Mint: The Essence of Freshness – Keep Your Digestive Tract in Mint Condition

“Mint” is a name like “Smith”—very common. There’s field mint, forest mint, marsh mint, and mountain mint; Egyptian mint, Vietnamese mint, and Corsican mint; curly mint, thorn mint, and slender mint. And, of course, there are the famous twins, spearmint and peppermint. In all, about 600 plants answer to the name “mint.” (There’s even a Smith’s mint.) And thousands of products contain it.

Mint is one of the most popular and recognizable flavors in the world. It’s an ingredient in (among other things) soft drinks, candies, cocktails and liqueurs, jellies, syrups, cakes, ice teas, and ice creams. However, the mint that flavors these tasty treats is one mint: Peppermint. The sweet mint.

When you go to the grocery store to buy a jar of mint for recipes that call for the spice, you also are buying one mint: Spearmint. The savory mint.

But sweet or savory, refreshing mint is a potent healer. Starting with your digestive tract.

Keep Your Digestive Tract in Mint Condition

Studies show peppermint can help ease the symptoms of irritable bowel syndrome (IBS), a digestive problem that strikes an estimated one out of every seven Americans, many of them women. Medical scientists call IBS a “functional” health problem—they can’t find any structural abnormality in the bowel, but they do know that it’s not functioning normally, as intestinal muscles contract slower or faster than normal. The result: a range of symptoms that can include abdominal pain, cramping, and bloating; excess gas; diarrhea and constipation (sometimes one, and sometimes both, alternating).

Peppermint relaxes the muscles of the GI tract, helping to normalize those contractions and ease symptoms.

In a study by Italian researchers, 54 people with IBS took enteric-coated peppermint oil for four weeks. (The coating ensures the pill dissolves in the intestines rather than the stomach.) At the start and end of the study, the researchers measured the severity of abdominal bloating, abdominal pain or discomfort, diarrhea, constipation, feeling of incomplete evacuation, pain at defecation, passing of gas or mucus, and urgency of defecation. Seventy-five percent of people taking the remedy had at least a 50 percent reduction in symptoms.

In another study, 110 people with IBS were divided into two groups: one group took a placebo, and one group took an enteric-coated peppermint oil capsule 15 to 30 minutes before each meal. Of those taking peppermint, 79 percent reported relief from abdominal pain and discomfort, and 29 were pain-free. Bloating was reduced in 83 percent. Flatulence was eased in 79 percent. And 83 percent reported having to take fewer trips to the bathroom. There was little improvement in the placebo group.

Researchers in Canada found that peppermint oil can help clear up bacterial overgrowth in the small intestine, a suspected cause of IBS. “The results in this case suggest one of the mechanisms by which enteric-coated peppermint oil improves IBS symptoms,” they concluded in Alternative Medicine Review.

And when researchers in the Gastroenterology Division of McMaster University in Canada evaluated 38 studies on treatments for IBS, they found three treatments were effective: more fiber in the diet, anti-spasmodic drugs—and peppermint oil.

But IBS isn’t the only digestive problem that mint can help solve.

Indigestion. Researchers in the UK evaluated 17 studies using a natural remedy combining peppermint and caraway oil, and found it effectively reduced stomachache and other post-meal digestive symptoms 60 to 95 percent of the time.

A study of 96 people in Germany found that a peppermint-containing remedy offered significant relief from what doctors call “dyspepsia” (and you call indigestion). After four weeks of use, there was a 40 percent reduction in symptoms.

Colonoscopy. Japanese researchers found that using peppermint oil during a colonoscopy reduced GI spasms in 86 percent of 409 people, with “no adverse affects”—making it a “convenient alternative” to anti-spasmodic drugs that “sometimes cause side effects.”

Upper endoscopy. During this medical test, a tube is inserted into the esophagus, stomach, and small intestine. The same team of Japanese researchers found that peppermint oil had “superior efficacy” compared to an anti-spasmodic drug in easing the procedure. Peppermint also produced “no significant side effects,” whereas the drug produced dry mouth, blurred vision, and urinary retention.

Mint may help prevent and/or treat:

Allergies

Anxiety

Breastfeeding

problems

Cancer

Chronic obstructive

pulmonary disease (COPD)

Cough

Fatigue, mental

Gum disease (gingivitis)

Hirsutism (unwanted hair growth in women)

Indigestion

Irritable bowel

syndrome

Menopause problems

Menstrual cramps

Nasal congestion

Nausea, postoperative

Polycystic ovarian

syndrome (PCOS)

Postherpetic neuralgia

Stress

Tooth decay

Caution: Peppermint isn’t perfect for all digestive problems. Some medical experts urge caution for those with heartburn, hiatal hernia, and kidney stones, because peppermint’s ability to relax the GI tract might make those problems worse.

Breathing Easier

Peppermint is rich in the compound menthol—the rush of coolness you feel from peppermint-containing foods, beverages, and self-care products is menthol stimulating coldness receptors in the mucous membranes or the skin.

In a study by Germany researchers investigating how menthol works to ease nasal congestion, they reached the same conclusion as enthusiastic buyers of mentholated lozenges: it produces “the subjective feeling of a clear and wide nose.”

Researchers in Wales agree. They studied 62 people with a cold, dividing them into two groups: half received a lozenge containing 11 milligrams (mg) of menthol and half a placebo lozenge. There was a “significant change” in “nasal sensation of airflow” in those sucking on menthol.

In the UK, researchers asked 20 people to repeatedly inhale a substance that would make them cough. Five minutes before each “cough challenge,” the people inhaled either menthol, a pine scent, or air. Only “menthol inhalation caused a reduction in cough,” wrote the researchers in the medical journal Thorax.

And when Japanese researchers impaired the breathing of 11 people, they found that breathing menthol produced a “significant reduction in sensations of respiratory discomfort.”

