CBD for IBS (Irritable Bowel Syndrome)

by Apoorva Shivankar, M.D

Irritable Bowel Syndrome and CBD - Can you see the link?

For cannabidiol, it’s no looking back since the moment of federal legalization of Hemp-derived CBD. Once seldom used, this Cannabidiol is now continuously marching towards the pinnacle of the health industry covering almost every aspect from the skin to heart to brain to nails and many more. Its influence has not spared the complex GI world too.

Cannabidiol (CBD) and gut health are the two buzziest topics in the field of healthcare today.

Let’s check here how they are interconnected

Irritable Bowel Syndrome (IBS) and Inflammatory bowel disease (IBD) are the 2 major chronic disorders of the gastrointestinal tract which are easier to catch up with but difficult to predict, prevent, and cure off. Lucky for us, we have CBD to save us from these 2 high magnitude sufferings. 

Understanding Irritable bowel syndrome

Irritable bowel syndrome is the gift of modern society to mankind affecting around 10-15% of the world’s population today. Previously underdiagnosed owing to the lack of shreds of physical evidences (e.g., bleeding, growths, obstructions), IBS has now emerged as ‘a real thing’ and is the talk of the town due to its increasing/evolving prevalence.

IBS can be described as a purely functional bowel disorder involving the colon (large intestine) and is characterized by intermittent and chronic abdominal pain associated with changes in bowel habits.

What causes IBS?

Though proven to be a real entity now, a definite cause is still missing.

Researchers link IBS to the following precipitating factors:

  • chronic stress
  • processed foods
  • gut flora imbalances
  • inflammation
  • impaired immune system
  • oversensitive gastrointestinal tract
  • low digestive enzymes
  • conditions like migraine, fibromyalgia, restless leg syndrome, etc.

Only recently, it was figured out (though not proven yet), that loss of digestive tract homeostasis due to clinical endocannabinoid deficiency can play a chief role in IBS development.

Having said that, there surfaced a possibility to use cannabis-derived cannabidiol as a replacement for deficient endocannabinoids to treat IBS. And to the surprise, this hypothesis is now strongly backed up by thousands of positive reviews by happy patients. 

How? We will come to that later. First, let us decide,

Is IBS really a concern?

Yes, it is.

Irritable bowel syndrome is actually IRRITATING.

Imagine spending hours in a washroom keeping everything else aside and still not getting over it. Isn’t it frustrating?

To add more to the sorrow, there are other IBS symptoms like

  • Abdominal pain due to sensitive nerve endings.
  • Abdominal cramping
  • Bloating
  • Gas
  • Diarrhoea or constipation or both alternatively due to intestinal motility dysfunction.
  • Food sensitivities and intolerances
  • Sexual dysfunction
  • Fibromyalgia
  • Urinary frequency and urgency
  • Fatigue, incontinence and nausea may also be part of your IBS experience.  

Above that IBS preferably affects the young working-class population (<45yrs) causing a great loss of work hours and productivity. This takes a toll on the quality of life leading to depression, anxiety, sleep disorders, and eventually their grave consequences. The search of a prompt solution is thus of utmost priority.

So, Is there any cure?

No, we don’t have it yet. Reason being the complexities of its origin and absence of physical parameters to treat.

Till now, the treatments for relieving IBS symptoms include,

  • stress reduction therapy
  • dietary modifications
  • lifestyle changes
  • medications like pre and probiotics, opioids, anticholinergics, and antidepressants

Above traditional treatments are not capable of targeting the entire spectrum of the disease as well as have a doubtful efficacy too.

Recently, the knowledge of the involvement of the endocannabinoid system in IBS development diverted the focus of treatment strategies towards CBD as a ‘game-changing molecule’ for IBS and this CBD, as we know, rarely disappoints anyone.

Coming back to CBD for IBS?

Yes, CBD can help relieve IBS symptoms by

1. Double Hit Mechanism via endocannabinoid system

  • Direct action: It reduces GI (gastrointestinal) disturbances such as motility issues, pain, inflammation, etc. by addressing the endocannabinoid system.
  • Indirect action: Removes the IBS triggering factors such as insomnia, stress, anxiety, etc.

How Cannabidiol manages all this?

  • CBD works through the endocannabinoid system, the biggest, most wide-spread receptor system scattered all over the body to maintain homeostasis (memory, cognition, immunity, pain perception, GI motility, appetite, immunity, heart rate, and many more).
  • These cannabinoid receptors (CB1) and (CB2) are located in higher concentration in the brain, spinal cord, immune system and the gut.

