Irritable Bowel Syndrome and Peppermint Oil

By Marcus Laux ND.

Irritable bowel syndrome is a painful and frequently frustrating disorder of the intestines that’s often difficult to treat. Fortunately, there are scientifically studied natural products that effectively reduce the distressing symptoms of Irritable Bowel Syndrome.

What is Irritable Bowel Syndrome?

Irritable Bowel Syndrome causes crampy pain, gassiness, bloating, and alterations in bowel habits. Irritable Bowel Syndrome is termed a functional disorder, because when the colon is examined, there is no visible sign of disease. While Irritable Bowel Syndrome causes significant pain and distress, no actual damage is occurring in the intestines.1,2

There is a wide variability in Irritable Bowel Syndrome. Symptoms may be mild and fairly well tolerated. Or, the pain, discomfort, and bowel dysfunction may be disabling, limiting social interactions, employment, or travel.1,2

While some individuals with Irritable Bowel Syndrome have diarrhea (frequent, loose stools with an urgent need to move the bowels), others have constipation (hard, infrequent stools that are difficult to pass). And, still others may experience both. Individuals with Irritable Bowel Syndrome also may have painful abdominal cramps and feel an urgent need to move the bowels, but are unable to do so.1,2

Irritable Bowel Syndrome - What are the causes?

The small intestine receives digestive material from the stomach and delivers it to the large intestine (colon). About two quarts (2,000 ml) of digestive material enter the colon from the small intestine every day. The colon absorbs water and salts from the material, which is progressively moved through the colon. This progressive movement continues until most of the fluid and salts are absorbed into the body and stool is formed. The stool passes to the left side of the colon, where it is stored until a bowel movement occurs.3

Because researchers haven’t been able to find actual damage in the colon, it once was suggested that individuals with Irritable Bowel Syndrome have emotional problems or are overly susceptible to stress. While stress may cause the symptoms of Irritable Bowel Syndrome to intensify, it doesn’t cause the condition.

Recent study has determined the colon muscle of an individual with Irritable Bowel Syndrome spasms after only mild stimulation. It’s thought the symptoms of Irritable Bowel Syndrome are produced by hyperactivity of the intestine.4-6 In other words, the intestines of individuals with Irritable Bowel Syndrome are more reactive to stressors and diet than usual. Almost everyone has experienced abdominal queasiness in response to everyday stress or certain foods. This may result in a brief bout of diarrhea or an upset stomach. However, this response is exaggerated in individuals with Irritable Bowel Syndrome.

How prevalent is Irritable Bowel Syndrome?

Irritable Bowel Syndrome is very common. In fact, it’s one of the most frequent problems seen by family physicians. It’s the most common disorder diagnosed by gastroenterologists (physicians specializing in the treatment of digestive disorders). The overall prevalence rates range from 10% to 20% of the general population in most industrialized countries.1,2 As a result, the pain and disabling symptoms associated with Irritable Bowel Syndrome result in significant socioeconomic costs, as well as reduction in quality of life for many individuals.

What are the symptoms of Irritable Bowel Syndrome?

Normal bowel function varies from person to person. Some people move their bowels daily, while others may only have two to three stools a week. A normal bowel movement is soft, formed, and is easily passed without cramping or pain.3

Irritable Bowel Syndrome, however, causes abdominal cramps and pain, which are often severe and disabling. Bowel movements may be irregular and alternate between diarrhea and constipation. The diarrhea may be quite loose and watery. Mucous may be passed. There is often much straining, urgency, and feeling of incomplete evacuation (emptying).1,2,7 Abdominal bloating and passing of gas is common.1 Nausea, lack of appetite, heartburn, and belching may also be present.2 Sleep may be disrupted resulting in fatigue and lack of energy.8 Understandably, persons with Irritable Bowel Syndrome often feel anxious and depressed.9,10

Diagnosis of Irritable Bowel Syndrome is usually based on the continuous presence or recurrence of these symptoms for at least three months. Other intestinal conditions must be ruled out. These include Crohn’s disease, ulcerative colitis, inflammatory bowel disease, colon cancer, inflammatory conditions of the stomach or pancreas, ulcers, infectious disease, or gastroesophageal reflux disease.2

Are there clinically demonstrated natural alternatives to the over-thecounter drugs prescribed by my doctor?