Minting More Relief

There are many other ways that peppermint and spearmint can refresh your health.

Postherpetic neuralgia. As mentioned a moment ago, menthol triggers cold-sensitive receptors in cells, producing a cooling sensation so intense that the compound is an ingredient in pain-relieving topical products such as Icy Hot and Bengay. Well, that rush of cold sensation is also why menthol might work in relieving the intense pain of postherpetic neuralgia—nerve pain after a bout of shingles, a blistering viral rash that typically afflicts people in middle and old age.

In a report in the Clinical Journal of Pain, researchers at the Pain Management Center of University College found that applying peppermint oil containing 10 percent menthol “resulted in an almost immediate improvement of pain” in a patient with postherpetic neuralgia, with the relief lasting four to six hours.

Work performance. Menthol also seems to refresh the mind. Researchers at Wheeling Jesuit University in the US found that sniffing peppermint oil improved performance on two clerical tasks: typing (speed and accuracy) and alphabetical filing. “Peppermint oil may promote a general arousal of attention” so people “stay focused on their task and increase performance,” concluded the researchers in the journal Perceptual and Motor Skills.

Polycystic ovarian syndrome (PCPCOS). This condition of abnormally high testosterone levels afflicts one out of 10 American women. One feature of the syndrome is unwanted facial and body hair (hirsutism). Researchers in the UK found that drinking spearmint tea twice a day for one month reduced abnormally high levels of testosterone in women with PCOS. “Spearmint has the potential for use as a helpful and natural treatment for hirsutism in PCOS,” they concluded in Phytotherapy Research.

Mint pairs well with these spices:

Allspice

Basil

Cardamom

Chile

Cinnamon

Coriander

Cumin

Fennel seed

Lemongrass

Onion

Rosemary

Sage

Sesame seed

Thyme

and complements recipes featuring:

Chutney

Crabmeat

Cranberries

Curries

Lamb

Mango

Papaya

Peas

Yogurt

___________________________________

Other recipes containing mint:

Chaat Masala

Dukkah

Roasted Tomato Soup with Fennel and Mint

Shellfish in Saffron Broth

Stress and anxiety. Korean researchers found that nursing students who inhaled peppermint and other essential oils had less stress and anxiety. Inhalation of peppermint and the other essential oils “could be a very effective stress management method,” concluded the researchers.

Postoperative nausea. US researchers studied 33 surgery patients and found that inhaling peppermint oil decreased postoperative nausea (a common problem) by 29 percent.

Breastfeeding. “Nipple pain and damage in breastfeeding mothers are common causes of premature breastfeeding cessation,” noted a team of researchers, writing in the International Journal of Breastfeeding. They studied 196 breastfeeding women, and found that those who used a topical treatment of peppermint water on their nipples were three times less likely to develop a cracked nipple and five times less likely to suffer from nipple pain.

Tuberculosis. Russian researchers found that adding peppermint oil to combined multidrug therapy for tuberculosis helped kill bacteria and improve symptoms. “This procedure may be used to prevent recurrences and exacerbations of pulmonary tuberculosis,” they concluded.

Chemotherapy-induced hot flashes. In a study by researchers in the UK, some women found a spray containing peppermint oil “extremely helpful” in lessening hot flashes induced by treatment for breast cancer.

Cancer. There are dozens of test tube and animal studies showing mint can battle cancer. Peppermint, spearmint, and compounds in them have been effective in slowing, stopping, or killing lung, prostate, liver, skin, stomach, bladder, brain, oral, and blood cancers.

Chronic obstructive pulmonary disease (COPD). A combination of emphysema and chronic bronchitis, this lung disease is the fourth leading cause of death in the US. Researchers in China found that spearmint oil decreased inflammation in the lungs of rats with experimentally induced COPD.

There are about 600 plants in the mint family.

Cavities and gum disease. Researchers in the Middle East found that peppermint oil killed the bacteria that cause tooth decay and helped stopped plaque buildup.

MINT IS A COMMON FLAVORING IN TOOTHPASTES AND MOUTHWASHS.

Hay fever. In the laboratory, researchers in Japan found that mint extracts stop the release of histamine, the chemical that causes allergic symptoms such as watery eyes, itching, and nasal congestion. “These results suggest that extracts [of mint] may be clinically effective in alleviating the nasal symptoms of allergic rhinitis [hayfever],” concluded the researchers.

Getting to Know Mint

Spearmint and peppermint have been used as an ingredient in toiletries and cosmetics for centuries, and today they’re a common flavoring in toothpaste and mouthwash. But mint didn’t flavor food until the 17th century.

The English were the first to eat mint and they’re still big fans—no English cook would serve lamb without the traditional mint sauce. Americans also favor mint with lamb, preferring mint jelly.

Countries in the eastern Mediterranean (Greece, Turkey, and the Mediterranean countries of the Middle East) and Southeast Asia use a lot of mint, as does India—fresh or dried, in sweet and savory dishes. (And, of course, in tea: black tea brewed with spearmint is a favored beverage in the Middle East and Africa.)

Grilled Lamb Patty Pockets with Cucumber Mint Sauce

This Middle-Eastern dish, perfect for a picnic, gives a spicy twist on the traditional cucumber mint sauce called tzatziki.

For the sauce:

1 cup plain yogurt

1 cup peeled and seeded cucumber, coarsely chopped

¼ cup fresh mint, tightly packed

1 tablespoon lime juice

½ teaspoon salt

¼ teaspoon ground cumin

¼ teaspoon sweet paprika

¼ teaspoon chili powder

¼ teaspoon sugar

Freshly ground white pepper to taste

For the patties:

1 pound lean ground lamb

½ cup fresh breadcrumbs

½ cup diced onions

1 large egg, beaten lightly

1 large garlic clove, minced

2 teaspoons olive oil

1 tablespoon dried mint leaves, crumbled

1 teaspoon ground allspice

½ teaspoon ground cinnamon

¼ cup white sesame seeds, toasted

Salt and freshly ground black pepper to taste

4 large pita breads

Toppings:

1 green bell pepper, sliced

1 red bell pepper, sliced

1 small red onion, thinly sliced

1 cup pepperoncini peppers, sliced

1. To make the sauce: Place the yogurt in a fine mesh strainer set over a bowl and let it drain for about five minutes. Discard any liquid that drains from the yogurt.

