People suffering from Inflammatory Bowel Disease (IBD) or Irritable Bowel Syndrome (IBS) can go through excruciating pain, numbness or struggle with a minefield of digestion. Elevated levels of stress can even land these individuals in more discomfort, with IBD patients risking hospitalization due to inflammation. Both IBD and IBS have a major impact on the quality of life and on the ability to do simple things such as eat, sleep, and work. Cannabis has been identified as an effective alternative treatment for some gastrointestinal disorders…but does that include IBD and IBS?
Inflammatory Bowel Disease (IBD) is an umbrella term used for disorders that include chronic inflammation of the digestive tract. According to the Mayo Clinic, there are different types of IBD which include Ulcerative Colitis and Crohn’s Disease. Ulcerative Colitis is a condition that causes long-lasting inflammation and ulcers (sores) in the innermost lining of the individual’s large intestine and rectum. Crohn’s Disease is also a condition that causes inflammation, but it affects the lining of the digestive tract, which can then spread deeply into the affected tissues.
Both conditions are often associated with severe diarrhea, abdominal pain, cramps, fatigue, fever, reduced appetite, and weight-loss. They can both also lead to serious life-threatening complications. The exact causes of IBD are still unknown but risk factors such as age, race, family history, cigarette smoking, anti-inflammatory as well as environmental factors such as where the individual lives. Factors such as diet and stress are known to aggravate IBD patients, but they do not cause it.
Individuals suffering from IBD are at greater risk of colon cancer, skin inflammation, eye inflammation, joint inflammation, blood clots as well as possible liver damage from primary sclerosing cholangitis because of IBD. Additionally, individuals specifically with Crohn’s disease may risk bowel obstruction, malnutrition, ulcers, fistulas, and anal fissure. Individuals specifically with Ulcerative Colitis may be at risk of toxic megacolon, holes in the colon, and severe dehydration.
Irritable Bowel Syndrome is classified as a “functional disorder,” which means that patients are suffering through a host of symptoms, but they are able to continue functioning from day to day, albeit what comes along with the symptoms. IBS is a common condition that affects the large intestine and is usually manageable through healthier diets, living a healthier lifestyle, and proactively reducing stress.
Similarly to IBD, IBS symptoms include abdominal pain, cramping, bloating, gas, diarrhea, or constipation. According to the Mayo Clinic, IBS is a chronic condition that requires life-long management but that it is less common to find patients with IBS suffering from severe related symptoms. Despite being a common condition, it seems that the experts haven’t identified an exact cause of the syndrome.
Individuals suffering from IBS usually only end up at the doctor’s office when there has been significant weight-loss, diarrhea during sleep, rectal bleeding, difficulty swallowing, and persistent pain. The main triggers of this syndrome include food that the body can’t tolerate (such as gluten), stress, and hormones (women with IBS can experience it at its worst during menstrual periods).
IBS patients have also been known to have changes in their gut motility due to stress via their gut-brain axis. According to a study published on PubMed, “The concept of a gut-brain-microbiota axis connects the psyche and nervous system with the intestine, its inhabitants and its metabolic, neuroendocrine, and immune functions”. It’s commonly known that IBS patients are likely to suffer from psychological comorbidities such as depression or elevated stress levels.
|Inflammatory Bowel Disease (IBD):||Irritable Bowel Syndrome (IBS):|
|Classified as a disease.||Classified as a syndrome.|
|Inflammatory-based condition.||Non-inflammatory based condition.|
|Can lead to hospitalization and/or surgery.||Rarely requires hospitalization or surgery.|
|Can lead to permanent damages.||Doesn’t lead to permanent damages.|
|Risk factor for colon cancer.||Not a risk factor for colon cancer.|
|Treated with anti-inflammatory medication and/or surgery.||Diet is used as the primary treatment.|
Although there is a clear difference between IBS and IBD, it should be known that the conditions share similarities. There is an overlapping of symptoms such as pain, cramping, diarrhea as well as nausea and vomiting. Patients suffering from either one may also feel the urgent need to go to the bathroom, even when they don’t really need to. Perhaps one of the most commonly overlooked similarities between the two is stress, which seeks to aggravate the symptoms and conditions of both IBD and IBS. Practicing stress-reduction in daily activities is essential.
Ethan Russo theorized that IBS may present itself in an individual as a result of a deficiency in the body’s’ own cannabinoid chemicals, which are located in the endocannabinoid system (the ECS). Gut mobility and visceral hypersensitivity have also been identified as factors contributing to the symptoms experienced and associated with IBS, both of which have been proven to interact with the endocannabinoid system.
The body’s’ indigenous endocannabinoid system acts to protect the digestive system from inflammation and stomach acids, and since the cannabinoids from cannabis react to the body’s’ endocannabinoid system, it opens the line of thinking about how cannabis can be used to further assist gut-based conditions such as IBS (and IBD).
