What to Take Before a Colonoscopy

Peppermint was not officially described—by a white guy—until 1696, but we’ve probably been using it for at least a few thousand years. After-dinner mints are used to reduce the gastrocolic reflex, the urge to defecate following a meal. The stretching of nerves in the stomach triggers spasms in the colon, which makes sense—our body’s making way for more food coming down the pipe. What peppermint does is relax the muscles of the colon.

If you take circular strips of human colons removed during surgery and just lay them on a table, they spontaneously contract on their own about three times a minute. Isn’t that kind of creepy? But then if you drop more and more menthol from peppermint on them, the contractions still happen, but they’re not as strong. Well, if peppermint can relax the colon and reduce spasms, might it be useful during a colonoscopy, as first suggested over 30 years ago. See, colon spasm can hinder the progress of the scope and cause the patient discomfort. So, they tried spraying some peppermint oil out the tip, and in every case, the spasm was relieved within 30 seconds. 30 seconds is a long time, though, when you have this snaking inside of you; so, the next innovation would be to just use a hand pump to flood the whole colon with a peppermint oil solution before the colonoscopy. Simple, safe, and convenient alternative to injecting an anti-spasm drug, which can have an array of side effects, whereas instilling some peppermint solution, dyed blue in the picture here, and within 20 seconds, the spasming colon opens right up.

Similar results were attained with upper endoscopy, working better, quicker, safer than the drug, and also when mixed into barium enemas. But wouldn’t it be easier to just swallow some peppermint oil instead of squirting it up the rectum? Premedication with peppermint oil in colonoscopy. Just popping a few peppermint oil capsules four hours before the procedure sped up the entire process, and increased both doctor and patient satisfaction, because reducing colon spasm reduces pain and discomfort, and makes the scope easier to insert and withdraw.

Pain and discomfort are not the only barriers to signing people up for colonoscopies, though. Even if peppermint oil makes it go seamlessly, there’s still the dreaded bowel prep, where you have to drink quarts of a powerful liquid laxative before the procedure to completely clean you out. And, aside from the pain, a fear of complications and feelings of embarrassment and vulnerability.

Serious complications occur in about 1 in every 350 colonoscopies: everything from perforations and bleeding to death. Perforations occur when the tip of the scope punches through wall of the colon, or because they inflated the colon too much—they have to pump in air so they can look around, or when they’re trying to cauterize some bleeding caused by like a biopsy, which, in extremely rare instances, can ignite some residual gas and cause the colon to explode.

Death from colonoscopy is rare, occurring only in about 1 in every thousand procedures, but with about 15 million colonoscopies performed annually in the United States, colonoscopies kill about 15,000 Americans every year, raising the question: do the benefits outweigh the risks? I’ll cover that next.

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.

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