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Can Cannabis Help IBS?

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Can Cannabis Help IBS?

Overview

In recent years, there has been a growing interest in the use of cannabis for a number of chronic conditions, such as Irritable Bowel Syndrome (IBS). The underlying causes of IBS are poorly understood, and available medications are limited and often carry burdensome side effects. As a result, alternative therapies like medical cannabis may be an appealing means of treatment for IBS sufferers.

The Endocannabinoid System

In recent years more and more research has illuminated the manner in which cannabis affects the body. Cannabis is made up of hundreds of compounds, including cannabinoids like THC and CBD. THC can cause psychotropic effects that include feelings of intoxication or mild euphoria while CBD does not have such effects.

In the 1990s, researchers found that cannabinoids are also naturally present in the human body, in what is known as the endocannabinoid system (ECS). Subsequent research found that the ECS has a vital role in maintaining equilibrium for the central nervous system and the immune system, and the regulation of visceral pain. 

The ECS also plays a large role in creating homeostasis in the digestive system, and is involved in the internal biological processes that lead to nausea, vomiting, gut motility, and intestinal inflammation. As a result, the ECS may be an important therapeutic target in the treatment of diseases affecting the gastrointestinal tract.

The gastrointestinal tract has two primary cannabinoid receptors, known as CB1 and CB2—both are present in the gastrointestinal tract. THC helps activate both CB1 and CB2 receptors, and some research indicates that activating cannabinoid receptors in the gastrointestinal tract may reduce in motility and inflammation. In addition, animal studies have found that that activation of CB1 receptors inhibits visceral pain—pain in internal organs.

Medical Cannabis Treatment for IBS

There is very limited research on medical cannabis and IBS. Given the legal status of cannabis in the past, this may be understandable and does not necessarily mean it isn’t a promising therapy. Several survey studies have found that patients with IBS who used cannabis do experience symptom relief, although not all studies have come to the same conclusion. 

  • A study was conducted on the impact of dronabinol (a synthetic THC) on visceral sensitivity to rectal distension. This randomized, double blind study was conducted with 10 IBS patients and 12 healthy volunteers. The study found that dronabinol does not affect visceral perception to rectal distension or alter the threshold of discomfort. 
  • A pharmacogenetic trial examined the impact of dronabinol on colonic motility and sensation in individuals with IBS and the genetic variants in IBS subtypes. The study included 35 patients with diarrhea predominant IBS, 35 patients with constipation predominant IBS, and five patients with alternating IBS. The study found that 5 mg of dronabinol reduced fasting colonic motility in patients with diarrhea predominant and alternating IBS and that specific genotypes may play a role on the effects of the medication. 
  • A small, short-term randomized control trial with 36 participants aged 18 to 69 with diarrhea predominant IBS evaluated the effect dronabinol had on gastrointestinal transit. Patients were randomized to dronabinol 2.5 mg twice daily, dronabinol 5 mg twice daily, or a placebo for two days; no treatment effects were found. 

In addition, there is a theory that holds that depressed endocannabinoid levels correlate with several difficult-to-treat conditions, including fibromyalgia, IBS, and migraine. The theory is predominantly based on pre-clinical research, and is as such still in preliminary stages. If the theory is proven, however, it would contribute to understanding why cannabis is effective in treating these conditions.

Side Effects of Cannabis 

In the studies on dronabinol, common side effects included fatigue, drowsiness, and headaches. In general, CBD is a well tolerated drug with very few side effects.

Cannabis Side Effects

Some of the short-term side effects of THC can include memory, motor and judgement impairment and the long term effects can include cognitive impairment, a small risk of addiction, as well as an increased risk of developing a psychotic disorder. Further research is necessary to explore the potential interaction between other IBS medications and specific doses and forms of CBD and THC.

