The following article is an academic narrative review I wrote for my doctoral program at Pacific College of Health Sciences. It analyzes the scientific evidence supporting the medicinal value of sea buckthorn oil for common gynecological disorders. If you would like to learn more about how to use sea buckthorn oil to support your own health, please book an appointment with me or another licensed medical provider to receive a customized treatment plan and recommendations that best suit your individual needs.

Abstract

Sea buckthorn, hippophae rhamnoides, is a thorny bush that grows around the world from Europe to the farthest parts of Eastern Asia. It produces golden orange berries and demands little soil or water to thrive. All parts of the plant have long been used in traditional medicine for their therapeutic benefits, in particular the berries which are pressed for their oil and used for an array of skin diseases and conditions. Beyond its uses in dermatology, it also has medicinal properties that are immune modulating, anti-microbial, cholesterol reducing and cellularly regenerative on multiple levels. Its biochemical make up has been extensively studied to better understand its unique composition of bioactive compounds including flavonoids, antioxidants, minerals, vitamins and fatty acids. While its therapeutical potential is extensive and applications are broad it has been shown to have promising outcomes for gynecological conditions including vulvovaginal atrophy, vaginitis, infections and dysbiosis. It is safe to use orally and topically and offers a well-tolerated, alternative approach to common gynecological diseases that are often chronic and difficult to address with conventional treatments. It offers an important and exciting new approach to treating and supporting health holistically from the inside out. Understanding its synergistic combination of ingredients as well as the research that’s been done on these individual substances is an important aspect of properly utilizing this phytotherapeutic substance in a clinical settings with patients. This narrative review aims to break down and evaluate the existing research, discuss similarities and discrepancies and give an overall assessment of sea buckthorn’s medicinal properties for patients and practitioners alike so it can be successfully used in treatment.

Methods:

Online databases searched include Pubmed, Oxford Academic, EBSCO, and Medscape. Search words included “sea buckthorn” and “sea buckthorn oil”. Article titles were reviewed for content and relevance to human health and the application in gynecological issues. Two of the articles involved human subjects in double-blind randomized placebo-controlled studies involving sea buckthorn oil efficacy for treating vaginal atrophy (De Seta et al., 2021; Larmo et al., 2014). One of the articles selected used mice to study the protective effects of SBO against radiation exposure (Shi et al., 2017). The remaining 7 articles were reviews of both efficacy, safety, impacts, therapeutic uses, health benefits as well as its phytochemical and pharmacological profile which references and summarizes extensive amounts of research. These articles are included to better understand the bioactivity and medicinal properties of SBO. No publishing date restrictions were applied in initial search but all clinical trials were conducted in the last decade. The oldest article was published in 2004 in the Journal of Biological Sciences. Additional statistics on disease etiology and prevalence of vaginitis and GMS were referenced from the CDC, Mayoclinic, PubMed and Medscape to further explain the etiology and prevalence of the conditions discussed and support the value and importance of the narrative review.

Introduction:

Sea buckthorn, is a fruit bearing deciduous shrub that grows all over Europe and Asia and has a long standing use in traditional medicine. It is a regenerative and beneficial pioneer species requiring little water or soil to flourish into a miraculous medicinal plant that has long been revered since ancient times (Wang et al., 2022). All parts of the plant can be used medicinally including the leaves, seeds, fruits and flowers. The most commonly used form of sea buckthorn is cold-pressed oil extracted from the seeds are fruits. On a chemical level the oil is composed of ester-linked glycerol compounds and higher fatty acids containing aliphatic chain hydrocarbons and numerous active ingredients that possess a broad spectrum of medicinal values (Marsiñach & Cuenca, 2019). Sea buckthorn oil has long been used in skincare products to soothe skin and rejuvenate its appearance. It has a rich golden orange color and an array of active ingredients that regenerate and repair the skin. These substances include unsaturated fatty acids Omega 7 (palmitooleic acid) and Omega 6 (gamma-linolenic acid) as well as vitamins A, B1, B2, B6 and C (Zielińska & Nowak, 2017). Sea buckthorn oil increases blood flow, oxygenates the skin, detoxifies the body and deeply absorbs into the dermis where Omega 6 converts to prostaglandins imparting infection fighting, anti-histamine and additional anti-inflammatory properties that slow the aging process. (Zielińska & Nowak, 2017). It has additionally been found to posses antioxidant, anti-tumor, anti-hyperlipidemic, neuroprotective, and hepatoprotective properties (Rohi-Boroujeni & Kiani, 2015).