2. Combine the cucumber, mint, lime juice, salt, cumin, paprika, chili powder, sugar, pepper, and drained yogurt in a food processor and blend until smooth. Refrigerate until ready to use.

3. To make the lamb patties: Combine the ground lamb, breadcrumbs, onions, egg, garlic, olive oil, mint, allspice, cinnamon, sesame seeds, salt, and pepper and mix well.

4. Wet your hands and form into eight patties. Spray the grate of a grill with non-stick spray and heat to high. Grill the patties for two minutes on each side or until desired doneness. Place two patties on a pita, ladle with the sauce, and serve with the toppings.

Makes 4 servings.

In India, mint raita, made with cucumber and yogurt, is a popular condiment; it’s a cooling contrast with hot curries. Mint is a key spice in the Indian meatballs known as kofta, and in the spice mix chaat masala. Spearmint is ground with coconut, chiles, onion, and green mango for chutney. It is also added to spicy rice dishes called biryanis.

In North Africa, mint is always around when harissa, one of the world’s hottest condiments, is served. It is a popular spice in Moroccan stews called tagines, and in stuffed vine leaves, a Middle Eastern specialty popular in the US. It is an ingredient in the Egyptian spice mix dukkah. It is also an important spice in Iranian and Turkish cuisines. Mint is the spice that defines the popular Greek yogurt and cucumber sauce called tzatziki.

In Malaysia, mint is combined with turmeric, galangal, lemongrass, and shrimp paste to flavor spicy noodle broths called laksas. Mint is in Thai green curry paste. It’s used in Asian stir-fries.

Mint is also one of a bartender’s best friends. There are about five dozen drinks in the bartender’s repertoire that include mint leaves or mint-flavored alcohol, such as the liqueur crème de menthe, used to make stingers and grasshoppers. The most popular mint cocktail these days is a mojito, which includes citrus juice and tequila. And, of course, there is the German favorite peppermint Schnapps. On the first Saturday in May, when Churchill Downs hosts the Kentucky Derby, 1,000 pounds of fresh mint are mulled to make Mint Juleps, the classic derby drink, made with bourbon, simple syrup, bitters—and lots of mint.

How to Buy Mint

As already mentioned, the generic mint you get from the grocer is dried spearmint, but you can get dried peppermint from specialty spice shops or online. (You’ll find a list of spice retailers in the “Buyer’s Guide”.)

Dried mint (spearmint) is sometimes referred to as rubbed mint, because the leaves break into tiny pieces when the dried leaves are rubbed off the stems. It darkens when dried, becoming almost black. But the color doesn’t affect quality or freshness.

For freshness, check the aroma. Spearmint should smell warm and slightly pungent; peppermint, cool and slightly peppery.

In the Kitchen with Mint

Unless you’re into making specialty cakes and confections, there is little use for peppermint in the kitchen other than making tea. There are, however, many uses for spearmint.

Mint is a dominant flavor. For this reason, many cooks think mint doesn’t marry well with other spices. But chefs adept at Indian and Asian cuisine blend it with other strong spices with success.

Here are ideas to put more mint in your diet:

• Break mint sprigs in small pieces and freeze them with water in ice cube trays. Use the ice in iced tea, lemonade, and tonics.

• Sprinkle mint in butter spread for corn on the cob.

• Grind fresh or dried mint with a pinch of salt in a mortar and pestle and add it to olive oil and vinegar dressing.

• Add mint to cream-based soups and sauces.

• Add mint to pea soup and dishes featuring peas.

• Add mint to cold cucumber soup.

• Substitute mint for basil in a mint pesto.

• Make an untraditional chimichurri sauce by substituting mint for the parsley.

• For a change of taste, use mint instead of oregano or marjoram in eggplant and tomato dishes.

Mint: The Essence of Freshness – Keep Your Digestive Tract in Mint Condition

“Mint” is a name like “Smith”—very common. There’s field mint, forest mint, marsh mint, and mountain mint; Egyptian mint, Vietnamese mint, and Corsican mint; curly mint, thorn mint, and slender mint. And, of course, there are the famous twins, spearmint and peppermint. In all, about 600 plants answer to the name “mint.” (There’s even a Smith’s mint.) And thousands of products contain it.

Mint is one of the most popular and recognizable flavors in the world. It’s an ingredient in (among other things) soft drinks, candies, cocktails and liqueurs, jellies, syrups, cakes, ice teas, and ice creams. However, the mint that flavors these tasty treats is one mint: Peppermint. The sweet mint.

When you go to the grocery store to buy a jar of mint for recipes that call for the spice, you also are buying one mint: Spearmint. The savory mint.

But sweet or savory, refreshing mint is a potent healer. Starting with your digestive tract.

Keep Your Digestive Tract in Mint Condition

Studies show peppermint can help ease the symptoms of irritable bowel syndrome (IBS), a digestive problem that strikes an estimated one out of every seven Americans, many of them women. Medical scientists call IBS a “functional” health problem—they can’t find any structural abnormality in the bowel, but they do know that it’s not functioning normally, as intestinal muscles contract slower or faster than normal. The result: a range of symptoms that can include abdominal pain, cramping, and bloating; excess gas; diarrhea and constipation (sometimes one, and sometimes both, alternating).

Peppermint relaxes the muscles of the GI tract, helping to normalize those contractions and ease symptoms.

