What is Clinical Endocannabinoid Deficiency?
Article written by
Where's WeedContributing Author
Content reviewed by
Dr. Lewis JasseyMedical Director - Pediatric Medicine
The endocannabinoid system (ECS) is a complex arrangement of networks in the body that is heavily responsible for regulating bodily functions and organs. Its job is to maintain homeostasis and keep the body operating at a stable rate regardless of any external influences. Any type of endocannabinoid system deficiency is likely to adversely affect the body and can result in well-known conditions like migraines, severe muscular pain and irritable bowel syndrome.
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How Does the Endocannabinoid System Work?
The ECS was discovered in the early 1990s at the National Institute of Drug Abuse by scientists who were able to identify the DNA sequence that encodes tetrahydrocannabinol (THC)-sensitive receptor in the brain of a rat. From 1990 to 2000, research into how this sequence operates turned into endocannabinoid system research once they confirmed that humans had an ECS, and the magnitude of its importance began to come to light. The possibility that doctors could manipulate the ECS to alleviate debilitating symptoms of a variety of illnesses sent a thrill through certain sections of the scientific community.
The endocannabinoid system is now considered to have three separate parts. There are endocannabinoids, receptors and enzymes. Endocannabinoids are lipid-based neurotransmitters that bind with the receptors, and the enzymes help break down the endocannabinoids. The body’s immune system, central nervous system, brain and other major organs are filled with receptors that have been identified as primarily CB1 and CB2 receptors. The receptors are access points for both internal and external cannabinoids to interact with the ECS. This allows the endocannabinoid system to support the body in maintaining homeostasis.
CB1s are mainly located in the central nervous system and CB2s are found primarily in the peripheral nervous system. CB1 receptors can link with THC and produce a psychoactive reaction. Activated CB1 receptors also produce the other sensations that cannabis users experience like an increase in appetite and pain mitigation.
The CB2 receptor is known to link with cannabidiol (CBD) and works across the immune and gastrointestinal systems to regulate inflammation, appetite, and pain. The endocannabinoid system and CBD have a special relationship because the CBD improves the functionality of cannabinoid receptors which helps the ECS maintain homeostasis. CBD can facilitate and restore natural balance when it interacts with the ECS. Even if the cause of certain unwanted symptoms is unknown, it IS known that cannabinoids, not only THC and CBD, can provide help.
Clinical Endocannabinoid Deficiency
Clinical Endocannabinoid Deficiency (CED) is the belief that certain crippling conditions can be linked to issues with the ECS. The theory first surfaced in 2001 and was more thoroughly posited in a study published in 2004 by neurologist and psychopharmacology researcher Ethan Russo. Russo proposed that issues with migraines, fibromyalgia (an awful condition that causes pain all over the body, as well as fatigue, sleep problems, mental and emotional issues), irritable bowel syndrome and other conditions that physicians find difficult to address are the result of endocannabinoid deficiency symptoms. The body might not be producing enough endocannabinoids or certain receptors might be absent or malfunctioning. When this happens, the body’s balance is lost, and diseases linked to the immune system can result.
Russo’s studies continued over the years, and he has confirmed that the “greatest evidence for CED is present for migraine, fibromyalgia and irritable bowel syndrome (IBS)” because of specific unifying pathophysiological trends in each of the three conditions. Beyond those three, Russo added neonatal failure to thrive, cystic fibrosis, causalgia, brachial plexopathy, phantom limb pain, infantile colic, glaucoma, dysmenorrhea, hyperemesis gravidarum, unexplained fetal wastage (repetitive miscarriages), post-traumatic stress disorder (PTSD) and bipolar disease as also possibly linked to clinical endocannabinoid deficiency.
In terms of endocannabinoid deficiency and fibromyalgia, migraine and IBS, the unifying trends Russo noted were the following:
- Each of the three must be clinically diagnosed based on subjective criteria as all lack characteristic tissue pathology or easily accessible objective laboratory findings.
- Each are diagnoses of exclusion that often generate extensive negative diagnostic results. This means that they are diagnosed only after several other possibilities have been proven to not be present.
- Each display elevated incidences of anxiety and depression and has been labeled psychosomatic.
- Comorbidity (the simultaneous presence of two or more diseases or conditions in a patient) exists across the three diagnoses. Primary headaches co-occurred in 97% of 201 fibromyalgia patients studied, 35.6% of 101 chronic daily headaches (transformed migraine) subjects also fit clinical criteria of fibromyalgia, and 31.6% of IBS subjects were also diagnosable with fibromyalgia, while 32% of fibromyalgia patients also fit for IBS.
How to Treat Endocannabinoid Deficiency
Like much of what remains unknown about the ECS, the options for endocannabinoid deficiency treatment lack substantial scientific understanding. Beyond Russo’s work, there has been a disappointing amount of research on CED and why it occurs. Genetic makeup, serious injury and diseases have been discussed as possible causes for CED onset, but nothing has been confirmed. What is known is what happens when the body is not balanced. Improper or inadequate endocannabinoid production and signaling has been linked to anxiety and depression. Endocannabinoids also help regulate bone metabolism and tissue creation. Since the ECS monitors so many of our body’s vital biological systems, it is important to maintain a proper endocannabinoid “tone.”
Russo’s suggestions for treating CED and maintaining a strong endocannabinoid tone combine basic advice like maintaining a healthy lifestyle with the introduction of cannabinoids to attempt to activate failing or inoperative receptors. A daily routine of aerobic exercise that is low intensity over a longer period of time and a diet replete with fatty acids like omega-3 can assist with endocannabinoid production and synthesizing. Foods like fish, shrimp, walnuts and oysters are heavy in omega-3 acid.
Low amounts of THC (to keep tolerance low) and the other incredibly beneficial cannabinoids in cannabis like CBD, cannabinol (CBN), and cannabigerol (CBG) can also help treat CED as they link with and stimulate receptors across the body. The vast amounts of terpenes produced in cannabis work with the body’s receptors and naturally occurring cannabinoids to contribute to the entourage effect, which provides a therapeutic umbrella and can ease the symptoms of clinical endocannabinoid deficiency.
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