Mints - Medicinal Uses, Interactions, Side Effects, Dosage
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<p><strong>Mints</strong></p>
<p>Spearmint <em>(Mentha spicata) </em>and the related horsemint were well known in the Graeco-Roman era, and mint was used in biblical times. Peppermint <em>(M. piperita) </em>appeared in the 18th century in England as a hybrid between spearmint and watermint. It is less flavorful than spearmint, while Japanese mint or cornmint <em>(M. arvensis) </em>is more flavorful. </p>
<p><strong>Uses and Benefits: </strong></p>
<p>Over the ages, spearmint, peppermint, and other mints have been used as flavors, aromas, and medications.They have been taken mainly for digestive symptoms such as dyspepsia and irritable bowel, and for respiratory and dermatologic conditions. In general, all of the common mints have similar effects and are best known because of the popularity of their characteristic taste in candies, foods, and medications and for the refreshing effect they give to skin and mouth preparations. <em>M. pulegium, </em>pennyroyal, is a dangerous member of the mint family, and its oil should not be used in herbal therapeutics. </p>
<p><strong>Pharmacology</strong></p>
<p>The most important of the over 80 compounds in mints is the essential oil menthol,3 also known as peppermint camphor. The I-isomer of menthol is found mainly in Japanese mint, constituting 70-95% of the essential oil; in peppermint, it may constitute 29-48%.2 Menthol, which can be synthesized from thymol, is a terpenoid alcohol; menthone, an­other major constituent, is a terpenoid ketone. Spearmint con­tains less menthol than peppermint, and its oil is used mainly as a flavoring agent. The related pennyroyal oil contains the characteristic toxic compound pulegone; this constitutes 90-95% of the content of the oil. Pulegone can be synthetically hydrogenated to I-menthone, which can then be reduced to give I-menthol. </p>
<p> Although menthol vapor subjectively appears to open conested nasal passages, studies have shown that this is not a physical effects Indeed, concentrated menthol can increase con­qestion and impair ciliary motion. Menthol has, however, shown benefits in the treatment of experimentally-induced cough. In one careful study, healthy volunteers were challenged with inhaled citric acid; a preparation of menthol in eucalyptus oil was found to significantly reduce the induced cough (p < 0.0005)</p>
<p><strong>Clinical Trials: </strong></p>
<p> Gastrointestinal Uses-Most studies have been carried out in Germany. The European commercial products Colpermin and Pepogest, which are enteric-coated, delayed-release, pH-sensitive capsules containing 0.2 ml peppermint oil, have been evaluated. They release the herbal chemical in the colon to treat spasm. Eight randomized, controlled studies involving a total of 265 pa­tients were critically reviewed in a meta-analysis to determine the outcome of treatment for gastric distress, flatulence, hyperactive intestines, and other symptoms that constitute irritable bowel syn­drome (IBS).3,5 Only five placebo-controlled, double blind trials were satisfactory for analysis, and overall there was a positive effect (p < 0.001). However, the criteria for diagnosing IBS in the eight trials were not judged to be satisfactory in 91.5% of the patients, although all had symptoms suggestive of colonic spasm. </p>
<p>A double-blind, randomized study on 141 patients undergoinlj barium enema examination showed that the addition of pepper mint oil to the barium suspension reduced colonic muscle spasm (no spasm in 60% vs. 35% in the placebo group). In anothor study, 405 patients were given intracolonic peppermint oil durin(l colonoscopy, resulting in a spasmolytic effect in 88.5%; a group 01 36 treated with placebos had a 33.3% response. </p>
<p>A randomized, double-blind trial of 213 patients with dypepsia combined with IBS evaluated two different formulations of an en­teric-coated, peppermint oil/carraway oil mixture given 3 times a day. One product (Enteroplant) contained 90 mg peppermint oil with 50 mg carraway oil; the reference product contained 36 mg and 20 mg, respectively. Equivalent benefits were obtained with each preparation in reducing pain intensity, but the frequency of pain was significantly less (p = 0.04) for the test preparation com­pared to the lower-dose reference preparation. The same investi­gators subsequently studied 96 outpatients with functional dyspepsia in a randomized, double-blind evaluation using the same 90mg/50mg combination test formulation compared with a placebo. Dosing was given only twice a day for 4 weeks. Statistically significant and clinically relevant improvements in symptoms were found in the test group (40% vs. 22%). </p>