In a study by Italian researchers, 54 people with IBS took enteric-coated peppermint oil for four weeks. (The coating ensures the pill dissolves in the intestines rather than the stomach.) At the start and end of the study, the researchers measured the severity of abdominal bloating, abdominal pain or discomfort, diarrhea, constipation, feeling of incomplete evacuation, pain at defecation, passing of gas or mucus, and urgency of defecation. Seventy-five percent of people taking the remedy had at least a 50 percent reduction in symptoms.

In another study, 110 people with IBS were divided into two groups: one group took a placebo, and one group took an enteric-coated peppermint oil capsule 15 to 30 minutes before each meal. Of those taking peppermint, 79 percent reported relief from abdominal pain and discomfort, and 29 were pain-free. Bloating was reduced in 83 percent. Flatulence was eased in 79 percent. And 83 percent reported having to take fewer trips to the bathroom. There was little improvement in the placebo group.

Researchers in Canada found that peppermint oil can help clear up bacterial overgrowth in the small intestine, a suspected cause of IBS. “The results in this case suggest one of the mechanisms by which enteric-coated peppermint oil improves IBS symptoms,” they concluded in Alternative Medicine Review.

And when researchers in the Gastroenterology Division of McMaster University in Canada evaluated 38 studies on treatments for IBS, they found three treatments were effective: more fiber in the diet, anti-spasmodic drugs—and peppermint oil.

But IBS isn’t the only digestive problem that mint can help solve.

Indigestion. Researchers in the UK evaluated 17 studies using a natural remedy combining peppermint and caraway oil, and found it effectively reduced stomachache and other post-meal digestive symptoms 60 to 95 percent of the time.

A study of 96 people in Germany found that a peppermint-containing remedy offered significant relief from what doctors call “dyspepsia” (and you call indigestion). After four weeks of use, there was a 40 percent reduction in symptoms.

Colonoscopy. Japanese researchers found that using peppermint oil during a colonoscopy reduced GI spasms in 86 percent of 409 people, with “no adverse affects”—making it a “convenient alternative” to anti-spasmodic drugs that “sometimes cause side effects.”

Upper endoscopy. During this medical test, a tube is inserted into the esophagus, stomach, and small intestine. The same team of Japanese researchers found that peppermint oil had “superior efficacy” compared to an anti-spasmodic drug in easing the procedure. Peppermint also produced “no significant side effects,” whereas the drug produced dry mouth, blurred vision, and urinary retention.

Mint may help prevent and/or treat:

Allergies

Anxiety

Breastfeeding

problems

Cancer

Chronic obstructive

pulmonary disease (COPD)

Cough

Fatigue, mental

Gum disease (gingivitis)

Hirsutism (unwanted hair growth in women)

Indigestion

Irritable bowel

syndrome

Menopause problems

Menstrual cramps

Nasal congestion

Nausea, postoperative

Polycystic ovarian

syndrome (PCOS)

Postherpetic neuralgia

Stress

Tooth decay

Caution: Peppermint isn’t perfect for all digestive problems. Some medical experts urge caution for those with heartburn, hiatal hernia, and kidney stones, because peppermint’s ability to relax the GI tract might make those problems worse.

Breathing Easier

Peppermint is rich in the compound menthol—the rush of coolness you feel from peppermint-containing foods, beverages, and self-care products is menthol stimulating coldness receptors in the mucous membranes or the skin.

In a study by Germany researchers investigating how menthol works to ease nasal congestion, they reached the same conclusion as enthusiastic buyers of mentholated lozenges: it produces “the subjective feeling of a clear and wide nose.”

Researchers in Wales agree. They studied 62 people with a cold, dividing them into two groups: half received a lozenge containing 11 milligrams (mg) of menthol and half a placebo lozenge. There was a “significant change” in “nasal sensation of airflow” in those sucking on menthol.

In the UK, researchers asked 20 people to repeatedly inhale a substance that would make them cough. Five minutes before each “cough challenge,” the people inhaled either menthol, a pine scent, or air. Only “menthol inhalation caused a reduction in cough,” wrote the researchers in the medical journal Thorax.

And when Japanese researchers impaired the breathing of 11 people, they found that breathing menthol produced a “significant reduction in sensations of respiratory discomfort.”

Minting More Relief

There are many other ways that peppermint and spearmint can refresh your health.

Postherpetic neuralgia. As mentioned a moment ago, menthol triggers cold-sensitive receptors in cells, producing a cooling sensation so intense that the compound is an ingredient in pain-relieving topical products such as Icy Hot and Bengay. Well, that rush of cold sensation is also why menthol might work in relieving the intense pain of postherpetic neuralgia—nerve pain after a bout of shingles, a blistering viral rash that typically afflicts people in middle and old age.

In a report in the Clinical Journal of Pain, researchers at the Pain Management Center of University College found that applying peppermint oil containing 10 percent menthol “resulted in an almost immediate improvement of pain” in a patient with postherpetic neuralgia, with the relief lasting four to six hours.

Work performance. Menthol also seems to refresh the mind. Researchers at Wheeling Jesuit University in the US found that sniffing peppermint oil improved performance on two clerical tasks: typing (speed and accuracy) and alphabetical filing. “Peppermint oil may promote a general arousal of attention” so people “stay focused on their task and increase performance,” concluded the researchers in the journal Perceptual and Motor Skills.

Polycystic ovarian syndrome (PCPCOS). This condition of abnormally high testosterone levels afflicts one out of 10 American women. One feature of the syndrome is unwanted facial and body hair (hirsutism). Researchers in the UK found that drinking spearmint tea twice a day for one month reduced abnormally high levels of testosterone in women with PCOS. “Spearmint has the potential for use as a helpful and natural treatment for hirsutism in PCOS,” they concluded in Phytotherapy Research.