Yes, both enteric-coated peppermint oil and clown’s mustard (in combination with other herbs) have significant scientific research behind them. Both have been demonstrated to benefit individuals with Irritable Bowel Syndrome.

What is clown’s mustard and what does it do?

The scientific name for clown’s mustard is Iberis amara. Other names for this herb are wild candytuft and bitter candytuft. Clown’s mustard is a white-flowering plant from Spain, where it grows in dry soil on hillsides and in cornfields. It is also grown in Britain, France, and the United States. Iberis amara is a member of the Brassicaceae family. Iberis refers to its place of origin, the Iberian Peninsula. Amara means bitter.11 The key components of clown’s mustard are glycosides and flavonoids that have specific actions on gastrointestinal tract tone.12

Is here scientific evidence that clown’s mustard benefits people with Irritable Bowel Syndrome?

There has been very impressive research on clown’s mustard (in combination with other herbs). And, it has been used with great success in Germany for many years to treat Irritable Bowel Syndrome and other gastrointestinal diseases.

In a study of an herbal combination containing clown’s mustard, 20 patients were given the herbal combination for three to 32 days. They all had been diagnosed with chronic functional disorders for at least one to 20 years. The symptoms the patients experienced included pressure and pain in the abdomen, belching, heartburn, vomiting, nausea, fullness, lack of appetite, constipation, and diarrhea. The patients had been treated for their problems with a variety of antacids, anti-spasmodic agents, and motilityinducing substances. For the purposes of the study, the patients stopped taking these medications and received treatment only with the herbal combination.13

Abdominal pressure and pain in the abdomen was the most common of all the experienced symptoms, with 11 of the patients rating it as severe. After six days of treatment, only six of the patients continued to rate their abdominal pain and pressure as severe. After two weeks, this symptom had completely resolved for 16 of the patients. Diarrhea had been rated as severe in five of the patients. By day 14, only one patient continued to have moderate diarrhea.13

Medications prescribed and taken for cardiovascular diseases, arthritis, and autoimmune diseases often cause gastrointestinal problems. Because these conditions are chronic, these medications must be taken for a long time, often for life. With long-term use, these medications can cause erosion of the stomach lining and actual ulcers. Many of these medication caused symptoms are similar to Irritable Bowel Syndrome symptoms: pressure and pain in the upper abdomen, nausea, abdominal fullness, and lack of appetite. Most, if not all, of the individuals who have gastrointestinal problems caused from medications experience two or more of these Irritable Bowel Syndrome symptoms.14

Forty patients who were taking medications for various types of cardiovascular disease and arthritis, and who were experiencing gastrointestinal problems related to their medications, were enrolled in a study. These symptoms included pressure and pain in the upper abdomen, nausea, abdominal fullness, and lack of appetite. Twenty patients received clown’s mustard combined with other herbs that support gastrointestinal motility. Three days after the trial started, a significant improvement of all symptoms was noted in those taking this combination. By day 14, abdominal pressure and pain, nausea, and heartburn were completely eliminated in the herbal combination group.14

Several other clinical trials that were conducted in Germany report similar results.15-18

How does this herb compare to prescription drugs?

A study compared clown’s mustard (combined with other herbs) to Reglan® (metoclopramide), which is frequently prescribed to reduce the symptoms of Irritable Bowel Syndrome. While metoclopramide is a very effective medication, it also has numerous side effects. Metoclopramide can cause fatigue, anxiety, agitation, jitteriness, insomnia, yellowing of the skin or eyes, changes in vision, hallucinations, and seizures. Because of these serious side effects, metoclopramide must not be taken longer than 12 weeks.19

In a comparison study, 77 subjects were randomized to receive treatment of either clown’s mustard in a combination with other herbs, or metoclopramide. All subjects had pain and pressure in the abdomen, cramping, abdominal fullness, nausea, heartburn, and lack of appetite. The subjects took 20 drops of their assigned treatment after meals three times daily. The duration of treatment was one to two weeks.

