Gastrointestinal disorders

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Common folklore states that the most common effect of cannabis on the gastrointestinal (GI) tract is the phenomenon known as the “munchies, a popular term for the food cravings that strike recreational cannabis users. The munchies are triggered in the brain, not the GI tract. But the munchies are more about encouraging eating; they are a mechanism to promote the consumption of rich, high-fat foods. The body’s endocannabinoid system regulates not only all feeding behaviors (including infant suckling) but nearly all gut functions. The endocannabinoid systems control in GI function is merely one aspect of its role in controlling energy balance and metabolism throughout the body. The endocannabinoid system and its receptors are crucial to how the body acquires energy and uses it, from feeding to insulin production to fat storage.

The profusion of cannabinoid receptors within the gastrointestinal system is the primary reason cannabis has been used effectively for gastrointestinal disorders, from vomiting and cramping to pain and inflammatory conditions. Cannabinoids interact with a range of gut receptors beyond just cannabinoid receptors, including the TRPV1 receptors though their role is not well understood.

Cannabinoids have been demonstrated to be effective in treating chemotherapy-induced nausea and vomiting in over 40 studies. Because of the widespread occurrence of cannabinoid receptors throughout the GI tract, it is not surprising that cannabis produces a range of effective treatments for GI disorders. As CB1 receptors are better understood, there is considerable promise for cannabinoid-based therapies. But this system is complex, and therapies will have to be better understood to avoid the disappointment of rimonabant.  

Rimonabant was a diet drug consisting of synthetic CBD designed to antagonize the CB1 receptor to reduce appetite. It was once considered to be the cure for diabetes. However, it had the side effect of making patients severely depressed, even suicidal. This is yet another example of the problem of using a single cannabinoid to treat ailments rather than employing the entourage effect. Rimonabant was withdrawn as a diet drug in 2008.

Molecules to target gastrointestinal disorders

Most patients use indica strains to treat GI disorders ranging from appetite stimulation to more serious immune disorders such as Crohn’s disease. THC effectively reduces spasmodic activity in the intestines, so high THC strains can be quite effective. CBD varieties can calm gut cramping and inflammation. THCV will reduce appetite since THCV is a cannabinoid receptor antagonist, but THCV-rich chemovars are challenging to find in the United States. In Italy, recent studies in mice provided evidence that the cannabinoid CBG may reduce gastrointestinal inflammation.  

Regarding terpenes, I suggest beta-Caryophyllene because of its contribution in treating ulcers and protecting the cells lining of the GI tract. As you know by now, I also consistently stand behind myrcene, limonene and pinene.

Dosing for gastrointestinal disorders

Chronic high doses of medical cannabis will likely reduce the effectiveness in treating the symptoms of bowel disorders. A recent study in Canada demonstrated that cannabis provided effective relief for inflammatory bowel disease but increased the likelihood of surgical intervention in Crohn’s disease patients. While in Israel, a study of Crohn’s patients found that cannabis treatment resulted in remission of symptoms in over half the participants.

Choosing an effective cannabis dose for GI disorders is condition-dependent.  Appetite stimulation usually requires a minimal dose, usually below the threshold for psychoactivity at 2 to 4 milligrams. Chemotherapy nausea is at the other end of the spectrum, sometimes requiring amounts above 20 milligrams. Most GI disorders require a dose between these two, typically in the 5 to 7-milligram range. Recent animal research into the use of non-psychoactive cannabinoid cannabigerol (CBG) appears quite promising for treating inflammatory bowel disease and ulcerative colitis. Varieties of cannabis are increasingly available with 1 to 2 percent CBG content, which should be factored into dose calculations.

Methods of ingestion

Oral cannabis medicines can be very soothing to the gut if properly prepared. Avoid strong spices and flavorings in cannabis edibles for gastrointestinal conditions. Most patients vaporize cannabis for GI disorders.