Juniperus communis (common juniper)
This article was written by Eric Yarnell, ND, RH(AHG) and is protected by copyright, 2020.
The information in this article cannot substitute for the care of a health care provider with expertise in herbal medicine in treating individual patients.
The information in this article cannot substitute for the care of a health care provider with expertise in herbal medicine in treating individual patients.
Introduction
Juniper (Juniperus communis) has long been in use as a diuretic, urinary antiseptic, anti rheumatic, and other purposes. During the Eclectic era of herbalism in North America (mid 1800s–1900s), writings discussed that juniper was specifically used for kidney disease. At some point following that era, a belief came about that juniper is toxic to the kidneys and is contraindicated in patients with kidney disease. This belief persists today, though it's basis is highly dubious. There are a variety of clinical situations in which juniper is a specific and valuable remedy, and shunning it out of irrational fear is not helpful to patients.
Using Juniper Correctly
Juniper can be helpful in patients with chronic kidney disease. The Eclectic physicians Ellingwood (1919) and Felter (1922) particularly recommended it in cases of renal atony in aged or feeble patients that are accompanied by a persistent sense of weight and dragging in the lumbar region and to prevent permanent damage in cases of kidney inflammation. They found it helpful for serious kidney infections. Yet today, various sources describe it as contraindicated in exactly these situations. While it might be tempting to say that Ellingwood and Felter were just making things up, the reality is they were fairly skeptical authors among the Eclectics, stated in many situations when they encountered ineffective therapies, and were definitely practicing what they preached.
Today juniper is more often used to treat lower urinary tract infections. I have found it among the most effective single herb in this regard, as it is a potent antimicrobial in the urine, a potent diuretic, and a passable inflammation modulator. In doses of just 1 ml of tincture (1:2–1:3 weight:volume) of the female cones (they aren't berries!) every 2–4 hours for the first 24–72 hours, it can cure an acute urinary tract infection. This also makes it a highly cost effective treatment. Combining it with other herbs only augments its efficacy. So it would be a great shame to lose this effective treatment based on a fear it is going to harm the kidneys it will actually help protect.
Today juniper is more often used to treat lower urinary tract infections. I have found it among the most effective single herb in this regard, as it is a potent antimicrobial in the urine, a potent diuretic, and a passable inflammation modulator. In doses of just 1 ml of tincture (1:2–1:3 weight:volume) of the female cones (they aren't berries!) every 2–4 hours for the first 24–72 hours, it can cure an acute urinary tract infection. This also makes it a highly cost effective treatment. Combining it with other herbs only augments its efficacy. So it would be a great shame to lose this effective treatment based on a fear it is going to harm the kidneys it will actually help protect.
Is Juniper Toxic?
With a vast array of clinical usefulness, how did juniper develop a reputation for toxicity? Tisserand and Young (2013), acclaimed aromatherapists, traced the problem back to a historical problem with adulteration of juniper volatile oil with Juniperus sabina (savin) volatile oil. Savin is a close botanical relative of juniper’s that is actually nephrotoxic. Though no modern studies could be found on the nephrotoxicity of savin, it has been shown to be hepatotoxic, teratogenic, oxytocic, and to interfere with embryo implantation in mice (Chamorro, et al. 1990). It is unclear but unlikely that savin adulteration occurs in modern times, and has nothing to do with using a tincture not a volatile oil of juniper.
Another theory is that the terpene alcohols in juniper are the safe compounds that support kidney health and provide the many other benefits of juniper, while the monoterpene hydrocarbons are nephrotoxic (Schilcher and Heil 1994). These authors recommend clinical use of juniper oils with a low hydrocarbon:terpinen-4-ol ratio (3:1) as they are safer, while those with a higher ratio (5:1) are not as safe. Few, if any, products are tested for or identify this ratio on the label in the United States, so it would be difficult to know if one were taking a problematic extract. And again, this may have nothing to do with crude extracts or whole cones compared to the volatile oil. Juniperus oxycedrus (cade) volatile oil applied to a large area of a newborn baby with atopic dermatitis also resulted in death, in part due to acute renal failure (Achour, et al. 2011). Clearly this product is not what is generally used clinically as juniper and is another reason to stick with crude extracts of J. communis and not to use volatile oils of other species of juniper clinically.
Animal studies have not been able to confirm a nephrotoxic effect of juniper. One rat study found that massive doses of juniper volatile oil or terpinen-4-ol were nontoxic (Schilcher and Leuschner 1997). One review of medical literature starting in 1844 concluded that the idea of juniper's nephrotoxicity originates from confusion with the use of turpentine oil in animals, and that cases of toxicity were associated with overdose (Schilcher and Heil 1994).
