mg twice daily. However, the study may have been inadequately powered to detect a difference between groups (106778).
• Oropharyngeal candidiasis. Although there has been interest in using topical myrtle for oropharyngeal candidiasis, there is insufficient reliable information about the clinical effects of myrtle for this purpose.
• Respiratory tract infections. Although there has been interest in using oral myrtle for respiratory tract infections, there is insufficient reliable information about the clinical effects of myrtle for this purpose.
• Vaginal candidiasis. Although there has been interest in using oral myrtle for vaginal candidiasis, there is insufficient reliable information about the clinical effects of myrtle for this purpose.
• Vaginitis. It is unclear if intravaginal myrtle is beneficial in patients with vaginitis. Details: Preliminary clinical research in adults with vaginitis secondary to bacterial vaginosis or trichomoniasis shows that applying a vaginal suppository containing myrtle extract 10% and oak gall extract 10% for 7 days reduces malodor discharge after intercourse when compared with placebo, but not when compared with metronidazole vaginal suppository. It is unclear if this effect is due to myrtle extract, oak gall, or the combination. Using the combination product did not reduce itching, dysuria, irritation, or dyspareunia when compared with placebo or metronidazole (106779).
• Warts. Although there has been interest in using topical myrtle for warts, there is insufficient reliable information about the clinical effects of myrtle for this purpose. More evidence is needed to rate myrtle for these uses.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Aging skin. It is unclear if a topical thyme flower and leaf extract reduces wrinkles. Details: A small clinical trial in healthy females aged 40-60 years with wrinkles shows that applying a specific gel preparation (ThymLec 2%, PhytoPharmaTech) containing thyme flower and leaf 1-3% extract in lecithin on the face twice daily for 60 days reduces facial wrinkles when compared with inactive control gel, but not when compared with an active comparator gel containing propanediol, ornithine, phospholipids, and glycolipids (105909).
• Alopecia areata. Topical thyme oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small clinical study shows that applying a combination of the essential oils from thyme, rosemary, lavender, and cedarwood improves hair growth in up to 44% of patients after 7 months of treatment when compared with baseline (5177). The validity of this finding is limited by the lack of a comparator group. Additionally, it is unclear if this effect is due to thyme, other ingredients, or the combination.
• Bronchitis. Oral thyme has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Some research has evaluated thyme in combination with cowslip. One observational study in adults and children has found that taking a specific product (Bronchipret) containing thyme and cowslip relieves symptoms of bronchitis and increases production of sputum (13557). A clinical study in patients with acute bronchitis shows that taking a similar combination extract (Bronchicum Tropfen) containing thyme and cowslip root 1 mL five times daily for 7-9 days seems to reduce severity and duration of coughing when compared with placebo (49219). Other thyme and cowslip preparations such as Bronchicum Elixir S and Bronchcium Tropfen seem to be similarly beneficial for bronchitis (49223). Thyme has also been studied in combination with other ingredients. A large clinical study in patients with acute bronchitis shows that taking a specific syrup (Bronchipret Saft, Bionorica AG) containing thyme and English ivy leaf 5.4 mL three times daily for 11 days reduces the frequency and duration of cough when compared with placebo (78152). Additionally, an observational study in children with acute bronchitis has found that taking this combination product in an age-specific dosing schema is associated with reduced bronchitis severity and coughing fits when compared to baseline (78181). However, due to the lack of a comparator group, it is unclear if these changes are due to the product or to the natural resolution of the condition.
• Colic. Although there is interest in using oral thyme for colic, there is insufficient reliable information about the clinical effects of thyme for this condition.
• Cough. Oral thyme has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A large open-label, uncontrolled study in adults with acute cough due to an upper respiratory tract infection who purchased a specific syrup (Bronchipret drops, Bionorica AG) containing thyme and English ivy leaf extracts suggests that taking this product as 2.6 mL three times daily for at least 4 days may improve patient-reported bronchitis symptom severity, cough severity, and quality of life, with over 90% of patients reporting overall satisfaction and product tolerability (110401). However, due to the lack of a comparator group, it is unclear if these changes are due to the product or the natural resolution of the condition. Additionally, the validity of these findings is limited by poor study methodology.
• Common cold. Although there is interest in using oral thyme for the common cold, there is insufficient reliable information about the clinical effects of thyme for this condition.
• Dementia. It is unclear if aromatherapy with thyme oil is beneficial in patients with dementia. Details: One very small clinical study in patients with advanced dementia shows that attaching a pad containing thyme oil to the collar area of the shirt does not reduce agitation when compared with lavender oil or unscented grapeseed oil (12213).
• Developmental coordination disorder (DCD). Oral thyme oil has only been evaluated in combination with other oils; its effect when used alone is unclear. Details: One very small clinical study in children with DCD shows that taking thyme oil, in combination with evening primrose oil, fish oil, and vitamin E (Efalex, Efamol Ltd.), seems to modestly improve movement disorders when compared with baseline (5708). The validity of this finding is limited by the lack of a comparator group. Additionally, it is unclear if this effect is due to thyme, other ingredients, or the combination.
• Dyspepsia. Although there is interest in using oral thyme for dyspepsia, there is insufficient reliable information about the clinical effects of thyme for this condition.
• Dysmenorrhea. It is unclear if drinking thyme tea is beneficial for the prevention of dysmenorrhea. Details: One small observational study in adolescents living in Ethiopia has found that drinking thyme tea is associated with a lower occurrence of primary dysmenorrhea when compared with those who did not drink thyme tea (105910).
• Halitosis. It is unclear whether oral thyme is beneficial for halitosis. Details: One small retrospective study in adults with gingival halitosis who received periodontal treatment and oral hygiene instructions suggests that drinking thyme tea twice daily for 1 week is associated with a reduction in volatile sulfur compounds, which is a marker for halitosis, when compared with chlorhexidine or oral hygiene alone (111716). However, the interpretation of this finding is limited by the lack of thyme dosing information and the narrow focus on intraoral halitosis, excluding most extraoral halitosis-associated conditions.
• Laryngitis. Although there is interest in using oral and topical thyme for laryngitis, there is insufficient reliable information about the clinical effects of thyme for this condition.
• Oral mucositis. Although there is interest in using oral and topical thyme for oral mucositis, there is insufficient reliable information about the clinical effects of thyme for this condition.
• Tonsillitis. Although there is interest in using oral and topical thyme for tonsillitis, there is insufficient reliable information about the clinical effects of thyme for this condition. More evidence is needed to rate thyme for these uses.