 

Conclusion

While some patients report that medical cannabis provides relief from their IBS symptoms, there is not enough high quality research or evidence to determine if medical cannabis is an effective treatment for IBS and its symptoms. More research, especially randomized clinical trials, is needed to assess the effect of medical cannabis on IBS. 

About IBS

Overview

Irritable Bowel Syndrome, or IBS, is a relatively common disorder that affects the intestines. It can cause a great deal of discomfort and even disability in sufferers, with many people getting inadequate relief. IBS is the most common type of gastro-intestinal disorder, occurring in 10-15% of adults. It can affect men and women, both adults and children, although women are twice as likely to develop IBS than men.

Sufferers often see many doctors seeking relief. They often have many procedures performed and undergo extensive testing, with no specific abnormality found. This can be extremely frustrating for patients and their families, who do not get an explanation of why they are suffering from chronic pain and discomfort. 

Symptoms

The main symptoms of IBS are:

  • Cramps or pain in the stomach and abdomen. Usually these feel worse just after eating, and feel better after a bowel movement. 
  • A bloated stomach that feels uncomfortably swollen.
  • Gaseousness.
  • Diarrhea or constipation, meaning a sudden need to relieve oneself urgently, and sometimes having real difficulty having a bowel movement. It’s quite common to experience both, at different times. 

Some other symptoms of IBS that one might experience:

  • Uncontrollable flatulence (farting)
  • Backache 
  • Passing mucus in the stool, or when trying to have a bowel movement
  • Having trouble peeing, needing to pee often, or feeling sudden urges to pee
  • Incontinence, ie. not always able to control when you have to relieve yourself
  • General tiredness and feeling low on energy
  • Feeling nauseous

Most people with IBS find that there are times when their symptoms are worse, and times when they feel less severe. Triggers which cause symptoms to flare up and get worse can include: 

  • Food. People with IBS often find that some foods, like milk and dairy products, acidic fruits like citrus fruits, beans, cabbage, wheat, and carbonated soft drinks make their symptoms worse. It’s not the same as a full food allergy or intolerance, though.
  • Stress. It’s very common for symptoms to get worse during times of stress.
  • Hormones. Women find that their symptoms get worse at certain points in their menstrual cycle.

When to see a doctor

If you experience any of the symptoms of IBS, together with any of the following symptoms, you should see a doctor urgently. It could be a sign of a more serious illness.

  • Weight loss
  • Bleeding from the rectum
  • Difficulty swallowing
  • Vomiting that doesn’t have an obvious cause
  • Night-time diarrhea
  • Persistent pain in the gut that doesn’t get any better after a bowel movement

Even if you don’t have the above symptoms, it is important to rule out other potential conditions so seeing a doctor is important and the first step in getting relief.

Diagnosis

There’s no single test to diagnose IBS. Along with performing a physical exam, your doctor will ask you about your symptoms, and carry out certain tests to rule out other causes like celiac disease, intolerance to gluten or other food types, a bacterial infection, or parasites. 

You can expect to answer plenty of questions about your medical history and your symptoms, including how often you feel symptoms of IBS and when they feel more severe. 

Some of the tests that you might undergo include:

  • X-ray or CT scan, to check for growths or obstructions in the abdomen, pelvis, and intestine.
  • Lactose intolerance tests, to see if the body is producing the enzyme lactase that is needed to digest dairy products. 
  • Breath tests, to check for too much bacteria growing in your small intestine.
  • Stool tests, to check for bacteria or parasites in the stool, or for a digestive enzyme called bile acid that’s produced in the liver. 
  • An upper endoscopy, to inspect the upper part of the digestive system and take a tissue sample from the small intestine. It’s used to check for excessive bacteria growth.
  • Flexible sigmoidoscopy or a colonoscopy, to inspect the lower part or entire length of the colon.
Elian Rosenfeld, PhD by Elian Rosenfeld, PhD

Overview

Cannabis has been proven to help patients suffering from nausea, inflammation, and abdominal pain, all of which are symptoms of Irritable Bowel Syndrome (IBS). 