This narrative review intends to investigate the scientific evidence existing to support the therapeutic use of sea buckthorn to support aspects of human health such as tissue repair and regeneration with a specific focus on gynecological issues. It will explore not only clinical trials using sea buckthorn but also reviews of scientific studies done on the therapeutic effects of its active ingredients and overall biochemical composition to explore the full spectrum of its value. This review is important and relevant because sea buckthorn oil promises a safe, effective and well-tolerated alternative to pharmaceuticals (De Seta et al., 2021). It is valuable for CAM clinicians to be fully informed and understand the scientific findings in order to provide evidence based recommendations to patients to improve quality of care and outcomes. This review aims to inform and educate about the most viable applications, administrations and relevant uses of this superfruit oil. It focuses on gynecological conditions commonly seen in practice such as vaginal atrophy in post-menopausal woman, an issue over 50% of women in this phase of life experience (De Seta et al., 2021). Vaginal atrophy is generally caused by a decrease of estrogen and can cause a variety of painful symptoms in both the genital and urinary systems and has thus been classified as genitourinary syndrome of menopause or GMS (Angelou et al., 2020). GMS can severely reduce quality of life for women, restrict or eliminate sexual activity entirely, increase risk of vaginal infections and cause urinary issues including incontinence. Vaginal atrophy does not exclusively occur in post-menopausal woman but also women who have had hysterectomies or undergone chemotherapy (Mayo Clinic, 2021). Women of any age can suffer from vaginitis caused by dysbiosis and ph imbalances leading to inflammation and vaginal tissue damage causing reoccurring infections which become chronic and treatment resistant. Vaginitis is the most frequently reported gynecological condition in women globally. 40-45% of women who report symptoms are suffering from bacterial vaginosis and an estimated 29% of women in the United States have BV (Hetal B Gor, 2021). The personal and intimate nature of these condition limits patients comfortability discussing them with healthcare practitioners. Treatment is often delayed or the condition goes undiagnosed entirely. Conventional treatments for GMS include estrogen replacement therapy (Angelou et al., 2020). Vaginitis related to dysbiosis is generally treated with antibiotics (CDC – BV treatment 2021). These drugs must be prescribed by a qualified physician and pose secondary health implications, often times not entirely resolving the problem and further compounding the dysbiosis and subsequent tissue inflammation. The estrogen in oral contraception is often associated with vaginitis and dysbiosis despite it being a standard treatment in menopausal women. Sea buckthorn oil is entirely natural, available over the counter and supports overall vaginal health (Larmo et al., 2014). It offers a relatively inexpensive, low-risk and holistic alternative to treat and manage these common issues while simultaneously serving as a potent nutritional supplement with a magnitude of medicinal properties and value.