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LIKELY SAFE ...when used orally in amounts found in foods (12). The highest levels of bay leaf used in food are 0.1% as an herb and 0.02% as an oil (11).

POSSIBLY SAFE ...when the ground leaf is taken orally in doses up to 3 grams daily for 30 days (33849) or prepared as a tea in doses of 5 grams daily for 10 days (104766). ...when bay leaf extract is used topically in cosmetics (11).

LIKELY UNSAFE ...when the whole, intact leaf is swallowed. The whole leaf is indigestible and can become lodged in the esophagus or hypopharynx (132,133,134,137). It may also perforate the intestinal lining (135,136).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using in amounts exceeding those commonly found in foods.

(Read more about BAY LEAF)

POSSIBLY SAFE ...when myrtle berry is used orally, short term. Myrtle berry powder 2,250 mg daily has been used with apparent safety for up to 5 days (106778). ...when diluted myrtle leaf extract is used topically and appropriately, short term. A paste containing myrtle leaf extract 5% has been used with apparent safety for up to 6 days (98643). Other myrtle leaf extracts have been applied to the face for up to 16 weeks with apparent safety (106780). ...when myrtle leaf extract is used intravaginally and appropriately, short term. Vaginal suppositories containing myrtle leaf extract 10% and leaf essential oil 0.5% have been used with apparent safety for up to three menstrual cycles (98644).

