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Review
Mint and Menthol: A Review of Potential Health Benefits and
wider Human effects
Russ Best1,2
1. Centre for Sport Science & Human Performance, Waikato Institute of Technology, Hamilton, New Zealand
2. Te Pukenga, Hamilton, New Zealand
Abstract: Mint and to a lesser extent menthol have been used since antiquity for medicinal purposes.
Key components of mint and menthol use such as composition and intake, safety and traditional
uses are discussed prior to a review of clinical and human performance outcomes in the areas of
digestive and respiratory health; antibacterial and anti-fungal properties, nocioception, migraine
and headache and emerging evidence regarding COVID 19. Evidence suggests benefit for patients
with irritable bowel syndrome and related digestive issues, with analgesic and respiratory effects
also noted. Perceptual characteristics relating to thermal comfort and sensation, taste sensitivity and
alertness are also considered; these effects are predominantly driven by stimulation of transient re-
ceptor potential melastatin 8 (TRPM8) activity resulting in sensations of cooling and freshness, with
lesser influence on thirst. Finally, sport performance is considered as a domain that may further
elucidate some of the aforementioned underpinning outcomes due to its systemic and dynamic na-
ture, especially when performed in hot environmental conditions.
Keywords: Mint; Menthol; Digestion; Respiration; COVID-19; Sport; Pain
Introduction
Characterisation and mechanisms of action
Mint and menthol have long been known to impart sensations of cool and freshness.
Menthol was characterised by German chemist F.L. Alphons Openheim, first in French in
1861108 and again in English in 1862109, as the camphor of mint; as it is analogous to cam-
pholic alcohol the name menthol is aptly derived from Mentha piperita, the Latin for pep-
permint. Academic literature dating to 1890 espouses the benefits of menthol for respira-
tory infections114 and cooling via stimulation of thermoreceptors is first noted in 1896131.
These subjective abilities to impart sensations of cooling and alleviate nasal congestion are
excellently reviewed by Ronald Eccles, who summarises menthol’s cooling characteristics
and associated psychophysiological responses39,41,42
Both peppermint and menthol stimulate transient receptor potential melastatin 8
(TRPM8) receptors. These are voltage gated ion channels embedded within cell mem-
branes and are especially prevalent in the dorsal and trigeminal ganglia69,104; but are also
found in the upper gut, vascular smooth musculature, bladder and male genitalia105. Upon
stimulation, through either a fall in temperature to < 26 ºC or application of menthol or
eucalyptol, there is a depolarisation and the electric potential of the membrane is altered
due to a flux in Ca2+ and Na+ ions, and subsequent generation of an action potential 50,51. If
a menthol containing stimulus is applied at a sufficient concentration/intensity, either
orally or topically, behavioural, physiological and sensation modifications may occur.
Bautista and colleagues 11 elegantly demonstrated that in TRPM8 knock-out mice there is
a loss of cold and menthol sensitivity down to a temperature of 10ºC 11 and in doing so
elucidated TRMP8’s role as the primary detector of environmental cold. It is also notewor-
thy that menthol stimulates in a manner that is inversely proportional to the thickness of
the stratum corneum in the area to which it is applied 148. This explains the use of the
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tongue as a tissue of interest in most animal research concerning the absorption and re-
sultant excitation of nerve fibres following menthol application, and the less potent effects
observed when menthol is applied topically, especially at low-moderate concentrations.
Composition, intake and kinetics
Peppermint is a naturally occurring hybrid of water mint and spearmint, typically
associated with Europe and the Middle East but now globally cultivated. Menthol is a
derivative of peppermint and is either extracted as an oil, then frozen and filtered to pro-
duce crystals, or synthesised. Of the eight isomers of menthol, the one that occurs natu-
rally and is most commonly consumed is (-)-Menthol. Other arrangements present with
lower or no perceptible intensity of freshness 70.
