Can CBD oil cause diarrhoea

by Apoorva Shivankar, M.D

Can CBD oil cause diarrhoea

With Cannabidiol(CBD) climbing the stairs of stardom, it has become the hot topic of discussion and research everywhere across the globe. With each passing day, the growing attention brings forth/out new and new medical merits of cannabidiol usage. But that’s not all, simultaneously the darker side of CBD is also getting highlighted. Diarrhoea associated with CBD oil usage is one such downside gaining huge limelight recently/nowadays.

Does that mean ‘If you enjoy CBD oil today, you will get free diarrhoea tomorrow?’

No, though a commonly known side-effect, this is just a once-in-a-while phenomenon linked to CBD oil.

But isn’t it surprising that a medical drug like CBD which is well known for its better tolerability and ability to keep the gastrointestinal issues at bay is itself being accused of causing diarrhoea? Difficult to digest, isn’t it?

Let’s trace the truth behind the accusations by delving into the facts and figures for CBD oil as or not as the cause of diarrhoea:

Logical thinking about Diarrhoea

Diarrhoea might sound like a petty insignificant cost to be paid for the myriad of health benefits that CBD offers, but when it actually comes it is not less than a storm that shakes you completely from within and this is obviously something which can’t be easily taken for. So, if the claims are true, then how a drug known to cause diarrhoea can reign the medical industry so easily?

CBD can protect and even heal gastrointestinal(GI) tract

  • Cannabidiol calms down an inflamed bowel, reduce the excess gastric acid secretion, prevents acid reflux disease and even promotes blood flow to the stomach lining which could mediate rapid healing of an upset stomach. CBD does this by binding and activating CB1 receptors of the ECS located in the GI epithelium.
  • By binding the CB2 receptors located in the immune cells of GIT, CBD pacifies the inflammatory responses of the GI tracts in order to promote healing.
  • CBD also interacts with the cannabinoid receptors of the vagus nerve to relax the hypersensitive gut nerves and muscles. This balanced brain-gut axis then restores normal bowel motility relieving diarrhoea or constipation.
  • CBD by boosting serotonin levels regulates bowel motility, and frees you from the symptoms of irritable bowel syndrome especially diarrhoea.

Possible Theories

With all the GI protecting/healing effects mentioned above, it becomes difficult to believe that CBD oil can land you up in shitty situations. But then the personal experiences of some users go the opposite way confusing the entire scenario. To bring an end to all the confusions, experts came forward with the following theories:

  • Diarrhoea is likely from one of the ingredients of CBD oil and not from the CBD itself.

The CBD oils in the market are usually blended with carrier oils such as coconut oil, olive oil, grapeseed oil, palm oil, lavender oil, etc. in order to maximize their absorption. A sensitivity to these oils carries a major potential to trouble your system causing abdominal pains and diarrhoea.

Presence of additives such as guar gum, inulin, potassium benzoate and modified food starch can also be the cause of CBD oil-induced stomach and digestive problems.

  • Higher THC levels:

Manufacturing and supply of CBD products are neither strictly regulated by State Federal laws nor approved by US-FDA. This provides a space for poor quality CBD oils containing higher THC than acceptable in the market. The appetite-stimulating property of THC4 and the associated binge eating could be linked to diarrhoea. (THC on its own can cause constipation.)

  • Unreliable purity:

Due to the lack of strict regulations, purity standards are difficult to maintain.

Pollutants can enter at any stage from cultivation to extraction to formulation and even at the user’s end. They can easily irritate the colon and cause diarrhoea.

  • Improper cultivation/sources:

CBD plant is a bio-accumulator and absorbs whatever it gets from the soil. Contaminated soil can incorporate harmful chemicals or heavy metals into the CBD plant which on ingestion can cause diarrhoea.

