Cbd oil for bowel obstruction

Cbd oil for bowel obstruction

R ecent research shows great promise for CBD as a potential treatment for IBS. Some studies indicate that CBD even promotes proper functioning of the brain and body. In this article we look at current IBS treatments and focus on the academic research related to using CBD to treat Irritable Bowel Syndrome and other gut related issues.

WHAT IS IRRITABLE BOWEL SYNDROME (IBS)?

IBS is a medical condition which causes stomach pain, decreased GI motility and digestive distress. Although the medical community has not identified the root cause of IBS symptoms, recent research indicates two potential factors. A study by Dr. Ethan Russo suggests that IBS and Inflammatory Bowel Disease (IBD) may be caused by Clinical Endocannabinoid Deficiency (CED). According to his study, chronic inflammation and IBS symptoms appear when the body is unable to produce endogenous cannabinoids like 2-AG or Anandamide. Other studies indicate a bacterial overgrowth of the small intestinal tract (SIBO) as the potential cause of IBS and other related digestive health conditions. In both cases, the inflammatory response of the body is increased when there is a lack of Endocannabinoids or a bacterial or parasitic infection (possibly created by a lack of endocannabinoid signaling).

IBS STATISTICS

  • IBS affects between 25 to 45 million people in the United States alone and affects approximately 10 to 15 percent of the global population.
  • Statistics show that 60% of IBS patients are women, while 40% are men, although it is likely that women are less hesitant to visit a doctor when experiencing discomfort.

IBS SYMPTOMS

Symptoms vary from mild to severe, yet the majority of IBS sufferers experience:

  • Abdominal pain and cramping
  • Irregular Bowel Movements
  • Increased Diarrhea or Constipation
  • Gas and Bloating
  • Food Intolerances and Sensitivities
  • GERD (Gastroesophageal Reflux Disorder)
  • Chronic Fatigue
  • Insomnia and Difficulty Sleeping
  • Depression and Anxiety
  • Fibromyalgia
  • Headache and Backache

WHAT CAUSES IRRITABLE BOWEL SYNDROME?

Most researchers agree that IBS is linked to chronic stress, gut flora imbalances, and low digestive enzymes in the digestive tract. Although Dr. Ethan Russo agrees that IBS is most likely related to chronic stress and gut flora, he suggests a deeper connection to the endocannabinoid system. He found that the body is unable to manage stress levels when it does not create enough endogenous cannabinoids such as anandamide and 2-AG. This inability to produce a necessary amount of endocannabinoids may cause the symptoms of IBS.

Your body’s GI tract may be telling you that you need more rest, balanced nutrition, and stress-relieving activities to get things back to normal. These may include activities such as walking, exercise, meditation and supplementing with phytocannabinoids like CBD or CBG.

CURRENT TREATMENTS FOR IBS

Depending on the severity of your IBS symptoms, you may benefit from a simple lifestyle or diet change. In severe cases you may try prescription or over the counter medications which are used for the treatment of IBS. Some of these medications come with unpleasant side effects, such as nausea or discomfort, and their long term efficacy has not been determined. It is important to note that while some people find relief from pharmaceutical prescriptions, many others do not. We encourage you to rule out all potential causes of your digestive symptoms with your primary care physician prior to using any pharmaceutical products.

Most doctors recommend dietary changes such as an elimination diet, lifestyle changes, probiotics and fiber supplements as a first trial to improve symptoms. These changes address the symptoms of IBS but may not address the root cause. You can also try an OTC test kit for harmful bacteria or parasites in your digestive tract. These are not uncommon in the era of factory farming.

1. Dietary Adjustments:

Nutrition is a key part of any health strategy and a well-balanced diet can benefit your symptoms in many ways. Depending on your severity level, try the following strategies.

  • Mild symptoms : try to eliminate unnatural sugars and processed foods. Get the bulk of your nutrition from lean meats and high omega 3 fish such as wild-caught salmon, anchovies and sardines. Also, include eggs, fermented dairy and other Low FODMAP fruits and vegetables as a part of your daily diet.
  • Moderate symptoms : follow the Low FODMAP guidelines or try an elimination diet for high sensitivity foods such as gluten or lactose. Some symptoms of IBS occur due to food allergies and sensitivities.
  • Severe symptoms : stick to the temporary B.R.A.T. diet of Bananas, Rice, Applesauce and Toast. You may try to add a vegetable or bone broth if you can tolerate it. After 5 days try to implement a new food suitable for the low-fodmap diet one day at a time. Continue with a low-fodmap diet for at least 1-2 months.

2. Lifestyle Changes

The cornerstone of your successful health plan is a daily routine and healthy habits. Try the following activities for stress reduction and general well-being:

  • Exercise : exercise helps to remove toxins in the digestive tract that may build up with certain IBS related symptoms. It is also a great way to boost your endorphin levels for pain relief and stress reduction.
  • Meditation or yoga : meditation and yoga have been proven to reduce stress levels and anxiety which may benefit some IBS sufferers.

3. Natural Treatments

Make sure that your body is getting all the necessary macro and micronutrients for optimal gut health:

  • Natural Fiber Supplements : taking natural fiber such as psyllium husk can help remove blockages in your lower digestive tract and reduce the occurrence of constipation.
  • Prebiotics and Probiotics : these micro bacteria are essential to a healthy gut and GI motility. You can find these in naturally occurring sources such as yogurt, natto, or sauerkraut. Prebiotics like Larch Arabinogalactan is another worth looking into supplementing with.
  • Epsom Salt Baths : helps to reduce bloating and cramping associated with IBS. Epsom salts also contain magnesium which is beneficial during periods of high stress.
  • Slippery Elm : a wonderful herb for gut repair that has been used for centuries in the United States. Slippery Elm has 3 main benefits:
  • Increased mucilage content in your digestive tract.
  • It stimulates nerve endings which help neutralize excessive acidity in the gut, soothing ulcers.
  • Provides antioxidants to relieve inflammation in the body.
  • Marshmallow Root : boasting a high mucilage content, this multipurpose herb covers your digestive tract with protective lining and eases inflammation in your gut. Many users report it helps to soothe ulcers, diarrhea, and constipation, as well as other symptoms of the digestive system.

4. Cannabidiol (CBD) and Cannabigerol (CBG) as potential new treatments for IBS

CBD and CBG are gaining new popularity as beneficial treatments for IBS symptoms including pain, inflammation, low GI motility and overall discomfort. Research is starting to show a relation between CBD and CBG and their anti-inflammatory effect for Irritable Bowel Syndrome. Additionally, new research suggests that overtime, CBD and THC may alter the gut microbiome in a positive fashion. This can have positive long-term results on IBS symptoms, and the ECS may be a future route for a IBS cure as well as additional gut diseases. While more research is needed, preliminary research studies suggest CBD and other phytocannabinoids may be able to cure IBS symptoms over time, most likely in combination with additional botanicals shown to help restore gut lining.

WHAT IS CBD? CAN IT CURE IBS?

CBD (cannabidiol) is a phytocannabinoid compound derived from cannabis, and a promising treatment for IBS sufferers. Although there is currently no definitive evidence that CBD can cure IBS, researchers have found that study participants report reduced abdominal pain, decreased gastrointestinal inflammation and less frequent constipation, and cramping after taking CBD to help alleviate the symptoms of IBS.