Peppermint and menthol are components in a vast array of products, thus intake is
remarkably prevalent. Most people are familiar with mint-flavoured mouth rinses, con-
fectionary and herbal teas, with medicinal uses also widespread e.g. as essential oils
within creams and gels. Cigarettes are the most controversial method of menthol delivery.
A 2017 systematic review investigated the effects of menthol containing cigarettes on
smoking initiation, dependence and cessation 146. Mentholated cigarettes increase smok-
ing initiation, especially in youth populations, encourage greater nicotine dependence and
results in lower cessation rates compared to non-mentholated cigarettes 146. These rela-
tionships have led to bans on the sale of menthol cigarettes in Canada, England and the
European Union 38,79 and a proposed ban in the United States of America 34.
The form of menthol and peppermint administration warrants practicable and phar-
macological consideration too. Liquids are likely the most easily administered and trans-
ported, but the potential for menthol to attenuate thirst 14,15,41 suggests this may not always
be the best option. Ice slurries or ice blocks present an appealing combination when phys-
ical and perceptual temperature effects are of concern. A hydrogel or gum allows for a
small dose of carbohydrate to be mentholated and easily packaged, with greater control
over the dose and concentration of menthol compared to the other potential forms out-
lined and thus has been used as a mode of drug administration 117; although it should be
noted that menthol itself is used to enhance transdermal drug delivery due to its pene-
trating effects 27. The pharmaco-kinetic effects of modes of administration differ, both with
respect to plasma and salivary concentration and urinary excretion rates 53,117. Encapsu-
lated menthol elicits approximately nine fold higher plasma concentrations and eight fold
greater urinary excretion rates than peppermint candy or tea 53, when areas under the
curve (AUC) and excretion (mg) are expressed as ratios. Importantly, peppermint con-
taining products also demonstrated a greater coefficient of variation in plasma elimination
and AUC, compared to menthol capsules, indicating that if we are to consider therapeutic
applications of these substances, whilst perhaps being viewed as more natural by patients,
whole peppermint products may elicit less consistent and thus potentially non-therapeu-
tic responses compared to menthol application/ingestion.
Safety
Despite being ubiquitously consumed and available in an array of applications, pep-
permint, and more specifically menthol, can impart systemic toxic effects; this has been
demonstrated in animal models and in humans, either by those consuming menthol or
involved in its preparation. The first documented case of menthol poisoning noted a cool-
ing sensation from the blood 60,123. Further case studies reveal coma inducement when in-
gested as peppermint oil 10 3 and excessive consumption of cough lozenges 4. Similarly,
acute lung injury and oedema can occur when peppermint oil is administered intrave-
nously 12. The mechanisms underpinning toxicity appear to be hepatotoxicity101 or ne-
phrotoxicity 76. Toxicity may still prove fatal when exposure is indirect and of a limited
duration i.e. inhalation of peppermint fumes for ~60 min 82. It should be noted that serious
or fatal cases used doses beyond the recognised upper tolerable limit and in environments
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that may have also facilitated a negative outcome e.g. poorly ventilated. Safe doses are
related to the form of administration; liquids containing doses of 0.1 – 0.5 g.L-1, sprays of
0.8% and topical gels of 8% have been safely administered 85,121,134. Importantly, menthol
may confer heat storage responses when applied topically in high concentrations due to
vasoconstrictive effects; likewise menthol or peppermint applications are not intended to
replace physiological cooling where exposure to high environmental temperatures or
presence of high core body temperature are apparent 9.
Traditional uses and inter-individual variation
Peppermint use is historically documented and evident across a wide range of an-
cient cultures, spanning from Iceland to China, via ancient Egypt 89, mainly for culinary
and medicinal purposes. Peppermint has traditionally been used to alleviate gastro-intes-
tinal (GI) symptoms, the proposed mechanisms for which are discussed later in this re-
view. Other traditional uses of peppermint include but are not limited to: calmative, anti-
tussive, anti-bacterial/fungal, pain reduction, and treatments for headache, migraine or
menstrual symptoms 89,132. Further, in traditional Chinese medicine, when applied as an
essential oil, peppermint may enhance penetration of other treatments.