A clinical study done by Steele Clark Smith and Mark Wagner found that cannabis consumption led to improved IBS symptoms as a whole. While another study has shown that patients suffering from IBS involving predominant diarrhea, will benefit most from synthetic tetrahydrocannabinol (THC) known as dronabinol- although we recommend using extreme caution with synthetic cannabinoids. Dronabinol is commonly used as a treatment in cancer patients due to the fact that it can decrease gut transit and increase colon compliance. Luckily, Dronabinol can be organically accessed in its botanical form, THC, directly from the plant.
While another study explains that due to the endogenous cannabinoid systems involvement in so many digestive systems offers up the opportunity for further investigations into how to specifically target gut-related cannabinoid receptors. Unfortunately, most of the current research concludes by suggesting that more research is needed in order to get a better understanding of IBS first and then of how cannabis can be used to alleviate the syndrome.
Anyone considering medical cannabis for IBD or IBS should check with their physician and a medical cannabis doctor. More research and clinical trials are needed to fully understand how cannabinoids help those suffering from GI pathologies. Here is a quick summary of what cannabis can do for patients with IBD and IBS:
Additionally, cannabis has been found to be one of the most effective forms of alternative medication and treatment with much less adverse side effects than those often associated with pharmaceutical medication.
The Veriheal team had the opportunity to engage with Viola Brugnatelli, a neuroscience researcher, and endocannabinologist. Dr. Brugnatelli became a researcher in 2012 and her interests lay in the interaction between natural products (such as plants and spices) and the nervous system. Dr. Brugnatelli co-founded Cannabiscienza, an innovative society dedicated to scientific training on the endocannabinoid system and medical cannabis.
Now, let us have a look at what Dr. Brugnatelli has to say about IBS and Cannabis.
Q: What is the gut-brain axis alteration in IBS?
A: “The interaction of the microbiome-gut-brain axis is highly dependent on hypothalamic–pituitary–adrenal (HPA) stress modulation, which is dysregulated in IBS patients.
The ECS regulates basal and circadian HPA axis activation, and these changes relate to the differences in the visceral sensation that feature in IBS.”
Q: How might THC and CBD be able to modulate it?
“We know that chronic stress causes loss of CB1 receptors, activation of the HPA stress response, and anxiety…Activating CB1 with THC may be recommended in IBS patients to improve abdominal spasms, cramps, and visceral pain.
Furthermore, given that endocannabinoid receptors are found along the GI tract, it follows logically that CBD and THC could reduce clinical endocannabinoid deficiency, and improve symptoms of IBS.”
Q: How would this benefit those living with IBS?
A: “Currently, IBS sufferers are prescribed opioids, anticholinergics, and antidepressants, however with quite suboptimal results. In this context targeting the ECS may represent a promising strategy to modulate gut motility…low-grade intestinal inflammation, and gut-brain axis alteration, all features that may improve IBS symptoms onset. It is also evident that both an IBS-diet and a stress-relief practice are required to boost the beneficial effects of any of the agents suggested.”
Dr. Brugnatelli’s research suggests that medical cannabis is a safe and effective treatment for endocannabinoid deficiency for patients struggling with IBS. As more research emerges, it is hopeful medical professionals will consider medical cannabis as a first line of treatment.
The symptoms and associated risks are quite horrible for anyone to deal with. Luckily, taking care of inflammation is one of cannabis’ most used medical benefits. Due to the severity of IBD which individuals deal with, they often try alternative treatments in search of something that will help. Most conventional methods of treating and alleviating IBD symptoms are often accompanied by the adverse side effects often associated with pharmaceutical medication and treatments.
Recently, as many as 40% of the IBD patients in America have turned towards cannabis with claims of pain relief, alleviated nausea, stimulated appetite, better sleep, reduced inflammation, and even a reduced need for pharmaceutical medication.
Additionally, a study done on animals revealed that tetrahydrocannabinol (THC) was the most effective cannabinoid, while cannabidiol (CBD) was ineffective on its own. The study induced colitis in rodents in order to assess the effectiveness of THC and CBD as potential treatments of IBD. Unsurprisingly, the researchers found that the cannabinoids THC and CBD were even more effective when they were combined with a lower dose of THC to CBD, as opposed to when they were administered in isolation. The study concluded with satisfactory results and have stated that the future of IBD treatment could be the THC and CBD combination.
A 2019 study has even shown that cannabis can significantly reduce the risk of further complications, especially when compared to those who do not consume cannabis. The researchers also found that cannabis consumers with IBD were also significantly less likely to develop issues such as fistulas, abdominal abscesses, and even a reduced risk for blood transfusions. The same study found that tetrahydrocannabinol (THC) had the biggest impact on IBD when compared to the placebo and other cannabinoids.
Professionals agree that the current pharmaceutical medication and treatment available is not meeting all the needs of individuals with IBD…and with such persistent symptoms, their quality of life is reduced.
If you have any experience with using cannabis for IBD or IBS, let us know in the comment section below!
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