Herbs to Treat SIBO: Peppermint

As a clinical herbalist, I often turn to peppermint oil as part of a broader treatment strategy for patients dealing with small intestinal bacterial overgrowth (SIBO). While peppermint has a long tradition of use in digestive health, its specific application for SIBO symptoms like bloating, gas, and digestive discomfort is an area that deserves more attention.

Research into herbal therapies for SIBO is still emerging, but peppermint oil has demonstrated promising antimicrobial activity in laboratory studies and a well-documented track record in related conditions like irritable bowel syndrome (IBS), where symptom overlap with SIBO is common.

In this article, I’ll cover what the research says about peppermint oil for SIBO, how I incorporate it in clinical practice, and important considerations to know before using it as part of your gut health protocol.

Peppermint: Traditional Use and Key Benefits for Digestive Health

Most of you would know peppermint and many probably enjoy this delicious herbal tea from time to time. It is one of the most widely used single herbal teas and has a tradition of use for a wide range of conditions including conditions involving the gallbladder and biliary tract, indigestion, inflammation in the small intestine and stomach, gassiness, intestinal colic, and digestive spasms too (1).

Here we can see how peppermint might help with the symptoms of SIBO. Most SIBO patients (but not all of them!) are gassier, inflamed, have digestive pain due to spasms and many are quite stressed and anxious (remember the gut-brain axis here!)

Peppermint is full of polyphenols including a handful of different flavonoids, lignans and phenolic acids but most of the studies on the antimicrobial actions are on the volatile oils of peppermint (3).

Menthol, the monoterpene that gives peppermint the minty flavour makes up the bulk of the volatile oil part of the plant (sometimes up to 30-55% of the oil (4, 5).

Let’s dive into some studies on how peppermint can help with SIBO and I’ll close it out with some of my personal thoughts on using this herb based on my clinical experience. 

Peppermint Research for SIBO and IBS

Starting with antimicrobial effects in a test tube can help. We want to work up to human studies but the groundwork is laid in petri dishes first.  

Peppermint oil has been shown to be effective against a whole range of bacteria (6). 

There has also been some in vitro studies showing that ethanol extracts of peppermint were quite antibacterial against a range of bacterial overgrowths and infections as well (7). 

Peppermint for SIBO studies

If we’re talking about peppermint as an effective herb for SIBO there really aren’t that many studies. We’ll cover them in a minute but just a word on that point. 

Herbs are relatively understudied, probably due to the expense of a study and the payoff. You can’t patent herbal medicine so there isn’t that much motivation for studying them. 

One case study looked at a woman who was treated with enteric coated peppermint oil for SIBO. It isn’t the highest quality study, I’ll be the first to admit, and the breath testing looked a bit wonky on the initial AND the repeat (it is a bit of a red flag to see high hydrogen on baseline before the SIBO sugar is ingested and normally means you have done the test prep diet improperly or there is an issue with gut motility)

Even though both the pre and post SIBO test results looked odd the patients symptoms improved dramatically on the peppermint oil treatment plan. She noted decreased bloating and pain and better bowel movements.

And really that’s what we’re after.

I would like to see a breath test negative on a follow up lab but if I had to choose between a negative test and a patient still symptomatic or a patient feeling better and lab telling us there is still a bit of work to do I would take the second option every time! 

Peppermint for IBS: What the Research Shows

Expanding the research parameters a bit to include peppermint in the treatment of irritable bowel syndrome is always helpful when SIBO studies come up short. 

Why would we include IBS when we’re talking about SIBO you ask? 

A decent chunk of patients with IBS have SIBO. The actual number is hotly debated and changes depending on which researcher you are reading but there is a definite cross over. A huge pearl here is that if you’ve been diagnosed with IBS by your primary care doctor or gastroenterologist look to screen for SIBO too.

There is so much data available on peppermint as a treatment for IBS

One systemic review with meta-analysis from the legend Dr Hawrelak et al. looked at 33 different trials for herbs in the treatment of IBS. 17 of these trials reviewed peppermint oil!

Of these 17 studies improvements varied but included abdominal symptom improvements, distention and abdominal pain improvements, ‘global’ IBS symptom improvements, and bowel movement improvements.

There are also a number of other studies and even studies of studies (reviews) that come to the same conclusion (10, 11).

But just so I don’t get accused of cherry picking the data there have been systemic reviews finding that we need more studies stating that ‘The role of peppermint oil in the symptomatic treatment of IBS has so far not been established beyond reasonable doubt. Well designed and carefully executed studies are needed to clarify the issue’ (12).

And my answer there would be that this particular review was quite a bit older (1998 compared to 2019!). 21 years later we do have the studies that have clarified the issue! 

Let’s move onto my clinical experience with peppermint oil but before we do just a note here on the science. It is only a part of the puzzle. My approach initially was very science based. In my profession as a clinical herbalist we would call this ‘evidence based’. The more I practise in the real world (not a controlled study) the more I value clinical experience and the traditional knowledge on herbs that can sometimes span back thousands of years. Science is still an important part but it isn’t the only part!

Ok, onto my clinical experience prescribing peppermint to patients with SIBO.

Clinical Insights: Using Peppermint for SIBO

Clinically peppermint is in the top 10 herbs that I will prescribe for SIBO patients.

I find it very soothing for the digestive tract and can help with bloating, gas production, cramping and indigestion. I mainly stick to herbal tinctures which are whole herbal extracts but have used peppermint oil from time to time when we need to ramp things up a notch.

Here is a great product from Amazon that some patients have had good success with! 

But there is a catch. 

The one patient that does not go well with peppermint is a patient who is dealing with reflux that is triggered by peppermint. I’ve seen this in clinical practice many times and this is also what we see in the reviews on peppermint for IBS. Many reflux patients might not know that peppermint is a trigger and not all people experiencing reflux, GERD or heartburn will be triggered by peppermint. Still it does pay to be cautious with this herb here. 

For anyone else peppermint is generally very well tolerated, safe and effective. It soothes the digestive tract, acts on the imbalanced bacteria, helps with trapped gas pain and spasms and calms down the anxious mind. If tolerated, bring it in as a tea, as an enteric coated essential oil or as a tincture as recommended by your health practitioner.

Now over to you! Have you found peppermint oil or tea to be helpful? Let me know in the comments below!

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References & Resources

1. A review of the bioactivity and potential health benefits of peppermint tea (Mentha piperita L.)
2. Medical Herbalism: The Science Principles and Practices Of Herbal Medicine
3. Ethnomedicinal, phytochemical and pharmacological updates on Peppermint (Mentha × piperita L.)—A review
4. 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
5. A Review On Peppermint Oil
6. In vitro antibacterial activity of peppermint
7. Antibacterial Activity and Phytochemical Analysis of Mentha piperita L. (Peppermint)—An Important Multipurpose Medicinal Plant
8. The treatment of small intestinal bacterial overgrowth with enteric-coated peppermint oil: A case report
9. Western herbal medicines in the treatment of irritable bowel syndrome: A systematic review and meta-analysis
10. Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis
11. Peppermint oil (Mintoil) in the treatment of irritable bowel syndrome: a prospective double blind placebo-controlled randomized trial
12. Peppermint oil for irritable bowel syndrome: a critical review and meta analysis