The degree to which peppermint or menthol containing treatments are employed
may also depend upon cultural preferences and physiological tolerance to either sub-
stance. Physiological and cultural differences are two plausible explanations for the emer-
gence of menthol liking thresholds within and between populations. Physiological varia-
tion is partly explained by a host of factors, ranging from genetic to systemic. Specifically,
genetic factors relating to the expression of TRPM8 receptors 98, the sensitivity of the tri-
geminal nerve 48,95,145 and one’s ability to differentiate between trigeminal stimuli 29,48 as
well as the thickness of the stratum corneum in the area under menthol exposure148. Cul-
tural preferences may influence menthol concentration within products, and in doing so
expose an individual to higher or lower concentrations of menthol acutely, or chronically
if one is a habitual consumer, which in itself can alter one’s sensitivity to menthol22,69,75,112.
The role and time course of individual habituation to menthol has practical implications
for those aiming to assess the effects of peppermint and menthol in health, disease and
associated settings. This may mean purposefully withholding menthol containing stimuli
from research participants’ diets, or withholding menthol concentrations to deliberately
alter physiological or subjective factors pertinent to conditions of interest.
Methods
Relevant database and repository searches (PubMed; Google Scholar; Researchgate)
were performed in alignment with the subheadings throughout this review. Where a
mechanistic or isolated application is preferred ‘menthol’ was used as a search term,
whereas ‘peppermint’ was used for more global topics. Previous reviews’ reference lists
were also consulted to inform further reading. Table 1 summarises these texts. Grey liter-
ature was not consulted as part of this review.
Table 1: Key reviews pertaining to peppermint and menthol administration as it pertains to
health effects and or other human benefit.
Authors
Date
Title
Area(s) reviewed
Barwood et al., 9 2020
Menthol as an Ergogenic Aid for the Tokyo 2021 Olympic
Games: An Expert-Led Consensus Statement Using the
Modified Delphi Method
Oral and topical
application and safety of
menthol for sport and
exercise performance
Best et al.,16 2021 Can Taste be ergogenic?
Effects of peppermint/
menthol and bitter,
carbohydrate and
capsaicin tastants upon
physical performance
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Eccles39 1994 Menthol and related cooling compounds
Overview of classical
menthol literature
Eccles41 2000
Role of cold receptors and menthol in thirst, the drive to
breathe and arousal
Effects of menthol on
titular parameters
Eccles et al.,42 2013 Cold pleasure. Why we like ice drinks, ice-lollies and ice
cream
Mechanisms underpinning
oral preference for
cool/cold
Ford et al.,47 2008
Effect of fibre, antispasmodics, and peppermint oil in the
treatment of irritable bowel syndrome: systematic review
and meta-analysis
As per title
Jeffries &
Waldron
67 2018
The effects of menthol on exercise performance & thermal
sensation: a meta-analysis
Exercise performance and
thermal sensation
Saniasiaya, Islam
and Abdullah
B
120
2020 Prevalence and Characteristics of Taste Disorders in
Cases of COVID-19: A Meta-analysis of 29,349 Patients.
Ageusia and anosmia as a
result of COVID 19
Stevens & Best134
2017 Menthol: a fresh ergogenic aid for athletic performance
Oral and topical
application of menthol for
sport and exercise
performance
Potential Health Benefits
In the following sub-sections, the effects of oral or topical application of menthol or
peppermint are reviewed.
Digestive health
Peppermint is commonly used to treat gastrointestinal symptoms, and has been
shown to be particularly effective in the alleviation of irritable bowel syndrome (IBS)
symptoms 2,47,77. IBS symptoms may improve within two weeks; children reported feeling
‘better’ or ‘much better’ (71% of population) and remaining participants reporting no dif-
ference 77 when compared to placebo. Similarly, in their meta-analysis Ford et al.,47 report
a pooled relative risk of IBS symptoms of 0.43 (95% CI: 0.32 to 0.59) compared to placebo
interventions. Importantly, this review notes only five adverse reactions from 174 who
received peppermint oil. A more recent review by Alanmar et al.,2 also notes minimal ad-
verse events, that adverse events are typically mild and transitory, and that evidence is
generally considered of high quality.