Discussion:

To understand the medicinal value of sea buckthorn oil (SBO), one must understand its biochemical composition. It is important to note there is a difference in chemical composition between sea buckthorn oil made from the berries (fruit, pulp) and sea buckthorn seed oil. Sea buckthorn fruit oil has more palmitoleic acid than any other vegetable oil (Marsiñach & Cuenca, 2019). This oil has a deep golden red hue due to its high carotenoid content which also differs from the seed oil. Regardless of the oil being from the seed or fruit pulp, both types of sea buckthorn (fruit & seed) oil contain a wide range of unsaturated fatty acids, tocopherols, tocotrienols and sterols which benefit the skin. Overall the research reviewed shows a greater therapeutic value in oil made from the fruit of sea buckthorn versus the seed (Marsiñach & Cuenca, 2019). While the seed oil still had medicinal properties some of the active ingredients are less concentrated than in SB fruit oil and the clinical outcomes were favorable in the groups treated with fruit oil compared to the seed oil. In conclusion sea buckthorn fruit oil is a more bioactive, potent phyto-therapeutic substance for clinical application and the recommended form to use (Rohi-Boroujeni & Kiani, 2015).

Taking a closer look at the individual ingredients in sea buckthorn oil provides a greater understanding of the effects each individual compound has on the body. Many of these compounds are found in other plant and animal sources that are regarded and used medicinally such as flavonoids, carotenoids, fatty acids, vitamins, minerals and more (Wang et al., 2022). There is extensive scientific research on the health benefits of many of the compounds found in SBO. While this research bolsters the medicinal value of SBO, it does not fully represent its therapeutic potential. It is important to take into account the potential synergism created by all the ingredients combined, leaving much to be discovered in future research and clinical trials. As demonstrated in Chinese Herbal Medicine, the formulas function on the concept that the whole is greater than the sum of the parts. This is most likely the case with sea buckthorn oil and simply studying the isolated ingredients does not fully explore its value or potential. It does however enable a better understanding of the bioactive ingredients in sea buckthorn that give it medicinal properties and encourages further investigation into potential uses and clinical applications. Overall the research into the bioactive compounds that compose SBO have similar findings without contradiction between studies. (Marsiñach & Cuenca, 2019).

The phospholipids and glycolipids found in SBO moisturize and soften the epidermis, increase elasticity, are anti-inflammatory and speed regeneration by promoting skin cell renewal. One such phospholipid, phosphatidylcholine, the primary component of lecithin, slows the cellular aging process. The oil contains sterols which strengthen the skin barrier and have a protective effect as well as reduce water loss to boost elasticity and firmness (Kumar et al., 2011). Additionally liposomes present in sea buckthorn oil enable the active ingredients in the oil to permeate the skin while its ceramides maintain hydration and promote regeneration. (Zielińska & Nowak, 2017).

SBO Contains vitamins A, C, E and B complex. Vitamin A is present in the form of carotenoids and has regenerative, anti-aging effects. The vitamin C content is 15 times higher in sea buckthorn than orange fruit providing its potent anti-oxidant properties. Vitamin E as tocopherols as well as other flavonoids and minerals strengthen capillary blood vessels. SBO also contains sterols, malic and citric acids, tannins, phenolic compounds, pectins and mineral salts such as zinc, copper, sulfur, and selenium. (Zielińska & Nowak, 2017). Heart disease is the leading cause of death in the United States (CDC, 2022). Sea buckthorn oil has been shown to benefit cardiovascular health in multiple studies in varying ways. 128 patients with coronary artery disease were given 10 mg of SBO, 3 times a day for 6 weeks. The patients in this double-blind clinical trial showed an improvement in cardiac function, decrease in total cholesterol and reduction in angina symptoms as compared to the control group. Notably, no harmful effects to renal or hepatic function were detected. Furthermore, the SBO’s mechanism of action of regulating inflammatory mediators may reduce cardiac muscle stress. The antioxidants in SBO are thought to inhibit the formation of atherosclerosis by reducing lipid oxidation damage. Sea buckthorn contains a plethora of both aqueous and lipophilic antioxidants. (Zeb, 2004).

Sea buckthorn oil is commonly used for its skin reparative qualities. There is a mountain of evidence supporting the use of SBO to protect and restore damaged tissues. A laboratory study (Zeb, 2004), confirmed the efficacy of sea buckthorn seed oil in the treatment of gastrointestinal ulcers. It was shown to normalize gastric acid output and reduce inflammation by controlling pro-inflammatory mediators. It actively prevented gastrointestinal tissue damage in models with both stress and NSAID induced ulcers (Zeb, 2004).

