Cannabis and IBS
Cannabis is one of the oldest crops in the world and has been used as medicine for more than 5,000 years.
Compounds in cannabis interact with the endocannabinoid system (ECS). The ECS helps to regulate many of your body's functions, including aspects of digestion, pain and inflammation.
Currently there are no recommendations for the use of cannabis as a management tool for IBS, but research is ongoing.
Find out more about cannabis as a treatment option for IBS...
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Cannabis and Phytocannabinoids
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Cannabis, also known as marijuana, refers to the plant itself (leaves, flowers, stems, oils and seeds). It is one of the oldest crops in the world and the medical use of cannabis is dated to approximately 5000 years ago.
The cannabis plant contains over 100 phytocannabinoids, which are the main chemical compounds responsible for the plant's effects. Other compounds, like terpenes and flavonoids, also contribute to the unique psychoactive and therapeutic properties of different cannabis strains.
Different cannabis compounds cause different effects in the body. For example, THC (delta-9 tetrahydrocannabinol) is psychoactive and causes a high, while CBD (cannabidiol) does not. THC and CBD are the most studied compounds, but researchers are also looking at dozens of other "minor" cannabinoids for their potential therapeutic properties.
Phytocannabinoids cause their effects by interacting with your body's endocannabinoid system.
The Endocannabinoid System
The endocannabinoid system (ECS) is found throughout your brain and your body. Your body produces molecules called endocannabinoids that stimulate cannabinoid receptors in your cells. Phytocannabinoids from plants and synthetic cannabinoids made in a lab are similar in structure and can also stimulate the same receptors in your cells.
The ECS was only "discovered" in the late 1980's, so research is obviously still ongoing.
The ECS controls the levels and activity of many other neurotransmitters. It regulates things by turning up or down the activity of whichever system needs to be adjusted.
The ECS is crucial for maintaining overall bodily function by regulating a wide range of processes, including:
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Learning and memory
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Emotional processing
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Pain and inflammation
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Temperature control
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Sleep and mood
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Immune responses
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Metabolism and energy balance
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Digestion and appetite regulation
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Stress regulation
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Cardiovascular and reproductive systems
Cannabis and the GI Tract
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Cannabis also interacts with the gastrointestinal (GI) tract through the endocannabinoid system.
Cannabinoid receptors (CB1 and CB2) are found in the enteric nervous system (ENS) and the vagus nerve. Remember that the ENS is a network of neurons within the walls of the GI tract that controls digestive functions like gut motility, acid secretion and immune responses. It communicates with the brain through the vagus nerve.
Cannabinoid receptors can also be found in the walls of the gut and play a role in keeping them healthy. Remember that if the lining of the gut is impaired things may leak out that shouldn't, leading to inflammation.
The effects of cannabinoids on the GI tract are complex, involving both direct action in the gut and a broader influence on the gut-brain axis.
Cannabis and IBS
At this time, recommendations can't be made for the use of cannabis as a treatment for IBS.
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BUT ... this is a space to watch!
Unfortunately, despite all the links between the GI tract and the endocannabinoid system, there just isn't enough good quality evidence to make recommendations about the use of cannabis as a treatment for IBS.
Much of the research to date has been done on rats. Although some of the research has been promising, results don't always translate to humans. The evidence from studies on actual humans is limited and often similar studies don't show the same results. More large-scale, controlled studies are needed.
It's also difficult to make comparisons between studies. Currently there are no standardized study protocols and there are many variables. These include type and combination of cannabinoids, synthetic vs naturally occurring, dosage and delivery system (smoking, vaping or eating).
So far there is weak evidence that...
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Certain cannabinoids may help with IBS pain and inflammation (especially CBD)
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Cannabinoids offer relief for abdominal pain, cramping and bloating
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Cannabis has an impact on sleep and anxiety, which in turn may reduce IBS symptoms
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Considering Cannabis for IBS?
Even though there isn't enough quality evidence to make specific recommendations about cannabis and IBS right now, there is some interesting up and coming research.
If you are thinking about medical cannabis as a treatment strategy for your IBS symptoms, be sure to talk to a healthcare provider first and ask yourself the following questions ...
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Is there evidence that cannabis might help my particular IBS symptoms?
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What dosage and type of cannabis should I take?
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How should I take it?
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Are there side effects and what can I do to reduce them?
