Articles

Peppermint

Plant Part Used

Leaf

Active Constituents

Volatile oils, including alcohols (menthol - 50-60%), ketones (menthone - 5-30%), esters (5-10%) and small amounts of cineole (eucalyptol) and limonene; flavonoids, phenolic acids and triterpenes.(1),(12)

[span class=alert]This section is a list of chemical entities identified in this dietary supplement to possess pharmacological activity. This list does not imply that other, yet unidentified, constituents do not influence the pharmacological activity of this dietary supplement nor does it imply that any one constituent possesses greater influence on the overall pharmacological effect of this dietary supplement.[/span]

Introduction

Peppermint is a widely used herb for both medicinal and culinary purposes. Peppermint tea has long been used in treating children’s digestive problems such as colic, flatulence, and upset stomach. The oil of peppermint is used routinely in Europe as a spasmolytic, carminative and cholagogue (promotes the flow of bile), with its most prevalent use in irritable bowel syndrome (IBS).(13)

Dosage Info

Dosage Range

Tea: 3-6gm dried leaf as infusion, 2-3 times a day.

Enteric Coated Preparation: 1-2 tablets (0.2ml oil per tablet), 2-3 times a day.

Most Common Dosage

Tea: 3gm as infusion, 3 times a day.

Enteric Coated Preparation: 2 tablets (0.2ml oil per tablet), 2 times a day.

Standardization

[span class=doc]Standardization represents the complete body of information and controls that serve to enhance the batch to batch consistency of a botanical product, including but not limited to the presence of a marker compound at a defined level or within a defined range.[/span]

The most current available medical and scientific literature indicates that this dietary supplement should be standardized to:

Oil: not less than 4.5% (w/w) and not more than 10% (w/w) of esters calculated as menthyl acetate; not less than 44% (w/w) of free alcohols calculated as menthol; not less than 15% (w/w) and not more than 32% (w/w) ketones calculated as menthone.

Leaf: contain not less than 1.2% of volatile oils.

Uses

Frequently Reported Uses

  • Carminative
  • Spasmolytic
  • Catarrhal Conditions Of The Upper Respiratory Tract
  • Choleretic
  • Nausea
  • Ulcerative Colitis
  • Irritable Bowel Syndrome (IBS)

Other Reported Uses

  • Functional Dyspepsia
  • External - Muscular And Nerve Pain (Oil)
  • Headache
  • Postoperative Nausea
  • Inflammation Of The Oral Mucosa
  • Intestinal Gas

Toxicities & Precautions

General

Peppermint leaf has been reported safe in recommended doses.

The estimated lethal dose of menthol in humans is 2-9gm.

Peppermint oil may cause allergic dermatitis in sensitive individuals.(14)

Health Conditions

Based on pharmacology, individuals presenting gastroesopageal reflux disease (GERD), biliary tract obstruction, cholecystitis and severe liver damage should avoid peppermint oil.(2)

Pregnancy/ Breast Feeding

If pregnant or nursing, consult a physician before use.

Age Limitations

Do not apply the oil to the face of children under 2 years of age, especially around the nasal area.

Do not use in children under 2 years of age unless recommended by a physician.

Pharmacology

Peppermint oil is reported to have an antispasmodic action on the isolated ileum of laboratory animals, characterized by a decline in the number and amplitude of spontaneous contractions. It reportedly relaxes the ileal longitudinal muscle, but is less potent than papaverine.(2) Peppermint oil acts competitively with nifedepine and blocks calcium stimuli, characteristic of calcium channel blockers.(3) A small human study found that peppermint oil had antispasmodic activity in individuals undergoing endoscopic retrograde cholangiopancreatography (ERCP).(15)

Randomized, controlled human trials have reported positive benefits in IBS when using enteric coated peppermint oil.(4),(5),(6) There has been one study that showed no effect in relieving symptoms of IBS.(7) A double blind study on 57 patients with IBS were treated with peppermint oil (two enteric-coated capsules twice per day or placebo) for 4 weeks and evaluated for: abdominal bloating, abdominal pain or discomfort, diarrhea, constipation, feeling of incomplete evacuation, pain at defecation, passage of gas or mucus and urgency at defecation.(16) At 4 weeks, 75% of the patients in the peppermint oil group showed a >50% reduction of symptoms.

A systematic review of the literature in 2008 found that peppermint oil was more effective than placebo in treating symptoms of IBS.(17)

The mean reduction of the pain score (primary variable) recorded on a visual analog scale (VAS) during the four-week treatment was 4.62 points with the peppermint oil/caraway oil preparation. This score was comparable with the mean reduction under cisapride (4.60 points) (p = 0.021; test for equivalence). Equivalence was also found in the secondary variable "frequency of pain" with a reduction by 4.65 points under PCC and by 4.16 points under cisapride carried out on an exploratory basis (p = 0.0034). Comparable results were attained with both treatments in the Dyspeptic Discomfort Score which included the other dyspeptic symptoms as well as intestinal and extraintestinal autonomic symptoms, in the prognosis as appraised by the physician and in the CGI scales (Clinical Global Impressions).

