Studies on CBD & IBS [Research papers Simplified}

Irritable Bowel Syndrome (IBS), believed to be caused by stress, depression, anxiety, or previous intestinal infection, is a chronic and recurrent abdominal pain, often accompanied by cramping, bloating, bloating, diarrhea, and/or constipation.

While it affects over 15% people of the world’s population, including around 25 to 45 million people in the United States alone, IBS’ symptoms vary from person to person, with some individuals experiencing severe, unbearable pain and irregular stool.

Incidentally, it is more common among women and tends to affect people of all ages. Most patients experience symptoms in times of intense stress or after a meal.

Recent studies have shown that cannabinoids like cannabidiol (CBD) may be used to manage these symptoms. CBD, being a non-intoxicating component of cannabis sativa species of plants, has negligible or no side effects on the user, making it a potentially preferred alternative to conventional medical treatments.

Studies supporting claims of CBD’s benefits on IBS patients

While the exact cause for IBS is not known, scientists are divided on its cause.

Some say it is linked to the time taken for food to pass through the digestive tract – either too quickly or too slowly. Others say it is caused by oversensitive nerves in the gut. Several other theories point to stress or even genetics.

Unfortunately, there is no real cure for IBS. But, conventional methods of treatment point to ways of managing it. They include changes in diet and lifestyle, and consuming probiotics through food supplements.

But, CBD is another agent that is increasingly being seen in the US and Europe as a therapeutic option, having multiple health benefits.

Some of the studies that suggest CBD can help treat symptoms of irritable bowel syndrome are as follows:

  • A 2008 [1] review, published in the Neuro Endocrinology Letters, neurologist Ethan Russo delved into the possibility that IBS may be caused due to clinical endocannabinoid deficiency (CECD). Endocannabinoids are natural cannabinoids found within our body. They are part of an influence on the endocannabinoid system, which is a biological system found in our brain and throughout the body. Russo’s review laid the foundation for fresh studies on the belief that CBD can help alleviate symptoms of IBS.
  • Later in 2016 [2], the same scientist revisited the issue, only to confirm what he had derived at eight years ago. This time his findings were published in the Cannabis and Cannabinoid Research. While both studies supported the idea that migraine, fibromyalgia, IBS and other treatment-resistant syndromes are caused by CECD, this particular one went one step forward in suggesting that CBD can not only be successfully used to manage the symptoms, but it is also a safer bet than most other traditional treatments.
  • A research paper [3], published in the British Journal of Pharmacology in 2007, also confirmed that CBD has quite a few positive effects on IBS symptoms. It was found that CBD interacts with the CB2 receptors in our digestive tract, causing spasms to cease and lead to better intestinal motility (i.e. less spontaneous movement within the intestines).
  • Another 2018 review [4], published in the Biochemical Pharmacology, shed light on the fact that cannabis products may be useful in treating the main digestive pathologies, like “irritable bowel syndrome, inflammatory bowel disease, colon cancer and gastrointestinal chemotherapy-induced adverse effects (nausea/vomiting, constipation, diarrhea)”.
  • Another review [5], published in the Cannabis and Cannabinoid Research in 2016, also suggested that “dysregulation of the endocannabinoid system might play a role in intestinal disorders, including inflammatory bowel disease, irritable bowel syndrome, as well as obesity”. The study was conducted by Nicholas V DiPatrizio, a neuroscientist. Given that CBD is a cannabinoid, known to be safe for human consumption, it can certainly help alleviate the symptoms of IBS.
  • According to a paper [6], published in the Phytotherapy Research, cannabis-based products can be quite effective against IBS. The authors of the paper pointed out that the phytocannabinoid’s (as it is a cannabinoid found in plants – cannabis sativa) anti-inflammatory and immunomodulatory effects makes CBD a potential therapeutic agent for treating IBS patients. They added that CBD can even slow the progression of IBS and ameliorate symptoms.
  • A 2011 paper [7], published in the PLoS One, indicates that CBD may reduce the severity of intestinal inflammation by controlling what is known as the “neuro-immune axis”. Enteric glial cells (EGC) (present beneath the intestinal epithelial cells) mediate both acute and chronic inflammation in the gut. The study states that ECG cells are responsible for maintaining the integrity of the gut mucosa and play an important role in gut immunity. But, they can also produce inflammation. According to the authors of the study, CBD has shown abilities to control inflammatory responses and ECG activation.
  • Another study, published in British Journal of Pharmocology in 2004 [8], has once again established that cannabinoids are potential therapeutic agents in managing bowel diseases owing mostly to its ability to reduce nerve pain, and to its anti-inflammatory properties.
  • While most conventional treatments advise the intake of probiotics to manage IBS pain, a 2007 pre-clinical study [9] on rodents, published in the Nature Medicine, found that the presence of a bacteria Lactobacillus acidophilus in the intestinal tracts is directly linked to an increased amount of cannabinoid and opioid receptors along the GI tract, resulting in a much reduced pain.

