There are few side effects more closely associated with chemotherapy than nausea.
Fortunately, we’re much better at preventing it than we used to be. Modern anti-nausea regimens have transformed chemotherapy-induced nausea and vomiting. But they haven’t eliminated it.
Some patients still feel miserable despite taking everything they’re supposed to take. Others control the vomiting but live with low-grade nausea that makes food, smells, and even the thought of their next treatment unpleasant.
“Is there anything else I can try?”
Peppermint. Ginger. Cannabis. Acupuncture. Capsaicin. Some sound like folk remedies. Interestingly, several have actually been studied — and the evidence is more interesting than you might expect.
First: don’t throw away the anti-nausea medications
None of the approaches below should replace appropriate antiemetic therapy. Modern supportive-care guidelines treat complementary approaches as adjuncts to guideline-recommended antiemetics, not substitutes. That’s especially important with highly emetogenic chemotherapy.
But once the conventional regimen is optimized, there’s room to ask whether something else might help.
Peppermint: more interesting than it sounds
If someone told me smelling peppermint helped their nausea, it would be easy to assume it was simply pleasant or distracting. There may be more going on.
Small clinical studies have tested peppermint aromatherapy alongside routine antiemetics in patients receiving chemotherapy, with signals of reduced nausea. More recent systematic reviews and meta-analyses of aromatherapy — including inhaled peppermint oil — also suggest benefit, although the studies remain heterogeneous and stronger trials are needed.
Peppermint inhalation: promising, inexpensive, low burden — and reasonable to discuss as an adjunct, not a replacement for antiemetics.
Importantly, we’re talking primarily about aromatherapy or inhalation here, not swallowing essential oils. Oral peppermint oil can cause adverse effects including reflux and indigestion.
Ginger: lots of studies, surprisingly messy answer
Ginger may be the best-known “natural” treatment for nausea, and it has been studied extensively during chemotherapy.
Unfortunately, more studies haven’t necessarily produced a clearer answer. Meta-analyses suggest possible reductions in acute nausea or vomiting in some settings, particularly when ginger is added to standard antiemetics, but results across trials are inconsistent. Major supportive-care guidelines have therefore stopped short of a firm recommendation.
Ginger isn’t nonsense. But “ginger works for chemo nausea” is stronger than the evidence allows us to say.
I would put it in the reasonable-to-consider, uncertain-magnitude-of-benefit category rather than present it as a proven antiemetic.
Cannabis: stronger evidence, bigger tradeoffs
Cannabinoids are different. They have genuine pharmacologic antiemetic activity, and the evidence is substantial enough that they appear in oncology guidelines.
For adults receiving moderately or highly emetogenic cancer therapy who still experience nausea or vomiting despite appropriate prophylaxis, ASCO says certain cannabinoid preparations may be considered as an addition to the antiemetic regimen.
That’s very different from saying, “use marijuana instead of your anti-nausea medications.” Route, dose, THC/CBD composition, and product consistency matter. THC-containing products can also cause sedation, dizziness, cognitive effects, anxiety, and intoxication.
So I would think of cannabinoids as a legitimate option for refractory chemotherapy-induced nausea and vomiting — but one with more tradeoffs than peppermint or ginger.
Capsaicin might be the most surprising one
Capsaicin is the compound responsible for the heat in chili peppers. A randomized placebo-controlled trial tested 0.075% capsaicin ointment applied to the abdomen in addition to standard antiemetics during highly emetogenic chemotherapy.
The intriguing signal was in delayed nausea: nausea occurred less often with capsaicin than placebo during delayed and extended phases, while there wasn’t a meaningful improvement during the immediate phase.
Capsaicin is an intriguing signal from a randomized trial that deserves replication.
One study is not enough to recommend that everyone receiving chemotherapy use capsaicin cream. But it is exactly the sort of inexpensive intervention worth studying further.
And not everything useful comes in a bottle
Acupuncture and electroacupuncture also deserve attention. International supportive-care guidelines suggest them as adjuncts for chemotherapy-induced nausea and vomiting in some settings, while evidence for acupressure is more inconsistent. Progressive muscle relaxation, sometimes combined with guided imagery, is another low-burden approach with supportive evidence.
That’s an important reminder: “natural” shouldn’t become synonymous with supplements.
So what would I actually tell someone?
I wouldn’t create a giant “natural anti-nausea cocktail.” I’d start by making sure the chemotherapy’s nausea risk has been correctly identified and that the standard antiemetic regimen is optimized.
Then ask when the nausea happens. Immediately after treatment? Days later? Before treatment even starts because the smell of the infusion center now triggers nausea? Is there vomiting despite prophylaxis, or persistent low-grade nausea?
Those aren’t necessarily the same problem, and the best add-on may differ.
The Missing Script take
Peppermint inhalation: promising, low-burden adjunct with increasingly interesting clinical data.
Ginger: mixed evidence; reasonable to discuss, but expected benefit is probably modest and inconsistent.
Cannabinoids: meaningful evidence for refractory nausea and vomiting, with more adverse effects and product-quality considerations.
Topical capsaicin: early but intriguing randomized evidence, especially for delayed nausea; needs replication.
Acupuncture: a guideline-supported adjunct in selected settings.
Relaxation and guided imagery: reasonable low-burden adjuncts.
The question isn’t whether something is “natural.” The question is how much evidence we have, how much benefit we expect, and what we risk by trying it.
Peppermint doesn’t need to outperform a modern multidrug antiemetic regimen to be useful. Capsaicin doesn’t need to cure nausea to deserve further investigation. And cannabis shouldn’t be treated as harmless simply because it comes from a plant.
The goal isn’t conventional versus natural.
The goal is to use the best evidence we have to help people feel better.
Evidence, not hype.
The Missing Script explores the science behind supplements, nutrition, supportive care, and the health questions that don’t always fit on the prescription pad.
This article is for general educational purposes and isn’t individualized medical advice. Chemotherapy-related nausea can sometimes indicate inadequate supportive care or other medical problems. Patients should discuss persistent nausea, vomiting, inability to maintain hydration, or complementary therapies with their oncology team. Complementary approaches should not replace prescribed antiemetic therapy.