Furthermore, presence of proteinuria associated with supposed juniper nephrotoxicity was just as easily explained by the acute kidney infections that were being treated (Moore 2003). There is actually evidence form recent animal studies that juniper volatile oil is actually nephroprotective in some settings (Butani, et al. 2013; Ali, et al. 2010). Since no clinical cases of supposed juniper nephrotoxicity have been published since 1937, and since no other studies on true juniper in preclinical settings showed nephrotoxicity up to and including research in the late 1980s, it seems juniper's nephrotoxicity is a myth (Schilcher and Heil 1994).
Another theory is that the terpene alcohols in juniper are the safe compounds that support kidney health and provide the many other benefits of juniper, while the monoterpene hydrocarbons are nephrotoxic (Schilcher and Heil 1994). These authors recommend clinical use of juniper oils with a low hydrocarbon:terpinen-4-ol ratio (3:1) as they are safer, while those with a higher ratio (5:1) are not as safe. Few, if any, products are tested for or identify this ratio on the label in the United States, so it would be difficult to know if one were taking a problematic extract. And again, this may have nothing to do with crude extracts or whole cones compared to the volatile oil. Juniperus oxycedrus (cade) volatile oil applied to a large area of a newborn baby with atopic dermatitis also resulted in death, in part due to acute renal failure (Achour, et al. 2011). Clearly this product is not what is generally used clinically as juniper and is another reason to stick with crude extracts of J. communis and not to use volatile oils of other species of juniper clinically.
Animal studies have not been able to confirm a nephrotoxic effect of juniper. One rat study found that massive doses of juniper volatile oil or terpinen-4-ol were nontoxic (Schilcher and Leuschner 1997). One review of medical literature starting in 1844 concluded that the idea of juniper's nephrotoxicity originates from confusion with the use of turpentine oil in animals, and that cases of toxicity were associated with overdose (Schilcher and Heil 1994).
Furthermore, presence of proteinuria associated with supposed juniper nephrotoxicity was just as easily explained by the acute kidney infections that were being treated (Moore 2003). There is actually evidence form recent animal studies that juniper volatile oil is actually nephroprotective in some settings (Butani, et al. 2013; Ali, et al. 2010). Since no clinical cases of supposed juniper nephrotoxicity have been published since 1937, and since no other studies on true juniper in preclinical settings showed nephrotoxicity up to and including research in the late 1980s, it seems juniper's nephrotoxicity is a myth (Schilcher and Heil 1994).
Bottom Line
Overall, juniper is safe in reasonable doses, including in acute kidney infection and people with chronic kidney disease. It is not particularly indicated for acute glomerulonephritis, but should not represent a particularly toxic influence in patients with this condition. Its use for chronic kidney disease needs to be evaluated, as it was so highly recommended by the Eclectics for this purpose.
Acknowledgement: Lauren Herold helped in the writing of this article; thanks!
Acknowledgement: Lauren Herold helped in the writing of this article; thanks!
References
Achour S, Abourazzak S, Mokhtari A, et al. (2011) "Juniper tar (cade oil) poisoning in new born after a cutaneous application" BMJ Case Rep 2011:bcr0720114427. PMID https://pubmed.ncbi.nlm.nih.gov/22675090
Ali SA, Rizk MZ, Ibrahim NA, et al. (2010) "Protective role of Juniperus phoenicea and Cupressus sempervirens against CCl4" World J Gastrointest Pharmacol Ther 1(6):123–131. PMID https://pubmed.ncbi.nlm.nih.gov/21577307
Butani L, Afshinnik A, Johnson J, et al. (2013) "Amelioration of tacrolimus-induced nephrotoxicity in rats using juniper oil" Transplantation 76(2):306–311. PMID https://pubmed.ncbi.nlm.nih.gov/12883183/
Chamorro G, Salazar M, Fournier G, Pages N (1990) "The anti-implantation effects of various savine extracts on the pregnant rat" J Toxicol Clin Exp 10(3):157–160 [in French]. PMID https://pubmed.ncbi.nlm.nih.gov/2231471
Ellingwood F (1919) American Materia Medica, Pharmacognosy and Therapeutics 11th ed (Sandy, OR Eclectic Medical Publications).
Felter HW (1922) Eclectic Materia Medica, Pharmacology and Therapeutics (Sandy, OR Eclectic Medical Publications).
Janku I, Hava M, Kraus R, Motl O (1960) "The diuretic principle of juniper" Naunyn Schmiedebergs Arch Exp Pathol Pharmakol 238:112–113 [in German]. PMID https://pubmed.ncbi.nlm.nih.gov/14406705
Mabey R, McIntyre M, Michael P, et al. (1988) The New Age Herbalist (New York, NY Collier Books).