Mint pairs well with these spices:

Allspice

Basil

Cardamom

Chile

Cinnamon

Coriander

Cumin

Fennel seed

Lemongrass

Onion

Rosemary

Sage

Sesame seed

Thyme

and complements recipes featuring:

Chutney

Crabmeat

Cranberries

Curries

Lamb

Mango

Papaya

Peas

Yogurt

___________________________________

Other recipes containing mint:

Chaat Masala

Dukkah

Roasted Tomato Soup with Fennel and Mint

Shellfish in Saffron Broth

Stress and anxiety. Korean researchers found that nursing students who inhaled peppermint and other essential oils had less stress and anxiety. Inhalation of peppermint and the other essential oils “could be a very effective stress management method,” concluded the researchers.

Postoperative nausea. US researchers studied 33 surgery patients and found that inhaling peppermint oil decreased postoperative nausea (a common problem) by 29 percent.

Breastfeeding. “Nipple pain and damage in breastfeeding mothers are common causes of premature breastfeeding cessation,” noted a team of researchers, writing in the International Journal of Breastfeeding. They studied 196 breastfeeding women, and found that those who used a topical treatment of peppermint water on their nipples were three times less likely to develop a cracked nipple and five times less likely to suffer from nipple pain.

Tuberculosis. Russian researchers found that adding peppermint oil to combined multidrug therapy for tuberculosis helped kill bacteria and improve symptoms. “This procedure may be used to prevent recurrences and exacerbations of pulmonary tuberculosis,” they concluded.

Chemotherapy-induced hot flashes. In a study by researchers in the UK, some women found a spray containing peppermint oil “extremely helpful” in lessening hot flashes induced by treatment for breast cancer.

Cancer. There are dozens of test tube and animal studies showing mint can battle cancer. Peppermint, spearmint, and compounds in them have been effective in slowing, stopping, or killing lung, prostate, liver, skin, stomach, bladder, brain, oral, and blood cancers.

Chronic obstructive pulmonary disease (COPD). A combination of emphysema and chronic bronchitis, this lung disease is the fourth leading cause of death in the US. Researchers in China found that spearmint oil decreased inflammation in the lungs of rats with experimentally induced COPD.

There are about 600 plants in the mint family.

Cavities and gum disease. Researchers in the Middle East found that peppermint oil killed the bacteria that cause tooth decay and helped stopped plaque buildup.

MINT IS A COMMON FLAVORING IN TOOTHPASTES AND MOUTHWASHS.

Hay fever. In the laboratory, researchers in Japan found that mint extracts stop the release of histamine, the chemical that causes allergic symptoms such as watery eyes, itching, and nasal congestion. “These results suggest that extracts [of mint] may be clinically effective in alleviating the nasal symptoms of allergic rhinitis [hayfever],” concluded the researchers.

Getting to Know Mint

Spearmint and peppermint have been used as an ingredient in toiletries and cosmetics for centuries, and today they’re a common flavoring in toothpaste and mouthwash. But mint didn’t flavor food until the 17th century.

The English were the first to eat mint and they’re still big fans—no English cook would serve lamb without the traditional mint sauce. Americans also favor mint with lamb, preferring mint jelly.

Countries in the eastern Mediterranean (Greece, Turkey, and the Mediterranean countries of the Middle East) and Southeast Asia use a lot of mint, as does India—fresh or dried, in sweet and savory dishes. (And, of course, in tea: black tea brewed with spearmint is a favored beverage in the Middle East and Africa.)

Grilled Lamb Patty Pockets with Cucumber Mint Sauce

This Middle-Eastern dish, perfect for a picnic, gives a spicy twist on the traditional cucumber mint sauce called tzatziki.

For the sauce:

1 cup plain yogurt

1 cup peeled and seeded cucumber, coarsely chopped

¼ cup fresh mint, tightly packed

1 tablespoon lime juice

½ teaspoon salt

¼ teaspoon ground cumin

¼ teaspoon sweet paprika

¼ teaspoon chili powder

¼ teaspoon sugar

Freshly ground white pepper to taste

For the patties:

1 pound lean ground lamb

½ cup fresh breadcrumbs

½ cup diced onions

1 large egg, beaten lightly

1 large garlic clove, minced

2 teaspoons olive oil

1 tablespoon dried mint leaves, crumbled

1 teaspoon ground allspice

½ teaspoon ground cinnamon

¼ cup white sesame seeds, toasted

Salt and freshly ground black pepper to taste

4 large pita breads

Toppings:

1 green bell pepper, sliced

1 red bell pepper, sliced

1 small red onion, thinly sliced

1 cup pepperoncini peppers, sliced

1. To make the sauce: Place the yogurt in a fine mesh strainer set over a bowl and let it drain for about five minutes. Discard any liquid that drains from the yogurt.

2. Combine the cucumber, mint, lime juice, salt, cumin, paprika, chili powder, sugar, pepper, and drained yogurt in a food processor and blend until smooth. Refrigerate until ready to use.

3. To make the lamb patties: Combine the ground lamb, breadcrumbs, onions, egg, garlic, olive oil, mint, allspice, cinnamon, sesame seeds, salt, and pepper and mix well.

4. Wet your hands and form into eight patties. Spray the grate of a grill with non-stick spray and heat to high. Grill the patties for two minutes on each side or until desired doneness. Place two patties on a pita, ladle with the sauce, and serve with the toppings.

Makes 4 servings.

In India, mint raita, made with cucumber and yogurt, is a popular condiment; it’s a cooling contrast with hot curries. Mint is a key spice in the Indian meatballs known as kofta, and in the spice mix chaat masala. Spearmint is ground with coconut, chiles, onion, and green mango for chutney. It is also added to spicy rice dishes called biryanis.