LIKELY UNSAFE ...when the undiluted oil of myrtle leaf is used orally. Myrtle leaf contains cineole. Ingesting more than 10 grams of cineole can result in respiratory failure and collapse (18). There is insufficient reliable information available about the safety of myrtle leaf and branch when used orally. There is also insufficient reliable information available about the safety of myrtle berry when used topically or myrtle berry extract when used orally or topically.

CHILDREN: LIKELY UNSAFE
when myrtle oil is used orally. Avoid facial contact with myrtle oil preparations which may cause glottal spasm, bronchospasm, asthma-like attacks, or respiratory failure in infants or small children (18). There is insufficient reliable information available about the safety of myrtle berry or myrtle berry extract when used orally in children.

PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally (18); avoid using.

(Read more about MYRTLE)

LIKELY SAFE ...when used in amounts commonly found in foods. Thyme has Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when thyme is used orally and appropriately in supplemental amounts. Orally, thyme, in combination with other herbs, has been used safely for up to 23 days (13557,49219,49223,78133). ...when diluted thyme oil is used topically, short-term. Diluted thyme oil has been used with apparent safety for up to 7 months (5177). There is insufficient reliable information available about the safety of thyme oil when used orally or when inhaled.

CHILDREN: LIKELY SAFE
when used in amounts commonly found in foods. Thyme has Generally Recognized as Safe (GRAS) status in the US (4912).

CHILDREN: POSSIBLY SAFE
when thyme is used orally in medicinal amounts in combination with English ivy. Thyme has been used with apparent safety in combination with English ivy for up to 10 days (78181). There is insufficient reliable information available about the safety of thyme oil when used orally or topically in children.

PREGNANCY AND LACTATION: LIKELY SAFE
when used in amounts commonly found in foods. Thyme has Generally Recognized as Safe (GRAS) status in the US (4912). There is insufficient reliable information available about the safety of thyme when used in medicinal amounts during pregnancy and breast-feeding; avoid using.

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ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Concomitant use of bay leaf with antidiabetes drugs might increase the risk of hypoglycemia.  Details Preliminary clinical research shows that bay leaf can lower blood glucose levels in patients with diabetes who are already taking antidiabetes medication (33849). Advise patients to monitor glucose levels closely. Dose adjustments may be necessary.

CNS DEPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking bay leaf in large amounts may enhance the therapeutic and adverse effects of sedatives.  Details Bay leaf contains methyl eugenol. Animal research shows that methyl eugenol has sedative properties (11). Avoid concomitant use.

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ANTICHOLINERGIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concurrent use of anticholinergic drugs and thyme essential oil might reduce the effects of anticholinergic drugs.  Details In vitro evidence suggests that thyme essential oil and specific essential oil constituents like thymohydroquinone and carvacrol can inhibit acetylcholinesterase (AChE) (78155). However, this effect has not been observed in humans.

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, thyme leaf extract might have additive effects with anticoagulant or antiplatelet drugs.  Details In vitro and animal research suggests that thyme leaf extract has antiplatelet effects (13457,18335,49445). However, this effect has not been observed in humans.

CHOLINERGIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concurrent use of cholinergic drugs and thyme essential oil might cause additive cholinergic effects.  Details In vitro evidence suggests that thyme essential oil and specific essential oil constituents like thymohydroquinone and carvacrol can inhibit acetylcholinesterase (AChE) (78155). However, this effect has not been observed in humans.

ESTROGENS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, thyme might competitively inhibit the effects of estrogen replacement therapy.  Details In vitro research shows that thyme has estrogen receptor-binding activity and phytoestrogen content (3701). However, this effect has not been observed in humans.

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General ...Orally, bay leaf is well tolerated when used in amounts found in foods and seems to be well tolerated when the leaf powder is used as medicine. However, the whole, intact leaf can cause severe adverse effects. Topically, bay leaf seems to be generally well tolerated.
Most Common Adverse Effects:
Topically: Allergic reactions, contact dermatitis.
Serious Adverse Effects (Rare):
Orally: Choking or perforated intestinal lining when the whole, intact leaf is consumed.