The condition affects between 25 and 45 million people in the United States alone, according to the International Foundation for Gastrointestinal Disorders. Currently available medications are limited and often carry harsh burdensome side effects. 

In recent years, there has been a growing interest in the use of cannabis to treat IBS, and studies have shown promising results for cannabis products in IBS treatment. In addition, cannabis can be effective in treating some of the secondary results of IBS, which can cause anxiety and depression.

How Cannabis Works on IBS 

The endocannabinoid system (ECS) exists in all vertebrates and helps regulate crucial functions such as sleep, pain, and appetite. The human body produces its own cannabinoids, which modulate and activate its various functions, but as its name suggests, the endocannabinoid system can also be regulated and triggered by cannabinoids found in the cannabis plant. 

The ECS also plays a large role in maintaining homeostasis in the digestive system, and is involved in the internal biological processes that lead to nausea, vomiting, gut motility, and intestinal inflammation. As a result, the ECS may be an important therapeutic target in the treatment of diseases affecting the gastrointestinal tract, including IBS.

The two primary cannabinoid receptors are present all over the body, and the receptor CB2 is particularly abundant in the gastrointestinal tract. Tetrahydrocannabinol (THC), the main psychoactive ingredient in cannabis, helps activate both receptors. Research indicates that activating cannabinoid receptors in the gastrointestinal tract may reduce motility and inflammation, and decrease hypersensitivity in the gut. In addition, animal studies have found that activation of certain cannabinoid receptors inhibits visceral pain — pain felt in the internal organs. In the case of IBS this refers to the intestines or bowels. 

In addition, there is a theory that holds that depressed endocannabinoid levels — known as endocannabinoid deficiency — correlate with several difficult-to-treat conditions, including fibromyalgia, IBS, and migraines. The theory is predominantly based on pre-clinical research, and as such is still in preliminary stages. If the theory is proven, however, it would contribute to understanding why cannabis is effective in treating these conditions.

Medical Studies on IBS & Cannabis 

Prohibitions on cannabis have stifled research in the past, but several survey studies have found that IBS patients who used cannabis do experience symptom relief, although not all studies have come to the same conclusion. 

  • A pharmacogenetic trial found that dronabinol (a synthetic THC) can slow down colon activity and make the organ more compliant for patients with diarrhea predominant and alternating IBS. 
  • A study concluded that dronabinol does not affect visceral perception to rectal distension or the threshold of discomfort. 
  • A small, short-term randomized control trial found no treatment effects among participants with diarrhea predominant IBS who were given dronabinol, or a placebo for two days. 
  • A 2016 study described how “increasing our understanding of the ECS will greatly advance our knowledge of interactions between the brain and gut and could lead to new treatments for gastrointestinal disorders.”

CBD and IBS 

Because they are usually derived from hemp — which has very low amounts of THC (legally defined as less than 0.3% in the US) — CBD products are widely available even in jurisdictions where medical marijuana has yet to be legalized. And while it is still in its early stages, research on CBD has indicated that it could potentially be effective as a treatment for IBS. 

  • A 2008 study described the ability of cannabinoids to “reduce gastrointestinal motility in randomized clinical trials,” indicating how the use of CBD could calm the symptoms of IBS. 

Chronic pain and cramping are symptoms of IBS, and CBD is being researched as a potential therapy for pain relief.  According to Gallup, 40% of all CBD consumers in the United States use it to deal with the symptoms of pain. Clinical research is still lacking in determining how CBD affects pain, though there have been promising studies, including one that described CBD’s potential as a way to suppress “mechanical and thermal pain hypersensitivity in both inflammatory and neuropathic pain conditions.”

Side Effects of Cannabis 

In the studies on dronabinol, common side effects included fatigue, drowsiness, and headaches. In general, THC has few side effects.

