Have You Heard Of Cannabinoid Hyperemesis Syndrome?

Have you heard of cannabinoid hyperemesis syndrome? Have you experienced intense vomiting after cannabis? Are some people more susceptible?

Nov 1, 2016

Cannabis has different effects on different people. For some, one of these effects may be cyclic vomiting. Recently, a rare condition known has cannabinoid hyperemesis syndrome (CHS) has been gaining notoriety. Yet, what is CHS exactly?  Not much is known about this rare condition, but it is thought to be a form of cannabinoid toxicity. Some experts question whether or not it exists at all. 

Does cannabis make some people vomit?

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Case studies and early reviews are the only evidence of cannabinoid hyperemesis syndrome thus far. In most case studies, CHS begin in young adults after a few years of heavy, protracted cannabis use. CHS symptoms began after three years of chronic cannabis consumption. Daily use is reported, often more than three to five times a day.

Symptoms of cannabinoid hyperemesis syndrome include,

  • Cyclic and uncontrollable vomiting
  • Abdominal pain
  • Compulsive bathing

The condition was first proposed in 2004. Australian researchers noticed that heavy cannabis use was common among patients with cyclic vomiting symptoms. In the study, 10 patients were asked to discontinue cannabis. Seven completed the study and found relief. Three did not abstain from cannabis and their symptoms continued.

More recently, medical professionals examined the potential existence of this condition in 98 patients. All patients were long-term cannabis users and experienced the above symptoms. Unfortunately, follow-up was only available in 10 patients. Of those 10, seven patients stopped using cannabis. Six of the seven patients went into remission after stopping cannabis.

What causes Cannabinoid Hyperemesis Syndrome?

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According to the theory, CHS is caused by too much cannabis over a long period of time. Though, the condition is at odds with the fact that cannabis is a powerful antiemetic (anti-nausea and vomiting) agent. In a 2011 paper from Temple University, researchers hypothesize why chronic cannabis use might have the opposite effects in some people.

Some pre-clinical research has associated cannabis with,

  • Low stomach acid
  • Slowed digestion and bowel movements (impaired mobility and elimination)
  • Relaxed lower esophageal sphincter (the valve that connects your stomach from your esophagus)
  • Increased visceral sensitivity and pain
  • Increased inflammation

All of these issues together prime the digestive tract for vomiting. Slow elimination means that there is a buildup of gunk in your gut. Inhibited gastric juices (stomach acid) means that you may not be digesting your food very well. A relaxed esophageal sphincter makes it easy to vomit.

The researchers articulate that the anti-nausea effects of cannabis are primarily due to the herb’s effect on the central nervous system. In the case of CHS, the gut seems to really want to get out all of the build-up. But, the brain has been given the opposite signal. Looks like the GI tract stands victorious in this case.

At this point, it’s important to remember that this is a theory. No substantial research has been done on CHS, and these proposals are mere hypothesizes of what could possibly have gone wrong. Yet, some people really do experience vomiting with cannabis. If that’s the case, it’s worth it to know the possible reasons.

Stages of CHS

Concerned about CHS? You may be able to tell if you have the condition prior to the horrendous vomiting phase. The Temple researchers outline three primary stages of cannabinoid hyperemesis syndrome. The stages are:

1. Prodromal Phase

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The prodromal phase is when a patient notices the beginning symptoms. According to the paper, this stage can last several months to a year. The symptoms include,

  • Morning sickness
  • Fear of vomiting
  • Abdominal discomfort

2. Hyperemetic phase

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The hyperemetic phase is when patients usually go to the emergency room. This is when the intense vomiting and discomfort begin. Symptoms of the hyperemetic phase include,

  • Persistent and cyclic vomiting and nausea that is incapacitating and interferes with daily life
  • Patients may vomit up to 5 times in an hour
  • Mild abdominal pain
  • Weight loss
  • Obsessive bathing
  • Dehydration

3. Recovery phase

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The recovery phase is just what it sounds like, recovery from hyperemesis. Eating patterns return to normal, weight stabilizes, and compulsive bathing more or less stops. This phase can last a few days, months, or years. Discontinuing cannabis use is thought to promote recovery from CHS.

Some criticisms

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When cannabinoid hyperemesis was first proposed, the theory came with a bit of criticism.

In 2006, Australian researchers responded to the idea,

Cannabis has been consumed for many centuries and is currently used by millions of people in many countries. It is hard to believe that a distinctive syndrome caused by cannabis has never been noted before by users or clinicians.

The authors later continue,

The title of the paper, “Cannabinoid hyperemesis” is unduly presumptive. Some of these cases appeared to improve with abstinence and then relapsed when patients were “rechallenged” with cannabis, but neither the patients nor the authors appear to have been blinded in the rechallenge. The proposed biological explanation is weak.

Other studies have failed to perform clinical, double-blind trials of this possible condition. So, at this point, it is difficult to say what exactly is going on with this new syndrome.

More questions than answers

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The digestive tract is a complicated organ. Not only is it communicate directly with the brain, but it also houses trillions of microbes that have a symbiotic relationship with the body. While cannabinoid receptors influence gut motility, so do the two kilograms (four and a half pounds) of microorganisms that live inside of your intestines.

Recent research also shows that gut bacteria can influence obsessive-compulsive behavior, as well as influence the expression of cannabinoid receptors in the brainstem and intestinal tract. Some bacteria produce chemicals that directly communicate with the center of the brain that controls nausea and vomiting.

Many of those diagnosed with cannabinoid hyperemesis syndrome find relief when they abstain from cannabis. Reports show that when they start up again, their symptoms come back. There is no doubt that those who experience CHS should stop consuming cannabis.

But, there is also probably a lot more going on than the medical research currently understands.

As of right now, CHS is a rare disorder that is only just beginning to make the mainstream radar. So rare that there are no estimates as to how many people may have the condition. Unfortunately, the few case studies available leave many questions unanswered.

Are some people genetically susceptible to this condition? Why do only some long-term consumers develop CHS, and not all of them? Does pesticide toxicity play a role? Does this only apply with psychoactive THC? Do gut microbes contribute to the CHS? Are people who have used certain antibiotics more susceptible to this condition? Is it just the herb?

With time, medical research will shed light on who is at risk for this condition. Meanwhile, taking tolerance breaks, starting small, and paying close attention to your body can help you play it safe with cannabis. If you notice any of the symptoms above, contact a doctor and consider abstaining from the herb.

Nov 1, 2016