In North Africa, mint is always around when harissa, one of the world’s hottest condiments, is served. It is a popular spice in Moroccan stews called tagines, and in stuffed vine leaves, a Middle Eastern specialty popular in the US. It is an ingredient in the Egyptian spice mix dukkah. It is also an important spice in Iranian and Turkish cuisines. Mint is the spice that defines the popular Greek yogurt and cucumber sauce called tzatziki.

In Malaysia, mint is combined with turmeric, galangal, lemongrass, and shrimp paste to flavor spicy noodle broths called laksas. Mint is in Thai green curry paste. It’s used in Asian stir-fries.

Mint is also one of a bartender’s best friends. There are about five dozen drinks in the bartender’s repertoire that include mint leaves or mint-flavored alcohol, such as the liqueur crème de menthe, used to make stingers and grasshoppers. The most popular mint cocktail these days is a mojito, which includes citrus juice and tequila. And, of course, there is the German favorite peppermint Schnapps. On the first Saturday in May, when Churchill Downs hosts the Kentucky Derby, 1,000 pounds of fresh mint are mulled to make Mint Juleps, the classic derby drink, made with bourbon, simple syrup, bitters—and lots of mint.

How to Buy Mint

As already mentioned, the generic mint you get from the grocer is dried spearmint, but you can get dried peppermint from specialty spice shops or online. (You’ll find a list of spice retailers in the “Buyer’s Guide”.)

Dried mint (spearmint) is sometimes referred to as rubbed mint, because the leaves break into tiny pieces when the dried leaves are rubbed off the stems. It darkens when dried, becoming almost black. But the color doesn’t affect quality or freshness.

For freshness, check the aroma. Spearmint should smell warm and slightly pungent; peppermint, cool and slightly peppery.

In the Kitchen with Mint

Unless you’re into making specialty cakes and confections, there is little use for peppermint in the kitchen other than making tea. There are, however, many uses for spearmint.

Mint is a dominant flavor. For this reason, many cooks think mint doesn’t marry well with other spices. But chefs adept at Indian and Asian cuisine blend it with other strong spices with success.

Here are ideas to put more mint in your diet:

• Break mint sprigs in small pieces and freeze them with water in ice cube trays. Use the ice in iced tea, lemonade, and tonics.

• Sprinkle mint in butter spread for corn on the cob.

• Grind fresh or dried mint with a pinch of salt in a mortar and pestle and add it to olive oil and vinegar dressing.

• Add mint to cream-based soups and sauces.

• Add mint to pea soup and dishes featuring peas.

• Add mint to cold cucumber soup.

• Substitute mint for basil in a mint pesto.

• Make an untraditional chimichurri sauce by substituting mint for the parsley.

• For a change of taste, use mint instead of oregano or marjoram in eggplant and tomato dishes.

Carcinoids of the Gastrointestinal Tract – Common Signs and Symptoms, Diagnosis and Treatment

Carcinoid tumors are uncommon cancers. Although they can develop in other organs, especially the lung, they generally arise in the intestinal tract, including the stomach, pancreas, small bowel, appendix, and rectum. They are the most common tumors of the appendix, occurring in 1 out of every 300 appendectomies. They make up 30 percent of small bowel tumors but less than 2 percent of all gastrointestinal malignancies.

In their early stages, carcinoid tumors are highly treatable and often curable. They are usually slow growing, and the risk of metastasis is related to the size of the primary tumor. Because these tumors are indolent in their behavior and the patient is usually asymptomatic early in the disease, the tumor often goes undetected for many years. Consequently, the disease is often in a more advanced stage at the time of diagnosis.

Small bowel carcinoids may occur in multiple sites (about 25 percent of patients have multiple tumors) and, except for those of rectal origin, may produce biologically active hormones and peptides. In many cases, there are no symptoms, so some carcinoid tumors are discovered incidentally during abdominal operations performed for other reasons. The survival of most people with carcinoid tumors is quite good, although symptoms may develop when the tumor cannot be removed, when it recurs after treatment, or when there is metastatic disease.

Manifestations of the carcinoid syndrome

Types There are no meaningful cell type (histologic) variations that help predict the clinical course of these tumors. Carcinoids are broadly defined as neuroendocrine or APUD (amine precursor uptake and decarboxylation) tumors. They are classified as foregut, midgut, or hindgut, according to site of primary tumor. Foregut tumors include lung, gastric, duodenal, and pancreatic tumors; midgut tumors include those in the small bowel, appendix, and the first portion of the large intestine; and hindgut tumors are from the remainder of the large intestine and the rectum. Each classification of carcinoid tumors represents not only differences in location of the primary tumor, but also where the tumor is likely to spread and differences in hormone production. Malignant midgut carcinoids may produce at least two hormones, serotonin and substance P, but some carcinoid tumors are nonfunctional and do not release any substances.

How It Spreads Carcinoid tumors spread by direct invasion of the underlying layers of tissue (submucosally). They can also spread via lymphatics to regional lymph nodes and through the bloodstream to the liver, lung(s), bones, or other organs.

The site of origin and size of the primary tumor are important in determining whether the carcinoid tumor is likely to spread. A tumor less than 1/2 inch (1 cm) rarely metastasizes. But 88 percent of patients with tumors larger than 3/4 inch (2 cm) have metastases, and 18 percent of these develop the carcinoid syndrome (see “Common Signs and Symptoms,” below).

What Causes It Unknown

Risk Factors

Factors that put an individual at risk have not been identified. It is exceedingly rare for carcinoids to be hereditary. However, there are certain genetic mutations found to be associated with the development of the disease. The majority of mutations associated with carcinoid tumors appear to be spontaneous mutations rather than a result of an inherent risk.

Screening

There are no effective screening methods.

Common Signs and Symptoms

Symptoms are unusual in the early stages. The tumors are small and grow slowly and the symptoms so vague, any changes noticed are considered normal. When pronounced symptoms do occur, the tumor has already spread in 90 percent of patients. The most common symptoms associated with gastrointestinal tumors are periodic abdominal pain, intermittent intestinal obstruction, and kinking of the bowel. Gastrointestinal bleeding is uncommon and ulcerations of the tumor are rare.