WAYS CBD CAN HELP MANAGE IBS SYMPTOMS

Owing to the overwhelming scientific and anecdotal pieces of evidence in support of cannabidiol’s abilities to treat patients with irritable bowel syndrome, it is only natural a lot of people would feel more encouraged to using this “magic potion” to treat themselves and their loved ones.

To understand the ways in which this cannabinoid actually helps us combat the symptoms, let us take a brief look at the physiology of how CBD really helps us.

  • Reduces spasms in frequency and intensity:

When CBD interacts with cannabinoid receptors (CB2) in the GI tract, it relaxes the tissues there, leading to fewer spasmodic episodes and far less discomfort.

  • Stimulates appetite:

One of IBS’ symptoms is a marked lowering in appetite, caused by nausea. When nausea dissipates, the affected individuals tend to binge, resulting in nausea kicking in all over again. While regular nausea suppressants don’t really help IBS patients, it has been found that CBD can actually effectively suppress nausea, thereby promoting a healthy appetite.

  • Regulates pain:

Besides alleviating nausea, CBD has been known for reducing pain, caused by different diseases.

  • Reduces inflammation:

While inflammation is a necessary mechanism by the immune system to fight pathogens, often the mechanism ends up attacking the healthy cells in an aggressive effort to guard against the pathogens. This may damage the GI tract lining too. When your body produces enough endocannabinoids, the inflammation gradually abates. However, in its absence or deficiency, the body can’t manage the inflammation naturally. This is where CBD, being a cannabinoid, can once again help manage IBS symptoms.

  • Better intestinal motility:

IBS is often caused by extreme stress, leading to hypermotility, i.e. a condition when food moves too quickly through the person’s intestinal tract. This can cause many to suffer the loss of fluids, poor digestion, and impaired nutrient absorption. Cannabinoids inhibit hypermotility. When used consistently, CBD increases the cannabinoid levels in the GI tract significantly, thus regulating its motility.

Do IBS patients run any risks while using CBD?

Even as CBD’s long-term effects on hormone production, cell viability, fertilization, as well as its interaction with other drugs, are still not entirely clear, it is often seen that its benefits in reducing symptoms of IBS far outweigh its side effects.

Cannabidiol has been found to be relatively safe when consumed in appropriate dosage among adults. [11]

  • CBD doses of up to 300 mg daily have been used safely for up to 6 months.
  • Doses of 1200-1500 mg daily have been used safely for up to 4 weeks.
  • Cannabidiol under-the-tongue sprays have been used in doses of 2.5 mg for up to 2 weeks.

However, we must remember that the benefits and side effects of CBD also differ from person to person.

Situations when CBD isn’t good for IBS patients

In certain cases, CBD use may not be conducive to a healthy treatment regime. These are some specific circumstances when patients would anyway have to be wary of making any changes in their diet, lifestyle or medications.

CBD oil is still unregulated, and hence, its correct dosage is yet to be determined. However, the data that we do have tends to suggest that CBD is well-tolerated up to a daily dose of 1,500 mg [10].

According to a 2017 review [11], published in the journal Cannabis and Cannabinoid Research, it was concluded that far more research is still needed in different areas relating to CBD and its benefits for humans.

They arrived at the following conclusions:

  1. More studies, researching CBD’s side effects after real chronic administration, need to be conducted. Many so-called chronic administration studies were only a couple of weeks long.
  2. Many trials were conducted with only a small number of individuals. To perform a thorough general safety evaluation, more subjects need to be roped in for future clinical trials.
  3. Several aspects of the toxicological evaluation of a CBD, such as toxicity depending on genes, hormones and the immune system, are still scarce.
  4. Studies to evaluate whether CBD-pharmaceutical drug interactions occur in clinical trials have to be performed.

Even though a safety profile of the cannabidiol oil has already been established through several studies, much is left to be desired as far as research on CBD is concerned, mostly owing to lack of sufficient clinical trials.

Other safety concerns

CBD oil in its pure form is believed to be of much help to people suffering from different diseases. However, the exact composition of the products available in the market often vary, posing a threat to human health.

