"Peppermint Oil for Irritable Bowel Syndrome"
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, the discomfort.
Using some measures, the health-related
quality of life of irritable bowel sufferers
can rival those 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 $2000 a year,
and cause— as side-effects—
many of symptoms you’re trying to treat.
Linaclotide is one of the newest, $3000 a year,
and again can cause the very problems
it’s designed to help.
Antidepressants are commonly given,
but may take 4 to 6 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 a 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-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 only lasted 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 only eat foods
with ingredients you can pronounce,
it may be better to try some mint
before novel pharmacological approaches,
such as the new dual mu-opioid agonist antagonist drug
with a name like JNJ-27-oh-1-8-9-66.