To a lesser extent supplementation has also been shown to reduce nausea 83,139, colonic
tension 125, and flatulence 77. Peppermint may also improve the rate of gastric emptying 63.
These findings suggest that the administration peppermint oil, or its natural derivative
menthol, may have potential therapeutic benefits for those that suffer with gastrointesti-
nal issues 61. The mechanism of action is a relaxation of smooth musculature within the
GI tract, brought about by antagonism of Ca2+ channels following peppermint exposure,
which induces a transient blockade, alleviating symptomology.
Respiratory health
Similar to the digestive tract mentioned above, menthol and peppermint also act as
smooth muscle relaxants when applied to the respiratory system. Within the upper res-
piratory tract, application via aspiration, inhalation or ingestion results in sensations of
increased nasal patency but this has not been shown to be objectively altered24,43,128. A re-
lated sensation is the decrease in the drive to breathe (i.e. ‘air hunger’) following menthol
application to the upper respiratory tract40,41. This mirrors effects seen with the application
of cold-air to target nasal cold receptors, indicating a use in those suffering with clinical
conditions associated with dyspnoea106,143. Effective doses are as low as 11mg of menthol,
administered via a lozenge43,71. The lozenge targets multiple mechanisms and sites of ac-
tion. Initially, by stimulating the major palatine nerve, which is hypothesised to have an
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independent role in nasal sensation of airflow102; then as a vapour, acting upon cold re-
ceptors within the nasal cavity that are served via the trigeminal nerve40,68, and finally
providing localised relief due to smooth muscle relaxation.
By the same mechanism, menthol vapour application may exert antitussive effects in
the lower respiratory tract62,113. Whilst these effects modulate the cough response lower
down the respiratory tract, the mechanism of action appears to be related to TRPM8 con-
taining trigeminal ganglia, as opposed to localised tissues 113,145. Relatedly, these effects are
not seen with either +(–) menthol (inactive isomer) or by icilin, which also targets TRPM8
and TRPA1 receptors 28,78,98. TRPA1 channels are susceptible to causing airway irritation
if higher concentrations of menthol are administered 62. A further potentially adverse ef-
fect of menthol is that it increases mucus production, but also minimises mucus clearance
due to ciliary movement reductions 62. In clinical populations suffering from conditions
that are associated with coughing e.g. COPD72,73,88, this may be problematic as menthol
may provide respiratory relief, but further impair mucus clearance 62.
As a result of the mechanisms listed above, menthol and peppermint application also
increase ventilation (VE; L⋅min-1) during exercise100 and have the potential to confer fur-
ther beneficial effects during activity too. These are discussed subsequently in sub-sec-
tions pertaining to thermal comfort and sensation, and sports performance.
Antibacterial and antifungal effects
Peppermint or menthol have the ability to exert anti-bacterial and anti-fungal effects,
against a range of common species. The efficacy of these effects are measured using zones
of inhibition diameters and minimum inhibitory concentrations, with peppermint or men-
thol typically applied as either an essential oil or crude extracts; however, some studies
have investigated individual constituent compounds (e.g. menthol, menthone, etc.). Stud-
ies may also distinguish between parts of the plant, whilst leaves are commonly used,
other groups employ either whole plant or leaves and stems approaches. Whilst these
methodological differences may not directly affect or be within the control of a medical
professional or patient, they are worth considering from product development, efficacy
and research perspectives. Readers are directed to tables 7 and 8 in Mahendran & Rahman
89 for a comprehensive overview of these effects, the scope of which extends beyond the
present review.
