Calmamile (Chamomile)

Chamomile is one of the gentlest things on our shelves, and when our naturopaths talk about it in store, it's nearly always about which form you're holding and what else you take.

A good fit if

• You'd like help winding down in the evening, which is where the combined evidence sits
• You want something you can take night after night, as side effects matched placebo or were even lower
• You'll choose by botanical name, so you know whether you've got German or Roman chamomile
• You're not on a blood thinner and daisies have never bothered you

Check with us first if

• You take a blood-thinning or antiplatelet medicine. Chamomile tea is named in a systematic review of 78 things that raise bleeding risk with warfarin, and chamomile affects platelets in the lab. Talk to whoever prescribes your medicine.
• You're pregnant or breastfeeding. There's no required warning for chamomile in the ingredient rules, and we have no evidence either way on taking it by mouth. That's a conversation for a practitioner rather than a choice off the shelf.
• It's for a baby or young child. Australian law allows a claim about baby colic, but we hold no chamomile trial in babies behind it, and the wording itself tells you to see a doctor if symptoms continue or get worse.
• You get hay fever, or react to other flowering plants. The daisy family is large, and reactions have been reported from both the tea and creams.
• You take blood pressure medicine, or you're underweight. At 1,500 mg a day for twenty-six weeks, chamomile lowered body weight and average blood pressure compared with placebo.
• You take several medicines and have inflammatory bowel disease. Chamomile is flagged in research on herb and medicine interactions for that group, where the issue is taking many medicines together.
• If you take prescription medicine, check with your doctor, pharmacist or our naturopaths before you start.

• Dried flower and tea bags (Schedule 1 items 1327 CHAMOMILE FLOWER DRY and 3234 MATRICARIA FLOWER DRY). Best known for: The traditional preparation, and what almost everyone means by chamomile. Absorption: Hot water draws out the water-soluble flavonoids and only a little of the essential oil. Typical use: Not standardised. What you get depends on the quality of the flowers, how much you use and how long you steep it, and the dose isn't stated on the pack.
• German chamomile extract standardised to apigenin (item 3233 MATRICARIA CHAMOMILLA). Best known for: The only form used in the good trials taken by mouth, and the only one with a dose that matches a study. Absorption: Standardised by the stated apigenin content rather than by weight of flower. Typical use: The longest controlled trial used a pharmaceutical-grade extract at 1,500 mg a day. Standardised single-herb chamomile is uncommon on Australian shelves.
• Roman or English chamomile, flower and oil (items 1326 CHAMAEMELUM NOBILE and 1328 CHAMOMILE OIL ENGLISH). Best known for: A different plant that shares the common name, grown mainly for its oil. Absorption: There's no common standardisation marker, and we hold no absorption data. Typical use: Traditional and aromatherapy use. No trial we hold tests it on its own, so don't apply German chamomile results to a Roman chamomile product.
• German chamomile essential oil (item 1329 CHAMOMILE OIL GERMAN). Best known for: The deep blue oil. Chamazulene gives it the colour, and alpha-bisabolol comes with it. Absorption: It carries the fat-soluble part rather than the flavonoids. Typical use: For breathing in or applying to the skin, never for swallowing. Strengths vary hugely between products.
• Creams, gels and multi-herb formulas. Best known for: Skin products, and blends where chamomile sits alongside several other herbs. Absorption: Depends on the formula, and not established for any product we can point to. Typical use: Azulene and bisabolol are allowed only in medicines applied to the skin. In a blend, it's the whole formula that's tested, so a blend result is never a chamomile result.

Reference values. There isn't one, and there can't be. Chamomile is a herb, not a nutrient, so there's no recommended intake, no way to be low in it and no upper limit. Any percentage-of-daily-intake figure on a chamomile product doesn't mean anything.

Typical supplemental range. Australian shelves are mostly tea bags and multi-herb sleep and digestion formulas, and these rarely give a standardised chamomile dose at all. The trials are quite different: the longest used a pharmaceutical-grade German chamomile extract at 1,500 mg a day, as three 500 mg capsules, for twelve weeks and then a further twenty-six. Shorter trials used smaller daily doses standardised to their apigenin content. Keep that gap in mind before you compare a product with a study, because tea isn't standardised and nobody can tell you what a cup delivers.

Upper level. Australia's permitted ingredients list (Schedule 1) sets no maximum daily dose and no limit on how it's taken for any of the six chamomile entries. That doesn't mean anything goes: a brand still has to hold evidence for the dose it uses, and 1,500 mg a day of extract is the highest dose tested in a controlled trial we hold.

Worth knowing. How long you take it matters as much as the dose, because the trials that found a sleep benefit ran for weeks, not nights. Follow the label of the product you buy, because chamomile products can't be swapped gram for gram. What you need depends on your age, diet and health, so talk to one of our naturopaths.

Food first, where the diet allows it.

• Chamomile tea, infused from the dried flower heads: the one dietary source there is, and one of the most popular single-ingredient herbal teas. No verified grams-per-serve or apigenin-per-cup figure exists in our sources, so we won't publish one. In a blend there's less again, and it's almost never stated

If any of these sound like you, talk to one of our naturopaths or your doctor before you start.

• Allergy to plants in the daisy (Asteraceae or Compositae) family, such as ragweed, chrysanthemum, marigold, feverfew and echinacea. Reactions have been reported from the tea and from use on the skin. Don't take it at all.
• Warfarin and other blood thinners. Chamomile tea is named in a systematic review of 78 items that raise bleeding risk. Check with your prescriber.
• Antiplatelet medicines. Chamomile showed significant antiplatelet activity in the lab, in line with the warfarin finding. Check with your prescriber.
• Blood pressure medicine, or being underweight. 1,500 mg a day for twenty-six weeks significantly reduced body weight and average blood pressure.
• Extracts taken by mouth at trial doses. Some people left controlled trials because of mouth sores, skin spots and itching. Mild, but real.
• Older people with inflammatory bowel disease who take several medicines. It's flagged in the research on herb–medicine interactions, so tell your prescriber.
• Pregnancy and breastfeeding. There's no Schedule 1 warning, and no source shows whether taking it by mouth is safe or harmful. It's unresolved, so see a practitioner.
• Babies and children. A permitted claim for infant colic exists, but no chamomile trial supports it. See a practitioner.
• Choosing herbal tea without checking where it comes from. A review of metals in herbal teas found contamination across commonly drunk teas, which is a good reason to buy from a reputable source.
• Product quality in general. Standardisation of herbal products is inconsistent, and most sleep trials never tested the purity or strength of what they used.
• If you take prescription medicines, check with your doctor, pharmacist or our naturopaths before you start.