In both groups, a parallel improvement of all symptoms was observed. At no point in the study was a statistically significant difference in symptoms found. Both treatments significantly reduced pain and pressure in the abdomen, cramping, abdominal fullness, nausea, heartburn, and lack of appetite. In short, both metoclopramide and the clown’s mustard herbal combination worked well at reducing the symptoms of Irritable Bowel Syndrome.

However, side effects occurred more frequently and severely in the metoclopramide group.20 Given the lack of differences noted between the products at reducing symptoms of Irritable Bowel Syndrome, it would seem sensible to choose the treatment with the fewest reported side effects and no limits on duration of use.

What evidence supports use of entericcoated peppermint oil capsules for Irritable Bowel Syndrome?

Peppermint oil has been shown to relax intestinal smooth muscle.21-24 In Great Britain, peppermint oil is currently being prescribed for Irritable Bowel Syndrome by physicians and it has been used as a digestive aid and to soothe upset stomachs for generations.25

Peppermint oil has also been studied for use in an important examination of the colon. A colonoscopy is a procedure of viewing the interior lining of the large intestine (colon) using a colonoscope, a slender, flexible, hollow, lighted tube about the thickness of a finger. A study published in the New England Journal of Medicine supports the idea that even people who are not at risk for colon cancer should have this test.26 The American Cancer Society recommends that men and women at average risk of colon cancer should have a colonoscopy every 10 years, beginning at age 50.27

During a colonoscopy, individuals are sedated and almost no discomfort is experienced. The insertion of the colonoscope into the rectum and up through the colon causes some spasming. This is a natural and expected event and the physician performing the exam administers medications that effectively reduce the spasms.

A recent study compared the use of peppermint oil and commonly used medications to reduce the colonic spasming in colonoscopy. The peppermint oil was introduced directly into the colon. Effective reduction of colon spasming was observed in 88% of the patients.28

In a critical review and meta-analysis of peppermint oil for irritable bowel syndrome published in The American Journal of Gastroenterology, eight randomized controlled trials were identified. The studies collectively showed peppermint oil is superior to placebo in improvement of the symptoms of Irritable Bowel Syndrome. Because of the good results of these trials, the authors of the review urged additional study of peppermint oil in Irritable Bowel Syndrome.29

However, straight peppermint oil is rapidly absorbed into the blood stream from the stomach. In recent studies comparing enteric-coated peppermint oil capsules and non-enteric coated oil, both preparations provided effective symptom relief. However, the studies concluded the enteric-coated capsules delivered the benefit of the peppermint oil directly to the intestines.30,31 In the treatment of Irritable Bowel Syndrome, enteric-coated supplemental peppermint is most definitely preferred.

In fact, an enteric-coated peppermint oil capsule containing rosemary and thyme is extremely effective in the treatment of Irritable Bowel Syndrome. All three of these oils are classified as volatile oils, derivatives found in plants that impart taste and aroma. The combination of peppermint, thyme, and rosemary oils in enteric-coated capsules provides significant relief in Irritable Bowel Syndrome-related pain.

Can clown’s mustard and other herbs be taken with enteric-coated peppermint oil?

Yes, peppermint oil capsules and clown’s mustard can be used together. However, depending on the symptoms, individuals with Irritable Bowel Syndrome may want to start with one supplement and then add the other if needed.

How do consumers find these formulas?

Fortunately, herbal combinations containing clown’s mustard and enteric-coated peppermint oil capsules are both available at health food stores, natural product supermarkets, pharmacies, and from health professionals. Most knowledgeable sales personnel and health professionals can direct consumers to the most effective products.

What should customers look for when purchasing peppermint oil?

As mentioned before, enteric coating of the peppermint oil is extremely important. The coating prevents the oil from being absorbed in the stomach. The enteric coated-capsule moves through the stomach to the small intestine and eventually to the colon, where it is released for maximum benefit.

What is the dosage for peppermint oil?

The German Commission E approved peppermint oil for the treatment of irritable colon. In enteric-coated form, the Commission E recommends 0.6 ml per day.32 Enteric-coated peppermint capsules are available.

Are there side effects or other contraindications?

Sometimes, the enteric-coated peppermint oil capsules may cause a transient burning sensation in the rectum when moving their bowels. Reducing the dose will correct this.

Individuals who must refrain from alcohol should not take clown’s mustard in an herbal tincture, which may contain alcohol.

