Does Peppermint Help IBS? | A Dietitian Explains

 In Feature, IBS

Does Peppermint Help IBS?

A few weeks ago, my colleague Andrea D’Ambrosio asked me to talk about foods that help to relieve digestive symptoms. As part one of this series, I’m going to be talking about one of the most popular herbs to help manage digestive woes, and one of my personal favourites, peppermint.

How Does Peppermint Help IBS?

People have been using peppermint to help with digestion for a LONG time. And I mean long. Fun fact – they can trace use of peppermint leaves in tea, and as a post meal digestive agent over 2000 years back in time.

I’m sure at the time, this habit arose out of the peppermint making their tummies feel better. Totally valid – a food-first herb that I’m sure many of you have taken after a big meal, or to help calm your stomach when it’s upset.

Fast forward 2000 years, and we now have some understanding of how peppermint works in the gut. One mechanism of action is that peppermint relaxes smooth muscles – like those in your GI tract. It appears to also have action as an anti-inflammatory and anti-microbial agent – by potentially reducing inflammation, or impacting the gut microbiome in some way. We don’t know all the answers yet as to how peppermint & peppermint oil acts on the gut – however we know from studies that those who take peppermint oil see an improvement in abdominal pain and bloating.

A 2014 meta-analysis (the crème de la crème in terms of quality evidence) looked at the role of peppermint oil versus a placebo for managing GI symptoms. A total of 9 studies met the scientific rigor the meta-analysis looked at – encompassing over 700 patients. The results of the studies were then weighed and combined to look at using peppermint to manage GI symptoms as a whole1.

It found that peppermint oil significantly improved symptoms when compared to a placebo – it was over 200% more likely (two times more likely) to result in symptom relief compared to the placebo. Abdominal pain, as well as ‘Global improvement IBS score’ (which measures quality of life, satisfaction with bowel habits, distention, and pain) were also improved1.

The primary negative outcomes were reflux – likely related to the peppermint oil causing smooth muscle relaxation higher up in the GI tract1,2,3.

Ok. Enough of the scientific jargon. You want to know:  Should I take peppermint for my IBS symptoms?

My rule of thumb when it comes to managing IBS symptoms is to not have too many cooks in the kitchen at once, so to speak.

Firstly, I like to ensure my clients have an IBS or functional gut disorder diagnosis. The only person who can diagnose IBS is your family physician. To understand IBS and diagnostic criteria a bit better, check out my post ‘Is it IBS – What You Need to Know’.

I like to approach IBS from a holistic perspective, focusing on what I consider the 4 pillars of IBS management:

  1. Nutrition management
  2. A focus on gut health
  3. Stress management – to shift how the brain and gut talk to one another, and how you perceive your gut symptoms
  4. Medication management

I like to focus on food and stress management as first line intervention. If symptoms don’t fully resolve, at that point, I see the value of bringing in medication management. This is dependent on symptoms, and a discussion with your physician about risks, benefits, and expected results. I always say, for every medication, there is a side effect – so if we can manage your IBS through lifestyle changes – that would always be my first-line recommendation.

As a ‘food first dietitian’, I really see the value in using food or a natural health product, like encapsulated, enteric coated peppermint oil to manage symptoms.

What I like about peppermint oil is, it’s low risk. Most negative symptoms in studies were minor – things like reflux, tingling, or burping peppermint. These resolve with discontinuation of the pills.

A study looking at the use of anti-spasmodic drugs versus peppermint, found that peppermint improved symptoms, and was associated with less side effects than the anti-spasmodic medication. The study suggested using peppermint oil capsules as a first-line treatment, rather than going straight to a medication that would potentially have side effects1,4,5.

In my opinion, trialing peppermint oil, prior to medication management has its benefits as it can have similar effects on symptoms as medications used to reduce IBS symptoms and gut pain, without the side effects of a prescription medication.

Talking with your doctor or dietitian about using peppermint oil in conjunction with your IBS management plan could provide additional symptom control.

