Cannabis For Gut Health: How Cannabinoids Can Help with Gut Microbiome, ECS, and Digestive Disorders

Cannabis is gaining attention not just for pain relief and anxiety reduction, but also for its potential to support gut health. 

Cannabinoids actively support gut health by easing symptoms of gastrointestinal (GI) disorders, promoting a healthier gut microbiome, and much more. As awareness grows around the connection between gut health and overall wellness, more people are choosing cannabis as a complementary therapy for targeting symptoms of myriad GI conditions.

In this article, discover some of the many ways cannabis is helping its consumers with gut health and symptom relief. 

Exploring Cannabis for Gut Health: What the Science and Experts Say

Cannabis may support gut health through multiple mechanisms. This includes reducing inflammation, regulating gut motility, and influencing the gut microbiome. It does so through the endocannabinoid system (ECS) and dozens of non-ECS targets, which combine to create the endocannabinoidome (eCBome).

Cannabis can help promote gut health, specifically in ways such as:

Reducing inflammation: Cannabidiol (CBD) and other cannabinoids actively reduce inflammation, offering potential relief for conditions such as inflammatory bowel disease (IBD).

Regulates gut motility: Cannabis compounds influence how quickly food moves through the digestive tract, which may help manage slow and fast digestion.

Reducing intestinal permeability: Cannabinoids like CBD may, in turn, reduce leaky gut in IBD, SARS-CoV-2, bacterial infections, and more by altering intestinal motility, inflammation, and enhancing GI cell stability.

Stimulating appetite: Tetrahydrocannabinol (THC) boosts appetite, benefiting individuals who experience appetite loss due to illness or treatment.

Supporting microbiome balance: Emerging research suggests cannabinoids may help create a healthier, more diverse gut microbiome. This important aspect may positively influence several conditions,q1 including IBD, IBS, non-alcoholic fatty liver disease, postmenopausal disorders, epilepsy, and more.

Easing digestive symptoms: Cannabis may relieve common symptoms of GI disorders, including abdominal pain, nausea, vomiting, and diarrhea.

Lowering opioid use: In some cases, cannabis may reduce the need for opioid medications to manage abdominal pain in many conditions like IBS, chronic constipation, and IBD. It also helps ease opioid withdrawal symptoms in animal models.

While cannabis shows promise in easing gastrointestinal symptoms, unfortunately, research on its full effects remains limited. One significant barrier to further research on how cannabis can help gut health is its classification as a Schedule I drug in the United States. This means medical marijuana is still grouped with hard drug substances like heroin and lysergic acid diethylamide (LSD), which restricts clinical research into its potential.

Despite these challenges, researchers have made progress in understanding how cannabis may affect gut health. For conditions like IBD, combining THC and CBD appears to offer the most significant symptom relief. This blend can reduce abdominal pain and lower the frequency of bowel movements. The collaboration between THC and CBD is particularly effective at activating CB2 receptors in the gut. Some effects of medical marijuana could particularly help manage symptoms like diarrhea in irritable bowel syndrome (IBS).

Cannabis may also help with: 

• Slow gastric emptying (but chronic THC use or binge-eating may be counterproductive)
• Reduce acid production
• Slow the movement of food through the digestive tract

However, while cannabis helps manage GI symptoms, there is some, but not enough, robust clinical research that it alters the underlying disease mechanisms of GI conditions. In lab studies, cannabinoids show anti-inflammatory effects, which can help symptomatically. 

More human studies are needed to understand how cannabis creates changes in inflammation markers. Experts generally agree that cannabis works best as a symptom-based therapy rather than a disease-modifying treatment.

Patients with Crohn’s disease may also benefit from medical cannabis. Crohn’s disease patients, however, may benefit more noticeably from cannabis use than those with ulcerative colitis. Many patients with these gastrointestinal diseases report reduced nausea, vomiting, abdominal pain, and diarrhea. 

Still, more research is needed to fully understand how to use cannabis effectively in gastrointestinal care. This means cannabis may complement, but not yet replace, traditional GI treatments.

READ: Relieve Your Chronic Pain With These Cannabis Strains

How the Gut Microbiome and Endocannabinoid System Work Together

The gut microbiome and the endocannabinoid system (ECS) work in tandem to regulate digestion, immune function, mood, and overall gut health. Additionally, many non-ECS receptors like serotonin, TRPV, and immune cells also respond to cannabinoids and bacterial metabolites, influencing symbiosis or dysbiosis. 

Gut bacteria affect brain activity by interacting with the body’s stress response system. Conversely, the endocannabinoid system (ECS) helps manage how food moves through the digestive tract, how much the gut secretes, how we feel pain in the stomach, and how the immune system reacts. 