A European supplement product that combines peppermint oil with caraway seed oil has reported clinical utility in functional dyspepsia. In a 4-week randomized, controlled double-blind study of 188 patients, a combination of peppermint and caraway oil was tested against cisapride (10mg tid) for use in functional dyspepsia.(8) The oil combination reduced frequency pain and Dyspeptic Discomfort Score (includes dyspeptic symptoms as well as intra and extraintestinal autonomic symptoms) as effective as cisapride. Corresponding results were also found in Helicobacter pylori-positive patients and patients with initially intense epigastric pain in the two treatment groups. Results were that the combination preparation consisting of peppermint oil and caraway, oil appears to be comparable with cisapride and provides an effective means for treatment of functional dyspepsia, thereby providing an alternative choice to the pharmaceutical drug in functional dyspepsia. Also, another study reported smooth muscle relaxation in the migrating motor complex (MMC) of the gastrointestinal tract.(9) A small human study found that peppermint oil increased gastric emptying.(18)

One study describes the use of peppermint oil in treating postoperative nausea, with the patients requiring fewer traditional antiemetics than the control group.(10) The effect of a locally applied (over forehead and temple areas) peppermint oil preparation on tension-type headache was examined in the design of a double-blind crossover study, and was tested against both the reference substance acetaminophen and to placebo.(11) The conclusion was that peppermint oil can be a well-tolerated and cost-effective alternative with similar efficacy to conventional therapies.

Human studies have also reported that peppermint oil can help improve oral and dental health, including gingivitis and dental caries.(19) Peppermint oil as aromatherapy has also been reported to improve memory in a small human study.(20) Peppermint oil has antibacterial, antiviral and antifungal activity in laboratory studies.(21)

References

  1. Peppermint Oil. Lancet. Jul1988;2(8602):98-99.
  2. Shulz V, et al. Rational Phytotherapy: A Physicians’ Guide to Herbal Medicine. New York: Springer-Verlag; 1996:187-90.
  3. Shulz V, et al. Rational Phytotherapy: A Physicians’ Guide to Herbal Medicine. New York: Springer-Verlag; 1996:187-90.
  4. View Abstract: Beesley A, et al. Influence of Peppermint Oil on Absorptive and Secretory Processes in Rat Small Intestine. Gut. Aug1996;39(2):214-19.
  5. Rees WD. Treating Irritable Bowel Syndrome With Peppermint Oil. Br Med J. Oct1979;2(6194):835-36.
  6. View Abstract: Pittler MH. Peppermint Oil for Irritable Bowel Syndrome: A Critical Review and Metaanalysis. Am J Gastroenterol. Jul1998;93(7):1131-35.
  7. View Abstract: Liu JH, et al. Enteric-coated Peppermint-oil Capsules in the Treatment of Irritable Bowel Syndrome: A Prospective, Randomized Trial. J Gastroenterol. Dec1997;32(6):765-68.
  8. Nash P, et al. Peppermint Oil Does Not Relieve the Pain of Irritable Bowel Syndrome. Br J Clin Pract. Jul1986;40(7):292-93.
  9. View Abstract: Madisch A, et al. Treatment of Functional Dyspepsia with a Fixed Peppermint Oil and Caraway Oil Combination Preparation as Compared to Cisapride. A Multicenter, Reference-controlled Double-blind Equivalence Study. Arzneimittelforschung. Nov1999;49(11):925-32.
  10. View Abstract: Micklefield GH, et al. Effects of Peppermint Oil and Caraway Oil on Gastroduodenal Motility. Phytother Res. Feb2000;14(1):20-23.
  11. View Abstract: Tate S. Peppermint Oil: A Treatment for Postoperative Nausea. J Adv Nurs. Sep1997;26(3):543-49.
  12. View Abstract: Gobel H, et al. Effectiveness of Oleum Menthae piperitae and Paracetamol in Therapy of Headache of the Tension Type. Nervenarzt. 1996;67(8):672-81
  13. Keifer D, Ulbricht C, Abrams TR, et al. Peppermint (Mentha piperita): an evidence-based systematic review by the Natural Standard Research Collaboration. J Herb Pharmacother. 2007;7(2):91-143. Review.
  14. Vermaat H, van Meurs T, Rustemeyer T, Bruynzeel DP, Kirtschig G. Vulval allergic contact dermatitis due to peppermint oil in herbal tea. Contact Dermatitis. Jun 2008;58(6):364-365.
  15. Yamamoto N, Nakai Y, Sasahira N, et al. Efficacy of peppermint oil as an antispasmodic during endoscopic retrograde cholangiopancreatography. J Gastroenterol Hepatol. Sep 2006;21(9):1394-1398. Erratum in: J Gastroenterol Hepatol. Nov 2006;21(11):1768.
  16. Cappello G, Spezzaferro M, Grossi L, et al. Peppermint oil (Mintoil) in the treatment of irritable bowel syndrome: a prospective double blind placebo-controlled randomized trial. Dig Liver Dis. Jun 2007;39(6):530-536.
  17. Ford AC, Talley NJ, Spiegel BM, et al. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ. 13 Nov 2008;337:a2313. doi: 10.1136/bmj.a2313. Review. Erratum in: BMJ.2009; 338:b1881.
  18. Inamori M, Akiyama T, Akimoto K, et al. Early effects of peppermint oil on gastric emptying: a crossover study using a continuous real-time 13C breath test (Breath ID system). J Gastroenterol. Jul 2007;42(7):539-542. Epub 2007 Jul 25.
  19. Shayegh S, Rasooli I, Taghizadeh M, Astaneh SD. Phytotherapeutic inhibition of supragingival dental plaque. Nat Prod Res. 20 Mar 2008;22(5):428-439.
  20. Moss M, Hewitt S, Moss L, Wesnes K. Modulation of cognitive performance and mood by aromas of peppermint and ylang-ylang. Int J Neurosci. Jan 2008;118(1):59-77.
  21. Soković MD, Vukojević J, Marin PD, Brkić DD, Vajs V, van Griensven LJ. Chemical composition of essential oils of Thymus and Mentha species and their antifungal activities. Molecules. 7 Jan 2009;14(1):238-249.