Additional research now shows that not only does CBD reduce abdominal pain, gastrointestinal inflammation, and constipation, CBD may also alter the gut microbiome. While the research is preliminary, early results bring about hope of CBD not only as an IBS symptom reliever, but also something that may be able to help cure IBS symptoms overtime and restore the microbiome to healthy function and makeup.

CBD RESEARCH FOR IBS

Here is a brief review of recent studies on the effects of CBD as a treatment for Irritable Bowel Syndrome. The first three studies will focus on the inflammatory and symptom reduction of IBS, while studies four through seven will focus on the microbiota effects of CBD and cannabinoids:

Focus: GI Inflammatory Reduction Studies

Study #1 – Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes By Ethan Russo.

In this study Dr. Ethan Russo explains the important role of the endocannabinoid system (ECS) for gut health. We learn that the Endocannabinoid System regulates GI propulsion, secretion and gut inflammation.

Dr. Russo references a previous study from 2004 which found that the Endocannabinoid system contained a powerful pain blocking mechanism which was able to mitigate the pain response in IBS sufferers:

“Cannabinoids have similarly demonstrated the ability to block spinal, peripheral and gastrointestinal mechanisms that promote pain in headache, fibromyalgia, IBS and related disorders.”

– Russo EB. Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes. Cannabis Cannabinoid Res. 2016;1(1):154–165. Published 2016 Jul 1. doi:10.1089/can.2016.0009

This is good news for the majority of people who suffer from chronic pain such as headaches, cramping, or stomach pain.

Study #2 Cannabidiol Reduces Intestinal Inflammation through the Control of Neuroimmune Axis by Department of Experimental Pharmacology, University of Naples FEDERICO II, Naples, Italy.

A group of scientists from Naples studied the effects of CBD on the immune system’s inflammatory response system. They found that CBD can prevent intestinal damage by reducing the inflammatory response.

“Taken together all these results suggest, for the first time, that CBD, by modulating the glial-immune axis, regulates the fire up of the inflammatory reaction in the intestine thereby preventing the detrimental intestinal damage.”

“Our results indicate that CBD is a key modulator molecule that may interfere with the enteroglial-mediated interactions in an intestinal inflammatory environment. Its activity, markedly focused on S100B protein downregulation, leads to consequent reduction of intestinal damage occurring during acute and chronic intestinal inflammatory status and highlights the importance of glial cells control during these pathological conditions.”

By regulating the inflammatory reaction, CBD helps to limit the damage caused by the body’s immune system as it tries to protect itself from the effects of irritable bowel syndrome and leaky gut.

Study #3 Therapeutic Use of Cannabis in Inflammatory Bowel Disease by Waseem Ahmed , MD and Seymour Katz , MD

Dr. Seymour Katz and Dr. Waseem Ahmed studied 30 individuals who were diagnosed with Crohn’s disease. All of the 30 patients reported an improvement in their general well-being due to cannabis use and 22 patients reduced their use of corticosteroids after treatment with cannabis.

“The authors conducted a retrospective, observational study of 30 CD patients in Israel who were legally using cannabis due to a lack of response to conventional treatments and chronic intractable pain. Disease activity before and after cannabis use was estimated using the Harvey-Bradshaw index for CD. All 30 patients rated their general medical well-being as improved after cannabis use via a visual analog scale. Twenty-one patients had a notable improvement after treatment with cannabis use, and the average Harvey-Bradshaw index for all patients improved from 14 to 4.7 (P

Focus: Impact of Phytocannabinoids on Microbiota

Study #4 Muccioli GG, Naslain D, Bäckhed F, Reigstad CS, Lambert DM, Delzenne NM, Cani PD. The endocannabinoid system links gut microbiota to adipogenesis.

A team of Belgian researchers revealed that altering the gut microbiome of obese mice through prebiotics, found that the promoted growth of beneficial bacteria, altered ECS expression in fat tissue with implications for lipid metabolism and fat cell formation.

While this is a preliminary study not done in humans, it does suggest there is a link between microbiota and the Endocannabinoid System (ECS).

Study #5 – Prevention of Diet-Induced Obesity Effects on Body Weight and Gut Microbiota in Mice Treated Chronically with Δ9-Tetrahydrocannabinol

Researchers in Canada administered a daily dose of THC to mice on a strict high-fat diet. Gut microbiome health in these animals improved in 3-4 weeks to resemble more closely that of animals fed a healthy and balanced diet.

This study looks at the opposite pathway of study #4. Instead of showing that the ECS is impacted by changes in microbiome, this study suggests the opposite is true as well. That cannabinoids stimulate the ECS and thus impact the microbiome makeup.

Study #6 – Endocannabinoids — at the crossroads between the gut microbiota and host metabolism

In 2018 researchers used anal swabs to assess the microbiome of HIV positive individuals. They found that cannabis use was associated with a decrease in abundance of a certain bacterial strain linked to obesity.

Study #7 – Administration of Δ9‐Tetrahydrocannabinol (THC) Post‐Staphylococcal Enterotoxin B Exposure Protects Mice From Acute Respiratory Distress Syndrome and Toxicity

A June 2020 study published in Frontiers in Pharmacology, Nagrkatti and colleagues demonstrated that administering THC to mice affected with acute respiratory distress syndrome (ARDS) could stop the condition. A severe consequence of runaway immune response known as cytokine storms. ARDS occurs in a small percentage of COVID-19 patients, but it is often fatal.

They concluded that THC alters the microbiome in the gut in a way that is beneficial in suppressing inflammation because bacteria that are favored by THC seem to produce short-chain fatty acids that suppress inflammation.

“We have a mouse model of ARDS where we inject bacterial toxins into the mice, and they die within four to five days because of cytokine storms. We found if you give THC, it cures the mice. They are just running around and healthy. That was amazing.”

While most would assume this study only shows the immune suppression activities of phytocannabinoids, this study found that a change in microbiota within the gut and lungs is what leads to the halting of cytokine storms.

The Takeaways:

  • While certainly more research is needed, we now have more insight than ever before on how gut health impacts the body and the inter-relationship between bacteria, the endocannabinoid system and almost all organs including the brain.
  • Not only does CBD reduce inflammation and reduce the symptoms of IBS, but it also stimulates the endocannabinoid system, which has been shown in mouse models to reshape the microbiome makeup.
  • The ECS serves as a bridge between bacteria and the body itself, including the brain, relaying signals back and forth in a symbiotic and mutually beneficial relationship.
  • CBD and THC can act as a probiotic and increase the natural count of lactobacillus bacterial strain, commonly found in over the counter probiotics.

WHAT IS CBG? CAN IT HELP WITH IBS?

Cannabigerol (CBG) is another important cannabinoid that shows promise in relieving IBS symptoms and potentially addressing the root cause of endocannabinoid deficiency. Surprisingly, CBG has shown to be an effective broad-spectrum antibiotic with an ability to fight antibiotic-resistant superbugs like MRSA. This may be particularly helpful if you suffer from GI conditions caused by bacterial infections like SIBO.

CBG RESEARCH FOR IBS

Study #1 Beneficial effect of the non-psychotropic plant cannabinoid cannabigerol on experimental inflammatory bowel disease

In this study, researchers at the University of Naples Federico II found that CBG showed an ability to regulate GI motility in animal studies of mice afflicted with chemically induced hypermotility. Additionally, CBG showed a curative and protective mechanism for Colitis within the GI tract.