Nociception, Migraine and Headache
Pain is considered the interpretation of a nocioceptive stimulus that has the potential
to cause actual or perceived tissue damage, or the perception thereof 135. Given the likeli-
hood of temperature extremes to inflict tissue damage (cold: frost-bite; heat: burns) and
the tendency of evolutionary pressure to produce economical outcomes, pathways asso-
ciated with pain are also involved in temperature detection and may propagate appropri-
ate behavioural outcomes 130,135. More specifically, noxious temperature stimuli are de-
tected by lamina 1 neurons which in turn stimulate the parabrachial nucleus. From here,
signals are diverted via the hypothalamus to efferent pathways or continue for further
processing to one or more of the anterior cingulate, anterior insula and interoceptive cor-
tices 32. The interoceptive cortex appears to be unique to primates, and is stimulated in a
graded manner by noxious, temperature, exercise and respiratory stimuli, as well as hun-
ger and thirst 31,32. Due to the shared higher-level pathways of these homeostatic stimuli,
an afferent to one pathway may confer wider systemic effects e.g. peppermint or menthol.
Topically applied menthol or peppermint have noted analgesic effects, especially
when applied following purposefully induced tissue damage e.g. resistance exercise
56,140,141 or in clinical scenarios such as arthritis or neuropathy related pain 44,81. Menthol
application (4% cream) may improve muscular recovery (quantified via vertical jump per-
formance; +1-5cm in comparison to placebo or control cream) when applied post-muscle-
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damage 56. In this context is unclear whether menthol facilitates enhanced tissue capabili-
ties, motivational factors, motor unit recruitment, or factors not otherwise stated 56. The
combination of chemical and mechanical stimuli, such as that outlined above, may induce
afferent signalling via indirect neuronal pathways, as keratinocytes have been shown to
affect local nerve endings either by calcium or adenonsine triphosphate release and sub-
sequent signalling 90,104,145. Further beneficial mechanisms associated with a reduction in
pain may be decreases in arterial blood flow and vasoconstriction of peripherical blood
vessels 140,141; the latter may lead to a reduction in local skin temperature dependent upon
the measurement approach used and the concentration applied, but this is not a true re-
duction in temperature per se, more an alteration in local blood flow that happens to alter
local temperature acutely 22.
It is important to note that the effects of peppermint and menthol are not proportional
to their concentration for the purposes of pain relief or underpinning mechanisms. The
optimal concentration of topical applicants for pain reduction appears to be circa 4%, with
higher concentrations capable of inducing pain and a localised heat storage response
22,56,121,140,141. These factors are particularly important when considering potential applica-
tion to migraine. Migraine is thought to have a genetic component that may be expressed
in part via TRPM8 receptors87. These receptors are densely distributed throughout the tri-
geminal region, so there is an opportunity for menthol/peppermint application to this re-
gion to either combat or induce migraine dependent upon the concentration and fre-
quency of application37. Another noxious effect is the onset of trigeminal-palatine gan-
glioneuralgia, otherwise known as ‘brainfreeze’, upon consumption of considerable vol-
umes of cold substances (with or without peppermint/menthol 13,127. Given the importance
of the trigeminal network in detecting a range of stimuli, menthol and peppermint’s abil-
ities to exert effects upon it and the susceptibility of cranial nerves to impairment as a
result of COVID-19 infection 45, investigation into the effects of menthol and peppermint
administration in COVID-19 affected individuals warrants consideration, and would be a
natural extension upon much of the work mentioned above.
Implications relating to COVID-19
Coronavirus 2019 (COVID-19) has been consistently demonstrated to adversely af-
fect a range of systems, beyond the obvious severe respiratory involvement, potentially
for a prolonged period of time exceeding that of acute infection 1,26,137. This continuation
of symptoms or impairment relative to normal function is deemed long-COVID. The neu-
ral system, and the cranial nerves in particular appear to have consistent involvement in
symptoms related to COVID-19 45. Most pertinent to this review are an impairment of
individuals’ senses of taste and or smell 93,94,120 and loss of sensitivity to TRP channel ago-
nists such as menthol (TRPM-8) and capsaicin (TRP-V1), which may occur in both hy-
posmic and anosmic individuals 48,116. This is primarily facilitated by infection of the olfac-
tory epithelia support cells and subsequent damage to olfactory neurons 45, 64,120. Prelimi-
nary. evidence has also suggested that the alpha variant may lead to loss of brain mass
(0.2% - 2%) in areas associated with olfaction relative to non-infected controls 36. Likewise,
a case study reported the only symptom of COVID-19 being trigeminal neuralgia 97. The
above indicate a mechanistic impairment of olfaction, facilitated by infection of neural
structures, as a result of COVID-19. The time course of recovery is unclear. However, the
location and severity of infection suggest there is a potential role to use mint and or men-
thol as targeted recovery tools, through smell training or similar rehabilitation processes,
to assess and accelerate recovery of olfaction following infection with COVID-19, pro-
vided they are administered safely.