Cannabis Side Effects

Some of the short-term side effects of THC can include memory, motor and judgement impairment and the long term effects can include cognitive impairment, a small risk of addiction, as well as an increased risk of developing a psychotic disorder. Further research is necessary to explore the potential interaction between other IBS medications and specific doses and forms of CBD and THC. 

If you are considering or already using cannabis to treat IBS, contact your doctor to discuss treatment options.

 

About IBS

Overview

Irritable Bowel Syndrome, or IBS, is a relatively common disorder that affects the intestines. It can cause a great deal of discomfort and even disability in sufferers, with many people getting inadequate relief. IBS is the most common type of gastro-intestinal disorder, occurring in 10-15% of adults. It can affect men and women, both adults and children, although women are twice as likely to develop IBS than men.

Sufferers often see many doctors seeking relief. They often have many procedures performed and undergo extensive testing, with no specific abnormality found. This can be extremely frustrating for patients and their families, who do not get an explanation of why they are suffering from chronic pain and discomfort. 

Symptoms

The main symptoms of IBS are:

  • Cramps or pain in the stomach and abdomen. Usually these feel worse just after eating, and feel better after a bowel movement. 
  • A bloated stomach that feels uncomfortably swollen.
  • Gaseousness.
  • Diarrhea or constipation, meaning a sudden need to relieve oneself urgently, and sometimes having real difficulty having a bowel movement. It’s quite common to experience both, at different times. 

Some other symptoms of IBS that one might experience:

  • Uncontrollable flatulence (farting)
  • Backache 
  • Passing mucus in the stool, or when trying to have a bowel movement
  • Having trouble peeing, needing to pee often, or feeling sudden urges to pee
  • Incontinence, ie. not always able to control when you have to relieve yourself
  • General tiredness and feeling low on energy
  • Feeling nauseous

Most people with IBS find that there are times when their symptoms are worse, and times when they feel less severe. Triggers which cause symptoms to flare up and get worse can include: 

  • Food. People with IBS often find that some foods, like milk and dairy products, acidic fruits like citrus fruits, beans, cabbage, wheat, and carbonated soft drinks make their symptoms worse. It’s not the same as a full food allergy or intolerance, though.
  • Stress. It’s very common for symptoms to get worse during times of stress.
  • Hormones. Women find that their symptoms get worse at certain points in their menstrual cycle.

When to see a doctor

If you experience any of the symptoms of IBS, together with any of the following symptoms, you should see a doctor urgently. It could be a sign of a more serious illness.

  • Weight loss
  • Bleeding from the rectum
  • Difficulty swallowing
  • Vomiting that doesn’t have an obvious cause
  • Night-time diarrhea
  • Persistent pain in the gut that doesn’t get any better after a bowel movement

Even if you don’t have the above symptoms, it is important to rule out other potential conditions so seeing a doctor is important and the first step in getting relief.

Diagnosis

There’s no single test to diagnose IBS. Along with performing a physical exam, your doctor will ask you about your symptoms, and carry out certain tests to rule out other causes like celiac disease, intolerance to gluten or other food types, a bacterial infection, or parasites. 

You can expect to answer plenty of questions about your medical history and your symptoms, including how often you feel symptoms of IBS and when they feel more severe. 

Some of the tests that you might undergo include:

  • X-ray or CT scan, to check for growths or obstructions in the abdomen, pelvis, and intestine.
  • Lactose intolerance tests, to see if the body is producing the enzyme lactase that is needed to digest dairy products. 
  • Breath tests, to check for too much bacteria growing in your small intestine.
  • Stool tests, to check for bacteria or parasites in the stool, or for a digestive enzyme called bile acid that’s produced in the liver. 
  • An upper endoscopy, to inspect the upper part of the digestive system and take a tissue sample from the small intestine. It’s used to check for excessive bacteria growth.
  • Flexible sigmoidoscopy or a colonoscopy, to inspect the lower part or entire length of the colon.

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