“We have found that CBG reduced colon weight/colon length ratio of the inflamed colonic tissue, which is considered a reliable and sensitive indicator of the severity and extent of the inflammatory response [34]. CBG was effective when given both before and after the inflammatory insult, suggesting a preventive and a curative (therapeutic) beneficial effect. Significant protective effects were achieved starting from the 1 mg/kg dose (preventive protocol) and 5 mg/kg (curative protocol). Maximal efficacy was achieved with the 1 mg/kg dose and the 30 mg/kg dose in the preventive and in the curative protocol, respectively.”

Study #2 Antibacterial Cannabinoids from Cannabis sativa: A Structure−Activity Study

The study showed an antibacterial effect from CBG and CBC. In the study both CBG and CBC were highly effective at fighting MRSA (Methicillin-resistant Staphylococcus aureus), which is highly damaging to the body.

“All five major cannabinoids (cannabidiol (1b), cannabichromene (2), cannabigerol (3b), Δ9-tetrahydrocannabinol (4b), and cannabinol (5)) showed potent activity against a variety of methicillin-resistant Staphylococcus aureus (MRSA) strains of current clinical relevance.”

CBD FOR IBS: WHAT’S THE RIGHT DOSE?

We recommend starting out your CBD intake with a low dose to see how it works. Depending on the type of CBD you are using, you may experience varied effects and a different uptake time. Have a look at the chart below to see what might work best for you:

**Consult a physician regarding if CBD is right for you and guidance regarding dosage. The above recommendation is not meant to diagnose or cure a disease. CBD affects everyone differently and we recommend staring low and going slow.

NOT ALL CBD IS EQUAL: TYPES OF CBD

The three main types of Cannabidiol (CBD) are Full Spectrum, Broad Spectrum and CBD Isolate. At Potter, we go a step further to select specific terpene combinations that provide benefits such as relaxation, pain and inflammation relief, and promotion of sleep. Here is a short overview of the different types of CBD:

Full Spectrum CBD:

The full spectrum variety of CBD is derived from the whole plant. It contains a balance of helpful cannabinoids, terpenes and a micro dose of THC (

Broad Spectrum CBD:

Broad Spectrum CBD products are similar to full spectrum products with one exception. They contain 0% THC. Broad spectrum products still contain helpful terpenes that contribute to the entourage effect, although the removal of THC may reduce the percentage of terpenes that remain in the end consumer products. Studies have also shown that having even a small amount THC (

CBD Isolate:

This is the purest form of CBD with all other cannabinoids, terpenes, flavonoids and residual plant matter removed completely. The isolate is often derived directly from the hemp plant and contains no detectable THC.

Potter CBD

While full spectrum products have been shown great benefits compared to broad spectrum and isolate based products, there is one drawback.The terpenes and additional cannabinoids that are present with CBD are not consistent with every product or every batch. The naturally occurring terpenes found in hemp dictate the flavour and effects of all CBD products. Depending on their type and concentration, terpenes can: easily cross the blood brain barrier (making it easier for cannabinoids to enter the bloodstream to be more effective), increase energy and focus, cause sedation, decrease anxiety and depression symptoms, etc.

Potter CBD combines organic full spectrum CBD with a selected and research-based terpene formula to provide a consistent and effective and dose of CBD, based on the effect you need: Calm, Sleep, Relief and Uplift.

Potter Select Spectrum oils:

Our Select Spectrum line utilizes full spectrum CBD and consistent terpene profiles along with beneficial cannabinoids like CBG (cannabigerol) at a consistent ratio of CBD to CBG. The high concentration of additional cannabinoids like CBG, CBC, or CBN contribute to a powerful entourage effect, designed for specific wellness needs.

The combination of multiple cannabinoids and terpenes which have shown in studies to fight inflammation should be more effective than traditional full spectrum CBD oil for certain ailments such as Irritable Bowel Syndrome.

NEW Leaky Gut Repair!

Potter has combined all the knowledge acquired from the research studies included in this write up as well as working with local naturopaths to develop our NEW Targeted Effects Leaky Gut Repair product. It combines water soluble CBD with other ingredients that heal the gut lining, reduce inflammation, and improve the epithelial barrier.

SIDE EFFECTS AND CONTRAINDICATIONS OF CBD

Most people are able to use CBD without any difficulties. However, some of the common side effects that are reported are dry mouth, lower appetite, minor fatigue and diarrhea at higher doses. If you are taking any medications, check with your doctor before using CBD. It may interact with blood thinners, potentially enhance the side effects of NSAIDs, and reduce the effects of other medications.

Are CBD and CBG Safe?

Due to the growing number of CBD, hemp and other cannabis products, it is important to buy CBD oil from a trusted supplier. Always look for high quality, third-party lab tested CBD products for your maximum benefit and safety. This ensures that they are independently tested for quality purity and strength.

At Potter, we test all our products at ProVerde Labs, an accredited third-party cannabis testing facilitly in Millford, Massachusetts. You can easily access the the lab report for each Potter product by batch number here , or by simply scanning the QR code located on our product labels. Recent studies have shown that up to 1500mg of CBD is generally well tolerated in humans. Side effects tend to be mild compared to traditional pharmaceuticals and may include appetite suppression, diarrhea, and fatigue.

USER REPORTS

Many of our users have personally experienced the unique benefits of CBD oil in their own lives ranging from mild indigestion to severe stomach pains and cramping due to food allergies, SIBO or IBS. There are many online users that have also reported significant benefits after using CBD oil for their IBS pain, such as this reddit user: Years of severe IBS curbed with CBD hemp oil! :

You can even find some Quora discussions related to Cannabis and IBS. Here is a response from Kellie G: Has cannabis helped alleviate SIBO or IBS issues at all?

SUMMARY

Research suggests that both scientists and patients have found benefits for IBS with CBD due to its anti-inflammatory action, pain relief, stimulation of the ECS, and its impact on gut microbiota. It is specifically helpful for people suffering from Gastrointestinal Disorders like IBS, SIBO, CD and IBD. While the science and feedback is promising, everyone’s body reacts differently and you may not experience the same effects as other users. However, if IBS symptoms are impacting your quality of life, then it is worth trying a natural treatment that is backed by science, such as CBD, CBG or Beta Caryophyllene.

***Disclosure: Please consult your physician and/or dietician before taking any supplements or making drastic changes to your diet..

CBD Oil and Constipation: Causes & Does It Help?

Chunky Dunky; bunged up; locked; no matter how discreetly you want to word it, being constipated will be as difficult to talk about as it is to experience.

The list of potential constipation triggers is vast, and actually, anyone can become a victim.

What’s worse, there’s no one treatment that would work for everyone. Trying to find the best solution for constipation may require some trial and error.

Whether you’re chronically constipated or you’re new to this touchy condition, I’d like to introduce you to a new approach to dealing with it: CBD oil.

In this article, I shed light on the current research regarding CBD and constipation. I also share my top 5 brand recommendations when it comes to buying CBD oil.

I’d ask you whether we should dive deeper into the subject, but given the nature of the topic, this could be a faux pas on my part.

Read on to learn more about CBD oil for constipation!

CBD For Constipation Relief: What Do We Know So Far?

Using CBD can help relieve symptoms and set your body back on track. At its core, CBD is known for its remarkably calming properties.

