Peppermint Oil for Irritable Bowel Syndrome

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Peppermint essential oil should be considered the first-line treatment for IBS.

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Irritable bowel syndrome is a chronic, episodic intestinal disorder characterized by abdominal pain and altered bowel habits affecting 1 in 7 Americans, though most go undiagnosed. It can have a substantial impact on well-being and health. Doctors underestimate the impact the disease can have, particularly the pain and discomfort. Using some measures, the health-related quality of life of irritable bowel sufferers can rival that of sufferers of much more serious disorders, such as diabetes, kidney failure, and inflammatory bowel disease. So, the first step toward successful treatment is for doctors to acknowledge the condition, and not dismiss the patient as just hysterical or something.

Another reason sufferers often don’t seek medical care may be the lack of effectiveness of the available treatments. There is a huge unmet therapeutic need.

Since there is no cure for IBS, treatment is targeted to alleviate the symptoms. The typical antispasmodic drugs can cause side effects, such as dry mouth, dizziness, blurred vision, confusion, and fall risk, but there are new drugs on the market now, like Lubiprostone, which can cost $2,000 a year, and cause—as side effects—many of the symptoms you’re trying to treat. Linaclotide is one of the newest, $3,000 a year, and again can cause the very problems it’s designed to help.

Antidepressants are commonly given, but may take four to six weeks to help for Prozac or Celexa; up to 12 weeks for Paxil, and have their own array of side effects–including sexual dysfunction caused by these three drugs in over 70% of the people who take them. There’s got to be a better way.

Acupuncture works, but no better than placebo. What’s placebo acupuncture? It’s where you poke people with a fake needle away from any known acupuncture points, yet, that worked just as well as real acupuncture, showing the power of the placebo effect. I’ve talked about the ethics of so many doctors effectively passing off sugar pills as effective drugs, who argue the ends justify the means. There’s actually a way to harness the placebo effect without lying to patients, though. You tell them it’s a sugar pill. Patients with irritable bowel syndrome were randomized to either get nothing—or a prescription medicine bottle of placebo pills with a label clearly marked “Placebo pills,” “Take 2 pills twice daily.” I kid you not.

And lo and behold, it worked. That’s how powerful the placebo effect can be for irritable bowel. They conclude that for some disorders, it may be appropriate for clinicians to recommend that patients try an inexpensive and safe placebo. Indeed, sugar pills probably won’t cost $3,000 a year, but is there a safe alternative that actually works?

Nine randomized placebo-controlled studies have found peppermint oil to be a safe and effective treatment for irritable bowel syndrome. A few adverse events were reported, but were mild and transient in nature, such as a peppermint taste, peppermint smell, and a cooling sensation around one’s bottom; whereas in some of the head-to-head peppermint versus drug studies, some of the drug side effects were so unbearable they had to drop out of the study. This suggests that it might be a reasonable approach for clinicians to treat IBS patients with peppermint oil as a first-line therapy, before trying anything else.

The longest trial lasted only 12 weeks, so we don’t know about long-term efficacy, though the benefits may last at least a month after stopping, thought perhaps to be due to lasting changes in our gut flora.

The studies used peppermint oil capsules, so they could match them with placebo pills. What about peppermint tea? It’s never been tested, but one might assume it wouldn’t be concentrated enough, but a quarter cup of fresh peppermint leaves has as much peppermint oil as some of the capsule doses used in the studies, which one could easily blend into a smoothie, or with frozen berries to make something like my pink juice recipe. You can grow mint right on your window sill.

We doctors need effective treatments that are cheap, safe, and available. This is particularly relevant now as newer and more expensive drugs have either failed to work or been withdrawn from the market owing to concerns about serious adverse events.

Just like it may be a good idea to eat only foods with ingredients you can pronounce, it may be better to try some mint before novel pharmacological approaches, such the new dual mu-opioid agonist delta-antagonist drug with a name like JNJ27018966.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to The Clear Communication People via Flickr.