By way of completeness it is important to acknowledge that there appears to be dif-
fering effects of COVID-19 in those with spinal cord injury 35. Individuals with spinal cord
injuries display non-normal thermoregulatory presentation, typically experiencing poiki-
lothermia (resting core temperature ~35.7 ºC) and impairment to other thermoregulatory
mechanisms 35, proportional to the level of injury. These reasons when combined with
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mint and menthol’s ability to impact thermoregulatory responses via stimulation of
TRPM-8 and wider neurological effects suggest application of (topical) menthol in
COVID-19 symptomatic individuals with spinal cord injury may interfere with desirable
health outcomes.
Thermal comfort and sensation modification
Recently, menthol has been adopted as a perceptual cooling strategy to attenuate
symptoms associated with exercising and task performance in the heat, namely thermal
comfort and sensation 9,67. As per the other stated benefits within this review, the degree
of perceptual change is driven by the concentration of the product applied and the
thermo-sensitivity of the location(s) to which it is applied 134,148. Larger effects are typically
seen at sites with the highest density of receptors (e.g. face; 121) and are inversely propor-
tional to stratum corneum thickness 134, 148.. There is documented genetic variation in the
allele that codes for the TRPM-8 receptor 74,87,130; the extent of which is sufficient to be de-
scribed by latitude and local temperature, with 88% of Finnish population thought to pos-
sess the upstream single nucleotide polymorphism, rs10166942 74. Clinicians should be
aware of this not just for the purposes of thermal perception, but because a related allele
may be protective to migraine 74,87,130, further highlighting the potential systemic therapeu-
tic application of menthol/peppermint.
Of further interest to clinicians are the decreased sensitivity of TRPM-8 receptors
across the lifespan and potential sex differences in response to stimuli. Menthol and pep-
permint containing compounds will likely display less efficacy in geriatric populations
49,147. This has been documented by Waldock and colleagues 147, who demonstrated no per-
ceptual differences compared to control when menthol was applied during daily living
tasks at temperatures representative of British Summer (35°C, 50% humidity). This popu-
lation was responsive to physiological cooling, but may not always feel sufficient percep-
tual thermal change to apply such strategies. These findings are of concern as the elderly
are considered a vulnerable population with regard to global warming induced heat ill-
ness23,65,96 due to a combination of health conditions, impaired sweat responses and med-
ication use impairing heat resilience 23,96. With respect to sex differences, Parton et al.,111
noted that thermal sensation was lowered in male and female participants but this reduc-
tion only lasted 40% of the trial duration in females, during self-paced exercise; this had
behavioural effects with respect to exercise pacing too. Gavel and colleagues52 similarly
found that females may experience non-perceptually mediated enhancements in perfor-
mance during a cycling time trial.
Habituation of thermal sensation has been observed when a moderate menthol con-
centration of 0.2% was applied topically over the course of a week57. This habituation re-
sponse was attributed to a pathway specific to thermal sensation, as it occurred independ-
ent of other physiological or perceptual responses57. Similarly, habituation to sweet stim-
uli have been reported 86, and was attributed to gustative habituation to sweet taste, as
opposed to a reduction in pleasure derived from exposure to sweet stimuli, although this
response is yet to be observed in oral menthol or peppermint application. This response
is absent in an acute menthol stimulus, but given habituation to topical application, it is
reasonable to suggest that oral cold receptors can also become habituated to menthol or
peppermint stimuli, at appropriate concentrations through a similarly mediated or tri-
geminal pathway.
