Peppermint

• How It Works

  Peppermint is used as a remedy for a variety of ailments including irritable bowel syndrome, general gastrointestinal (GI) discomfort, and respiratory difficulties. It has not been shown to treat or prevent cancer in humans.

  Peppermint is an herb prevalent in Europe and North America and has been used as medicine for several centuries. It is taken orally as a carminative to treat digestive problems, applied topically as a counter-irritant for aches and cold symptoms, and its essential oil is used in aromatherapy. Peppermint is also widely used to flavor candies and oral hygiene products. Clinical studies have shown that peppermint is useful for headaches, irritable bowel syndrome, dyspepsia, and colonic/gastric spasms. Studies done in the lab and in animals have shown that peppermint has anticancer properties, but human data are lacking.

  Patients with a history of gallstones, gallbladder inflammation, hiatal hernia, or gastroesophageal reflux disease should consult a physician before consuming peppermint.

• Purported Uses
  • Colonic and gastric spasms
    Clinical studies have demonstrated peppermint’s effectiveness in reducing colonic/gastric spasms.
  • GI discomfort
    Peppermint was shown effective in reducing dyspepsia and general GI discomfort.
  • Irritable Bowel Syndrome (IBS)
    Peppermint has been reported beneficial for alleviating the symptoms associated with IBS.
• Do Not Take If
  • You are taking felodipine: Peppermint oil has been reported to increase bioavailability and can increase side effects of this drug. Clinical significance is not known.
  • You are taking cyclosporine: Peppermint oil increases the bioavailability of cyclosporine in rats. Human studies have not been conducted.
  • You are taking cytochrome P450 substrates: Peppermint oil was shown to inhibit CYP1A2/2C8/2C9/2C19/2D6 and 3A4 enzymes and may increase the risk of side effects of these drugs. Clinical significance is not known.
  • You use topical 5-fluorouracil: Peppermint can increase absorption of 5-fluorouracil.
• Side Effects
  • Heartburn, nausea, and vomiting among patients with IBS.
  • Dermatitis with external application of peppermint oil.
  • Toxicity: Acute lung injury has been reported following intravenous injection of peppermint oil.
• Scientific Name

  Mentha piperita L.

• Clinical Summary

  Peppermint is an herb prevalent in Europe and North America and has been used as medicine for several centuries. It is taken orally as a carminative to treat digestive problems, applied topically as a counter-irritant for aches and cold symptoms, and its essential oil is used in aromatherapy. Peppermint is also widely used to flavor candies and oral hygiene products. Both extracts and essential oil derived from peppermint demonstrated antiviral, anti-inflammatory, antioxidant ⁽³⁵⁾, antibacterial ^(36) (37), antifungal ⁽³⁸⁾, antidiabetic ⁽⁴⁷⁾ and antifibrotic ⁽⁴⁸⁾ effects in preclinical studies.

  Clinical data indicate effectiveness of topical peppermint oil for alleviating headaches ⁽¹⁾; oral peppermint oil for irritable bowel syndrome ^(4) (5); and oral peppermint oil, tea, and extracts for dyspepsia, gastric spasm, and general gastrointestinal discomfort ^{(7) (33) (39)}. Pre-treatment with peppermint oil capsules was also found effective in decreasing pain and in reducing colonic spasms in patients during colonoscopy ⁽³⁴⁾; and conclusions from a meta analysis indicate peppermint oil to be safe and effective against pain and global symptoms associated with irritable bowel syndrome ⁽⁴⁰⁾. Preliminary data suggest benefits of oral peppermint oil in modulating cognitive performance ⁽⁴³⁾.

  Inhaling peppermint oil may also confer benefits. In a study of postoperative cardiac surgery patients, it was reported useful in controlling nausea ⁽⁴¹⁾, but conflicting findings suggest aromatherapy to be only as effective as a placebo for relief of postoperative nausea ⁽⁴⁵⁾; and for nausea and vomiting in pregnant women ⁽⁴⁶⁾. An exhaustive systematic review revealed low-quality evidence to support use of peppermint for postoperative nausea and vomiting ⁽⁴²⁾.

  Peppermint has also been studied for possible anticancer effects. A significant anti-tumorigenic potential was observed against several human cancer cell lines ^(10) (11). Studies in animal models indicate peppermint’s effectiveness against radiation-induced testicular damage ⁽¹²⁾; benzo[a]pyrene-induced lung carcinogenicity ^(13) (14); and preventive effects against tobacco-induced carcinogenesis ⁽¹⁵⁾.
  An herbal mouthwash containing chamomile and peppermint was shown to alleviate complications and symptoms associated with oral mucositis in patients undergoing hematopoietic stem cell transplantation ⁽⁴⁴⁾. Further research is warranted.

• Food Sources

  Peppermint is used as flavoring agent in some foods and candy.