CB1 receptors-intestinal epithelium and central nervous system-

regulates intestinal motility.

CB2 receptors immune cells (especially those of GIT) and peripheral nervous system-      checks visceral pain and inflammation.

  • In case of any imbalance such as sleep disturbances, anxiety, stress, inflammation, GI insults or dysfunctions; endogenous cannabinoids are synthesized on demand.
  • These endocannabinoids then bind to the endocannabinoid receptors, turn them on, and send positive neurotransmitter signals to rectify the imbalances and maintain a relaxed harmonious state in the body.
  • Deficiency of these endogenous cannabinoids result in absence of this counterbalance and thus, leads to anxiety, stress, GI disturbances such as irritable bowel syndrome, and many more.
  • CBD extracted from hemp variety of cannabis plant share similar structure with endogenous cannabinoids and thus, can replace them in case of deficiency. CBD can also prevent the breakdown of endocannabinoids to ease homeostasis.

2. Balanced brain-gut axis

CBD relaxes the hypersensitive gut nerves and muscles to restore intestinal motility and relieve visceral pains (by interacting with the cannabinoid receptors of the vagus nerve). 

3. CBD beyond ECS

CBD by boosting serotonin levels - Hormone of Happiness - elevates your mood, regulates intestinal motility, and frees you from important stimulators of IBS such as stress and anxiety.

Thus, Cannabinoid can do magic with your irritable bowel in a more scientific way.

How much CBD oil should I take for IBS?

For any medicine to work, proper dosage is a must.

TRICKY, as it depends on various factors:

  • body weight,
  • indication,
  • type of CBD used isolate, broad-spectrum, full-spectrum.
  • mode of CBD administered orally, sublingually, inhalation, topically
  • the time interval for desired effects

So, our suggestion is to talk to your doctor and get the dose, type, and mode verified.

If not possible, follow the thumb rule:

Start with a minimal dose of 10-20 mg and gradually increase it, say by 5 mg per day till you get the desired effect.

How long does CBD oil take to work for IBS?

There is no specific evidence or FDA approval on how long it takes for CBD oil to help relieve IBS symptoms. 

The time gap again depends on the dose, type of CBD, mode of administration, and body weight.

1.Oral-

  • Oils, Capsules, Gummies
  • Have to pass-through digestive process before entering the bloodstream
  • Onset- delayed (30-90 min)
  • The effect stays longer.

 

2. Sublingual-

  • Oils and Tinctures
  • Absorbed directly in the bloodstream
  • Onset – rapid (within minutes)
  • Stays longer

 

3. Inhalation

  • Smoking, Vape pens
  • Enter the bloodstream directly
  • Onset – Superfast
  • Wanes off fast

 

4. Topical

  • Oils, lotions, balms, patches, creams, gel
  • Directly reach the receptors at the target site
  • Onset- Superfast
  • Stays longer

 

 

How to select the best CBD for IBS treatment?

But the good news is we have the guidelines:

  • Tip 1- Select best quality, organically cultivated, branded, hemp-derived CBD product.
  • Tip 2- Check the label for contents and quantity
  • Tip 3 -Say no to heavy metals, artificial sweeteners, preservatives, colouring agents, pesticide.
  • Tip 4- Should be third party tested.
  • Tip5- Prefer full-spectrum CBD product because the ‘entourage effect’ ensures maximum health benefits
  • Tip 6- Use the form which works for you.
  • Tip 7- Made in the United States should be preferred as they are subjected to strict agricultural regulations.

IBS or IBD? Same or Different? Are you confused too?

Apart from similar names and some clinical features, in reality, these two are quite distinct ailments of the GI tract.

Sneak-peek through Inflammatory Bowel Disease (IBD)

‘IBD is not just a gut feeling.’

It is a chronic inflammation of your digestive tract, more complicated by the physical insults of the intestinal lining as compared to the purely functional nature of IBS.

IBD is more debilitating with the potential to have serious complications and sometimes even life-threatening.

Presents with:

  • Diarrhoea
  • Fatigue
  • Abdominal pain and cramping
  • Blood in stool
  • Reduced appetite
  • Unintended weight loss

Forms of IBD:

Ulcerative colitis- Inflammation and ulcers involving the superficial lining of the colon (large intestine). Here the inflammation is continuous with no healthy area in between.

Crohn’s Disease- Inflammation can extend any length of the GI tract from mouth to anus with healthy areas in between and can even penetrate to deeper layers. 