The ECS receptors are “designed” to work against the fight-or-flight response, prompting a sense of ease and slowing down an overstimulated nervous system. They can also combat inflammation, providing relief for those suffering from severe pain.

The connection between CBD and constipation lies exactly in these three areas of CB-receptor activity. Something as simple as a very stressful situation can cause trouble with the gut.

As CBD circulates in the body, it can quiet the mind and relieves the muscles from unnecessary tension [1]. Just like it protects the mind against fight-or-flight responses, it “tells” pain signals to be at ease.

CBD controls inflammation and the pain response by increasing your anandamide levels. Anandamide, one of the endocannabinoids produced by our bodies, moderates pain and inflammation in damaged tissue[2].

This benefit has proven helpful for patients with spastic constipation as a result of Irritated Bowel Syndrome (IBS).

By blocking an enzyme responsible for breaking anandamide down (FAAH), CBD helps us maintain the sufficient levels of anandamide and makes it more available for the body.

CBD can relieve certain forms of constipation by addressing the triggers, not just the symptoms.

Finding the Right CBD Product For Your Type of Constipation

CBD comes in many forms. As far as the quality goes, I recommend doing thorough research on both the company of your choice and their product lineup. On top of checking the product label to ensure it has enough CBD to provide benefits, look for the lab testing results for each batch of the product. Only then will you be able to tell if the brand doesn’t stretch reality too far.

The appropriate type of CBD product for your constipation will tackle the underlying causes. If you get constipated from painkillers or antidepressants, you want something that addresses the affected area.

Patches, edibles, pills, and oil drops circulate to pain sources inside your body; they travel to your gut to reduce inflammation caused by IBS and other conditions that affect your digestive system. On the other hand, topical treatments will relieve muscle pain because they affect the cannabinoid receptors under the skin.

Top CBD Oil Brands for Constipation (Editor’s Choice)

There are lots of different CBD brands trying to conquer the market with their products. Some companies provide high-quality CBD oil and can back up their claims with the third-party lab testing, while others prefer to lure unaware customers with salesy language and far-fetched promises.

To maneuver in the emerging market and choose the right manufacturer, you must be able to tell the difference between the good- and bad-quality CBD oil.

If you don’t have the time to do your own research, worry not — I did the job for you.

Below I show you my list of top 5 CBD brands I use to take care of my health, including constipation relief:

1. Royal CBD

Get 15% off all Royal CBD products. Use code “CFAH” at checkout.

Pros:

  • They offer both full-spectrum or “zero-THC” products
  • Extracted with CO2; the products are clean and safe for your gut
  • Their CBD oil comes in four different potencies: 250mg, 500mg, 1000mg, and 2500mg
  • Every batch of product has been tested by a third-party laboratory
  • Their hemp comes from American farms that prefer to use organic farming methods
  • Suspended in premium MCT oil

Cons:

  • The price is on the higher end, although well justified

What I Like About Royal CBD:

Royal CBD is a premium brand that uses only high-quality ingredients in their products. Their assortment is pretty simple, consisting only of CBD oil, gummies, and capsules.

What I love about Royal CBD products is that they’re extracted with CO2; this ensures that no toxic solvents are left at the bottom of the bottle, which could worsen your constipation instead of relieving it.

One time my gut was upset to the point where I became nauseous. After using a few drops of the 1000mg oil, it numbed the pain and my gut stopped feeling so cramped, so yes — this is my personal favorite.

If you don’t like the taste of their oil, you can get the capsules instead. These are soft gel caps, so you shouldn’t have any problems swallowing them, and they can bring you long-lasting relief because the CBD is gradually released when ingested that way.

2. Gold Bee

  • Organic hemp grown in California
  • CO2 extraction
  • Broad selection of products
  • Full-spectrum CBD
  • Up to 2400 mg of CBD per bottle
  • Flavored and sweetened with natural ingredients
  • Third-party tested for quality and safety
  • Not as potent as the strongest Royal CBD oil
  • No low-strength oils
What I Like About Gold Bee:

Gold Bee is a Nevada-based brand that has transitioned from making superfood-infused products to premium CBD extracts from organic hemp grown in the Golden State. The company offers a broad selection of products, including full-spectrum CBD oils and softgels, as well as THC-free gummies, honey sticks, vapes, and even products for pets.

What I love about the Gold Bee CBD oil is that they contain honey, which is perfect to mix with my morning water infused with lime juice. It’s a great way to help with stomach pain and constipation, especially with the high-strength option, which delivers 80 mg of full-spectrum CBD in every milliliter

While not as potent as Royal CBD, these products deserve the hype they’re getting thanks to their well-thought-out formulas.

3. Hemp Bombs

Pros:

  • This company offers a diverse product lineup based on CBD isolates
  • Each batch of product goes through extensive third-party lab testing
  • Their pure CBD oil is available in 5 different potencies.
  • High dose of CBD per serving and up to 4000mg of CBD per bottle

Cons:

  • The company’s extracts aren’t as high quality as Royal CBD
  • The isolate doesn’t give you the synergy from other cannabinoids and terpenes

What I Like About Hemp Bombs:

While Hemp Bombs isn’t as premium a manufacturer as Royal CBD, the diversity of their product range is out of this world. The company offers topicals, edibles, tinctures, vape oils, pet treats, CBD shots, and a line of beauty products.

Hemp Bombs specializes in making CBD isolates. Their extracts are purged from all the other cannabinoids, terpenes, and essential oils, leaving the user with 99% pure CBD.

On one hand, that’s a good feature. I have a friend who’s allergic to many foods and hemp is one of them. She’s not allergic to CBD, though, so the only way to get her dose of cannabidiol is to use isolate or distillate. She’s a huge fan of hemp bombs.

But on the other hand, isolates lack the entourage effect coming from full-spectrum products. For me, this is important because super-high doses of CBD makes me feel sleepy, and with full-spectrum oil, I need less CBD to get relieved.

4. CBDistillery

Pros:

  • Their products are sold as full-spectrum CBD or pure CBD oil (Zero THC)
  • Each batch of product is sent to a 3rd-party laboratory for testing
  • 5 potency options to choose from

Cons:

  • Their products aren’t made from organic hemp
  • No flavored options to choose from

What I Like About CBDistillery:

There are two reasons why CBDistillery has scored third place in my ranking of best CBD oils for constipation — the way the company sources its CBD (their hemp isn’t organic) and how their website makes me want to use more CBD oil for relaxation.

On a positive note, I love the fact that they care about every type of CBD consumer out there. CBDistillery offers its extracts in two options: full-spectrum or pure oil. On top of that, they sell these products in a wide potency range, from 250mg to 5000mg of CBD per bottle.

This means that their CBD oils can suit different types and levels of constipation. I’ve had a very good experience with their 1000mg bottle when my gut was upset from the chronic stress I’ve been through with my second child. It did exactly what it had to do.

Constipation: A Brief Overview

Constipation is a common physical condition including irregular and infrequent bowel movements. Infrequent bowel movements can cause pain in the abdominal part of the body, as the waste from consumed food builds up and sits in the bowels, refusing to pass through.

