Endocannabinoid System Dysregulation, IBS and IBD: Could Medical Cannabis Help?

What are IBS and IBD?

IBS stands for irritable bowel syndrome, and IBD stands for inflammatory bowel disease and includes Crohn’s disease and ulcerative colitis (UC). While there are many similarities in signs and symptoms between the two conditions, there are also several differences. Both can cause abdominal pain, GI upset, and cramps. However, in IBD, inflammation is a significant diagnostic criteria, whereas inflammation is (arguably) not always present in IBS. Both conditions can impact the quality of life, but IBD has the potential to be life-threatening as well.

Although IBS and IBD are different in many ways, they could both result from endocannabinoid dysregulation. In IBD, inflammation and the immune system attacks the intestines (an autoimmune disorder). In IBS, this results in miscommunication between the brain and the gut. Medical cannabis could help reduce inflammation and improve communications between the brain and gut via endocannabinoid signaling.

Key Information and Takeaways

No. of Studies

• Total Studies = 83 (Crohn’s, Colitis, and IBS combined)
• Positive Studies = 66
• Inconclusive Studies = 16
• Negative Studies = One

Potentially Useful Cannabis Compounds

Cannabinoids

THC, CBD, CBG, CBC, CBN,

Terpenes

Beta-caryophyllene, linalool, pinene

Flavonoids

Quercetin, rutin

Potential Pros

• May prevent colitis.
• Cannabis contains many cannabinoids, terpenes, and flavonoids with anti-inflammatory properties.
• Stimulates appetite.
• Could help reduce or replace the number of pills needed to control the various symptoms of IBD, including chronic pain.
• Cannabis may possibly “reduce the increase of intestinal motility induced by inflammatory stimuli.”
• Carefully dosing plant cannabinoids (phytocannabinoids) could help regulate anandamide in people with higher levels (like those with Crohn’s Disease or Ulcerative Colitis).

Potential Cons

• Some people may increase nausea and decrease appetite after long-term use (cannabinoid hyperemesis syndrome, or CHS).
• Long-term cannabis use may inflame the pancreas (pancreatitis).
• One study shows that the use of cannabis for more than six months was associated with an increased risk of surgery in those with Crohn’s.

Possible Efficacy

High

About IBS and IBD

IBS is a functional gut disorder with a wide variety of potential causes. IBS is thought to be caused by miscommunication between the brain and the gut, which can slow down motility (constipation, or IBS-C), speed up motility (diarrhea, or IBS-D), or both speed up and slow down motility (IBS-M). IBS might also be associated with bacterial overgrowth in the intestines. IBD is also associated with polymorphisms in the PTPN2 gene, which may cause type 1 diabetes and some types of arthritis.

IBD includes Crohn’s disease and ulcerative colitis. They are autoimmune disorders where the immune system attacks the intestines, causing damage and inflammation of the bowels and rectum. IBD has a genetic component not present in IBS.

Despite their differences, there are many similarities in the signs, symptoms, triggers, and impacts on quality of life (QOL). These include:

• Abdominal pain
• Anxiety
• Depression
• Stress
• Cramps
• GI upset
• Nausea and vomiting
• Fatigue
• Aches and pains in the back and legs
• Loss of appetite

Although inflammation is not necessarily a part of IBS, some argue that inflammation plays a role in its development as well:

“Inflammation may play a pathogenic role in IBS. Studies have highlighted the persistence of mucosal inflammation at the microscopic and molecular level in IBS, with increased recruitment of enteroendocrine cells. Substantial overlaps between IBS and inflammatory bowel disease have also been reported.”

Current Treatments for IBS and IBD

For both IBS and IBD, current treatments include:

• Dietary changes, in particular the FODMAP diet, including reducing the consumption of foods that are difficult to digest (e.g., cauliflower, many lactose-containing foods, and grains like rye)
• Reduction in caffeine intake
• Loperamide and other antidiarrheal medications (except in cases of IBD where fever and abdominal pain is present)
• Stress reduction techniques, such as meditation, cognitive behavioral therapy (CBT), and mindfulness-based cognitive therapy (MBCT)
• Probiotics
• Physical exercise
• Regulating sleep patterns

For IBD, other treatments can include:

• Immunosuppressants (e.g., steroids or azathioprine)
• Aminosalicylates or mesalazines (anti-inflammatory drugs)
• Antibiotics and other antibody-based treatments
• Surgery in cases where inflammation has progressed–surgery is quite common for long-term IBD sufferers

How Might Cannabis Help Manage IBS and IBD?

People who take medicinal cannabis to relieve IBD and IBS experience an improved quality of life. Medical cannabis may help manage:

• Chronic abdominal pain
• Insomnia
• Stress
• Anxiety
• Depression
• Nausea
• Lack of appetite

Beyond QOL improvements, medical cannabis contains a multitude of cannabinoids, terpenes and flavonoids that have anti-inflammatory properties. Combined with the ECS’s critical role in immune system regulation, pain detection and inflammation, the ability of the cannabinoids in cannabis to re-regulate the ECS and dampen inflammation is one of the reasons it could help with so many health problems. Moreover, cannabinoids and terpenes can re-regulate other receptor systems that are dysregulated due to IBS or IBD, including serotonin, dopamine, and toll-like receptors (TLRs).

Medical cannabis may also help:

• Regulate anandamide levels, which are raised in those with Crohn’s or colitis
• Improve gut microbiome health
• Reduce or eliminate the need for prescription pills
• Manage other conditions associated with IBS and drastic changes in the gut microbiome, such as autism, Parkinson’s, fibromyalgia, chronic fatigue syndrome (CFS), and diabetes

Data Overview

• Total Studies = 83 (Crohn’s, Colitis, and IBS combined)
• Positive Studies = 66
• Inconclusive Studies = 16
• Negative Studies = One
• 47 Meta-Analyses (33 positive, 13 inconclusive, one negative); 27 Animal Studies (all positive); eight Double-Blind Human Trials (five positive, three inconclusive); two Human Trials (all positive); five Lab Studies (all positive)
• 24 studies include CBD (20 positive, 4 inconclusive); 15 studies include THC (15 positive, three inconclusive); studies including THCA, CBC, CBG = six (all positive)
• No. of Leafwell Patients (2022) = 780 (IBD); 380 (IBS)
• Possible Overall Efficacy: High

Conclusion

Although more clinical trials with more substantial numbers of participants are required to determine whether or not medical cannabis helps manage IBS and IBD, the evidence we have so far is solid. We know that the ECS plays a significant role in regulating gut function and that there are many cannabinoid receptors in the gut. We also know that cannabis contains hundreds of compounds with anti-inflammatory properties, and that patients have been using it successfully to manage their symptoms. Therefore, medical cannabis could be of immense use for treating IBS and IBDs.

Please note: the information in this article does not constitute medical advice