• Purported Uses
  • Colonic and gastric spasm
  • Dyspepsia/general GI discomfort
  • Headache
  • Inflammation
  • Irritable bowel syndrome (IBS)
  • Muscle pain
  • Nausea
  • Respiratory problems
• Mechanism of Action

  Peppermint oil relieves gastrointestinal symptoms likely by regulating calcium channel-dependent processes within the gastric, intestinal, and colonic systems. Both peppermint oil and menthol, a major ingredient in peppermint, produce antispasmodic effects in these systems by diminishing calcium influx ^{(6) (8) (18)}. Studies using murine models have shown that menthol improves body weight gain, mean macroscopic and microscopic ulcer scores, attenuates lipid peroxidation, oxidative stress and inflammation in acetic acid-induced colitis ⁽⁴⁹⁾; essential oil of peppermint demonstrated antidiabetic effects in streptozotocin-nicotinamide-induced type 2 diabetes by upregulating the expression of Bcl-2 and insulin ⁽⁴⁷⁾, along with attenuating hepatic fibrosis by improving the redox status, suppressing p53 and modulating TGF-beta1 and SMAD3 protein expression ⁽⁴⁸⁾.

  Flavonoids in peppermint have antioxidant activity that may protect cells from radiation damage ⁽¹²⁾. Menthol has also been reported to induce PC-3 prostate cancer cell death by activating c-jun N-terminal kinase (JNK) ⁽¹⁹⁾.

• ontraindications
  • Patients with a history of cholelithiasis, cholecystitis, hiatal hernia, or gastroesophageal reflux disease should consult a physician before consuming peppermint ⁽²⁾.
• Adverse Reactions
  • Heartburn, nausea, and vomiting were reported by patients with IBS ⁽⁴⁾ .
  • Dermatitis was reported following external application of peppermint oil ^{(9) (22) (23) (24)}.
  • Toxicity: Acute lung injury was observed following intravenous injection of peppermint oil ⁽²⁵⁾.
• Herb-Drug Interactions
  • Felodipine: Peppermint oil has been reported to increase bioavailability of felodipine (Plendil) ⁽²⁸⁾. Clinical relevance has yet to be determined.
  • Cyclosporine: Peppermint oil increases the bioavailability of cyclosporine in rats ⁽²⁹⁾. However, a patient with renal transplant had decreased cyclosporine level after consumption of herbal tea containing peppermint ⁽³⁰⁾.
  • Cytochrome P450 substrates: Peppermint oil was shown to inhibit CYP1A2/2C8/2C9/2C19/2D6 and 3A4 enzymes and can affect the intracellular concentration of drugs metabolized by these enzymes ^{(28) (31) (2)}. Clinical relevance is not known.
  • 5-fluorouracil: Peppermint oil, when applied externally, can increase dermal absorption of 5-fluorouracil ⁽³²⁾. Clinical significance is not known.
• References

  1. Gobel H, Schmidt G, Soyka D. Effect of peppermint and eucalyptus oil preparations on neurophysiological and experimental algesimetric headache parameters. Cephalalgia. Jun 1994;14(3):228-234; discussion 182.

  2. Kligler B, Chaudhary S. Peppermint oil. Am Fam Physician. Apr 1 2007;75(7):1027-1030.

  3. Eccles R, Griffiths DH, Newton CG, Tolley NS. The effects of menthol isomers on nasal sensation of airflow. Clin Otolaryngol Allied Sci. Feb 1988;13(1):25-29.

  4. Pittler MH, Ernst E. Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis.Am J Gastroenterol. Jul 1998;93(7):1131-1135.

  5. Merat S, Khalili S, Mostajabi P, et al. The effect of enteric-coated, delayed-release peppermint oil on irritable bowel syndrome. Dig Dis Sci. May 2010;55(5):1385-1390.

  6. Baliga MS, Rao S. Radioprotective potential of mint: a brief review.J Cancer Res Ther. Jul-Sep 2010;6(3):255-262.

  7. Hiki N, Kurosaka H, Tatsutomi Y, et al. Peppermint oil reduces gastric spasm during upper endoscopy: a randomized, double-blind, double-dummy controlled trial. Gastrointest Endosc. Apr 2003;57(4):475-482.

  8. McKay DL, Blumberg JB. A review of the bioactivity and potential health benefits of peppermint tea (Mentha piperita L.).Phytother Res. Aug 2006;20(8):619-633.

  9. Nair B. Final report on the safety assessment of Mentha Piperita (Peppermint) Oil, Mentha Piperita (Peppermint) Leaf Extract, Mentha Piperita (Peppermint) Leaf, and Mentha Piperita (Peppermint) Leaf Water. Int J Toxicol. 2001;20 Suppl 3:61-73.