  • Higher dosage:

Excess is dangerous. The same is true for CBD. It is safer as medicine in regular doses but high doses can lead to loose stools

  • New-user’s diarrhoea:

One of our body’s natural defensive response is to expel out anything foreign which goes inside. This stands true for first time CBD users too. The body recognises CBD as a foreign material and tries to get rid of it leading to diarrhoea. This form of CBD oil-related diarrhoea settles on its own after few weeks.

Relevant Studies

Even after an ardent run through a number of researches and articles, we were not able to find any study or evidence strongly illustrating a direct role of CBD in causing loose motions. Only two studies meekly pointed towards CBD causing diarrhoea that too without any solid explanation.

  • The results of a Randomized, Double-Blind, Placebo-Controlled human trials by Taylor L, Gidal B, et al in 20185 showed that oral administration of CBD at doses up to 6000 mg were well tolerated but there were episodes of mild to moderate diarrhoea, nausea, headache, and somnolence as adverse events in subjects taking CBD as compared with placebo. 
  • Research published in 20173 suggested that CBD is well tolerated and effective in different forms of epilepsy but also recorded that around 16% of patients developed diarrhoea as a side-effect once the CBD treatment was started.

Other Studies 

  • A similar study (2015)6 conducted on epilepsy patients being treated with CBD product Epidiolex reported that around 19% of patients experienced diarrhoea. Though the researchers could not pinpoint the exact cause of diarrhoea here, they suggested that the sesame oil used as CBD carrier could be the reason behind diarrhoea.
  • In another study7 published in the year 2011, experts claimed that CBD can effectively improve gut health by reducing intestinal inflammation through the control of neuroimmune axis.
  • The concept that CBD positively influences gut health was once again strengthened in 2018 wherein a study8 proved that cannabidiol-rich botanical extract can bring symptomatic improvements in the patients with Ulcerative Colitis.

From an overall view, we can conclude that the diarrhoea people are experiencing with CBD is mostly related to CBD oil ingredients (instead of CBD) or the higher dosage of CBD.

So, the next time if you feel queasy and sick after taking CBD oil,

Analyse the full list of ingredients

  • Look for the oil carrier used in the formulation. Try different combinations of CBD oil and carrier oils and see which one works for you.  Safest option is to shift to a CBD oil with a carrier of hemp origin only (hemp seed oil) or seek out a CBD product that doesn’t use a carrier oil itself, like CBD vapes or gummies to avoid any risk of hypersensitivity reaction.

  • If CBD is an issue, choose tinctures or topicals or vapes or smoke as they directly enter the bloodstream bypassing the digestive tract and hence no issue of diarrhoea.

  • Say no to CBD products containing heavy metals, artificial sweeteners, preservatives, colouring agents, pesticides as they can cause diarrhoea.

  • Look for the contents and quantity especially the concentration of THC which should never exceed 0.3%.

Check the dosage you are taking

  • Shift to a lower dose, if needed.
  • Avoid long term regular dosage, take cannabidiol for 3 weeks, give a break of 1 week and start again.
  • First-time users start with a lower dose and then work your way up while checking your body’s responses.
  • It’s better to consult a doctor to decide the dosage.

 

  1. Check whether the CBD is sourced from a supervised cultivator where the farms are routinely inspected.

  2. Prefer the best quality and branded (trust-worthy) CBD oil.

  3. Look for third party tested CBD products as a proof of quality.

  4. Avoid consuming CBD empty stomach. Take some proteins and ensure your stomach is full to help the body absorb oil better.

  5. Last but not the least always consult a doctor the moment you experience side effects

If you are one of the sufferers of CBD oil diarrhoea, we hope that these remedies might help you enjoy the positive health effects of CBD without any increase in washroom trips.

FAQs

Q. CBD Oil or Hempseed Oil: Which one is Best for Diarrhoea?

Both the oils share similar medical benefits in diarrhoea but the higher number of side effects seen with hempseed oil give CBD oil an upper hand. These side effects of hemp seed oil include:

  • Immune suppression.
  • Aural hallucinations.
  • Explosion risk while cooking. 
  • Risk of exposure to noxious peroxides.

