Peppermint Oil for Digestive Woes (IBS) vs. Side Effects of Amitiza, Linzess or Lotronex?

Q. I’ve heard that taking enteric-coated peppermint oil can help IBS. My worst symptoms are stomach cramps and flatulence, but I’m reluctant to eat out or travel. Some of my friendships have suffered.

What does “enteric” mean, and why would peppermint oil help?

How does peppermint oil compare to prescription drugs?

A. Irritable bowel syndrome (IBS) can produce symptoms such as abdominal pain, gas, cycles of constipation and diarrhea, urgency of stools and bloating. Doctors are not entirely clear on what causes IBS, so they tend to treat symtoms rather than what is underlying the condition, whatever that might be. Some physicians think leaky gut syndrome (see this link) might be involved. Patients are often encouraged to manage stress, which may help some people, but not everyone.

Fiber supplements are sometimes prescribed along with OTC diarrhea medicine like loperamide (Imodium). Antidepressants may be prescribed, but they have a number of potentially unpleasant side effects.

People are often told to keep a fart chart to see which foods are most likely to trigger flatulence. Sadly, many healthy foods are on the list, such as beans, cabbage, cauliflower, broccoli, brussels sprouts and bran.

The prescription drugs that have been approved for this condition include: Linzess, Lotronex and Amitiza. They may help, but such drugs also come with side effects:

Amitiza (lubiprostone) Side Effects:

• Digestive disturbances including nausea, abdominal pain, vomiting, diarrhea, gas, indigestion, fecal incontinence
• Headache
• Shortness of breath
• Sinus inflammation (sinusitis)
• Arthritis pains, muscle pain, back pain
• Fatigue

Linzess (linaclotide) Side Effects:

• Disgestive distress including diarrhea, abdominal pain, gas, bloating, gastroenteritis, heartburn, reflux, vomiting, fecal incontinence
• Headache
• Fatigue

Lotronex (alosetron) Side Effects:

• Digestive discomfort including constipation, abdominal pain, nausea, bloating, reflux, hemorrhoids
• Liver enzyme elevation
• Colitis (a rare but very serious complication)
• Blood disorders
• Arrhythmias (irregular heart rhythms)
• Constipation that leads to obstruction
• Diverticulitis

Given the substantial side effects of Amitiza, Linzess and Lotronex, it is not suprising that you might be interested in alternatives. Sadly, we could not find any head-to-head clinical trials that tell us how other options might compare with these prescription medicines.

Enteric-coated peppermint oil has been shown to relieve symptoms of IBS. One study published in the Journal of Gastroenterology in 1997 showed that this preparation reduced bloating, abdominal pain, flatulence, frequency of bowel movements and stomach noises. A trial in the Journal of Pediatrics (Jan, 2001) found that children given peppermint oil capsules had significantly less stomach pain. A recent review in the Journal of Gastroenterology (online, May, 2014) notes that peppermint oil is considered a “first-line treatment for abdominal pain in IBS.”

Peppermint in the stomach could make heartburn worse, which is why enteric coated pills are essential. This special coating by definition doesn’t dissolve until it gets to the small intestine. There, peppermint oil eases spasms, relieving symptoms with relatively few side effects.

To learn more about peppermint oil and the science behind its use in IBS along with other integrative approaches, you may wish to check out this free article in the World Journal of Gastroenterology (Jan. 14, 2014).

Share your own experience with prescription drugs (Amitiza, Linzess, Lotronex) or with enteric coated peppermint oil below.