Back to CBD

Can CBD play a crucial role in IBD management too?

  • There is still no known cause or cure for IBD necessitating a symptomatic management.
  • The growing knowledge about the endocannabinoid system involvement in gut health prompted researchers to study cannabinoids for IBD management too.
  • Studies (Couch DC 2019, Irving PM 2018, Martinez V 2020, De Petrocellis L(2012)) suggest that IBD symptoms can be successfully relieved by

CBD 3 SHOTS THERAPY by addressing the endocannabinoid system

  • soothe the inflamed GI tract with its anti-inflammatory properties (CB2),
  • improve intestinal motility (CB1) and
  • pain relief (CB2)
  • CBD’s excellent anti-anxiety and calming properties can be cherry on the cake for IBD patients.
  • But for IBD, CBD alone is not sufficient; other remedies such as ulcer management must be administered simultaneously.
  • Studies also suggest that a combination of THC and CBD may help IBD sufferers better.

Can CBD help with digestive issues?

Digestive is a problem of every-hold, no age-group is spared.

We suggest, ‘Give your digestion with a CBD treat to treat it.’

Pathology

Symptom caused

CBD Management

  • Increased GUT wall permeability leading to inflammation
  • Abdominal Pain,
  • Nausea.
  • Vomiting

 

  • Analgesic (CB2)
  • Anti-inflammatory (CB2)
  • Lowers serum cortisol to reduce permeability
  • Intestinal motility dysfunction
  • Diarrhoea,
  • Constipation,
  • Bloating
  • Regularizes intestinal motility (CB1)

 

Thus, with CBD, you are blessed with a calm, relaxed, perfectly well functioning digestive system. 

Does CBD help with stomach inflammation?

Cause: Stomach inflammation or gastritis is usually seen when an exogenous insult reaches the stomach and irritates the stomach lining triggering the immune response causing inflammation. This inflammation causes stomach pain.

What happens normally: the endogenous cannabinoid (anandamide) is released, binds to the cannabinoid receptors within the stomach lining to release neurotransmitters regulating pain and inflammation.

In case of ECS deficiency: inflammation persists leading to pain and gastritis.

How CBD helps:

1. replaces anandamide or potentiates the endocannabinoid system by inhibiting anandamide degradation.

2. reduce gastric acid secretion, prevent reflux, and increases blood flow to the lining of the stomach to help it heal quicker (by binding to CB1).

 

FAQs

Can IBS shorten your life?

No, Irritable bowel syndrome is neither life-threatening nor shorten lifespan. But it can irritate you for an entire life-span on and off.

How to diagnose IBS?

Rome III Criteria for Irritable Bowel Syndrome

In order to meet a diagnosis of IBS, the patient must have the following symptoms:

  • Recurrent abdominal pain or discomfort at least 3 days per month over 3 months with onset occurring at least six months prior.
  • Symptoms involving at least two of the following characteristics:
  • Improvement of symptoms with defecation
  • Onset associated with a change in stool frequency
  • Onset associated with a change in stool form

If these criteria are met and there is no other explanation for a cause (such as inflammation, traumatic damage, or infectious disease) the patient is diagnosed with IBS.

What is CBG? Can it help with IBS?

CBG is Cannabigerol.

It is a type of cannabinoid and can help relieve IBS symptoms by

  • Managing endocannabinoid deficiency.
  • As an effective broad-spectrum antibiotic- can treat Small intestinal bacterial overgrowth (SIBO), a well-known precipitator of IBS.

Is IBS psychosomatic?

Yes, as its onset, course, severity, and even relief are influenced by psychological factors. 

Which infections are associated with an increased prevalence of IBS?

Bacterial- Campylobacter, Salmonella, Shigella, etc,

Protozoal- Giardia lamblia 

What does a low FODMAP diet? Can it affect IBS?

FODMAP stands for.

"Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols.

These fermentable short-chain carbohydrates are prevalent in the diet.

  • Oligosaccharides: fructans and galacto-oligosaccharides (GOS)
  • Disaccharides: lactose
  • Monosaccharides: fructose
  • Polyols: sorbitol and mannitol
  • Reduction of these substances in the diet is called a low FODMAP diet.

Research suggests around 50% of IBS sufferers have experienced significant relief in their symptoms with this diet.

But all these diet plans should be done under the observation of a trained dietician.

 

References:

Couch DC 2019, Irving PM 2018, Martinez V 2020, De Petrocellis L(2012) 

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