Q. Difference between CBD oil and Hemp seed oil?

There are 2 major differences: sources and contents.

CBD oil is extracted from stalks, leaves, and flowers of the hemp plant whereas hempseed oil is usually made through cold-pressing hemp seeds.

CBD oil is rich in cannabinoids like CBD, THC, etc, whereas hempseed oil is a great source of omega 3, omega 6 fatty acids, nutrients and other bioactive compounds.

References:

    1. De Filippis D, Esposito G, Cirillo C, Cipriano M, De Winter BY, Scuderi C, Sarnelli G, Cuomo R, Steardo L, De Man JG, Iuvone T. Cannabidiol reduces intestinal inflammation through the control of neuroimmune axis. PLoS One. 2011;6(12):e28159. doi: 10.1371/journal.pone.0028159. Epub 2011 Dec 6. PMID: 22163000; PMCID: PMC3232190.
    2. Gyires K, Zádori ZS. Role of Cannabinoids in Gastrointestinal Mucosal Defense and Inflammation. Curr Neuropharmacol. 2016;14(8):935-951. doi: 10.2174/1570159x14666160303110150. PMID: 26935536; PMCID: PMC5333598.
    3. Iffland K, Grotenhermen F. An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis Cannabinoid Res. 2017 Jun 1;2(1):139-154. doi: 10.1089/can.2016.0034. PMID: 28861514; PMCID: PMC5569602.
    4. Kirkham TC. Cannabinoids and appetite: food craving and food pleasure. Int Rev Psychiatry. 2009 Apr;21(2):163-71. doi: 10.1080/09540260902782810. PMID: 19367510.2017 Jun 1;2(1):139-154. doi: 10.1089/can.2016.0034. PMID: 28861514; PMCID: PMC5569602.
    5. Taylor L, Gidal B, Blakey G, Tayo B, Morrison G. A Phase I, Randomized, Double-Blind, Placebo-Controlled, Single Ascending Dose, Multiple Dose, and Food Effect Trial of the Safety, Tolerability and Pharmacokinetics of Highly Purified Cannabidiol in Healthy Subjects. CNS Drugs. 2018 Nov;32(11):1053-1067. doi: 10.1007/s40263-018-0578-5. Erratum in: CNS Drugs. 2019 Apr;33(4):397. PMID: 30374683; PMCID: PMC6223703.
    6. Devinsky O, Marsh E, Friedman D, et al. Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. The Lancet. Neurology. 2016 Mar;15(3):270-278. DOI: 10.1016/s1474-4422(15)00379-8.
    7. De Filippis D, Esposito G, Cirillo C, Cipriano M, De Winter BY, Scuderi C, Sarnelli G, Cuomo R, Steardo L, De Man JG, Iuvone T. Cannabidiol reduces intestinal inflammation through the control of neuroimmune axis. PLoS One. 2011;6(12):e28159. doi: 10.1371/journal.pone.0028159. Epub 2011 Dec 6. PMID: 22163000; PMCID: PMC3232190.
    8. Irving PM, Iqbal T, Nwokolo C, Subramanian S, Bloom S, Prasad N, Hart A, Murray C, Lindsay JO, Taylor A, Barron R, Wright S. A Randomized, Double-blind, Placebo-controlled, Parallel-group, Pilot Study of Cannabidiol-rich Botanical Extract in the Symptomatic Treatment of Ulcerative Colitis. Inflamm Bowel Dis. 2018 Mar 19;24(4):714-724. doi: 10.1093/ibd/izy002. PMID: 29538683.
    9. Carvalho ACA, Souza GA, Marqui SV, Guiguer ÉL, Araújo AC, Rubira CJ, Goulart RA, Flato UAP, Bueno PCDS, Buchaim RL, Barbalho SM. Cannabis and Canabidinoids on the Inflammatory Bowel Diseases: Going Beyond Misuse. Int J Mol Sci. 2020 Apr 22;21(8):2940. doi: 10.3390/ijms21082940. PMID: 32331305; PMCID: PMC7215817.

 

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