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Cannabis for IBS? Everything You Need to Know

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Cannabis use for IBS symptoms is on the rise.

In Canada cannabis is legal, which makes it easy to access. This often leads to self-medication.

But what does the evidence say about cannabis for irritable bowel syndrome, specifically? Today we will be talking about the use of cannabis for IBS symptom management. Although I am a registered dietitian, I am by NO means an expert in cannabis. But, I have attended a variety of educational events on the appropriate use of cannabis. I have also reviewed the literature in order to provide this informational blog post. So, let’s talk about the current research around cannabis usage for IBS symptom management.

Table of Contents

  1. What is Cannabis?
  2. How is Cannabis Taken?
  3. What is the Endocannabinoid System?
  4. What are the risks of using cannabis for IBS symptoms?
  5. Endocannabinoid System and IBS Symptom Management
  6. Where Patients may see Benefits of Cannabis for Treating IBS Symptoms
  7. Improving your Endocannabinoid Function – without Cannabis
  8. Diet and the Endocannabinoid System
  9. Key Take-Aways for Cannabis in IBS Symptom Management

What is Cannabis?

Cannabis is a plant that produces a chemical called phytocannabinoids. It can be smoked, vaped, or orally consumed. The two major phytocannabinoids you hear about, that naturally occur in a cannabis plant, are D9-tetrahydrocannabinol (THC) and cannabidiol (CBD). However, there are 100’s of chemicals, including terpenes, flavonoids, and other phytocannabinoids. These phytocannabinoids interact with our ‘endocannabinoid system’, producing a variety of different effects in the body.

THC is the compound responsible for the psychoactive effects of cannabis that produces a high or euphoria. CBD also has psychoactive effects but will not produce a high or euphoria.

How is Cannabis Taken?

Smoking – is not recommended. This is because burning cannabis releases toxic chemicals. It is important to understand that smoking cannabis is just as dangerous as smoking cigarettes.

Vaping – reduces likelihood of inhaling toxic chemicals and has less impact on the respiratory system. Fast acting, but effects fade after a few hours (5-30 minutes and can last 2-4 hours)

Oral – Slow acting, but effects last longer (60-90 minutes and can last 6-8 hours)

What is the Endocannabinoid System?

Our body has its own system to produce and manage ‘endocannabinoids’ – or cannabinoids that are produced in the body. We’re still learning a lot about the endocannabinoid system, however, it’s proper function, or ‘tone’ is necessary for almost all aspects of our health and wellness, including:

  • Immune function
  • Inflammation
  • Appetite & digestion
  • Pain
  • Metabolism
  • Stress
  • Sleep
  • …. And so much more
Piece of cannabis coming out of an orange pill bottle on top of a prescription paper.

Since the discovery of the endocannabinoid system, researchers and medical professionals have been hypothesizing how we can use ‘exogenous cannabinoids’ (synthetic & phyto – or plant-based cannabinoids produced outside the body) to regulate the endocannabinoid system and provide therapeutic treatments for a variety of different conditions.

While the research is exciting, it’s crucial that we understand the risks, benefits, and limitations of using cannabis for IBS symptoms.

At this point, there are a lot of biases we need to be aware of in the research. These biases limit the potential quality of the studies. Not only that, but as always, citing animal research to provide human recommendations is never appropriate. Yet, it’s what I see a LOT of people doing online! As a registered dietitian, my biggest concern with cannabis use is self-medicating without fully understanding the risks.

What are the risks of using cannabis for IBS symptoms?

Cannabis isn’t without risk. With the legalization of cannabis, I see people dismiss the risks associated with use. It’s crucial that we understand cannabis isn’t risk-free just because it’s legal. This is why I encourage patients, who are interested in using cannabis for therapeutic purposes, to pursue the medical route rather than self-medicating. A prescribing physician will review your individual risks, based on your medical history. So that you can make an informed decision and choose appropriate forms & strains of cannabis.

Here are some risks of using cannabis for IBS symptom management:

  • Increased risks of motor vehicle accidents (remember – CBD still has psychoactive effects without it intoxicating you!)
  • Intoxication
  • Nausea or vomiting (with THC or excessive oral intake)
  • Liver disease and fibrosis (especially those with pre-existing liver conditions)
  • Increased risk of cardiac disease
  • Cognitive impairment with acute or excessive use
  • Increased risk of bronchitis (for smoking/vaping)
  • Psychosis (especially in high THC users)
  • Increase in social anxiety for chronic users
  • Risks in those with a history of mental health issues
  • Violent behaviour (synthetic cannabinoids)
  • Suicidal ideation (synthetic cannabinoids)
  • Cannabinoid hyper-emesis syndrome (chronic excessive use)
  • Depression/Anxiety (chronic excessive use)
  • Addiction / Cannabis use disorder
  • Cannabis withdrawal

Endocannabinoid System and IBS Symptom Management

The endocannabinoid system is present in the GI tract. It is mostly localized to the enteric nervous system. Receptors for cannabinoids are also present on epithelial cells (our gut wall). Thus making the endocannabinoid system in the gut a potential target for diarrhea, pain, nausea & vomiting, and gut inflammation.