Constipation can be caused by a number of factors, including:

  • Neglecting fiber intake in your diet (not eating enough fruit, vegetables, and whole-grain foods)
  • Ignoring the urge to pass stools
  • Side effects of certain medications
  • Not drinking enough water
  • Chronic stress
  • Anxiety or depression
  • Lack of exercise
  • Poor eating habits overall
  • Vitamin deficiencies

The fact that constipation isn’t widely talked about doesn’t derive from the rareness of this condition; in fact, everyone has experienced constipation at least once in their lifetime. It’s just an embarrassing subject to talk about.

Remember that constipation is a symptom, not a disease — and because of that, there are many reasons why someone would experience it. Thus, the range of treatments can be equally vast.

Why Most OTC Supplements Are Counterproductive in Relieving Constipation

In today’s world, there’s an OTC supplement/medicine for nearly every type and severity of a condition.

This rule applies to constipation as well.

You can choose between different laxatives or stool-softeners that might help move things along. However, the problem with these products is that they sometimes can lead to moving on too quickly — resulting in diarrhea instead.

Moreover, laxatives can also end up worsening your constipation. At first glance, they’re harmless and easily accessible as somewhat of a quick turn-off-the-symptoms solution. Some days they help, but another day they just make things worse instead.

People who notoriously reach for laxatives can experience dehydration in the body — hence the perpetuation of the problem.

Relieving one symptom shouldn’t come at the expense of creating another. There are more natural and potentially effective ways to regulate bowel movements.

Below I explain how CBD can help with constipation.

The Link Between the Endocannabinoid System and Digestive System

Quick relief from anything is hard to experience, but a good supplement can set the right gears in motion by “suggesting” your body what it needs to do.

CBD is known for its powerful range of health benefits because it’s a chief modulator of the endocannabinoid system.

The endocannabinoid system (ECS) plays an important role in the majority of homeostatic functions in the body. It’s believed to have an influence on our emotional state, feelings of hunger, pain, and fear, and is present predominantly in the brain, nervous, and immune systems.

The performance of the immune system relies heavily on the health of the gut.

This versatile, endocannabinoid system uses two types of receptors — the CB1 and CB2 receptors. These receptors are found in the brain and nervous system as well as most other organs in the human body — including digestive organs.

The gut is at our core, both metaphorically and literally. In order to stay alive and perform efficiently, we must consume food and drink water. The gut is where both food and water stop.

If the gut gets upset, the rest of your body suffers.

The unique relationship between our organs and the ECS helps keep everything in balance. When the balance is compromised, the endocannabinoid system sends its own messenger molecules that bind to cannabinoid receptors and restore that equilibrium.

As mentioned, CBD is a modulator of the endocannabinoid system, meaning it can regulate its functioning via both receptor-based and receptor-independent routes.

While the FDA doesn’t officially recognize CBD as a treatment for anything save seizures, people are quietly turning to it to alleviate a wide range of symptoms, including constipation.

Can CBD Oil Cause Constipation?

Constipation is a very rare side effect of CBD oil, so it hasn’t undergone extensive studies by researchers. Early studies and consumer experiences suggest that certain forms of CBD that pass through the digestive tract — like oils and edibles — can cause constipation. However, that’s most likely because of their additional ingredients, not the CBD itself.

In fact, excessive use of CBD oil is linked to the opposite. Extremely high doses of CBD administered on a regular basis can cause diarrhea, which is due to the increased intake of oil the CBD is suspended in.

Lifestyle Changes to Help With Constipation

You may be able to prevent constipation if you follow certain lifestyle patterns. These include:

1. Staying Hydrated

Our bodies are mostly comprised of water, so proper hydration is a must if you want your body to function well. Water boosts the metabolism of food and it can reduce the chances of any digestive issues.

Drinking plenty of water will help in rehydrating your body and ensuring proper bowel movements. On top of that, regular hydration with water can also prevent constipation to a large extent. Drinking less water makes your stools tight and thus more difficult to move through the gut.

2. Consuming Fiber

A diet rich in fiber can contribute to relief from constipation and protect you against developing it.

Foods full of fiber such as whole-grain products, fruits, and vegetables can keep constipation at bay. The reason why fiber is so effective at relieving constipation is that our bodies can’t digest fibers, so they use them as a “broom” to clean our intestines by moving the bowels with them.

If you suffer from constipation on a regular basis, adding fiber to your diet can benefit your gut and help you put an end to this troublesome symptom.

3. Increasing Physical Activity

If your job requires you to sit in one place for eight to ten hours, you’re at more risk of constipation. Staying inactive for the most part of the day is one of the major contributors to this condition.

It’s important to keep exercising regularly. This way, you can help move food through the digestive system and spur the bowels to work. Any type of exercise — walking, playing catch, cycling, running, working out at the gym, jumping — will do the job as long as you remain consistent.

4. Not Holding Your Stools

As silly as it may sound, this is actually a serious problem. Many people hold their stools when they’re in the middle of an important meeting, or they have a date and they don’t want to cause awkward situations.

Whatever your reason is — don’t resist your body’s urge to go to the bathroom. Doing so can make the stool harder and more difficult to pass later. Always make sure that you take out enough time to answer the call of nature.

Is CBD Oil a Valid Solution for Constipation?

Although there aren’t many studies relating directly to CBD and constipation, current evidence suggests that CBD can help with the causes of this troublesome symptom.

By reducing inflammation and regulating the activity of the endocannabinoid system, CBD can help you relieve swollen veins stomach pain, relieve inflammation, and maintain regular bowel movements. CBD oil may not only relieve constipation but can also work as a preventative supplement.

Have you tried CBD oil when you were constipated? Don’t be shy about your problem, no one’s going to judge you!

  1. DiPatrizio N. V. (2016). Endocannabinoids in the Gut. Cannabis and cannabinoid research, 1(1), 67–77. Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015). Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics: the journal of the American Society for Experimental NeuroTherapeutics, 12(4), 825–836.
  2. Russo E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and clinical risk management, 4(1), 245–259.
  3. Nagarkatti, P., Pandey, R., Rieder, S. A., Hegde, V. L., & Nagarkatti, M. (2009). Cannabinoids as novel anti-inflammatory drugs. Future medicinal chemistry, 1(7), 1333–1349.
  4. Ahmed, W., & Katz, S. (2016). Therapeutic Use of Cannabis in Inflammatory Bowel Disease. Gastroenterology & hepatology, 12(11), 668–679.
Livvy Ashton

Livvy is a registered nurse (RN) and board-certified nurse midwife (CNM) in the state of New Jersey. After giving birth to her newborn daughter, Livvy stepped down from her full-time position at the Children’s Hospital of New Jersey. This gave her the opportunity to spend more time writing articles on all topics related to pregnancy and prenatal care.

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Inflammatory Bowel Disease and Cannabis: A Practical Approach for Clinicians

Although still not approved at the federal level for medical or adult recreational use, cannabis has been approved in the United States (USA) by individual states for both of these purposes. A total of 15 states now regulate cannabis for adult use and 36 states for medical use. In more recent years, cannabis has gained popularity for the treatment of chronic conditions, inflammatory bowel disease (IBD) being one of them. However, the exact role of cannabis in the treatment of IBD remains uncertain. While cannabis may help in some instances with symptom management, it has not been proven to help with inflammation or to fundamentally correct underlying disease processes. Additionally, along with the perceived symptom benefits of cannabis come concerning issues like dosing inconsistencies, dependence, and cannabinoid hyperemesis syndrome. In this review article, we explore the nuanced relationship between cannabis and the treatment of IBD by summarizing the current research. We also use clinical vignettes to discuss the more practical considerations surrounding its use.