Clinicians may be reluctant to employ menthol as an adjunct treatment when symp-
toms such as dehydration or elevated core temperature are also observed 9,84. In severe
cases of heat illness, menthol or peppermint application is not recommended. However,
in mild cases of heat stress or heat exertion, combining menthol with physiological cooling
strategies that directly reduce core temperature and or improve hydration status e.g. ice
slurry ingestion, may attenuate thermal sensation and encourage consistent cooling be-
haviours due to menthol/peppermint’s hedonic qualities.
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In occupational settings, menthol has been shown to positively influence thermal
perception during simulated firefighting, but may lead to earlier increases in core temper-
ature elevation 85, and unfavourable increases in oxygen consumption 149. Similar to fire-
fighters and military personnel and of relevance to current and future pandemic proto-
cols, access to cooling strategies reduces heat strain symptoms in healthcare workers,
when wearing appropriate personal protective equipment 20,21,80. To date menthol has not
been considered in these settings but may be an appropriate adjunct strategy, provided
the task duration does not confer a significant hyperthermic risk in and of itself. In this
instance improved thermal comfort and reduced sensation may lead to better task out-
comes, which may prove critical. The importance of alterations in thermal perception for
sports performance are discussed below.
Other Human Benefits
Alertness
There is a small body of literature assessing peppermint and menthol’s ability to af-
fect alertness. Delivery modes have varied from vapour (as previously outlined under
Respiratory health) to chewing gum3,5,99,115,129. Both peppermint and menthol odours af-
fects upon reaction time and cognitive tasks have been researched 5,58,91,99,107,138, but these
effects appear to diminish under repeated trials as does the perceived qualitative charac-
teristics of these odours. This indicates a potentially rapid habituation to menthol contain-
ing stimuli, or that a sufficient interval is required to observe repeatable effects15. Simi-
larly, chewing peppermint/menthol gum improves alertness in healthy participants and
upper respiratory tract infection patients (URTI; 129), but again there is an habituation to
the hedonic component of this exposure. Nasal symptoms were also reduced as a result
of chewing gum, suggesting that either menthol (at the dose in chewing gum) or chewing,
or the combination thereof, sufficiently stimulates the trigeminal nerve, which is impaired
by URTI 40,129. When menthol has been administered as a mouth rinse in military personnel
performing cognitive tasks in the heat3 increases in brain metabolism, expressed as signif-
icant alterations in oxygenated (p = 0.024) and deoxygenated (p = 0.17) haemoglobin, were
observed. Despite these alterations in brain metabolism, cognitive decline did not accom-
pany participants’ elevated core temperature, thus the practical implications from these
findings remain unclear3.
Taste sensitivity
Individuals with anosmia and ageusia are still capable of experiencing sensations
elicited by menthol and peppermint containing products, likely through a combination of
chemesthetic and trigeminal pathways16,30,48. Similar effects may also be seen acutely fol-
lowing upper respiratory tract infection40, but may be particularly important in document-
ing the time course of recovery following COVID-19 infection by using return of taste and
sensitivity to these compounds post-infection144. The implications regarding long COVID
are unclear at present, but some participants in related trials have reported prolonged
impairment of olfactory sensitivity. Polymorphisms in bitter taste receptors have also
been considered relevant candidates with respect to COVID mortality, due to extra-oral
links with mucosal immunity110. However, these suggestions have not been investigated
sufficiently and one research group has used this mechanism to suggest vaccine scepti-
cism110. Whilst menthol or peppermint sensitivity may be a proxy for infection and subse-
quent recovery in those with low to mild degrees of infection, this system is also af-
fected/impaired by age25,30 and may show genetic differences 74,130 as per thermal percep-
tion; thus, clinicians are encouraged to consider taste and related chemosensory sensitiv-
ity of secondary importance in those with moderate to severe infection.
