Peppermint oil and irritable bowel syndrome


Peppermint oil has long been well regarded for its stomach soothing properties. So much so that In 1833, oil of peppermint was even thought be “a more or less advantageous remedy for cholera.” An enormous quantity, some 700 pounds of it, was imported to Germany from France in just one month alone (1).

But it wasn’t the case that physicians of the time were convinced that peppermint could save people from the cholera. Far from it. As one doctor wrote,

“Fear being a great exciter of cholera, the inhabitants have been advised to carry about them different odoriferous substances, such as peppermint oil… but in fact the physicians do not really believe in the repelling power of these ingredients; they merely look upon them as a species of amulet, fit for tranquilizing the minds of the timid.”

Peppermint oil may have offered a modicum of relief for cholera sufferers, but it wouldn’t have saved them. As we now know, water and electrolyte replacement therapy, with antibiotics to kill the cholera bacteria, are the most effective treatments for this disease. Still, peppermint oil was also widely used for its therapeutic benefits in other indications.

In pharmacy manuals of the time, peppermint oil was recommended for spasmodic and flatulent pains of the stomach and bowels, as well as for cramp, faintness and nausea (2). The earliest reference for this indication that I could find dated as far back as 1778 (3); it also mentioned that peppermint was employed by the Edinburgh College in their aqua mirabilis, or “miracle water”, a popular health tonic.

The old has become new again, with reports that peppermint oil, which has antispasmodic properties, outperformed placebo in treating irritable bowel syndrome (IBS). A recent meta-analysis compared the effects of peppermint oil, pharmaceutical antispasmodics and fiber on IBS (4). The analysis considered four trials that used peppermint oil, three of which scored more than 4 on the Jadad scale, a measure of study quality. A score of 4 out of 5 indicates that these three studies fulfilled a majority of quality criteria.

The results? The NNT, or ‘number needed to treat’ with peppermint oil to prevent one patient having persistent symptoms, was between 2.5-3.0. By comparison, the same meta-analysis found that the NNT for the antispasmodic medications reviewed was 5, and 11 for fiber.

This meta analysis provides good evidence that even simple remedies like peppermint oil do have tangible benefits for IBS sufferers.

And please, if you are reading this because you have cholera, go see a physician instead. Fast.

oooOooo

(1) Oil of Ocymum basilicum, M. Bonastre. Journal of the Philadelphia College of Pharmacy. Published by Philadelphia college of pharmacy, 1833

(2) A Manual of Pharmacy By William Thomas Brande Published by Underwood, 1825

(3) The New Dispensatory: Elements of Pharmacy By William Lewis Published by J. Potts, 1778

(4) BMJ 2008;337:a2313

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