Although classified as a Schedule I substance and not approved for medical or recreational purposes at the federal level, cannabis has now been approved by 36 states for medical use.
Through population studies, cannabis has been shown to alleviate symptoms associated with inflammatory bowel disease (IBD), like abdominal pain, joint pain, abdominal cramping, and diarrhea.
Although the clinical studies are limited, cannabis has not been shown to significantly reduce inflammation or improve endoscopic healing in patients with IBD.
Important considerations for patients with IBD who use cannabis include legal constraints, dosing inconsistencies, dependence, smoking, and cannabinoid hyperemesis syndrome.
Ultimately, the role of cannabis in the treatment of IBD is a decision that will be made on a case by case basis, taking into account the unique attributes of each individual patient, as illustrated through the clinical vignettes featured in this review.

Digital Features

This article is published with digital features, including a summary slide, to facilitate understanding of the article. To view digital features for this article, go to https://doi.org/10.6084/m9.figshare.14625798.

Background of Medical Cannabis Use

Although terms often used interchangeably, “cannabis” and “marijuana” do not refer to the same substance. Cannabis is a more general term that refers to the plant family Cannabis sativa, which includes both hemp and marijuana. The main difference between hemp and marijuana is that marijuana contains greater amounts of delta-9-tetrahydrocannabinol (THC). Hemp, which consists of little THC, is found to have higher levels of cannabidiol (CBD) [1].

In 2009, approximately 10.7% of North Americans between the ages of 15 and 64 years of age reported cannabis use [2]. As classified by the US federal government, cannabis is currently a Schedule I substance. On the federal level, it is not approved within the USA for recreational or medical purposes. Schedule I substances are defined as having no accepted medical use as well as high potential for abuse, and thus generally they cannot be used in research studies. However, despite these federal regulations, individual states within the USA have now gone on to pass laws approving cannabis for both medical and recreational use [3, 4].

Historically speaking, Proposition 215 in 1996 made California the first state to enable residents to use cannabis for medical purposes. Since then, 35 additional states, the District of Columbia, Guam, Puerto Rico, and the United States Virgin Islands have passed similar legislation. As of the November 2020 elections, Mississippi and South Dakota joined 34 states and four territories in sanctioning the medical use of cannabis. Arizona, Montana, New Jersey, and South Dakota also approved the regulation of adult recreational cannabis use, totaling 17 states, two territories, and the District of Columbia who have now done so [4].

Internationally, there is considerable variation in terms of the legality surrounding cannabis use. In the majority of countries and regions, however, cannabis is prohibited for medical and recreational purposes. To date, cannabis regulation is one of the more dynamic regulatory issues, and some countries, like Canada, the Netherlands, and Uruguay, have even gone on to approve recreational consumption of cannabis at the national level [5].

Physiology of Cannabis

To understand the role of cannabis in the management of inflammatory bowel disease (IBD), it is essential to consider the physiological mechanisms of the substance. Cannabis contains a variety of cannabinoids, chemical compounds that have long been thought to have anti-inflammatory and analgesic properties. The two main cannabinoids are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). The more pharmacologically active component of cannabis, 9-tetrahydrocannabinol (THC) possesses psychoactive properties [6]. Cannabinoid receptors, CB1 and CB2, are located in the nervous system, gastrointestinal tract, and immune cells, particularly within mast and plasma cells. These receptors are stimulated by the endogenous ligands anandamide and 2-arachidonoylglycerol (2-AG) in addition to THC, which is a partial agonist of CB1 and CB2 [7]. For this reason, it was hypothesized that cannabis might be a mediator within the gastrointestinal system, affecting inflammation, motility, and the secretory response.

Case 1

A 30-year-old man with Crohn’s disease in remission on adalimumab maintenance therapy expresses an interest in using cannabis for occasional complaints of abdominal pain. He has intermittently smoked cannabis in the past and felt that it improved his symptoms. He works in advertising and travels throughout the USA frequently.

This case illustrates two important considerations. To begin with, this patient was forthcoming about his cannabis use, but as clinicians, it is essential to realize that many patients with IBD may not be. For this reason, clinicians should inquire about cannabis use in general in order to initiate a discussion of the risks and benefits surrounding it. In this specific instance, the patient is currently in remission, and thus there is no need for additional therapy.

Secondly, given that this patient travels frequently for work, cannabis may not be an ideal adjuvant therapy for him. It is important to counsel this patient on the fact that while cannabis may be approved for medical use in his home state, if he were to travel to a different state for work, he would then be subjected to the legal constraints of that state. Furthermore, this patient should be informed that airports represent federal property and as a result it would be a criminal offense to have cannabis in his possession within any US airport.

Cannabis and IBD: Population Studies

In order to understand the cannabis use patterns among patients with IBD, numerous population studies were performed. Lal et al. [8] performed a study of 100 patients with ulcerative colitis (UC) and 191 patients with Crohn’s disease (CD), determining that 51% and 48% of patients with UC and CD , respectively, reported being lifetime users of cannabis. The patients cited symptom relief from diarrhea and abdominal pain in addition to increased appetite as benefits of cannabis. Patients with IBD with a history of abdominal surgery and long-term use of pain medications were also more likely to use cannabis, further highlighting its role in the symptom management of IBD.

One of the largest cannabis population studies consisted of 2,084,895 patients with IBD and 2,013,901 healthy controls from the National Health and Nutrition Examination Survey (NHANES) database. Survey data revealed that patients with CD and UC were more likely to use marijuana or hashish (67.3% versus 60.0%) and to begin doing so at a younger age (15.7 years versus 19.6 years) in comparison to healthy controls. Those with IBD were also found to consume cannabis less frequently than controls but in greater amounts at a time when they did use it. More specifically, male gender, age above 40 years, and history of IBD were all predictive factors for cannabis use [9].

Storr et al. [10] collected survey data on 313 patients with IBD, discovering that 17.6% of these patients regularly used cannabis to alleviate IBD symptoms, with over 96% of this group preferring inhalation as the means of consumption. The most common symptoms mitigated by the use of cannabis were abdominal pain (83.9%), abdominal cramping (76.8%), joint pain (48.2%), and diarrhea (28.6%), all of which suggests that cannabis is beneficial in terms of symptom relief. One potentially concerning finding from this study was that patients with CD who consumed cannabis for more than 6 months were more likely to need surgery (odds ratio = 5.03, 95% CI 1.45–17.46). It is difficult to say why this was the case. However, one possible explanation is that cannabis use masks symptoms, which may be early signs of worsening inflammatory disease processes, thereby causing patients to delay in seeking treatment.

Cannabis and IBD: Clinical Studies

It has proven difficult to perform clinical studies on cannabis in the USA largely because of its Schedule I classification. For this reason, initial studies to assess the clinical benefit of cannabis in IBD were performed using mice models. In a study by Pagano et al. [11], colitis was induced in mice with intracolonic injections of dinitrobenzene sulfonic acid (DNBS). CBD was given to mice either intraperitoneally or by oral gavage. Regardless of administration route, it was found to decrease the extent of colonic damage based on myeloperoxidase activity (MPO) and reduce intestinal hypermotility. This study in conjunction with other mice studies suggested cannabis might help slow gastric motility and reduce inflammation [11,12,13,14]. However, one critique of this study was that the cannabis given to mice contained a high concentration of CBD, amplifying the effect seen, making findings less applicable to human models.