  10. Yi W, Wetzstein HY. Anti-tumorigenic activity of five culinary and medicinal herbs grown under greenhouse conditions and their combination effects. J Sci Food Agric. Aug 15 2011;91(10):1849-1854.

  11. Jain D, Pathak N, Khan S, et al. Evaluation of cytotoxicity and anticarcinogenic potential of Mentha leaf extracts. Int J Toxicol. Mar 2011;30(2):225-236.

  12. Samarth RM, Samarth M. Protection against radiation-induced testicular damage in Swiss albino mice by Mentha piperita (Linn.).Basic Clin Pharmacol Toxicol. Apr 2009;104(4):329-334.

  13. Samarth RM, Panwar M, Kumar A. Modulatory effects of Mentha piperita on lung tumor incidence, genotoxicity, and oxidative stress in benzo[a]pyrene-treated Swiss albino mice.Environ Mol Mutagen. Apr 2006;47(3):192-198.

  14. Samarth RM, Panwar M, Kumar M, Kumar A. Radioprotective influence of Mentha piperita (Linn) against gamma irradiation in mice: Antioxidant and radical scavenging activity.Int J Radiat Biol. May 2006;82(5):331-337.

  15. Samman MA, Bowen ID, Taiba K, Antonius J, Hannan MA. Mint prevents shamma-induced carcinogenesis in hamster cheek pouch.Carcinogenesis. Oct 1998;19(10):1795-1801.

  16. Grigoleit HG, Grigoleit P. Pharmacology and preclinical pharmacokinetics of peppermint oil.Phytomedicine. Aug 2005;12(8):612-616.

  17. Hussain AI, Anwar F, Nigam PS, Ashraf M, Gilani AH. Seasonal variation in content, chemical composition and antimicrobial and cytotoxic activities of essential oils from four Mentha species. J Sci Food Agric. Aug 30 2010;90(11):1827-1836.

  18. Hawthorn M, Ferrante J, Luchowski E, et al. The actions of peppermint oil and menthol on calcium channel dependent processes in intestinal, neuronal and cardiac preparations.Aliment Pharmacol Ther. Apr 1988;2(2):101-118.

  19. Kim SH, Nam JH, Park EJ, et al. Menthol regulates TRPM8-independent processes in PC-3 prostate cancer cells. Biochim Biophys Acta. Jan 2009;1792(1):33-38.

  20. Hiki N, Kaminishi M, Hasunuma T, et al. A phase I study evaluating tolerability, pharmacokinetics, and preliminary efficacy of L-menthol in upper gastrointestinal endoscopy. Clin Pharmacol Ther. Aug 2011;90(2):221-228.

  21. Kaffenberger RM, Doyle MJ. Determination of menthol and menthol glucuronide in human urine by gas chromatography using an enzyme-sensitive internal standard and flame ionization detection. J Chromatogr. Apr 27 1990;527(1):59-66.

  22. Santucci B, Cristaudo A, Cannistraci C, Picardo M. Contact dermatitis to fragrances.Contact Dermatitis. Feb 1987;16(2):93-95.

  23. Tran A, Pratt M, DeKoven J. Acute allergic contact dermatitis of the lips from peppermint oil in a lip balm. Dermatitis. Apr 2010;21(2):111-115.

  24. Eccles R.Menthol and related cooling compounds. J Pharm Pharmacol. Aug 1994;46(8):618-630.

  25. Behrends M, Beiderlinden M, Peters J. Acute lung injury after peppermint oil injection.Anesth Analg. Oct 2005;101(4):1160-1162.

  26. Thorup I, Wurtzen G, Carstensen J, Olsen P. Short term toxicity study in rats dosed with peppermint oil.Toxicol Lett. Dec 1983;19(3):211-215.

  27. Akdogan M, Ozguner M, Kocak A, Oncu M, Cicek E. Effects of peppermint teas on plasma testosterone, follicle-stimulating hormone, and luteinizing hormone levels and testicular tissue in rats.Urology. Aug 2004;64(2):394-398.

  28. Dresser GK, Wacher V, Wong S, Wong HT, Bailey DG. Evaluation of peppermint oil and ascorbyl palmitate as inhibitors of cytochrome P4503A4 activity in vitro and in vivo. Clin Pharmacol Ther. Sep 2002;72(3):247-255.

  29. Wacher VJ, Wong S, Wong HT. Peppermint oil enhances cyclosporine oral bioavailability in rats: comparison with D-alpha-tocopheryl poly(ethylene glycol 1000) succinate (TPGS) and ketoconazole. J Pharm Sci. Jan 2002;91(1):77-90.

  30. Nowack R, Nowak B. Herbal teas interfere with cyclosporin levels in renal transplant patients. Nephrol Dial Transplant. Nov 2005;20(11):2554-2556.