Several studies demonstrate SBO’s ability to protect the liver from chemical damage and also its ability to help normalize serum levels in patients undergoing anti-viral treatment for patents with chronic hepatitis B. Studies also demonstrated SBO normalizes liver enzymes, serum bile acids and regulates immune markers responsible for inflammation and degeneration of the liver. (Zeb, 2004).

A study using mice demonstrated SBO’s ability to protect against radiation. Two groups of mice that were exposed to full body radiation. The group pretreated with SBO lived approximately twice as long as the control group treated with olive oil. With the use of TUNEL staining, scientist were able to determine the SBO reduced the percentage of apoptotic cells in the intestines as well as the presence of inflammatory markers. A western blot determined radiation-induced enzymatic activity was inhibited significantly by pretreatment with sea buckthorn oil. (Shi et al., 2017). SBO can substantially relieve and reduce symptoms of chemotherapy for cancer patients. It promotes health tissue growth, reduces site infections, improves digestive function and elimination, increases appetite, protects the liver and kidneys, and overall enhances the patients quality of life (Kumar et al., 2011).

Sea buckthorn has a soothing effect on the digestive system and is used to treat inflammatory gastric ulcers and diarrhea. The oil lowers cholesterol levels and decreases risk of thrombophlebitis. It soothes symptoms of rheumatoid disease. It can also relieve symptoms of febrile disease in particular ones cause by bacteria and viruses due to its anti-microbial and anti- viral properties (Zielińska & Nowak, 2017).

Specific to use in gynecology, SBO has promising therapeutic applications for vaginal atrophy and generalized vaginitis. In one case study, the vaginal mucous membranes were examined and evaluated in 30 postmenopausal female subjects, 15 of which had received treatment with SBO and 15 in the control group. The elasticity, moisture, ph level, epithelial integrity as well as the individuals evaluation of symptoms were documented before, during and after treatment. The study findings support that oral intake of SBO strengthens the vaginal epithelium. 3 grams of SBO taken 1x a day for a 3 month period relieved symptoms of itching pain, burning and dryness for the entire treatment group. (Larmo et al., 2014) The study concluded this is because SBO has a beneficial effect on the integrity of the vaginal epithelium, most likely due to its bioactive compounds and not because of any interaction or activation of the estrogen receptors. This is a positive finding as it demonstrates SBO does not interact with hormonal receptors, unlike conventional treatment for vaginal atrophy that contains estrogen. It offers a natural, better tolerated alternative method of treatment for both hormone sensitive women and women who would prefer a natural approach. (Larmo et al., 2014). It is also used to treat non-menopausal vaginitis and cervicitis and cervical erosion and is safe for pregnant and breastfeeding women (Zielińska & Nowak, 2017).

A study involving postmenopausal women suffering from vulvovaginal atrophy, VVA, found an intra-vaginal gel containing sea buckthorn oil, aloe vera, 18β-glycyrrhetinic acid, hyaluronic acid and glycogen to be a safe, effective and well tolerated treatment. In this study the gel was applied for 14 days straight and then applied 2x a week for 90 days, consecutively. Results were measures using the Vaginal Health Index which includes vaginal pH as well as Female Sexual Function Index (FSFI), which is a patient reported index used to evaluate sexual function. The gel successfully reduced pain, dyspareunia, and lowered vaginal pH with significant improvement at 90 days. There was a significant reduction in vaginal dryness itching and burning after 2 weeks maintained through the end of the study. The FSFI scores were significantly improved in the treatment group by the end of the 90 days. (De Seta et al., 2021).