Many of the original human studies examining cannabis use and IBD were performed in Israel. One of the most promising was a retrospective observational study in 2011 involving 30 patients with CD. Outcome metrics such as disease activity (based on a Harvey–Bradshaw index), need for additional medications, and total number of surgeries were assessed both before and after cannabis use. This study found 21 of 30 patients experienced significant benefits from using cannabis. Overall, the average Harvey–Bradshaw index improved from 14 to 7 (p < 0.001) and fewer surgeries were required in the years after cannabis use. Furthermore, only 4 of the initial 26 patients on corticosteroids continued to require corticosteroids, and patients demonstrated less of a need overall for additional medications. While not double-blind or placebo-controlled, this study suggested cannabis might improve underlying disease [15].

In addition to improving quality of life metrics, it has been proposed that regular cannabis use might stimulate appetite, thereby facilitating weight gain in patients with IBD. A prospective pilot study in 2012 by Lahat et al. [16] found that after receiving inhaled cannabis for 3 months, patients with IBD reported having less physical pain (p = 0.004), less depression (p = 0.007), and an improved ability to work (p = 0.0005). Patients on average gained 4.3 kg (p = 0.0002) and had lower average Harvey—Bradshaw index scores by a difference of 11.36 (p = 0.001). It is important to note though that this study only consisted of 13 patients in total. It was also susceptible to bias given that knowledge of having received cannabis might impact final results from self-reported questionnaire data.

Ultimately, the majority of subsequent studies on cannabis were unable to replicate these findings, concluding that while cannabis helped with IBD symptom management, it does not change inflammatory markers or affect endoscopic healing. Naftali et al. [17] performed a second study, this time a placebo-controlled study of 21 patients with a Crohn’s Disease Activity Index (CDAI > 200), who had failed to respond to therapy. Patients were assigned to cannabis (THC cigarettes twice daily) or a placebo group (flowers without THC) for 8 weeks. Though not statistically significant, 45% of those in the THC group achieved complete remission (CDAI < 150), whereas only 10% of patients in the placebo group achieved complete remission. Patients who received cannabis cited having improved sleep and appetite. As a result of the sample size, however, this study was underpowered, and no difference was seen between placebo versus THC groups in terms of C-reactive protein (CRP), a marker of inflammation.

Even if cannabis is beneficial for alleviating IBD-related symptoms, it is difficult to establish exactly what dose of cannabis would be optimal. Irving et al. [18] conducted a randomized control study of 60 patients with left-sided or extensive UC (Mayo score 4–10), who were assigned at random to either a cannabidiol (CBD) or placebo group. Patients were gradually uptitrated to a gelatin capsule dose of 250 mg twice daily, which they continued for 8 weeks. Interestingly, patients found the gelatin capsules difficult to tolerate, and tended to take one-third of the intended dose, resulting in inadequate exposure. Remission rates at the end of 10 weeks were 28% for the CBD group and 26% for the placebo group. However, patients in the CBD group endorsed significantly better quality of life than those in the placebo group. This study highlights that while cannabis might improve UC symptoms, additional research is needed to determine which dose achieves benefits and minimizes adverse effects.

Naftali et al. [19] also performed a randomized controlled trial of 20 patients with CD to further explore what dose might achieve a clinical benefit and still avoid side effects. Patients who had failed to respond to standard treatment and had a CDAI of greater than 200 were randomized to receive 10 mg of CBD or placebo twice daily. Patient’s hemoglobin, albumin, creatinine, and liver enzymes were checked throughout the study. This study ultimately concluded that although safe, 10 mg of cannabis twice daily for 8 weeks did not produce a significant difference in average CDAI between cannabis and placebo groups. One possible weakness of this study is that 10 mg twice daily is a relatively small dose of CBD in the first place.

More recently, a double-blind, randomized, and placebo-controlled trial involving 32 patients with UC observed that those in the cannabis group achieved clinical remission and reported better quality of life. Patients were given either cigarettes containing 0.5 g of dried cannabis flowers with 80 mg of THC or placebo cigarettes. The study determined that smoking cannabis did not contribute to an improvement in Mayo endoscopic score or a reduction in serum inflammatory markers, like CRP and calprotectin [20].

Another study from 2021 by Naftali et al. [21] that examined the relationship between CBD oil and CD reached similar conclusions. This study was also a double-blind, randomized, and placebo-controlled trial. It consisted of 56 patients with CD consuming CBD oil or placebo orally for 8 weeks. As seen in the prior study, patients in the cannabis group had a significant improvement in quality of life metrics and CDAI scores but did not exhibit less inflammation as evidenced by endoscopic appearance, CRP, or calprotectin.

Case 2

A 23-year-old male graduate student with ileocolonic CD in clinical but not endoscopic remission currently requires 5 mg of prednisone daily to decrease his diarrhea symptoms. He says that he would like to try cannabis. His job is an NIH-funded position, for which he has to complete annual drug testing.

It is possible that this patient would benefit from cannabis from both the perspectives of symptom management and a reliance on steroids. Cannabis could decrease gut motility and in doing so would likely result in fewer episodes of diarrhea. Diarrhea was one of the most common symptoms that patients cited improved with cannabis use in population studies [10].

Additionally, in the Naftali et al. [15] study involving 30 patients with CD, it was found that after cannabis use, patients with CD needed fewer medications overall, particularly corticosteroids. For this reason, there may be some role for steroid sparing with cannabis supplementation in this patient.

However, these proposed benefits would have to be weighed within the greater context of what is at stake for this patient professionally. Regardless of individual state laws, cannabis remains federally illegal, and this patient is routinely drug tested. Failure to pass an annual drug test might result in the patient losing his government funding if found to be in violation of a federal law.

Concerns for Clinicians Whose Patients Use Cannabis

Storr et al. [10] reported that more than a third of patients with IBD who were not cannabis users were worried about the possible side effects of the substance. Furthermore, even for patients who achieve a reduction in IBD symptoms with cannabis, there are still concerns among clinicians regarding the long-term consumption of it. One issue that must be viewed within the larger context of needing more standardized dosing is that of toxicity. When inhaled in doses of 2–3 mg or ingested in doses of 5–20 mg, THC has been found to impair attention, concentration, short-term memory, and executive functioning, which consists of more advanced cognitive tasks like planning and emotional self-regulation. Severe adverse effects are typically not seen until concentrations of higher than 7.5 mg/m 2 , and include nausea, postural hypotension, delirium, panic attacks, anxiety, and myoclonic jerking. Given that cannabis is delivered through a multitude of means and formulations, it is challenging to ensure therapeutic dosing that entirely avoids toxic effects for individuals with varying levels of prior exposure [22].

Cannabis dependence and addiction potential are other facets that may limit the practicality and widespread use of cannabis. It was initially disputed whether or not cannabis possesses addictive properties. However, recent studies have proven that frequent cannabis users are at high risk of dependence. A prospective cohort study of 600 frequent cannabis users (ages 18–30) determined that 3 years later, the incidence of dependence was 37.2% (95% CI = 30.7–43.8). Living alone, total number, and type of recent negative life events were all predictive of developing a dependence [23]. A 2012 National Survey on Drug Use and Health revealed that a total of 2.7 million people above the age of 12 met diagnostic criteria for cannabis dependence as defined by the DSM-IV [24]. Thus, the impact of daily cannabis use on the potential for addiction cannot be underestimated. For those dependent on cannabis, withdrawal symptoms commonly include irritability, poor sleep quality, dysphoria, craving, and anxiety [22].