Irritable bowel syndrome is a chronic, episodic intestinal disorder characterized by abdominal pain and altered bowel habits affecting 1 in 7 Americans, though most go undiagnosed. It can have a substantial impact on well-being and health. Doctors underestimate the impact the disease can have, particularly the pain and discomfort. Using some measures, the health-related quality of life of irritable bowel sufferers can rival that of sufferers of much more serious disorders, such as diabetes, kidney failure, and inflammatory bowel disease. So, the first step toward successful treatment is for doctors to acknowledge the condition, and not dismiss the patient as just hysterical or something.

Another reason sufferers often don’t seek medical care may be the lack of effectiveness of the available treatments. There is a huge unmet therapeutic need.

Since there is no cure for IBS, treatment is targeted to alleviate the symptoms. The typical antispasmodic drugs can cause side effects, such as dry mouth, dizziness, blurred vision, confusion, and fall risk, but there are new drugs on the market now, like Lubiprostone, which can cost $2,000 a year, and cause—as side effects—many of the symptoms you’re trying to treat. Linaclotide is one of the newest, $3,000 a year, and again can cause the very problems it’s designed to help.

Antidepressants are commonly given, but may take four to six weeks to help for Prozac or Celexa; up to 12 weeks for Paxil, and have their own array of side effects–including sexual dysfunction caused by these three drugs in over 70% of the people who take them. There’s got to be a better way.

Acupuncture works, but no better than placebo. What’s placebo acupuncture? It’s where you poke people with a fake needle away from any known acupuncture points, yet, that worked just as well as real acupuncture, showing the power of the placebo effect. I’ve talked about the ethics of so many doctors effectively passing off sugar pills as effective drugs, who argue the ends justify the means. There’s actually a way to harness the placebo effect without lying to patients, though. You tell them it’s a sugar pill. Patients with irritable bowel syndrome were randomized to either get nothing—or a prescription medicine bottle of placebo pills with a label clearly marked “Placebo pills,” “Take 2 pills twice daily.” I kid you not.

And lo and behold, it worked. That’s how powerful the placebo effect can be for irritable bowel. They conclude that for some disorders, it may be appropriate for clinicians to recommend that patients try an inexpensive and safe placebo. Indeed, sugar pills probably won’t cost $3,000 a year, but is there a safe alternative that actually works?

Nine randomized placebo-controlled studies have found peppermint oil to be a safe and effective treatment for irritable bowel syndrome. A few adverse events were reported, but were mild and transient in nature, such as a peppermint taste, peppermint smell, and a cooling sensation around one’s bottom; whereas in some of the head-to-head peppermint versus drug studies, some of the drug side effects were so unbearable they had to drop out of the study. This suggests that it might be a reasonable approach for clinicians to treat IBS patients with peppermint oil as a first-line therapy, before trying anything else.

The longest trial lasted only 12 weeks, so we don’t know about long-term efficacy, though the benefits may last at least a month after stopping, thought perhaps to be due to lasting changes in our gut flora.

The studies used peppermint oil capsules, so they could match them with placebo pills. What about peppermint tea? It’s never been tested, but one might assume it wouldn’t be concentrated enough, but a quarter cup of fresh peppermint leaves has as much peppermint oil as some of the capsule doses used in the studies, which one could easily blend into a smoothie, or with frozen berries to make something like my pink juice recipe. You can grow mint right on your window sill.

We doctors need effective treatments that are cheap, safe, and available. This is particularly relevant now as newer and more expensive drugs have either failed to work or been withdrawn from the market owing to concerns about serious adverse events.

Just like it may be a good idea to eat only foods with ingredients you can pronounce, it may be better to try some mint before novel pharmacological approaches, such the new dual mu-opioid agonist delta-antagonist drug with a name like JNJ27018966.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to The Clear Communication People via Flickr.

Doctor's Note

I have some other mint videos (Enhancing Athletic Performance With Peppermint and

Peppermint Aromatherapy for Nausea) and more coming up! Lemon balm is also in the mint family (Reducing Radiation Damage With Ginger & Lemon Balm).

You can also sprinkle dried mint on various dishes. See Antioxidants in a Pinch.
What else might work for IBS? See Kiwifruit for Irritable Bowel Syndrome and Cayenne Pepper for Irritable Bowel Syndrome and Chronic Indigestion.

Irritable bowel symptoms can overlap with problems with gluten. Make sure your physician rules out celiac disease:

For all of my videos on irritable bowel syndrome (IBS), see the topic page.

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