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What are the risks?
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Will cannabis interact with any of my medications?
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Are there potential interactions between cannabis and my other illnesses?
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Can I use it safely during pregnancy or breast feeding?
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Is medical cannabis covered by my insurance?
The Future of Cannabis and IBS Research
Currently there isn't enough good quality evidence to make recommendations about using cannabis to help with IBS symptoms.
However, research is ongoing and there have been some interesting findings. The two main areas of study are the connections between the endocannabinoid system (ECS) and IBS and the possible dysfunction of the ECS in some people with IBS.
So stay tuned as this is definitely a space to watch!
The ECS and IBS
Numerous studies show that the endocannabinoid system (ECS) is involved in regulating possible underlying drivers of IBS and IBS symptoms, including...
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Gut motility (diarrhea and constipation)
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Stress response
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Mood, anxiety and memory retrieval of traumatic events
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Hypersensitivity to pain
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Low-grade inflammation of the intestines
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Gut-brain axis
ECS Dysfunction and IBS
Compared to normal populations, endocannabinoid signalling appears to be altered with IBS. This means that ECS communication in your brain and body may not be working properly, possibly affecting functions like stress response or gut motility.
Some research is suggesting that some people with IBS may also have difficulties naturally producing endocannabinoids. Clinical Endocannabinoid Deficiency (CED) could play a role in conditions like IBS, where mental factors like emotions play a direct role in causing or worsening a physical illness.
Risks of Cannabis Use
Cannabis isn’t without risk and the long-term safety and effectiveness of cannabis for IBS are still largely unknown. There may also be undesirable side effects.
The effects of cannabinoids can be quite different for different people and some could experience negative effects even at low doses.
It's best to talk to a healthcare professional about using cannabinoids as a treatment for IBS, instead of self-medicating. They can help you weigh the potential benefits against the risks and to choose the best forms and strains of cannabis based on your symptoms and medical history.
Cannabis comes with possible risks and side effects, including...
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Dry mouth, fatigue, dizziness and anxiety
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Depression/anxiety (chronic excessive use)
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Risks in those with a history of mental health issues
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Psychosis (especially in high THC users)
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Addiction and withdrawal symptoms from long-term cannabis use
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Cannabinoid hyperemesis syndrome - chronic, high-dose may cause nausea, vomiting and belly pain
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Some users experience side effects like nausea, vomiting, bloating, or abdominal pain on lower doses
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Possible reactions with other drugs
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THC can produce mind-altering effects (psychoactive)
Different cannabinoids and delivery systems will have different risks and side effects
Other Ways to Boost Your ECS
There are many things you can try, other than cannabis, that may improve your endocannabinoid tone.
Since everything is connected, it should come as no surprise that strategies to boost the functioning of your ECS are, for the most part, also strategies for IBS management and overall health.
Food and Nutrition
Many food components have been found to activate and regulate the ECS. Of note are terpenes, flavonoids and polyunsaturated fats.
Terpenes and flavonoids are compounds found in plants that play a role in how they smell and taste, as well as their colour. Research is still in early stages, but animal models have shown they can boost the ECS. Increasing your intake means eating lots of different plant-based foods with lots of flavour. so worth a try! Add herbs like thyme, basil, cloves, bay leaves, lemon grass, pepper, peppermint and citrus. At the very least, your tastebuds will thank you.
Your body needs polyunsaturated fats to make endocannabinoids. To find out more about polyunsaturated fats and how to increase your intake go to Fats and IBS in the Tips for Healthy Eating section.
Stress Management
When the body is under constant, prolonged stress, the ECS can become impaired. This can affect your ability to regulate your emotions and increase the risk of mental health conditions like anxiety and depression.
Go to the Stress Management section for lots of ways to help manage stress.
Exercise
A growing body of evidence strongly indicates interplay between physical exercise and the ECS. Research is of course ongoing, but exercise has been shown to activate endocannabinoids to reduce stress and anxiety and improve wellness.
Exercise is also a management strategy for IBS. Go to Get Moving! for more info and classes.
Body Work
Some research has shown that massage, acupuncture and osteopathy could help boost your ECS.
As of yet the exact mechanisms are unclear, but there are many overlaps between systems like the parasympathetic nervous system (PNS) and the ECS that could be affected by body work.
To find out more about body work and IBS go to the Body Work section.