What else can Irritable Bowel Syndrome patients do to feel better?

Food allergies or food intolerance may be associated with Irritable Bowel Syndrome. Dairy products and certain grains may trigger a painful episode of Irritable Bowel Syndrome. Determining those foods that initiate the problems and eliminating them from your diet can be very helpful.33

Many people report their symptoms occur after a meal. Hyperactivity of the intestine of Irritable Bowel Syndrome is the response. Often, the strength of this response after a meal is in direct relation to the number of calories and the amount of fat in the meal. Reducing saturated fat, limiting calories, and increasing fiber intake may be helpful.34-35

Stress also stimulates the intestinal hyperactivity. Relaxation training may reduce some Irritable Bowel Syndrome symptoms. Listening to therapeutic audiotapes, hypnosis, counseling, and biofeedback all have been shown to improve improvements in persons with Irritable Bowel Syndrome.36-39

Conclusion

Irritable Bowel Syndrome can be painful and frustrating, capable of causing much distress. While currently there is no reverse for Irritable Bowel Syndrome, the symptoms can be managed. The pain, abdominal discomfort, and bowel problems of Irritable Bowel Syndrome all respond well to treatment with the use of key herbs, including clown’s mustard, and enteric-coated peppermint oil. These herbal combinations can be both effective and safe in treating Irritable Bowel Syndrome. Clown’s mustard and enteric-coated peppermint oil are both effective front-line natural alternatives for Irritable Bowel Syndrome treatment.

References

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2. Porth CM. Irritable bowel syndrome. In: Pathophysiology: Concepts of Altered Health States. 5th ed. Philadelphia, Pa: Lippincott; 1998: 729-730.

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4. Simren M, Castedal M, Svedlund J, Abrahamsson H, Bjornsson E. Abnormal propagation pattern of duodenal pressure waves in the irritable bowel syndrome (IBD). Digestive Disease Science. 2000;45:2151-2161.

5. Elsenbruch S, Orr WC. Diarrhea-and constipation-predominant IBS patients differ in postpriandial autonomic and cortisol responses. American Journal of Gastroenerol. 2001;96:460-466.

6. Aros SD, Camilleri M. Small-bowel motility. Curr Opin Gastroenterology. 2001;17:140-146.

7. Collins SM. Stress and the gastrointestinal tract IV. Modulation of intestinal by stress: basic mechanisms and clinical relevance. American Journal of Physiology Gastrointestal Liver Physiology. 2001;280: G315-G318.

8. Jarrett M, Heitkemper M, Cain KC, Burr RL, Hertig V. Sleep disturbance influences gastrointestinal symptoms in women with irritable bowel syndrome. Digestive Disease Science. 2000;45:952-959.

9. Herschbach P, Henrich G, von Rad M. Psychological factors in functional gastrointestinal disorders: characteristics of the disorder or of the illness behavior? Psychosom Medicine. 1999;61:148-153.

10. Whitehead WE, Crowell MD. Psychologic considerations in the irritable bowel syndrome. Gastroenterol Clinical North Am. 1991;20:249-267.

11. Iberis amara. Plants for a Future Database. Available at: www.metalab.unc.edu. Accessed June 29, 1999.

12. Iberogast® for functional Gastro-Intestinal Diseases. Darmstadt, Germany: Steigerwald, 1998. Scientific Brochure.

13. Bruckel MH, Gisevius W. Therapeutic effect of Iberis amara in functional gastric disorders. Arztliche Praxis. 1984;494-498.

14. MacLean N, Hubner-Steiner U. Treatment of drug related gastrointestinal disorders. Fortschritte der Medizin. 1987;12:239-242.

15. Bleimann H, Hartman R. Treatment of functional gastrointestinal symptoms with Iberogast®. Gastro Entero Hepatologie. 1984;52-59.

16. Holsher HJ. Treatment of non-specific upper gastrointestinal symptoms in elderly patients. Therapiewoche. 1984;34:657-659.

17. Ohms P. Daily oral treatment: how long can the stomach tolerate it? Arztliche Praxis. 1983;11:3109-3110.

18. Steimer P. Iberogast® therapy in gastroenterology. Der Krankenhaus Arzt. 1983;56:1005-1008.

19. Reglan® (metoclopramide). In: Physicians’ Desk Reference. 54th ed. Montvale, NJ: Medical Economics Company, Inc; 2000:2603-2605.