<p>A similar study on 118 patients compared the same test formulation of Enteroplant with cisapride for functional dyspepsia. Similar reductions in pain over the course of 4 weeks were found with both agents compared to baseline. One problem with these studies is that they did not evaluate peppermint alone. </p>
<p> Headaches-Topical peppermint oil has also been evaluated for the treatment of headaches. In three randomized, double­blind, placebocontrolled trials in a total of 190 patients with ten­sion headaches, there was a significant benefit of a 10% ethanol solution of peppermint oil applied to the forehead and temples, </p>
<p><strong>Adverse</strong> <strong>Effects: </strong></p>
<p>Most clinical studies found peppermint oil products to be well tolerated, with only minor adverse effects. Side effects included heartburn, nausea, vomiting, and perianal burning. </p>
<p><strong>Side Effects and Interactions:</strong> </p>
<p>here are no recognized drug interactions. Since acts as a calcium-channel blocker, it theoretically should be used cautiously in patients who are receiving one of these drugs or are intolerant of the class. However, its wide use, without reported problems, suggests it has considerable safety and probably lacks significant interactions. </p>
<p><strong>Cautions:</strong></p>
<p>Menthol ingested in amounts of 2 g has been fatal in some cases. Large doses of peppermint oil can cause CNS stimulation; a dose of about 1 g/kg can be fatal. Pennyroyal oil, which contains pulegone, was formerly taken to induce menstruation; it could also induce abortions, with concomitant severe liver toxicity and fatalities. Pennyroyal oil can cause multiple organ faliure in infants. Menthol cannot be metabolized by neonates with G6PD deficiency and it may cause jaundice; neonates and other susceptible subjects should only use mints and their oils With extreme caution. </p>
<p>Inhalation of menthol or its instillation into the nose can cause irritation and even nasal obstruction. Reflex gagging, apnea, and collapse can occur in infants, and cardiac arrhythmia in susceptible adults. Allergy to mint oils results in rashes, headaches, flushing, and asthma. Occasionally, asthma can be induced by minimal doses of menthol, such as occur in toothpaste.</p>
<p>Some physicians advise that peppermint should be avoided in patients with esophagitis, hiatal hernia, or gastroesophageal leflux disease, since it can relax the gastroesophageal sphincter. prevent this problem, entericcoated capsules are used for lreating lower bowel disorders; they release the oil in the distal howel where it has a local effect. The safety of peppermint products during pregnancy and nursing has not been established for therapeutic ranges of dosing. </p>
<p><strong>Preparations & Doses:</strong></p>
<p>Mint extracts, menthol, and related chemicals are found in numerous types of health products, varying from foods and cigarettes to creams and cough preparations. </p>
<p>Menthol can be given orally to adults in a dosage of 30-120 mg and is used in topical formulations in 1-10% concentrations. The typical oral dose of peppermint oil is 0.2-1.2 ml/day, usually given in divided doses. One enteric-coated product evaluated in the European clinical trials, Pepogest, is marketed in the U.S. by BioTherapies and Nature's Way. It contains 0.2 ml of peppermint oil/capsule, and recommended dosing is 1-2 capsules t.i.d. bo. tween meals. Mint leaf products, which can be brewed in teas, aro given in 1.5-6 g dosages. The brewed product contains <em>very </em>low concentrations of menthol and menthone. </p>
<p><strong>Summary Evaluation </strong></p>
<p>Peppermint and other mints and their natural and synthetic com­pounds, of which menthol is the most important, are frequently used in <em>everyday </em>life. Their main <em>value </em>is as flavorful aromatic products, and it is commonly accepted that they soothe skin, throat, respiratory, and bowel conditions. One major therapeutic indication for menthol and mint products is IBS; benefits <em>havo </em>been found in several controlled clinical trials. These products may also relieve colonic spasm when introduced locally during endoscopy or enemas. There is evidence that topical use may re­lieve tension headaches. Preparations made from the herb <em>have </em>low toxicity for most people. However, small amounts of the es­sential oils from Mentha species can be harmful when given to neonates and infants.</p>
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