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Many patients with irritable bowel syndrome rely on cannabis to relieve symptoms during a flare-up. But, what does the research say? Is the herb the perfect treatment for IBS? Unfortunately, there is still much to be desired in terms of studies and medical research. Yet, some experts think that there’s a lot more to the cannabis and IBS story than meets the eye. 

What is irritable bowel syndrome (IBS)?

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Irritable bowel syndrome (IBS) is a chronic condition that causes extreme gastrointestinal distress. Unlike inflammatory bowel disease (IBD), IBS is not associated with tissue changes in the digestive organs.

However, it still causes a wealth of severe symptoms that can drastically impact on a patient’s quality of life. Some of these symptoms include:

  • Diarrhea
  • Constipation
  • Abdominal pain
  • Bloat
  • Gas
  • Weight loss
  • Rectal bleeding
  • Mucus in stool

IBS is also thought to play a role in various psychiatric illnesses, though no direct causal relationship has been found. Thus far, there is a suspected link between IBS and mental health concerns such as:

Interestingly enough, both IBS and various psychiatric ailments are becoming the targets of human microbiome research. The microbiome is the term for the complex ecosystem of microorganisms that live all over the body and inside the digestive tract.

Over the past decade, evidence increasingly suggests that disruptions in the microbiome can trigger both severe gastrointestinal illness as well as psychiatric distress.

What is perhaps even more interesting to some is that there is a connection between the microbiome and the endocannabinoid system (ECS), which is the cellular network that cannabis engages inside of the body.

Is it an endocannabinoid deficiency?

Medical cannabis isn’t a cure for IBS, but the herb certainly may help treat the condition. Some researchers might go as far as to say that cannabinoid therapy may be one of the most effective ways to relieve IBS symptoms and improve quality a life.

Back in 2008, neurologist and medical researcher, Dr. Ethan Russo, proposed that IBS may be caused by an endocannabinoid deficiency. Endocannabinoids are compounds like psychoactive THC that the body produces naturally.

These compounds make up the ECS, a large regulatory network in the body. The ECS plays a role in a wide range of functions, including appetite, digestion, immune regulation, mood, sleep, reproduction, and pain.

Russo has theorized that for some reason, those with IBS do not have enough endocannabinoids. In an interview with Project CBD, Russo explains what this deficiency might mean,

If you don’t have enough endocannabinoids you have pain where there shouldn’t be pain. You would be sick, meaning nauseated. You would have a lowered seizure threshold. And just a whole litany of other problems.

It occurred to me that a number of very common diseases seem to fit a pattern that would be consistent with an endocannabinoid deficiency, specially these are migraine, irritable bowel syndrome, and fibromyalgia. – Russo

Though there are signs that there may be an endocannabinoid problem in IBS, pharmaceutical researchers thus far have been focusing on a different solution: drugs that target the serotonin system. Serotonin is the neurotransmitter commonly associated with depression.

In his 2008 review, Russo articulates that serotonin-targeting drugs have only been about 15% successful in treating IBS and have had serious health consequences in clinical trials. Yet, anecdotal evidence and analysis suggest that the endocannabinoid system is a much better target for the condition. He writes,

Rational analysis suggests that endocannabinoids may well be the more likely therapeutic neuromodulatory target, and that phytocannabinoid treatment might represent a more efficacious and safer therapeutic approach.

Simply stated, plant-based cannabinoids, like those found in cannabis, may be a safer and more effective treatment than drugs currently in development for IBS.

The microbiome and the ECS

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Unfortunately, the most recent thoughts on IBS are highly theoretical and anecdotal at this point. But, microbiome discoveries have uncovered a connection between gut bugs, the endocannabinoid system, and IBS.

One 2007 pre-clinical study found that the presence of the bacteria Lactobacillus acidophilus in rodent intestinal tracts increased expression of cannabinoid and opioid receptors, decreasing pain.

The authors suggested that this may have some serious implications for the treatment of IBS. As Russo mentioned above, increased pain sensitivity is a hallmark in IBS.

While many IBS patients take some sort of probiotic, human microbiome research is still a very new field of science. The 2007 study highlighted just one species of gut microbe among up to 1,000. Perhaps this is why medical cannabis access for IBS patients is so important.

Though there is good evidence that IBS is a microbial issue, and while researchers have discovered that microbes can influence the endocannabinoid system, the overarching connection just isn’t there yet. In the meantime, cannabis seems to be one of the most promising options for the management of unrelenting IBS.

Cannabis and IBS symptom relief

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Let’s face it, solid research on cannabis and IBS is still lacking. Yet, there are a few ways that cannabis can improve the quality of life in those with this condition. Here’s how the herb can ease three primary symptoms of IBS:

1. Diarrhea

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There is nothing pleasant about needing to run to the bathroom multiple times after a meal. Luckily for those with diarrhea-dominant IBS (IBS-D), cannabis has been shown to reduce hypermotility and ease abdominal cramping. Hypermotility is when food moves through the GI tract too fast.

In a 2016 paper, Russo cites evidence that those with IBS-D showed genetic variations in coding for the endocannabinoid system. He also explains that treating those who had this variation with synthetic THC reduced hypermotility.

Apparently, cannabis was one of the first effective treatments for cholera-related diarrhea in the 19th century.

2. Abdominal pain

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A reduced pain threshold is another major symptom of IBS. Cannabis has been shown to reduce visceral sensitivity in those with gastrointestinal disorders.

“Visceral perception” is a fancy way of saying internal pain sensitivity. A 2004 study suggests that there is strong evidence for cannabinoid treatments in managing bowel diseases like IBS, partly thanks to the herb’s ability to knock out nerve pain and partly perhaps due to its anti-inflammatory properties.

Another 2008 review highlights the discovery that cannabinoid treatment can calm sensitivity and inflammation in the intestinal lining of those with GI disorders. All good signs for IBS patients in need of relief.

3. Depression

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The mental symptoms of IBS are just as important to address as the physical. It’s common knowledge that a little herb can lift spirits and inspire a positive mood. But, for those who want depression relief without the high, there may be another great option.

A rodent study published in April of 2016 found that cannabidiol (CBD), a nonpsychoactive component in cannabis, discovered that a single dose of CBD treatment effectively began to ease anti-social and reduce anxiety-like behavior in minutes.

CBD continued to work over time. This is amazing, as it can take up to six weeks for common antidepressant medication to become effective.

What about constipation?

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Unfortunately, the impact of medical cannabis on constipation is up for debate. The majority of research suggests that the plant slows things down rather than speeds things up.

However, as with most things gut and cannabis related, a lot depends on each individual’s unique internal situation.

Since there is no clinical research on the subject, many cannabis patients opt for the “try and see” approach with the herb.

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Delilah Butterfield

Delilah Butterfield is a Pacific Northwest native with a passion for cannabis and natural health. Contact her on Twitter @delilahbfield.
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