In addition to the symptoms caused by the tumor, there may be symptoms of the carcinoid syndrome. This is characterized by facial flushing, wheezing, diarrhea, and cardiac valvular disease. Midgut carcinoid tumors are more likely to be associated with the syndrome compared to foregut tumors. Hindgut tumors are usually asymptomatic. The syndrome is associated with abnormal amounts of the two hormones produced by malignant carcinoids, serotonin and substance P. The syndrome occurs in approximately 10 percent of patients with carcinoid tumors, almost always because of carcinoid metastases in the liver.

Diagnosis

Physical Examination

• Palpating the abdomen to identify an abdominal mass and/or an enlarged liver.

• Examination of the facial skin to identify prominent skin veins (telangiectasis) and flushing.

• Listening with a stethoscope for signs that may be associated with carcinoid syndrome—heart murmur and wheezing on expiration.

Blood and Other Tests

• Chromogranin A (CgA) is a general biochemical marker for neuroendocrine tumors. Not all carcinoid tumors overproduce and secrete measurable CgA, but most do. If levels are abnormal, it provides a marker for the disease.

• Metastatic carcinoid tumors may be diagnosed by the twenty-four-hour urine 5-hydroxyindoleacetic acid (5-HIAA) test, which detects elevated levels of 5-HIAA, a metabolic product of the serotonin produced by the tumor. Plasma serotonin levels represent only the level at the time of blood sampling, but the 5-HIAA urine sample provides a twenty-four-hour picture of the serotonin levels, thus providing a more accurate measure for abnormal serotonin production. False positive 5-HIAA tests can be caused by foods such as bananas, avocados, and pineapple and by certain drugs. The laboratory should provide a complete list of foods to be avoided during urine collection.

Imaging

• X-rays of the chest and gastrointestinal tract (small bowel and barium enema).

• Endoscopic evaluation of the stomach may include endoscopic ultrasound (EUS), bronchoscopy for lung tumors, enteroclysis (small bowel enema) for tumors of the small intestine, and colonoscopy to detect large intestinal or rectal tumors.

• CT or MRI scans (with contrast) of the abdomen to detect primary tumors and liver metastases.

• Octreoscan is a nuclear medicine test to determine where the tumor has spread. This test uses a radio-labeled somatostatin analogue that binds to receptors in a lock-and-key fashion. These receptors are located on the tumor cell surface and allow the tumor to be detected through imaging by a nuclear medicine camera. This imaging is used for initial staging of disease and restaging when disease progression is suspected. Since this test reveals somatostatin receptors, it also provides a means for evaluation if the tumor cells would be responsive to somatostatin analogue therapy.

Biopsy Tissue biopsy is the most definitive means of diagnosing the disease. Biopsies may be done of the primary tumor and/or the metastatic lesions.

Staging

There are no specific staging criteria for carcinoids. The tumors are usually referred to as local, local/regional, or metastatic, with emphasis on the extent and location of metastatic disease.

Treatment Overview

Surgery is the standard therapy. The extent of disease spread is important in deciding treatment options.

Surgery Surgical removal of the tumor is the standard treatment for cure. If the primary tumor is localized and can be removed, the five-year survival rate is in the range of 70 to 90 percent. Since carcinoid tumors are usually slow growing, even patients with tumors that can’t be removed have an average survival of several years. Surgery often offers excellent relief from symptoms—for example, by removing the liver metastases causing the carcinoid syndrome or by resecting or bypassing intestinal obstructions. Such surgery may add years to a patient’s life, an uncommon result of surgery for other types of liver metastases.

Radiation Radiation therapy may be used for symptomatic treatment of bone metastases.

Chemotherapy There has been modest success with chemotherapy. Drug combinations of 5-fluorouracil and streptozocin (Zanosar) have had responses of 10 to 30 percent. Clinical trials evaluating newer drugs are preferable.

Palliation Drugs such as Periactin (cyproheptadine), alpha- and beta adrenergic blockers, chlorpromazine (Thorazine), and corticosteroids may be used to alleviate the symptoms related to the carcinoid syndrome.

Octreotide (Sandostatin), a somatostatin analogue, is very effective in decreasing the secretion of serotonin and can help relieve symptoms of the carcinoid syndrome such as flushing, diarrhea, and wheezing. Interferon-alpha may alleviate symptoms and arrest tumor growth.

Treatment of Localized Tumors by Site

Appendiceal Carcinoids

Appendiceal tumors account for 22 percent of all carcinoids. They are treated by appendectomy and, in fact, are usually diagnosed for the first time at surgery. Lesions less than 3/4 inch (2 cm) in diameter are essentially 100 percent curable.

Appendiceal tumors larger than 3/4inch (2 cm) are rare and treated like a carcinoma of the colon. For these larger tumors, removal of the right side of the colon and the lymphatics is recommended.

Five-Year Survival 99 to 100 percent

Rectal Carcinoids

These account for a quarter of all carcinoids. Rectal carcinoids less than 1/2 inch (1 cm) can be treated adequately by local excision (fulguration), with cure rates approaching 100 percent.

Carcinoid lesions larger than 3/4 inch (2 cm) are treated surgically. As with carcinoma, an abdominal-perineal resection may be necessary, but sphincter-preserving surgery may be performed in some cases.

Lesions between 1/2 and 3/4 inch (1 to 2 cm) are in a “gray zone” and receive individualized treatment depending on age, operative risk, and acceptability of a colostomy. The cure rate is excellent.

Five-Year Survival 76 to 83 percent

Small Bowel Carcinoids

Small bowel tumors make up 28 percent of all carcinoids. Conservative local excision is sufficient for tumors less than 1/2 inch (1 cm) in diameter. For larger tumors, a wedge of the tissues supporting the bowel (mesentery) containing the regional lymph nodes should also be removed.