This is particularly true due to the presence of Tetrahydrocannabinol or THC as well as several contaminants. While we may be benefitted from its use at an initial stage, there is a possibility that on prolonged use, our conditions may further aggravate due to the presence of THC. It is also possible that a patient may develop issues that there were not present before. Such situations may prove to be detrimental to the patient’s health.

Cases of Mislabeling: According to a research paper, published in the Journal of the American Medical Association in 2017 [12], almost 70% of all CBD products sold online are mislabeled. This is to say that they may contain higher traces of THC than what is permissible by law i.e. considered safe by the authorities (only 0.3% and lower are permitted in industrial grade CBD or hemp oil).

Presence of Contaminants: Some studies [13, 14 & 15] have pointed out that cannabis plants from uncontrolled sources often contain contaminants that are harmful to human health, such as pesticides and metal particles that can severely damage our organs.

Sometimes, these are deliberately added by manufacturers to increase the yield, weight, or potency of the product, while on other occasions, they creep into the products due to lack of regulation and carefulness.

Case I: A recent paper from the Netherlands Ministry of Environment and Health revealed that over 90% of Dutch cannabis sold in coffee shops contains traces of illegal crop protection products, like pesticides [16].

Case II: Pesticides are also found in cannabis offered under state law in California [17] as well as medicinal cannabis from licensed producers in Canada [18].

Some unintentional contaminants, such as heavy metals, molds and bacteria and aflatoxins, have also been found to make their way into the CBD products.  

Interaction with other medications: It is quite unsafe to mix pharmaceutical drugs with CBD oil for treatment of any disease, even IBS. However, it has also been seen that CBD at times does tend to boost the power of pharmaceutical medications.

The cause for concern here is that the CYP450 liver enzyme, needed by pharmaceutical drugs to metabolize, is also the same agent that breaks down CBD in the bloodstream of humans. There is the danger of these drugs accumulating in high levels in the bloodstream of the users, causing unwanted side effects, possibly even an overdose.

Drugs that require the CYP450 enzyme to metabolize are[19]:

  • Steroids
  • HMG CoA reductase inhibitors
  • Calcium channel blockers
  • Antihistamines
  • Prokinetics
  • HIV antivirals
  • Immune modulators
  • Benzodiazepines
  • Antiarrhythmics
  • Antibiotics
  • Anesthetics
  • Antipsychotics
  • Antidepressants
  • Anti-epileptics
  • Beta-blockers
  • PPIs
  • Angiotensin II blockers
  • Oral hypoglycemic agents
  • Sulfonylureas

However, it is not always necessary that all of these drugs will adversely react with cannabidiol oil.

Parting Thoughts:

Even though a lot more research into the benefits of CBD as a therapeutic agent is still required, an increasing number of people have turned to it to manage their symptoms, owing mostly to its seemingly fewer side effects compared to conventional drugs and medications.

For people with irritable bowel syndrome, who haven’t got any relief from traditional treatments, CBD oil may seem to offer a potentially safe alternative solution.

However, if you are considering using it (that is, of course, if it is legal in the area where you live), first make it a point to consult a doctor who is familiar with CBD oil as a treatment option, and then find out if this “solution” is really suitable for your specific condition and health.

About the legalities, it is true that hemp-derived CBD oil/products are legal at the federal level across the US – and that covers all of the 50 states. However, certain states are still wary about this cannabinoid and have imposed stricter laws to regulate it, mostly owing to the reasons stated in the above section.

We can only hope that these hurdles will soon be sorted out, so that a patient of irritable bowel syndrome, who have failed to get relief from his/her symptoms by using traditional methods of treatment, can safely use CBD oil and get benefitted from it.

……………………………………..

Reference links:

  1. Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Russo EB; Neuro Endocrinology Letters; April 29, 2008;  https://www.ncbi.nlm.nih.gov/pubmed/18404144  
  2. Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes; Ethan B Russo; Cannabis and Cannabinoid Research; July 1, 2016; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576607/ https://www.liebertpub.com/doi/pdf/10.1089/can.2016.0009
  3. Cannabinoid CB2 receptors in the gastrointestinal tract: a regulatory system in states of inflammation; KL Wright, M Duncan, and K A Sharkey; British Journal of Pharmacology; October 1, 2007; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219529/
  4. Cannabinoid pharmacology and therapy in gut disorders; JA Uranga, G Vera, R Abalo; Biochemical Pharmacology; Volume 157, November 2018, Pages 134-147; https://www.sciencedirect.com/science/article/abs/pii/S0006295218303186
  5. Endocannabinoids in the Gut; Nicholas V DiPatrizio; Cannabis and Cannabinoid Research; Feb 24, 2016; https://www.liebertpub.com/doi/10.1089/can.2016.0001; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940133/
  6. Cannabidiol in Inflammatory Bowel Diseases: A Brief Overview; Phytotherapy Research; Giuseppe Esposito, Daniele De Filippis, Carla Cirillo, Teresa Iuvone, Elena Capoccia, Caterina Scuderi, Antonio Steardo, Rosario Cuomo, Luca Steardo; July 20, 2012; https://onlinelibrary.wiley.com/doi/pdf/10.1002/ptr.4781; https://www.ncbi.nlm.nih.gov/pubmed/22815234
  7. Cannabidiol Reduces Intestinal Inflammation through the Control of Neuroimmune Axis; PLoS One; Dec 6, 2011; Daniele De Filippis, Giuseppe Esposito, Carla Cirillo, Mariateresa Cipriano, Benedicte Y De Winter, Caterina Scuderi, Giovanni Sarnelli, Rosario Cuomo, Luca Steardo, Joris G De Man, and Teresa Iuvone; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3232190/  
  8. Involvement of cannabinoid receptors in gut motility and visceral perception; British Journal of Pharmocology; Pamela J Hornby, and Stephen M Prouty; Apr 22; 2004; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1574910/
  9. Lactobacillus acidophilus modulates intestinal pain and induces opioid and cannabinoid receptors; Nature Medicine; Jan 13, 2007; Rousseaux C, Thuru X, Gelot A, Barnich N, Neut C, Dubuquoy L, Dubuquoy C, Merour E, Geboes K, Chamaillard M, Ouwehand A, Leyer G, Carcano D, Colombel JF, Ardid D, Desreumaux P; https://www.ncbi.nlm.nih.gov/pubmed/17159985/
  10. A Critical Review of the Antipsychotic Effects of Cannabidiol: 30 Years of a Translational Investigation; Antonio Waldo Zuardi, José Alexandre S Crippa, Jaime EC Hallak, Sagnik Bhattacharyya, Zerrin Atakan, Rocio Martín-Santos, Philip K. McGuire and Francisco Silveira Guimarães; Current Pharmaceutical Design, 2012, https://www.ncbi.nlm.nih.gov/pubmed/22716160
  11. An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies; Kerstin Iffland and Franjo Grotenhermen; Cannabis and Cannabinoid Research; June 1, 2017; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569602/
  12. Labeling Accuracy of Cannabidiol Extracts Sold Online; Marcel O Bonn-Miller, PhD, Mallory JE Loflin, PhD, Brian F. Thomas, PhD, Jahan P Marcu, PhD, Travis Hyke, MS and Ryan Vandrey, PhD; Journal of the American Medical Association; November 7, 2017; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5818782/
  13. The Health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research (2017); National Academies of Sciences, Engineering, and Medicine  https://www.nap.edu/catalog/24625/the-health-effects-of-cannabis-and-cannabinoids-the-current-state
  14. Health and Medicine Division; Board on Population Health and Public Health Practice; National Academies of Sciences, Engineering, and Medicine;  http://nationalacademies.org/hmd/About-HMD/Leadership-Staff/HMD-Staff-Leadership-Boards/Board-on-Population-Health-and-Public-Health-Practice.aspx  
  15. Evaluating the Effects of Gamma-Irradiation for Decontamination of Medicinal Cannabis; Hazekamp A; Frontiers in Pharmacology; April 27, 2016; https://www.ncbi.nlm.nih.gov/pubmed/27199751  
  16. Cannabis contaminants;   https://www.rijksoverheid.nl/documenten/rapporten/2016/01/18/cannabis-contaminanten  
  17. Steep Hill, ACCL Find Pesticides in Over 50% of Cannabis Samples; Aaron G. Biros; November 30, 2016;   https://cannabisindustryjournal.com/news_article/steep-hill-accl-find-pesticides-in-over-50-of-cannabis-samples/  
  18. Random testing, million-dollar fines: Canada’s cannabis pesticide crackdown; RANDI DRUZIN; January 8, 2018; https://www.leafly.com/news/industry/random-testing-million-dollar-fines-canadas-cannabis-pesticide-crackdown
  19. Cannabinoids in the management of difficult to treat pain; Ethan B Russo; Therapeutics and Clinical Risk Management; February 2008 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503660/