Moore M (2003) Medicinal Plants of the Mountain West Revised and Expanded Edition (Santa Fe, NM Museum of New Mexico Press).
Pages N, Fournier G, Chamorro G, et al. (1989) "Teratological evaluation of Juniperus sabina essential oil in mice" Plant Med 55(2):144–146. PMID https://pubmed.ncbi.nlm.nih.gov/2748731
Renaux J, La Barre J (1941) "Regarding the oxytocic effects of essences of rue and savin" Acta Biol Belg 1:334–335 [in French].
Schilcher H, Boesel R, Effenberger S, Segebrecht S (1989) "Recent results with effective aquaretic, antibacterial and prostatotropic medicinal plants" Z Phytother 10:77–82 [in German].
Schilcher H, Leuschner F (1997) "The potential nephrotoxic effects of essential juniper oil" Arzneim Forsch 47(7):855–858 [in German]. PMID https://pubmed.ncbi.nlm.nih.gov/9324932
Schilcher H, Heil BM (1994) "Nephrotoxicity of juniper berry preparations: A critical review of the literature from 1844 to 1993'' Z Phytother 15(4):205–208, 211–213 [in German].
Tisserand R, Young R (2013) Essential Oil Safety Second Edition (Churchill Livingstone).
Wojcikowski K, Wohlmuth H, Johnson DW, et al. (2009) "An in vitro investigation of herbs traditionally used for kidney and urinary system disorders: Potential therapeutic and toxic effects" Nephrology (Carlton) 14(1):70–79. PMID https://pubmed.ncbi.nlm.nih.gov/18808387
Ali SA, Rizk MZ, Ibrahim NA, et al. (2010) "Protective role of Juniperus phoenicea and Cupressus sempervirens against CCl4" World J Gastrointest Pharmacol Ther 1(6):123–131. PMID https://pubmed.ncbi.nlm.nih.gov/21577307
Butani L, Afshinnik A, Johnson J, et al. (2013) "Amelioration of tacrolimus-induced nephrotoxicity in rats using juniper oil" Transplantation 76(2):306–311. PMID https://pubmed.ncbi.nlm.nih.gov/12883183/
Chamorro G, Salazar M, Fournier G, Pages N (1990) "The anti-implantation effects of various savine extracts on the pregnant rat" J Toxicol Clin Exp 10(3):157–160 [in French]. PMID https://pubmed.ncbi.nlm.nih.gov/2231471
Ellingwood F (1919) American Materia Medica, Pharmacognosy and Therapeutics 11th ed (Sandy, OR Eclectic Medical Publications).
Felter HW (1922) Eclectic Materia Medica, Pharmacology and Therapeutics (Sandy, OR Eclectic Medical Publications).
Janku I, Hava M, Kraus R, Motl O (1960) "The diuretic principle of juniper" Naunyn Schmiedebergs Arch Exp Pathol Pharmakol 238:112–113 [in German]. PMID https://pubmed.ncbi.nlm.nih.gov/14406705
Mabey R, McIntyre M, Michael P, et al. (1988) The New Age Herbalist (New York, NY Collier Books).
Moore M (2003) Medicinal Plants of the Mountain West Revised and Expanded Edition (Santa Fe, NM Museum of New Mexico Press).
Pages N, Fournier G, Chamorro G, et al. (1989) "Teratological evaluation of Juniperus sabina essential oil in mice" Plant Med 55(2):144–146. PMID https://pubmed.ncbi.nlm.nih.gov/2748731
Renaux J, La Barre J (1941) "Regarding the oxytocic effects of essences of rue and savin" Acta Biol Belg 1:334–335 [in French].
Schilcher H, Boesel R, Effenberger S, Segebrecht S (1989) "Recent results with effective aquaretic, antibacterial and prostatotropic medicinal plants" Z Phytother 10:77–82 [in German].
Schilcher H, Leuschner F (1997) "The potential nephrotoxic effects of essential juniper oil" Arzneim Forsch 47(7):855–858 [in German]. PMID https://pubmed.ncbi.nlm.nih.gov/9324932
Schilcher H, Heil BM (1994) "Nephrotoxicity of juniper berry preparations: A critical review of the literature from 1844 to 1993'' Z Phytother 15(4):205–208, 211–213 [in German].
Tisserand R, Young R (2013) Essential Oil Safety Second Edition (Churchill Livingstone).
Wojcikowski K, Wohlmuth H, Johnson DW, et al. (2009) "An in vitro investigation of herbs traditionally used for kidney and urinary system disorders: Potential therapeutic and toxic effects" Nephrology (Carlton) 14(1):70–79. PMID https://pubmed.ncbi.nlm.nih.gov/18808387