Doctor Higginson’s Blog

“The medicinal use of peppermint and other mint plants probably dates back to the herbal pharmacopoeia of ancient Greece, where peppermint leaf traditionally was used internally as a digestive aid and for management of gallbladder disease; it also was used in inhaled form for upper respiratory symptoms and cough,” write Benjamin Kligler, MD, MPH, from the Albert Einstein College of Medicine of Yeshiva University in New York, and Sapna Chaudhary, DO, from the Beth Israel Continuum Center for Health and Healing in New York. “Peppermint oil, which is extracted from the stem, leaves, and flowers of the plant, has become popular as a treatment for a variety of conditions, including irritable bowel syndrome (IBS), headache, and non-ulcer dyspepsia.”

• Peppermint oil appears to be mildly effective in reducing symptoms of IBS, particularly flatulence, abdominal pain, and distension, in adults. However, there has been significant heterogeneity among research into this subject.
• A study of children between the ages of 8 and 17 years who had IBS found that peppermint oil was more effective than placebo in reducing the severity of abdominal pain.
• 2 trials have demonstrated that treatment with peppermint oil reduced the risk for gastrointestinal spasm during barium enema, with peppermint associated with up to a 3-fold increase vs placebo in the rate of having a procedure free of spasm.
• The combination of 90 mg of peppermint oil plus 50 mg of caraway oil has been demonstrated to reduce symptoms of nonulcer dyspepsia, including fullness, bloating, and spasm. This combination should be used cautiously for patients with dyspepsia, as peppermint oil may promote gastroesophageal reflux.
• 2 studies have delineated the efficacy of topical peppermint oil in tension headache. In 1 study, a combination of peppermint and ethanol was superior to placebo in terms of analgesia. Another trial demonstrated that topical peppermint oil was similar to acetaminophen in terms of treatment efficacy.
• The therapeutic dosage in most trials of peppermint oil and IBS was 0.2 to 0.4 mL taken 3 times daily in enteric-coated capsules. The 1 trial examining its use for childhood IBS used a dosage of 0.1 mL of peppermint oil 3 times daily for children weighing less than 45 kg.
• Peppermint oil can be toxic in overdose, leading to interstitial nephritis and acute renal failure. Because it may promote gallstone formation, it should not be used in patients with cholelithiasis or cholecystitis. Peppermint oil also may trigger menstruation and should not be used during pregnancy.
• The most common adverse events associated with peppermint oil include allergic reactions, heartburn, perianal burning, blurred vision, nausea, and vomiting. Peppermint oil may inhibit the cytochrome P450 1A2 system.

Because peppermint oil may inhibit the cytochrome P450 1A2 system, it may interact with drugs metabolized via this system.

Peppermint oil is contraindicated in patients with hiatal hernia, severe gastroesophageal reflux, and gallbladder disorders and should be used with caution in pregnant and lactating women.

Consumer Labs is a unbiased lab that evaluated supplements and determines if that contain the ingredients that they claim.  The following is from a report that was published from consumer labs in which they studies 10 different brands of St. John’s wort.

The vast majority of double blind placebo-controlled studies have found that St. John’s wort extracts are effective as a treatment for mild to moderate depression. However, three well-publicized human studies found no benefit with St. John’s wort; two of them also found the antidepressant with which St. John’s wort was compared ineffective for treating depression. These seemingly paradoxical results may have been due to factors such as the products tested, the outcomes being measured, and the number of people involved in the studies. Note that the expression “mild to moderate depression” does not refer to mere “blues” or “moodiness.” Rather, it means “major depression of mild to moderate severity.” This rather confusing terminology refers to true clinical depression, simply not the most severe form of clinical depression. (As a rule of thumb, people with the most severe forms of clinical depression are probably depressed enough to need hospitalization. People with mild to moderate major depression usually do not need hospitalization.) St. John’s wort does not cause euphoria and, like regular antidepressants, is unlikely to elevate mood in people who aren’t truly depressed.

One study involving menopausal women with depression found that a combination of St. John’s wort and black cohosh extracts improved both menopause symptoms and mood. St. John’s wort is also sometimes tried for other conditions in which standard antidepressants might be recommended, such as anxiety, attention deficit disorder, PMS, seasonal affective disorder (SAD), chronic pain, insomnia, neuropathic pain, obsessive compulsive disorder, social phobia, and quitting smoking, but there is no reliable evidence as yet that it really works for these purposes. 

Among the 10 products selected by ConsumerLab.com for evaluation, only four passed the testing. The other six failed for the following reasons:

The four brand of St. John’s wort that were recommended by consumer labs are as follows:

Doctor’s Trust® Vitamins St. John’s Wort Extract (300 mg standardized extract per capsule, 1-2 per day)

Gaia Herbs St. John’s Wort Extra Strength (450 mg liquid extract per tablet, 2 per day)

Kira® St. John’s Wort (300 mg extract per tablet, 3 per day)

MRM Metabolic Response Modifiers™ St. John’s Wort 450 mg 0.3% Hypercins (450 mg per capsule, 1-2 per day)