This two-way communication system is critical in conditions such as obesity, metabolic endotoxemia, IBS, and IBD. The microbiome also influences liver, bone, and brain health – which also goes both ways to create established axes of communication.

The ECS—an internal signaling network—relies on cannabinoid receptors like:

• CB1 in the brain and the gut nervous system
• CB2 on immune cells in the gut lining
• Endocannabinoids (naturally occurring cannabinoids like 2-AG)
• Enzymes that regulate their activity 

CB1 receptors slow muscle contractions and reduce gut secretions, while CB2 receptors modulate inflammation and help maintain healthy intestinal barriers, immune balance, and an anti-inflammatory profile in the digestive tract.

Cannabis compounds such as THC and CBD interact directly with the ECS and influence gut health. THC produces the characteristic “high,” and CBD, which does not, modulate ECS activity. Together, they may help regulate digestion, reduce inflammation, and influence gut-brain signaling. 

Low doses of THC and CBD are shown to promote the growth of beneficial bacteria like Akkermansia muciniphila, and support healthy microbiota fat metabolism. However, higher THC doses may disrupt the microbiome, potentially causing imbalances like dysbiosis.

Studies in germ-free mice show that gut microbes are necessary for the ECS to work correctly. When CB1 receptors in the ECS are activated, they can change how quickly food moves through the gut and affect which microbes grow there. In return, gut bacteria shift towards an anti-inflammatory, antidiabetic, and antiobesogenic profile as demonstrated in mice studies. 

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Plus, good bacteria make compounds that influence endocannabinoid tone, and some that act like natural endocannabinoids. These compounds can activate ECS receptors and affect how long endocannabinoids stay active by controlling the enzymes that break them down.

As medical cannabis use grows among people with gastrointestinal conditions and those undergoing cancer treatment, understanding the complex interactions between cannabis, the ECS, and gut microbes becomes increasingly essential. These interconnected systems influence digestive health and shape how the body responds to illness and treatment. 

Medical Marijuana for Gastrointestinal Disease Relief

People have used marijuana, derived from the Cannabis sativa plant, for millennia in both medical and recreational purposes. 

The U.S. Food and Drug Administration (FDA) has approved specific cannabinoid medications to treat chemotherapy-induced nausea and to stimulate appetite in AIDS patients experiencing weight loss. Although the FDA has not approved cannabis as a treatment for IBD, and it is not considered a cure, many patients report relief from symptoms such as pain and appetite loss.

 Interest in using medical marijuana to manage gastrointestinal conditions—especially Crohn’s disease and ulcerative colitis—has also steadily increased in recent years.

Inflammatory Bowel Disease (IBD)

 A 2013 study surveyed 292 IBD patients at a major medical center. Researchers found that 12.3% actively used marijuana and 39% had used it in the past. Among those who used it to manage symptoms, most reported significant relief from abdominal pain, nausea, and diarrhea.

Some studies found similar results in younger patients. Among 99 teens and young adults with IBD, nearly one-third had used marijuana. Of those users, 57% cited medical reasons—primarily pain relief—as their motivation for use.

More recently, a small 2018 study using twice daily CBD at 10mg for 8 weeks was well-tolerated, but did not show efficacy for Crohn’s. However, this small dose is likely just too low to be therapeutic.

Regarding ulcerative colitis (UC), another major form of IBD, CBD-rich botanical extract used in another small 2018 clinical study resulted in lower severity scores, endoscopic subscores, and reduced pro-inflammatory molecules called cytokines. 

Preclinical evidence from 2013 using CBG and animal studies also supports similar potential in IBD. Later, a groundbreaking 2022 clinical survey shows that Crohn’s and ulcerative colitis patients consistently self-reported higher relief on average than conventional medications.

Emerging evidence also links therapeutic cannabis use with GI conditions such as gastroesophageal reflux disease (GERD) and acute pancreatitis.

Gastroesophageal Reflux Disease (GERD)

Cannabis, particularly THC-rich strains, may help manage GERD symptoms by actively reducing inflammation, relieving pain, easing nausea, lowering stomach acid, and improving esophageal muscle function to prevent acid reflux. 

These notions are largely derived from a 2009 clinical study using 10mg of oral THC per week over 3 weeks, among a few other studies. Patients showed reduced lower esophageal pressures, relaxations, and a nonsignificant reduction of acid reflux episodes in the first hour after eating. However, 20 mg of THC induced nausea and vomiting – highlighting the need for cautious dosing and avoiding cannabis smoking in GI-sensitive persons.

Cannabinoids in marijuana interact with gut receptors that regulate acid secretion, potentially decreasing stomach acid production and alleviating acid reflux symptoms. 

