Peppermint Oil for IBS

It is not Colonoscopy Chronicles’ intention to provide specific medical advice to users of its blog, instead we provide users with information to help them better understand their health, diagnosed conditions, and the current approaches related to treatment, prevention, screening, and supportive care. Colonoscopy Chronicles urges users to consult with a qualified health care professional for diagnosis and answers to their personal medical questions.

Irritable Bowel Syndrome (IBS) is the most common gastrointestinal condition in America, affecting 15-20% of the adult population. The most common symptoms of IBS are abdominal pain, and changes in the bowel pattern,either constipation, diarrhea, or alternating constipation and diarrhea. Amazingly, our understanding of IBS is still very limited, and treatments have been less than satisfactory. 

While there have been several prescription drugs developed for IBS over the last several decades, these advances have been countered by the fact that several of the new medications that were released had to be withdrawn from the market due to safety concerns. This has left many patients searching for safer, more natural solutions for their IBS symptoms. Enter peppermint oil. Recognized for years as a remedy for digestive problems, peppermint oil seems to have found new life as a natural treatment for IBS.

There have been numerous scientific studies supporting the effectiveness of peppermint oil for pain and bowel dysfunction resulting from IBS. But what seems to have caused the renaissance in peppermint oil enthusiasm is the aggressive marketing of a new peppermint oil product-IBgard-by a company called IM Health Science. IBgard’s sleek packaging and marketing campaign seem to be working. But the product is not cheap. The directions say to take 1-2 capsules three times daily. A box of 48 capsules is $29.99. If you take 6 capsules a day, that box of 48 will last only 8 days.  While this seems a bit pricey, the good news is that there are other companies making similar products at a lower price point. For example, Pepogest by Nature’s Way costs $11.49 on the Walgreen’s website for a container of 60 capsules, which comes to a 20 days supply (if taken three times per day as directed).

Although it is a natural, and basically safe product, peppermint oil does have some safety issues. For example, due to the potential for decreased milk production, it should probably be used sparingly toward the end of pregnancy, and during breastfeeding. It is generally not advisable for children under seven. There is concern about causing low blood sugar in diabetics, and there has been a link to gallbladder inflammation. Finally, those with gastroesophageal reflux must be aware of the fact that peppermint oil can lower the pressure in the lower esophageal sphincter and cause aggravation of the acid reflux.

Despite these cautions, I am enthusiastic about the renewed interest in peppermint oil as an option for my IBS patients. I am hopeful that as our understanding about the underlying nature of IBS evolves, we will have more to offer our patients.

http://www.webmd.com/ibs/news/20081113/peppermint-oil-fiber-can-treat-ibs

https://umm.edu/health/medical/altmed/herb/peppermint

http://www.ncbi.nlm.nih.gov/pubmed/16121521

http://www.lalecheleague.org/nb/nbiss56-09p38.html

http://www.medicalnewstoday.com/articles/265214.php

Irritable Bowel Syndrome

Irritable Bowel Syndrome

It is not Colonoscopy Chronicles’ intention to provide specific medical advice to users of its blog, instead we provide users with information to help them better understand their health, diagnosed conditions, and the current approaches related to treatment, prevention, screening, and supportive care. Colonoscopy Chronicles urges users to consult with a qualified health care professional for diagnosis and answers to their personal medical questions.

Tackling the topic of Irritable Bowel Syndrome(IBS) is ambitious, for many reasons. For one, it is the most common gastrointestinal disorder in America, affecting up to 10-15% of the population. Another reason it is a difficult topic to manage is the fact that IBS means different things to different people, including health care professionals. While there are well defined diagnostic criteria for IBS(Rome Criteria), not all healthcare providers utilize these criteria. To make matters even more dicey, IBS is what can be considered a "functional" disorder, meaning that it is a disorder of how the bowel functions rather that a structural abnormality.  What this means is that you can't see it with a scope, you can't see it with an x-ray, you can't detect it with a blood test(tho there is some excitement about a new blood test that might be promising), and you can't prove it via a biopsy. 

The elusive nature of the diagnosis sometimes creates the illusion that this is an imaginary illness. It is not. Patients with IBS sometimes get frustrated with healthcare providers, feeling that they are being treated as if the disorder is psychosomatic. Indeed, sometimes physicians do treat patients as if IBS is not a legitimate medical illness. I like to use the following analogy with patients: I explain IBS can be likened to migraine headaches, in the sense that you can't really demonstrate a migraine on an x-ray, blood test, or biopsy. Yet, we know that migraines are a legitimate disorder, and just because we can't see or touch them doesn't minimize the grief they cause. The same goes for IBS. 

Another feature of IBS that presents a challenge is the fact that, despite its prevalence, it is poorly understood. This lack of  understanding about some of the most basic features of IBS, such as what causes it, leads to a number of unfortunate consequences. For one, when the medical establishment doesn't understand a disease entity, and has challenges treating it, there is a tendency to pawn it off as a psychosomatic disorder, or to try to avoid seeing such patients, whom they may perceive as a nuisance. A second unfortunate consequence is that IBS patients become prey to charlatans who hawk unproven, useless, and costly remedies, that waste their time and money. It is understandable, however, that patients look outside the mainstream when they feel that their needs are not being met. 

In reality, IBS is probably not a single illness, but rather a multitude of different disorders that we lump together under a single banner, because we currently don't know any better. The different individual disorders probably each have a separate underlying cause, and thus should probably be treated differently. The state of the art, however, is such that currently it is difficult to really distinguish between these "variations" of IBS. I truly believe that one day we will be able to pinpoint the type of functional gastrointestinal disorder a patient has(versus lumping them together under the IBS umbrella), and focus our treatment in a much more effective manner. There is definitely progress being made.

This series will outline some of the variants of IBS that are currently recognized, as well as the current state of the art as far as treatment goes. Along the way I will interject my observations and personal experiences, having cared for IBS patients for over 25 years. I hope you find it helpful and meaningful for yourself or someone you care about.