Compared to normal populations, endocannabinoid signaling appears to be altered with IBS. Not only that, but some research suggests that those with IBS may also have difficulties naturally producing their endocannabinoids. Something being termed ‘endocannabinoid deficiency syndrome’. Cannabinoids can affect gut motility (movement) and visceral sensation (pain & nausea). Therefore, administration of synthetic or phytocannabinoids may help with pain and symptoms of irritable bowel syndrome. But what does the research say?

So far, almost all studies done in IBS have primarily been with synthetic cannabinoids, specifically dronabinol. The study results are very mixed. One study showed a slight benefit on reducing IBS-D symptoms with THC. But, the remaining studies showed no benefit, specifically on visceral hypersensitivity, or pain. Interestingly, participants in one study with a genetic polymorphism in genes dictated possible response. This underscored that cannabis may only have benefit for IBS symptoms in certain genetic variants.

The majority of research looking at the mechanisms of action of the endocannabinoid system in the gut are in animal models. While exciting – it’s important to understand that this may not represent a human endocannabinoid system and its functioning.

At this point, research does NOT suggest that synthetic cannabis or THC will help with IBS symptoms.

CBD and other phytocannabinoids are currently being researched. This research specifically looks at chronic pain and inflammation – which may in turn influence IBS symptoms.

Where Patients may see Benefits of Cannabis for Treating IBS Symptoms

What is IBS? IBS is a condition where patients struggle with abdominal pain and often have concurrent anxiety. So, it’s no surprise that some patients anecdotally report that cannabis, especially CBD, helps to reduce pain and anxiety. However, I do have to say that many patients I see have also had negative experiences using cannabis.

Up to this point, most studies are done in rats. Making it hard to provide recommendation around appropriate cannabis use. There is weak supportive evidence for the use of certain cannabinoids in neuropathic and inflammatory pain. Which can be concurrent to IBS symptoms. There is also weak evidence to support cannabis’s impact on sleep and anxiety. Which in turn, may reduce IBS symptoms.

At this time, we cannot recommend cannabis for irritable bowel syndrome. However, with the favourable safety profiles of CBD specifically, and the up and coming research, it may be worth discussing appropriate use with your gastroenterologist, if all other treatment modalities have been insufficient.

Improving your Endocannabinoid Function – Without Cannabis

Our endocannabinoid system plays a major role in how we function. It’s no surprise that certain self-care and wellness activities have a positive impact on the endocannabinoid system. In fact, there are many things you can do without cannabis that may improve your endocannabinoid tone (and, help with IBS symptoms!).

Ways to Improve your Endocannabinoid Tone and your IBS Symptoms:

Diet and the Endocannabinoid System

Many dietary components, such as terpenes, flavanoids, and polyunsaturated fats are found to activate and regulate endocannabinoid system tone.

What are terpenes & flavanoids?

Terpenes are aromatic compounds that have medicinal effects. In animal models terpenes and flavanoids activated cannabinoid receptors. Therefore, diets high in terpenes may optimize endocannabinoid function.

How to Increase your intake of terpenes & flavonoids?

Bottom line: eat a variety of plant-based foods with lots of flavour! Some of our favorite herbs contain terpenese and flavonoids. Such as – thyme, bay leaves, lemon grass, pepper, cloves, basil, peppermint, and citrus. Eating more of these herbs may have positive effects on the endocannabinoid system. While more research is required, these are simple, food-first strategies that pose additional benefits. They are worth adding into your diet!

How can I increase my intake of polyunsaturated fats?

Include a variety of fatty fish and plant-based fats such as olive oil, avocado, sesame oil, whole grains, flax, nuts, and seeds to increase your intake of these fats. Diets high in polyunsaturated fats are required for endocannabinoids synthesis in our bodies.

Key Take-Aways for Cannabis in IBS Symptom Management

  • The evidence is very weak and at this point we cannot recommend cannabis for managing IBS symptoms.
  • When looking at different components of cannabis, specifically CBD, further research is required.
  • Always discuss your personal risks of using cannabis, as it can vary based on your past medical history.
  • Cannabis is contraindicated in certain cases.
  • If you are taking cannabis for a medical reason, ALWAYS work with a medical prescriber to ensure you start low, go slow and stay low. Never drive on any form of cannabis.

Still feeling like you have some unanswered questions to do with your IBS symptom management and cannabis usage? Feel free to reach out to one of our IBS dietitians.

Piece of cannabis coming out of an orange pill bottle on top of a prescription paper.

FAQs About Cannabis for IBS

Does cannabis oil help with IBS?

The evidence for using cannabis oil to help with IBS symptom management is very weak. At this point we cannot recommend cannabis oil for managing IBS symptoms.

Does CBD help with IBS-D?

Based on current research, we don’t know about the usage of CBD to help with managing IBS-D symptoms. But, one study did show a slight benefit with THC helping to reduce IBS-D symptoms.

Categorized: Gut Health & IBS

One response to “Cannabis for IBS? Everything You Need to Know”

  1. hi, really appreciate the efforts you have put in! every confusion is clear about cannabis that i had

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References

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