  31. Unger M, Frank A. Simultaneous determination of the inhibitory potency of herbal extracts on the activity of six major cytochrome P450 enzymes using liquid chromatography/mass spectrometry and automated online extraction. Rapid Commun Mass Spectrom. 2004;18(19):2273-2281.

  32. Abdullah D, Ping QN, Liu GJ. Enhancing effect of essential oils on the penetration of 5-fluorouracil through rat skin. Yao Xue Xue Bao. 1996;31(3):214-221.

  33. Imagawa A, Hata H, Nakatsu M, et al. Peppermint oil solution is useful as an antispasmodic drug for esophagogastroduodenoscopy, especially for elderly patients. Dig Dis Sci. 2012 Sep;57(9):2379-84.

  34. Shavakhi A, Ardestani SK, Taki M, et al. Premedication with peppermint oil capsules in colonoscopy: a double blind placebo-controlled randomized trial study. Acta Gastroenterol Belg. 2012 Sep;75(3):349-53.

  35. Li Y, Liu Y, Ma A, Bao Y, Wang M, Sun Z. In vitro antiviral, anti-inflammatory, and antioxidant activities of the ethanol extract of Mentha piperita L. Food Sci Biotechnol. 2017 Nov 30;26(6):1675-1683.

  36. Rosato A, Carocci A, Catalano A, et al. Elucidation of the synergistic action of Mentha Piperita essential oil with common antimicrobials. PLoS One. 2018 Aug 1;13(8):e0200902.

  37. Raghavan R, Devi MPS, Varghese M, Joseph A, Madhavan SS, Sreedevi PV. Effectiveness of Mentha piperita Leaf Extracts against Oral Pathogens: An in vitro Study. J Contemp Dent Pract. 2018 Sep 1;19(9):1042-1046.

  38. Samber N, Khan A, Varma A, Manzoor N. Synergistic anti-candidal activity and mode of action of Mentha piperita essential oil and its major components. Pharm Biol. 2015;53(10):1496-504.

  39. Rich G, Shah A, Koloski N, et al. A randomized placebo-controlled trial on the effects of Menthacarin, a proprietary peppermint- and caraway-oil-preparation, on symptoms and quality of life in patients with functional dyspepsia. Neurogastroenterol Motil. 2017 Nov;29(11).

  40. Alammar N, Wang L, Saberi B, et al. The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical data. BMC Complement Altern Med. 2019 Jan 17;19(1):21.

  41. Briggs P, Hawrylack H, Mooney R. Inhaled peppermint oil for postop nausea in patients undergoing cardiac surgery. Nursing. 2016 Jul;46(7):61-7.

  42. Hines S, Steels E, Chang A, Gibbons K. Aromatherapy for treatment of postoperative nausea and vomiting. Cochrane Database Syst Rev. 2018 Mar 10;3:CD007598.

  43. Kennedy D, Okello E, Chazot P, et al. Volatile Terpenes and Brain Function: Investigation of the Cognitive and Mood Effects of Mentha × Piperita L. Essential Oil with In Vitro Properties Relevant to Central Nervous System Function. Nutrients. 2018 Aug 7;10(8). pii: E1029.

  44. Tavakoli Ardakani M, Ghassemi S, Mehdizadeh M, et al. Evaluating the effect of Matricaria recutita and Mentha piperita herbal mouthwash on management of oral mucositis in patients undergoing hematopoietic stem cell transplantation: A randomized, double blind, placebo controlled clinical trial. Complement Ther Med. 2016 Dec;29:29-34.

  45. Anderson LA, Gross JB. Aromatherapy with peppermint, isopropyl alcohol, or placebo is equally effective in relieving postoperative nausea. J Perianesth Nurs. 2004 Feb;19(1):29-35.

  46. Joulaeerad N, Ozgoli G, Hajimehdipoor H, Ghasemi E, Salehimoghaddam F. Effect of Aromatherapy with Peppermint Oil on the Severity of Nausea and Vomiting in Pregnancy: A Single-blind, Randomized, Placebo-controlled trial. J Reprod Infertil. 2018 Jan-Mar;19(1):32-38.

  47. Abdellatief SA, Beheiry RR, El-Mandrawy SAM. Peppermint essential oil alleviates hyperglycemia caused by streptozotocin- nicotinamide-induced type 2 diabetes in rats. Biomed Pharmacother. 2017 Nov;95:990-999.

  48. Ogaly HA, Eltablawy NA, Abd-Elsalam RM. Antifibrogenic Influence of Mentha piperita L. Essential Oil against CCl₄-Induced Liver Fibrosis in Rats. Oxid Med Cell Longev. 2018 Apr 19;2018:4039753.

  49. Bastaki SM, Adeghate E, Amir N, Ojha S, Oz M. Menthol inhibits oxidative stress and inflammation in acetic acid-induced colitis in rat colonic mucosa. Am J Transl Res. 2018 Dec 15;10(12):4210-4222.