Peppermint Oil for Irritable Bowel? Sweet!

Irritable bowel syndrome (IBS) is beyond “irritating” to the 10-15% of the US population (mostly young people in their 20’s or 30’s) that deal with this frustrating medical problem. The typically cramping abdominal pain occurs on average at least one day per week, along with either a change in frequency or consistency of bowel movements along with painful pooping. (Bowels can either speed up or slow down in IBS, and sometimes they flip back and forth between diarrhea and constipation.) The IBS diagnosis is made when you’ve had these symptoms consistently for three continuous months, and your physician does not suspect any other disease or structural abnormality to account for your symptoms. Typically your doctor will do some basic blood tests and ask more about additional symptoms, but the good news is that a GI scoping (colonoscopy) is NOT required to make the diagnosis!

IBS is very common in college students, and there is no question that stress (like upcoming midterms) can aggravate the symptoms! Let me be clear this is not a disease that’s “just in your head, sweetie”- but stress can certainly be an additional trigger. We are learning from brain imaging studies that in IBS patients, brain autonomic functions that process visceral pain are altered, and this can directly affect gut motility. 

So how do we treat IBS?

Fiber USED to be our mantra for all things constipated, including the version of IBS that includes decreased frequency of BM’s, but we now know that FIBER is INEFFECTIVE for treating adult IBS. There are two prescription medications that may help with constipation-predominant IBS: Lubiprostone (Amitiza) and Linaclotide (Linzess). Additionally, we have older, less expensive prescription medications such as hyoscyamine (antispasmodic drug) and a variety of low dose antidepressant medications and antidiarrheal agents that may help with diarrhea-predominant IBS.

However, many people would prefer to treat their IBS WITHOUT prescription medications if possible, and happily we have a few evidence-based treatments to offer. The first is COGNITIVE BEHAVIORAL THERAPY (CBT), which is a unique counseling “talk therapy”  that emphasizes a “skills-based approach that focuses on modifying behaviors and altering dysfunctional thinking patterns to influence mood and physiological symptoms” as noted in this 2017 study CBT for patients with IBS .  CBT is remarkably effective, with a number needed to treat (NNT) of 4 (similar to the NNT scores for antidepressants and antispasmodics, which range from 3-7 in various high quality studies.) Additional studies support hypnotherapy (yes, hypnosis) though the evidence is less robust.

So what about PEPPERMINT OIL? This herbal oil is derived from hybrid spearmint/watermint plants, and may be purchased over-the-counter in liquid or capsule form, typically taken three times per day with meals (doses vary depending on the individual product.) The main side effect noted in some people is transient heartburn, but the smooth muscle relaxation effect of the peppermint oil seems to give significant relief for the cramping pain of IBS. Numerous high quality blinded, randomized, placebo controlled trials have confirmed that peppermint oil “improves global symptoms” of IBS, with an NNT of 2.5.

What about pre- and probiotics? Per a 2018 systematic review, “Particular combinations of probiotics, or specific species and strains, appeared to have beneficial effects on global IBS symptoms and abdominal pain, but it was not possible to draw definitive conclusions about their efficacy.” So that’s a MAYBE at this point.

BOTTOM LINE: Treatment for IBS should include Cognitive Behavioral Therapy (CBT) and Peppermint Oil as first line therapy options.

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