Gastrointestinal ...Orally, the whole, intact leaf is indigestible and can become lodged in the esophagus and hypopharynx (132,133,134,137,33784,33866), and perforate the intestinal lining or other areas of the digestive tract (135,136,33812,33868,33872).

Immunologic ...Bay leaf can cause allergic reactions, including contact dermatitis (15571,33791,33864). In one case, allergic contact dermatitis occurred with a positive skin test after use of a massage oil containing bay leaf (15571). Another patient developed erythematous plaques on the elbow after applying bay leaves with a topical occlusion for 2 days. The dermatitis resolved after a two-week course of topical corticosteroids (104767).

Pulmonary/Respiratory ...Inhalation of bay leaf may cause occupational asthma, as confirmed by several challenges (783).

(Read more about BAY LEAF)

General ...There is currently a limited amount of information on the adverse effects of oral and intravaginal myrtle. A thorough evaluation of safety outcomes has not been conducted. Topically, myrtle leaf seems to be generally well tolerated in adults.
Most Common Adverse Effects:
Topically: Dry skin.
Intravaginally: Vaginal irritation and dryness.
Serious Adverse Effects (Rare):
Orally: Hypotension, respiratory failure.
Topically: Bronchial spasm and respiratory failure, most commonly in infants or children.

Cardiovascular ...Orally, very large amounts of undiluted myrtle leaf oil might lead to low blood pressure and circulatory disorders due to the cineole constituent (18).

Dermatologic ...Topically, myrtle leaf extract has been reported to cause dry skin (106777).

Gastrointestinal ...Orally, myrtle berry extract has been reported to cause constipation in infants and young children (106781).

Genitourinary ...Intravaginally, myrtle leaf extract suppositories have been reported to cause vaginal irritation and dryness (98644).

Pulmonary/Respiratory ...Orally, consumption of very large amounts of undiluted myrtle leaf oil might lead to respiratory failure and collapse (18).
Topically, facial contact with myrtle oil preparations may cause glottal or bronchial spasm, asthma-like attacks, or respiratory failure in infants and children (18).

(Read more about MYRTLE)

General ...Orally, thyme is well tolerated when used in food and seems to be well tolerated when used medicinally. Topically, thyme seems to be generally well tolerated.
Most Common Adverse Effects:
Orally: Allergic reactions, diarrhea, dizziness, headache, heartburn, nausea, or vomiting.
Topically: Contact dermatitis and skin irritation.

Dermatologic ...Topically, thyme, thyme oil, or the constituent thymol can cause contact dermatitis and skin irritation (13463,78252,78362,78384,77982,78154,78310,78313,78384). In one study of 100 patients with contact allergies, 5% were attributed to thyme oil as an allergen contained in wound dressings (78362). Toothpastes containing thymol have been associated with cheilitis and glossitis (13463).

Gastrointestinal ...Orally, thyme and thyme oil may cause heartburn, nausea, vomiting, stomach upset, or diarrhea (13557,94033). In a clinical study, two patients using extracts of thyme herb and ivy leaves experienced temporary stomach ache and mild nausea (78181).
Intravaginally, cream containing thyme and garlic has been associated with reports of nausea and vomiting in one clinical study (88387). It is not clear if these adverse effects were associated with thyme, garlic, or the combination.

Genitourinary ...Intravaginally, cream containing thyme and garlic has been associated with reports of vaginal dryness and vaginal irritation in one clinical study (88387). It is not clear if these adverse effects were associated with thyme, garlic, or the combination.

Immunologic ...Orally, thyme can cause allergic reactions; however, this is uncommon (13463). Allergic reactions to thyme might be more common in people who are also allergic to oregano and other Lamiaceae species (3808).

Neurologic/CNS ...Orally, thyme may case headache or dizziness (94033).

Pulmonary/Respiratory ...By inhalation, occupational exposure to thyme dust can cause acute airway obstruction (783,13463,13464,77982,78098).

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