Conclusion:

Ultimately, sea buckthorn has a plethora of medicinal applications and scientific evidence to support its use for a variety of health conditions including heart disease, inflammatory diseases and immunological problems. Gynecologically speaking this oil is a perfect solution to the prevalent problem of vulvovaginal atrophy (VVA), in post menopausal women and women of all ages suffering from vaginal symptoms and inflammation. Furthermore it has an overall positive effect on many aspects of the human health and well-being, making it an even better option than conventional estrogen treatments for many patients. An additional remarkable component of using sea buckthorn medicinally is, while it may be intended to treat one specific condition it may also have an overall beneficial effect on one or many other aspects of health. Sea buckthorn has been extensively studied, not only its biochemical composition but its medical applications. Overall the findings are consistent and in agreement, there are no discrepancies between claims or described biochemical composition. Although much of the research included in this narrative are summarizations of studies, with further investigation, quantitative data on specific outcomes can be found. Continuing to focus on conducting clinical trials to determine the efficacy of SBO for specific conditions will further bolster its clinical use and value. While this narrative review helps to inform and advocate for the use of sea buckthorn oil for treatment of gynecological issues and beyond, a SBO treatment protocol and method should be developed on an case by case basis, to best suit the patients individualized needs and treatment goals.

References

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Centers for Disease Control and Prevention. (2021, July 22). CDC – BV treatment. Centers for Disease Control and Prevention. Retrieved February 8, 2023, from https://www.cdc.gov/ std/bv/treatment.htm

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De Seta, F., Caruso, S., Di Lorenzo, G., Romano, F., Mirandola, M., & Nappi, R. E. (2021). Efficacy and safety of a new vaginal gel for the treatment of symptoms associated with vulvovaginal atrophy in postmenopausal women: A double-blind randomized placebo- controlled study. Maturitas, 147, 34–40. https://doi.org/10.1016/j.maturitas.2021.03.002

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Kumar, R., Kumar, G. P., Chaurasia, O. P., & Bala Singh, S. (2011). Phytochemical and pharmacological profile of Seabuckthorn Oil: A Review. Research Journal of Medicinal Plant, 5(5), 491–499. https://doi.org/10.3923/rjmp.2011.491.499

Larmo, P. S., Yang, B., Hyssälä, J., Kallio, H. P., & Erkkola, R. (2014). Effects of sea buckthorn oil intake on vaginal atrophy in postmenopausal women: A randomized, double-blind, placebo-controlled study. Maturitas, 79(3), 316–321. https://doi.org/10.1016/ j.maturitas.2014.07.010

Mayo Foundation for Medical Education and Research. (2021, September 17). Vaginal atrophy. Mayo Clinic. Retrieved February 8, 2023, from https://www.mayoclinic.org/diseases- conditions/vaginal-atrophy/symptoms-causes/syc-20352288

Rohi-Boroujeni, H., & Kiani, S. (2015, July 1). A review of therapeutic and non-therapeutic properties of Sea Buckthorn. Future Natural Products. Retrieved February 8, 2023, from http://futurenatprod.skums.ac.ir/article_12701.html

Shi, J., Wang, L., Lu, Y., Ji, Y., Wang, Y., Dong, K., Kong, X., & Sun, W. (2017). Protective effects of seabuckthorn pulp and seed oils against radiation-induced acute intestinal injury. Journal of Radiation Research, 58(1), 24–32. https://doi.org/10.1093/jrr/rrw069

Marsiñach, M. S., & Cuenca, A. P. (2019). The impact of sea buckthorn oil fatty acids on human health. Lipids in Health and Disease, 18(1). https://doi.org/10.1186/s12944-019-1065-9

Wang, Z., Zhao, F., Wei, P., Chai, X., Hou, G., & Meng, Q. (2022). Phytochemistry, health benefits, and food applications of sea buckthorn (hippophae rhamnoides L.): A comprehensive review. Frontiers in Nutrition, 9. https://doi.org/10.3389/ fnut.2022.1036295

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