The cannabis consumed today is thought to be between 6–7 times more potent that than used in the 1970s. Among adolescent use, blunts, which contain purely cannabis, have become more popular than joints, which contain a combination of cannabis and tobacco, suggesting the amount of THC consumed overall per instance is much higher today than in past decades. Patients with IBD who are pregnant must be explicitly counseled to avoid the use of cannabis while pregnant. Although the research is limited, prenatal use of marijuana in particular has been connected to infertility, placental complications, and fetal growth restriction as well as long-term offspring effects on executive function and learning [25].

Additionally, for patients with psychiatric disease, cannabis is not an ideal adjuvant therapy for symptom control. Cannabinoid agonists have been shown to exacerbate the symptoms of patients with schizophrenia, for example, regardless of if being treated with an antipsychotic. This is not surprising given the connections between THC and psychosis. Laboratory studies have largely disproved the notion of cannabis as self-medication for those with schizophrenia, failing to identify any significant clinical benefit of cannabis in this patient population [26].

Chronic heavy use of cannabis can also predispose patients to cannabinoid hyperemesis syndrome (CHS), which only resolves with abstinence from cannabis. CHS is described as a cyclical vomiting illness that occurs within the context of regular cannabis use. The regular cannabis use typically predates the recurrent episodes of nausea and vomiting. Further complicating this picture, the symptoms of CHS are similar to those of a CD flare with a partial small bowel obstruction [27]. However, one pathognomonic feature that distinguishes CHS is the fact that symptoms improve or temporarily resolve with hot showers or baths. Allen et al. [28] found that 9/10 patients with CHS took multiple hot showers or baths a day. They also found that of this group, only those who abstained from cannabis achieved resolution of symptoms, and once it was resumed, patients again suffered from CHS. This study illustrates that CHS symptomatology is disruptive to daily life and must be taken into account when considering long-term use of cannabis for medical purposes.

Lastly, patients contemplating cannabis use must be counseled on the need to avoid operating heavy machinery, as marijuana is the illicit drug most commonly associated with impaired driving and fatal accidents. The exact relationship between chronic cannabis use, lung cancer, and airway disease is less apparent. It is reasonable to conclude that patients who inhale cannabis long-term are more likely than non-users to incur lung damage. At the same time, cigarette smoking is known to be more carcinogenic than cannabis smoking [29].

It must be emphasized that one of the primary means by which cannabis is consumed is smoking, which alone poses inherent health risks. Smoking cannabis results in more rapid effects compared to oral ingestion. With smoking, a peak plasma concentration of THC can be reached in minutes versus with oral ingestion it may take hours [30]. A cohort study of young adults found that those who were cannabis-dependent exhibited respiratory symptoms at a similar rate as those who smoked between 1 and 10 cigarettes a day. Some of these symptoms included wheezing, exercised-induced shortness of breath, nocturnal wakening with chest tightness, and increased sputum production. This study concluded that as early as 21 years of age, those who smoke cannabis heavily may experience respiratory symptoms and changes in spirometry [31]. Overall, cannabis is a treatment modality that requires thoughtful evaluation of these potentially negative attributes prior to recommending it for patients with IBD.

Case 3

An 18-year-old woman with a past medical history of well-controlled schizophrenia, intermittent alcohol binging, and Crohn’s colitis, who is maintained on vedolizumab, lives in Tennessee, a state where cannabis remains fully illegal. She plans to cross state lines to obtain recreational cannabis and wishes to stop medical therapy, opting for “natural” remedies instead.

For multiple reasons, this patient should be advised to continue with her current treatment regimen, rather than stop it in favor of pursuing cannabis exclusively as therapy for Crohn’s colitis. Although well-controlled, this patient’s history of schizophrenia suggests that she would be a poor candidate for cannabis, as she might be more vulnerable to THC and its psychoactive properties than a patient without underlying psychiatric illness. Her history of binge drinking and desire to engage in risky behavior by traveling to a different state in pursuit of cannabis because it is illegal in her home state also raises concerns for cannabis dependence. In this particular scenario, it would be important to assess if she has been using cannabis, and if so, how much and how often. It is also essential to stress that cannabis should not be used in conjunction with alcohol, especially when consumed in large quantities.

Even aside from this issue of addiction potential in a patient who already engages in alcohol binging, cannabis should never serve as a replacement for standard maintenance therapy. Although cannabis might assist with symptom management, traditional therapy in the form of vedolizumab will provide greater benefit in terms of inflammation for this patient. Currently, there is no compelling evidence to suggest that cannabis alone would result in disease treatment.

Conclusion

In the USA, cannabis is classified as a Schedule I substance, which severely limits the scientific research that can be conducted on it. As cannabis gains popularity, both amongst patients and clinicians, governments will likely continue to pass laws at the state level approving its use, despite limited evidence of its clinical utility. By November of 2020, a total of 36 US states and four territories have already approved cannabis for medical use.

Patients with IBD often experience pain, nausea, and decreased appetite. As described here, in multiple studies, patients with IBD reported a significant improvement in symptoms and quality of life metrics with the use of cannabis. While initially promising, additional double-blind, placebo-controlled studies have found that even though CBD may improve perceived symptoms, it does not reduce inflammation or address underlying disease activity. These studies failed to demonstrate that when given cannabis, patients with IBD had an improvement in inflammatory markers or mucosal healing on endoscopy compared to patients with IBD in placebo conditions. Thus, in many circumstances, patients with IBD would benefit more from maintenance therapy optimization than from the initiation of cannabis as adjuvant therapy.

These studies also suggest that additional investigations are warranted to further elucidate the role of cannabis in the treatment of IBD. Changing the current classification of this substance would be the first step to facilitating more comprehensive studies on IBD and cannabis within the USA specifically. Overall though, from what is known, cannabis is a medication that offers benefits but also comes with appreciable legal considerations and potential side effects. When recommending it to patients for symptom relief, it is imperative to reflect on how issues of toxicity, dependence, and adverse effects from chronic use might impact a patient. As cannabis continues to become more widespread in consumption, it is essential for providers to ask patients about their cannabis use and have informed, non-judgmental conversations about risks and benefits of it.

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All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

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Megan C. Buckley, Anand Kumar, and Arun Swaminath all contributed to the writing and editing of this review paper.

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Megan C. Buckley, Anand Kumar, and Arun Swaminath have nothing to disclose.

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This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. We thank the patients who inspired some of the clinical vignettes we shared in this article.

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Department of Medicine, Northwell Health, Lenox Hill Hospital, New York, NY, 10075, USA

Megan C. Buckley

Division of Gastroenterology, Northwell Health, Lenox Hill Hospital, New York, NY, 10075, USA

Anand Kumar & Arun Swaminath

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Buckley, M.C., Kumar, A. & Swaminath, A. Inflammatory Bowel Disease and Cannabis: A Practical Approach for Clinicians. Adv Ther 38, 4152–4161 (2021). https://doi.org/10.1007/s12325-021-01805-8

Received : 28 April 2021

Accepted : 24 May 2021

Published : 10 June 2021

Issue Date : July 2021

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