Terpenes like beta-caryophyllene can also target CB2, similar to THC, but without the high from CB1. This activity may also help alleviate pain and inflammation in GERD according to mice studies, but needs further clinical study.

Additionally, cannabis may stimulate appetite suppressed by discomfort and reduce stress and anxiety that can exacerbate GERD.

Acute Pancreatitis (AP)

Cannabis may help manage certain symptoms of acute pancreatitis (AP), such as pain, nausea, and loss of appetite, through its anti-inflammatory, analgesic, and antiemetic properties. Some early studies and anecdotal reports suggest that cannabis users with pancreatitis experience less severe outcomes, possibly due to its ability to reduce inflammation. 

Nevertheless, excessive THC use is reported in 2022 as a rare, paradoxical cause of pancreatitis – supported by a 2024 review. Cannabis-induced pancreatitis (CIP) is more common in biological men than women by a 4:1 ratio, with an average age between mid-late 20s, although other substances like alcohol are most commonly involved. This emphasizes the need for lower, less frequent, and non-smoking THC dosing strategies in favor of non-impairing, anti-inflammatory cannabinoids like CBD, CBG, etc., because those avoid CB1 activity and airway effects.

THC and CBD show potential in managing various types of pain, which may help lessen AP-related pain and reduce reliance on opioid medications. Cannabinoids like THC in low doses may also ease nausea and vomiting, common and distressing symptoms of AP, though in some individuals, cannabis can trigger cannabinoid hyperemesis syndrome and CIP. Hemp-based alternatives like CBD may be best explored here. 

Additionally, cannabis can stimulate appetite, offering further support for AP patients struggling with poor food intake due to pain or digestive issues. While promising, current evidence remains limited and mixed, and more research is needed to confirm these effects and understand their clinical significance.

Stomach Ulcers 

Medical cannabis may support the treatment of stomach ulcers when used alongside traditional therapies. Research suggests that cannabis can help by suppressing gastric acid secretions, which relieves heartburn, and by regulating appetite and calming nausea. Cannabis may also reduce inflammation caused by stomach acid and help alleviate intestinal pain through the actions of cannabinoids and certain anti-ulcerogenic terpenes such as myrcene, linalool, and nerolidol.

Historically, boiled cannabis root has been used in Réunion, a French island in the Indian Ocean, to prevent vomiting. In Argentina, people have mixed cannabis plant bark with wine to ease stomach pain and weakness, with the belief that it helps eliminate toxins and infections from the stomach. 

The Role of Gut Microbiota in Cannabis-Based Cancer Treatment

Cannabis shows promise in cancer care, both for its potential to fight tumors and manage symptoms. Preclinical studies suggest cannabinoids like THC and CBD may slow cancer growth by triggering cancer cell death, blocking cell division, cutting off blood supply to tumors, and potentially preventing cancer spread.

Cannabis also helps relieve chronic pain, reduce nausea and vomiting from chemotherapy, surgery, and improve appetite during treatment. Medicinal cannabinoids—the active compounds in marijuana—play a key role in managing these symptoms. 

CBD plays a significant role in potentially enhancing chemotherapy. In breast cancer cells, it works with certain drugs to increase cancer cell death and disrupt pathways involved in cell repair, growth, and immune response, hinting at some anticancer effects.

Recent findings also suggest that gut bacteria may influence how cannabis works against cancer. Gut microbes can break down cannabinoids, affecting how long they stay active and how they behave in the body. These bacteria also produce compounds like short-chain fatty acids (SCFAs) that interact with the body’s ECS, helping regulate inflammation and gut function, which also play roles in cancer development.

Because many cancers start in the gut and the microbiome influences immune response and inflammation, the gut microbiota could shape how well cannabis works in cancer therapy. Adjusting the gut microbiome with diet, probiotics, or prebiotics might enhance cannabinoid effects or reduce side effects from cannabis use.

Some researchers are also exploring how the microbiome might improve responses to cannabis-based immunotherapies. Since gut microbes and cannabinoids affect immune function, combining the two could unlock new ways to treat cancer more effectively.

Key Takeaways

Cannabis shows promise as a supportive tool for gut health and gut-related conditions by interacting with the endocannabinoid system, endocannabinoidome, and influencing the gut microbiome. 

Early research suggests it may reduce inflammation, regulate digestion, ease GI symptoms, and even fight cancer. As science and regulations advance, cannabis could even play a growing role in personalized digestive care alongside diet, probiotics, and medical guidance. 

As cannabis continues to be legalized across the country, these much-needed studies will hopefully continue to help patients fully understand the many ways medical cannabis can improve these diseases and their symptoms.