20. Nickolay K. Double blind trial of metoclopramide and Iberogast® in functional gastroenterology. Gastro Entero Hepatologie. 1984;2:4.

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22. Dew MJ, Evans BK, Rhodes J. Peppermint oil for the irritable bowel syndrome: a multicentre trial. British Journal of Clinical Pr.12:394, 398. 23. Hawthorn M, Ferrante J, Luchowski E, Rutledge A, Wei XY, Triggle DJ. The actions of peppermint oil and menthol on calcium channel dependent processes in intestinal, neuronal and cardiac preparations. Aliment Pharmacological Therapy. 1988;2:101-118.

24. Hills JM, Aaroncon PI. The mechanism of action of peppermint oil on gastrointestinal smooth muscle. An analysis using patch clamp electrophysiology and isolated tissue pharmacology in rabbit and guinea pig. Gastroenterology. 1991;101:55-56.

25. Kingham JGC. Commentary: peppermint oil and colon spasm. Lancet. 1995;346:986.

26. Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group. New England Journal of Medicine. 2000, 343:162-168.

27. American Cancer Society. Colon and Rectal Cancer. Available at: www3.cancer.org/cancerinfo/load. Accessed March 19, 2001.

28. Asao T, Mochiki E, Suzuki H, et al. An easy method for the intraluminal administration of peppermint oil before colonoscopy and its effectiveness in reducing colonic spasms. Gastrointestal Endosc. 2001;53:172-177.

29. Pittler MH, Ernst E. Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis. American Journal of Gastroenterology. 93:1131-1135.

30. May B, Kuntz HD, Keiser M, Kohler S. Efficacy of a fixed peppermint/ caraway oil combination in non-ulcer dyspepsia. Arzneim-Forsch. 1996;46:1149-1153.

31. Micklefield GH, Greving I, May B. Effects of peppermint oil and caraway oil on gastroduodenal motility. Phytother Research. 14:20-23.

32. Peppermint oil. In: Blumenthal M., ed. The Complete German Commission E Monographs. Austin, Tex: American Botanical Council; Integrative Medicine Communications; 1998:181-182.

33. Mascolo R, Satzman JR. Lactose intolerance and irritable bowel syndrome. Nutrition Review. 1998. 56:306-308.

34. Friedman G. Diet and the irritable bowel syndrome. Gastroenterol Clinical North Am. 1991;20:313-324.

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Professional Organizations

The American Academy of Family Physicians provides a wealth of health information for the entire family.

The American College of Gastroenterology was founded in 1932 to advance the study and medical treatment of disorders of the gastrointestinal tract.

Founded in 1917, the American Dietetic Association (ADA) is the largest organization of food and nutrition professionals in the USA.

The American Gastroenterological Association (AGA) was founded in 1897 and is the oldest nonprofit specialty medical society in the country.

The American Society of Colon and Rectal Surgeons is the leading professional society representing more than 1000 board certified Colon and Rectal surgeons and other surgeons dedicated to advancing and promoting the science and practice of the treatment of patients with diseases and disorders affecting the colon, rectum, and anus.

The American Society for Gastrointestinal Endoscopy represents over 7,000 gastroenterologists, surgeons, and other digestive health specialists who remain committed to furthering the knowledge of the diagnosis and treatment of GI disease through the appropriate use of endoscopic techniques.

The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) strives to improve the care of infants, children and adolescents with digestive disorders by promoting advances in clinical care, research and education.

The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) provides several resources for patients and the general public to educate themselves about surgical options.

Society of Gastroenterology Nurses and Associates. Gastroenterology (GI) nursing is a specialty practice area in which nurses and associates provide care to patients with known or suspected gastrointestinal problems who are undergoing diagnostic or therapeutic treatment and/or procedures.

Founded in 1968, the Wound, Ostomy and Continence Nurses Society (WOCN) is a professional, international nursing society of more than 3,700 nurse professionals who are experts in the care of patients with wound, ostomy and continence problems.




Marcus Laux

Author Marcus Laux is a licensed naturopathic medical doctor.




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