Ways to Add Peppermint to Your Diet

  1. Peppermint Tea – often, including peppermint tea is a good way to ingest the active ingredient – menthol – however – the problem with peppermint tea is it can cause smooth muscle relaxation higher up in your GI tract – which can contribute to reflux. As well, the dose of menthol in a cup of peppermint tea would vary based on preparation.
  2. Peppermint Oil – ingesting peppermint oil on its own is discouraged – it’s far too concentrated to take orally and may cause mouth sores, reflux, or headaches.
  3. IBGard.ca: Enteric coated peppermint capsules, is the most evidence-based way to incorporate peppermint oil into your IBS management regimen.
    What I like about IBGard.ca is two-fold. 1) The dose is controlled. 2) It’s enteric coated – meaning they’ve taken peppermint oil, and coated it to ensure that the oil reaches the small intestine – where we want the muscle relaxation to take place. Their process of coating the peppermint oil is called ‘Site Specific Targeting’. The microspheres move quickly through the stomach, straight to the small bowel. By delivering the peppermint oil to the small bowel, instead of the stomach is that my clients are less likely to get reflux with this form of delivery3.

Does IBGard peppermint oil help IBS? Dietitian and gut health expert Andrea Hardy, explains why peppermint may help for IBS and what her evidence based suggestions are. She is a registered dietitian nutritionist from Calgary Alberta specializing in irritable bowel syndrome, functional gut disorders, and GI disorders

When to Take Peppermint Oil

I use peppermint oil in three different ways in my practice, depending on the client.

IBS ‘Flare Ups’ and Unexpected Symptoms

Research shows that within 2 hours of taking  IBGard.ca, over 75% of those with IBS symptoms saw improvement in their symptoms. I like to recommend keeping peppermint tea or peppermint oil capsules on hand for those times when you have symptoms you didn’t expect, or to take before a meal you know may cause you some GI distress3.

As a Preventative Approach

The second way I use peppermint oil capsules, like IBGard.ca, is before each meal to manage symptoms. Again, evidence supports the use of encapsulated peppermint oil to reduce IBS symptoms long term, by as much as 40%, without any other nutrition changes3.

Mindfulness-Based Techniques

Lastly, another way I use peppermint is incorporated into mindfulness and self-care. By taking some time to slow down, drink tea mindfully, and take the time to relax is a great way to being reducing stress in your life, start to shift how we perceive pain in our gut.

As always, with any medication or natural health product, I strongly recommend formulating a plan with your health care provider. Talk to your dietitian or physician about how peppermint may benefit your symptoms.

Disclosure: This is a sponsored post. I was compensated for my time in writing this post. While the information conveyed may support clients’ objectives, the opinions expressed are my own and based on current scientific evidence. I do not engage in business with companies whose products or services do not match my personal and professional beliefs.

References

  1. Khanna R1, MacDonald JK, Levesque BG. Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. J Clin Gastroenterol. 2014 Jul;48(6):505-12. doi: 10.1097/MCG.0b013e3182a88357.
  2. Grigoleit HG, Grigoleit P. Peppermint oil in irritable bowel syndrome. Phytomedicine. 2005 Aug;12(8):601-6.
  3. Cash, Brooks D. et al. Su1373 Ibgard®, a Novel Small Intestine Targeted Delivery System of Peppermint Oil, Results in Significant Improvement in Severe and Unbearable IBS Symptom Intensity. Results from a US Based, 4-Week, Randomized, Placebo-Controlled, Multi-Center Ibsrest™ Trial. Gastroenterology , Volume 148 , Issue 4 , S-489.
  4. Muenst GJ, Schlaurl H, Nuesch HJ, et al. Peppermint oil Colpermin) compared to mebeverine (Duspatalin) in the therapy of irritable bowel syndrome. A double-blind study. Therapiewoche Schweiz. 1987;9:853–858.
  5. Carling L, Svedberg LE, Hulton S. Short term treatment of the irritable bowel syndrome: a placebo-controlled trial of peppermint oil against hyoscyamine. Opusc Med. 1989;34:55–57.

 

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