Anyone with a tumor larger than 3/4 inch (2 cm) should be followed closely for a minimum of ten years. The follow-up program should include quarterly or semiannual CT scan of the abdomen and measurements of CgA and urinary 5-HIAA levels.

Five-Year Survival 54 to 67 percent

Treatment of Invasive and Metastatic Carcinoids

Regional Gastrointestinal Carcinoids

Carcinoid tumors with regional metastasis or local extension should be treated by aggressive surgery. If all visible malignant disease can be removed, long-term survival rates will be excellent.

No surgical adjuvant treatment is known to be helpful.

If the regional disease cannot be removed, palliative surgery—to remove all the accessible disease, for example—should be carried out.

Chemotherapy is not required; these patients frequently have many months or even years of comfortable life without further treatment.

Metastatic Carcinoid Tumors

A number of standard treatment options are available for metastatic carcinoid tumors.

Surgery This has considerable value when there are large liver metastases involving surgically accessible areas of the liver. Liver metastases that recur after surgery should be considered for another resection if they are in an area where the operation can be done with minimal complications. Since these tumors are often slow growing, such surgery may result in significant improvement in life span.

• Radiofrequency ablation of liver metastasis is an option for multiple smaller tumors (less than 2?3/4 inches [7 cm]) and it is often used in conjunction with surgical removal of larger liver tumors. A needle is placed in the tumor, and radiofrequency current is transmitted. This current heats the tumor tissue, causing tumor cell death. The heat also closes up small blood vessels, thereby minimizing the risk of bleeding.

• For very carefully selected patients with slowly progressive disease and symptomatic carcinoid heart disease, heart valve replacement may be indicated.

Hepatic Artery Embolization This is an option for bulky or symptomatic liver metastases that are not surgically resectable. Hepatic artery embolization is used to reduce the blood flow through the hepatic artery, the artery that feeds most liver cancer cells. A material that can plug up the artery is injected. Most of the healthy liver cells will be unaffected because they get their blood supply from the portal vein. A catheter is inserted into an artery in the groin area and threaded up into the liver. A dye is usually injected into the bloodstream at this time to allow the doctor to see the path of the catheter by a special type of X-ray called angiography. Once the catheter is in place and it is confirmed that the portal vein is not blocked, small particles are injected into the artery, cutting off the blood supply to the tumor cells.

Embolization may be done with or without chemotherapy. This can lead to substantial tumor regression. It can also cause significant side effects—abdominal pain, fever, nausea, and a short-term worsening of the syndrome—but many patients do experience substantial relief from symptoms.

Embolizations are often performed over several procedures until the desired effect is appreciated, usually one month apart. This procedure can be repeated years later in the course of disease management.

Radiation The role of radiation therapy in managing carcinoid tumors with distant metastasis is restricted to relief of symptoms, most commonly from bone involvement. However, localized metastasis will occasionally respond to radiation therapy.

Supportive Therapy There are a number of ways to manage symptoms from metastatic disease with medication:

• Diarrhea, if not severe, will frequently respond to standard antidiarrheal medications such as Lomotil, Imodium, or tincture of opium and to dietary changes such as restricting consumption of foods high in fat.

• The somatostatin analogue octreotide (Sandostatin) has been shown to be useful in improving symptoms of the carcinoid syndrome and may be life saving in carcinoid crisis (sudden exacerbation of symptoms). It targets the cell receptors that control the abnormal production and release of the hormones that cause the syndrome and carcinoid heart disease. This method of therapy is the standard for reducing elevated levels of 5-HIAA.

• Interferon-alpha preparations may have a role in controlling symptoms of the carcinoid syndrome and/or in arresting tumor growth.

• Acute symptoms—carcinoid crisis—may be prevented by pretreatment, and an active crisis can be reversed with short-acting octreotide. Some specific drugs are to be avoided in these patients because of the risk of causing the release of vasoactive substances. This is especially true during surgery and in the treatment of low blood pressure.

Chemotherapy Although activity with a variety of single agents and drug combinations has been reported—5-fluorouracil (5-FU), doxorubicin (Adriamycin), and dacarbazine (DTIC) or 5-FU + streptozocin—response rates seldom exceed 30 percent. Complete responses are uncommon, and the duration of the response may be short, if chemotherapy is used alone.

Chemotherapy should be used for palliation in patients with symptoms and in the case of liver metastases, after blocking the hepatic (liver) artery and then giving chemotherapy (chemoembolization).

Investigational A novel approach has been introduced recently where octreotide is tagged with a radionuclide that kills tumor cells. This is given intravenously and targets tumor cells with somatostatin receptors. Newer drugs that target other molecular pathways are also being investigated.

Treatment Follow-Up

Patients should be evaluated every three to twelve months. The evaluation should include

• physical examination;

• twenty-four-hour urine 5-HIAA levels;

• chromogranin A;

• octreoscan, if required;

• chest X-ray, if required; and

• abdominal MRI or CT scan, if required. If a CT scan is used, it is preferable to use a three-phase scan.

Recurrent Cancer

The selection of further treatment depends on many factors, including the therapy initially used, the site of the recurrence, and individual considerations.

Since some tumors grow rather slowly, attempts to remove them again or multiple operations to remove liver metastases are worthy of consideration. Reducing tumor volume may provide long-term relief of symptoms.

Investigational treatments are appropriate and should be considered when standard treatment fails.

The Most Important Questions You Can Ask

• How are carcinoids different from the usual cancers of the bowel?

• What tests are needed to follow my progress after surgery?

• What does a rising urine 5-HIAA mean?

• What are the toxic side effects of chemotherapy?

• What is the role of repeated surgeries for recurrent carcinoid cancers?

• Am I eligible for any research or investigational protocols?