Peppermint Extract for LI? No.

I'm doing mostly questions this week, some new, some old. I like the questions that make me think, and can't just answered by a yes or no, although a yes or no may emerge out of the available evidence. Like this one.

I read something about different things to try for lactose intolerance
including peppermint extract...Are there non-medicinal methods that work?

The basics. Lactose intolerance (LI) is caused by the body not producing enough lactase to digest all the lactose that comes in. That lactose goes to the colon, where it is fermented by bacteria that live in the colon.

That suggests two approaches to alleviating the symptoms: add lactase or get rid of the bacteria.

And those are the two approaches taken. Lactase pills provide the missing lactase. Probiotics, from the cultures in yogurt to targeted pills like Digestive Advantage Lactose Intolerance, DairyCare, or Lactagen, provide the different type of bacteria that digest lactose rather than ferment it.

Neither approach affects the body itself. Lactase is a natural enzyme that works only on lactose. The bacterial supplements thrive in the colon and eat the lactose, but don't themselves enter the body. I'd be hard-pressed to call either one of them medicines. In fact, I'd say that both approaches are non-medicinal to start with.

Being non-medicinal is a big advantage. Neither lactase nor probiotics have side effects. (A tiny, tiny handful of people are allergic to the fungus that lactase is grown from, but even that is not a reaction to the lactase itself.)

Back to peppermint extract. It doesn't do either of the things known to reduce LI symptoms. What does it do? Traditionally, peppermint extract has been used to relieve bloating and gas. LI produces both bloating and gas, because the fermentation of the lactose. There would seem to be a connection.

If so, it's hard to find medical research that backs it up. One interesting report is "Peppermint oil (Mintoil®) in the treatment of irritable bowel syndrome: A prospective double blind placebo-controlled randomized trial," by G. Cappelloa, et al. in the journal Digestive and Liver Disease, Volume 39, Issue 6, June 2007, Pages 530-536. It found that peppermint extract relieved symptoms of Irritable Bowel Syndrome better than a placebo. But patients with LI were excluded from the testing. I can't find any articles that report on testing peppermint extract on patients with LI.

Right now I'd have to say that peppermint extract may help soothe the insides of certain people. Does it help LI? No evidence that it does. Is it non-medicinal? No more than the choices that are known to work. Would I recommend it? No. But reaching that answer proved more complicated than I thought at first.