Sport and exercise performance
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As per the above subsections, menthol can be applied before, during or post-sport or
exercise performance as either a topical (gel, spray) or oral (mouth-rinse) agent. The tim-
ing and mode of administration likely depend upon the activity in question, this also al-
lows clinicians and sport and exercise scientists to better understand the potential health
benefits listed above, as exercise/ sport amplifies many of the metabolic constraints or ef-
fects that may be clinically relevant. This is particularly true for respiration, nociception
and thermal perception.
Before or during endurance exercise, topical application of menthol has consistently
been shown to improve subjective thermal sensations6–8,10,55,57 with accompanying in-
creases in sweat rate, skin blood flow and potentially heat storage 55. This may or may not
(positively) influence exercise performance, with effects likely proportional to the strength
(i.e. concentration or area to which menthol is applied) or frequency of the menthol appli-
cation ‘signal’. Barwood and colleagues10 showed that a repeated application of a 0.20%
menthol spray, delivered at 20 and 40 min of an exercise bout consisting of 45min fixed
work and a time to exhaustion effort (TTE; 70% maximum power), improved TTE. This
had previously not been shown following single application by the same research group
6–8. This suggests a relatively quick decay of menthol’s effects that may be mediated by
exercise intensity and the rate of evaporative cooling within the exercise environment e.g.
wind-speed14; these effects are also known to be exaggerated if a topical application con-
tains alcohol55.
Oral menthol supplementation exerts temperature dependent effect upon cycling119
and triathlon142 training performance when athletes are concomitantly physiological
cooled. These enhancements were statistically moderate18 when administered before and
during exercise. The same research group subsequently challenged these findings118 as
when completing a 30km cycling time trial, the combination of pre and percooling with a
cold beverage and menthol ice slurry respectively, evoked trivially slower performances
(3815 ± 455 s) relative to percooling with menthol ice slurry only (3737 ± 522 s). This may
be indicative of a trigeminal sensory threshold, whereby the cold stimuli are perceived as
too intense when simultaneously targeting physiological and perceptual mechanisms,
thus detracting from performance enhancement.
Oral application of menthol as a mouth swill or co-ingested with physiological cool-
ing strategies has been consistently shown to lower thermal sensation 46,59,66,122,improve
thermal comfort54 and increase VE100,133. These effects may improve endurance perfor-
mance either by improving TTE46, 66,100 or time trial performance133,136. However, when
paired with carbohydrate during endurance exercise, carbohydrate sensing may out-
weigh any perceptual benefit caused by menthol 14. These effects have not been observed
when oral menthol administration takes place during intermittent or high intensity exer-
cise19,33,54. There are no known negative side-effects reported following menthol swilling
or ingestion, nor has oral menthol administration been shown worsen performance. The
effects of oral application of menthol are thought to last ~10 min 14,17. These findings may
be of interest in pre or post-operative care where menthol has been administered as ice
popsicles to attenuate thirst124.
A single paper had shown improvements across a range of physiological markers
during exercise following chronic peppermint oil supplementation92, however, the mag-
nitude of reported effects warranted scepticism and a replication study debunked these
effects126. In light of the perceptual similarity and common pharmaceutical pairing with
both peppermint and menthol, researchers are advised to consider potential effects of eu-
calyptol or eucalyptus essential oil use circa-exercise as a model of better understanding
potential clinical applications of both agents.
Conclusion
1. Mint and menthol have been used to impart sensations of refreshing and cool for
millennia, alongside other purported traditional medicinal effects
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2. Mint and menthol are typically safe when consumed in recommended quantities,
although there is variability in individuals’ sensitivity, predominantly driven by var-
iation in TRPM-8 receptors
3. Peppermint and menthol exert effects across digestive, nocioceptive and respiratory
systems. There are potential considerations relating to COVID-19, especially in those
with spinal cord injuries.
4. Sports performance may reveal further insights into the limits of mint and menthol
consumption and application, and advance research into related health outcomes
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