CBD for GI Issues

By Dr. Frank Michalski


CBD has been shown to have multiple positive impacts on the human body. One group of conditions that may benefit from CBD are gastrointestinal disorders. These disorders can include, but are not limited to, colitis, Chron’s, Celiac, IBD (inflammatory bowel disease), and IBS (irrigatable bowel syndrome).  Inflammatory bowel diseases impact over 200,000 people in the US a year. 

Of particular importance are colitis and Chron’s. Both are inflammatory conditions that impact the intestine.  

IBD: Understanding Inflammatory Bowel Disease

Colitis is a inflammation of the inner lining of the colon, hence inflammatory bowel disease. Ulcerative colitis causes ulcers or sores to develop in the digestive tract, including the inner lining of the large intestine (colon), and rectum. Like many inflammatory disease processes symptoms usually develop over time. Again, for many this disease process did not occur over night. 

The colon’s job is to process waste products, remove water, and eliminate any leftovers as feces. You could imagine the negative impact colitis could have on one’s lifestyle. 

Common Symptoms: 
  • Diarrhea 
  • Abdominal pain or cramping 
  • Rectal pain 
  • Rectal bleeding 
  • Urgency to defecate 
  • Fatigue 
  • Weight loss
  • Fever 
  • Constipation despite urgency to “go”
The bulk of colitis cases are believed to be caused due to immune system malfunction. If your body tries to fight off a bacterial infection or virus it may wind up attacking your own normal cells in the digestive tract as well. This attack may result in a immune response. 

Common Causes: 

  • Infection of the colon 
  • Loss of blood flow to the colon 
  • Diet 
  • Stress 
  • Genetics 
  • Age 

There is currently no cure for Inflammatory bowel disease including colitis and Chron’s. People who suffer from this group of conditions are only offered medical treatments that aim to relieve the symptoms of the disease versus the disease itself. Some of the common symptoms are listed below.

Symptoms: 

  • Severe bleeding 
  • Dehydration 
  • Liver disease 
  • Bone loss (osteoporosis) 
  • Inflammation of the skin, joints and eyes
  • Increased risk of blood clots in the veins and arteries. 

IBS: Understanding Irritable Bowel Syndrome

IBS is a condition that impacts the large intestine. IBS is a common condition that effects 1 in 6 people. IBS is more likely to effect women than men, especially those between the ages of 18-40. There is no known cause of IBS but many factors play a role. Currently the “gut brain connection” is being closely studied as a cause of IBS. If you have ever experienced IBS you will recognize some of the common symptoms below. 

Symptoms: 
  • Abdominal pain 
  • Cramping 
  • Bloating 
  • Gas 
  • Constipation 
  • Diarrhea 
  • Mucus in the stool 
  • Gas 

Some common causes of IBS are listed below: 

  • Muscle contractions from the intestinal walls can be stronger and longer, which leads to gas, bloating, and diarrhea. Weak contractions often result in hard stools. 
  • Nervous system abnormalities due to poor connections between the brain and intestines can result the body to overreact to changes that normally occur in the digestive process, resulting in pain. 
  • Inflammation of the intestines. 
  • Infection from a Bactria or virus. 
  • Changes in the gut flora. 
  • Hormonal changes, especially those experienced by a female. 

Much like IBD there is no cure for IBS. Exercise, nutrition and stress management can go a long way. Many people will many symptoms by consuming over the counter laxatives or anti-diarrheals.  

CBD AND IBS/IBD 

According to CBD What You Need To Know, the small and large intestine have high levels of CB2 receptors.  The GI tract is embedded with the enteric nervous system, a web of neurons that regulate gut function where both CB1 And CB2 receptors exist. Use of CBD stimulates these receptors. Stimulation of CB2 receptors will result in muscle contraction (colicky pain) and absorption of water into the stool (diarrhea or constipation).

The high prevalence of CB2 receptors in the intestinal tract also means that CBD will turn down the inflammatory processes that cause colitis, and Crohn’s disease. 

Dr. Ethan Russo believes that IBS is due to a deficiency of the bodies natural cannabinoids much like seen in fibromyalgia and migraine. In Dr Russo’s study it was concluded that CBD may have the ability to block GI mechanisms that promote symptoms of IBS, celiac disease, and other related disorders. 


Daniele De Filippis studied the effect of CBD on intestinal biopsy’s of patients with colitis an from intestinal segments of mice with intestinal inflammation. 


“The results of the present study correlate and expand the findings of CBD as a potent compound that is able to modulate experimental gut inflammation…in this study we demonstrate that during intestinal inflammation, CBD is able to control the inflammatory scenario and the subsequent intestinal apoptosis through the restoration of the altered glia-immune homeostasis. CBD is therefore regarded as a promising therapeutic agent that modulates the neuro-immune axis, which is recognized as a new target in treating inflammatory bowel disorders.”  


A study in 2016 showed that by inhibiting an enzyme called FAAH may suppress colitis by reducing activated T cells and inflammatory response to the colon. This may play a crucial role in linking GI disorders to stress. 


The ECS is involved in the manifestation of stress, and endocannabinoid signaling reduces the activity of the hypothalamic-pituitary- adrenal pathways via actions in specific brain regions, notably the prefrontal cortex, amygdala, and hypothalamus. Agents that modulate the ECS are in the early stages of development for treating GI disease. Increasing our understanding of the ECS, brain and gut is a promising field of study. 


In short, CBD increases the function of the endocannabinoid system. The GI tract has many CB2 receptors. Activation of these receptors occurs through indirect effects of CBD. Activation results in decreased inflammation, muscle relaxation, and relief from cramps, diarrhea, constipation, and spasm. 


CBD helps with both relieving stress, calming the mind, and restoring homeostasis between the gut-brain axis. In combination with its more direct impact on the GI system CBD is a sure win for those looking for IBS and IBD relief. 


How much CBD should you take?

As always, go slow, monitor symptoms, and use intuition. More CBD is not always the answer. Most people will respond between 5mg and 140mg daily. It is not encouraged to consume more than 400mg daily for GI conditions. Please refer to this video for dosing. 



References: 

  1. CBD What You Need to Know by Gregory L. Smith, MD, MPH
  2. CBD A Patient’s Guide To Medicinal Cannabis by Leonard Leinow & Juliana Birbaum 
  3. https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-20353326