Health Immune System Medical Science

Why People Use CBD for Digestive Problems

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Cannabinoids have long been regarded as potential therapeutic agents for various conditions. Specifically, they show promise for conditions resulting from dysfunction of the immune system such as unresolved inflammation that leads to tissue damage. In particular, many individuals have claimed to use cannabinoids, in the form of various cannabis-based products, to alleviate symptoms of irritable bowel syndrome (IBS) such as abdominal pain, diarrhea, and reduced appetite. They also have been used for a similar, but much more serious condition, known as inflammatory bowel disease (IBD).

Despite their well-known analgesic and anti-inflammatory properties, the psychoactive effects of the THC found in many cannabis-based products have impeded their use as the go-to therapeutic agent for idiopathic conditions, and have prompted healthcare providers to approach the use of these compounds with cautious apprehension.

Nonetheless, through extensive research, scientists have cultivated an interest in the use of cannabidiol, another cannabinoid, as a promising therapeutic agent for digestive disorders due to its potent anti-inflammatory properties and its lack of psychotropic effects. The following article will review in detail some studies regarding the use of CBD for digestive disorders, as well as the possible benefits and side effects of the clinical use of CBD.

Why we need an alternative

In the last century, irritable bowel syndrome (IBS) has become an epidemiologically important condition affecting many individuals around the world. Many doctors write it off as a psychosomatic issue, due to a notable lack of diagnosable changes to the structure of the digestive tract. As the name suggests, it involves irritability of the bowel; uncontrollable stomach aches. Many individuals suffer frequent bowel movements and diarrhea, and are unable to plan their life around the schedule of their gut.

Inflammatory bowel disease (IBD), while similar in pronunciation to IBS, is much more severe, and much more concrete. Inflammatory bowel diseases include Crohn’s disease and ulcerative colitis (UC). Thus, IBD does not represent one condition, but instead is used as an umbrella term for any disease state that primarily causes inflammation of the digestive tract.

Crohn’s disease results in inflammation through the entire thickness of the digestive lining, and usually presents in cycles, with asymptomatic periods followed by periods of intense pain, fatigue, lack of appetite, and ulcers through the entire length of the digestive tract, from the mouth to the anus. UC is similar, but generally confined to the large intestine (colon) and rectum.

The current “best practices” for treating IBD often entail the use of drugs with names you probably couldn’t pronounce which aim to reduce inflammation by inhibiting certain inflammatory mechanisms in the gut or clearing out recurrent infections.

Although these treatments have been used for some time now, they are still largely ineffective for reducing or eliminating common IBD symptoms, and their toxicity profile is often questioned by patients and physicians alike. For this same reason, medical researchers are seeking therapeutic agents that provide symptomatic relief without severe risks associated with long-term use. According to a review of CBD for inflammatory bowel disease, drugs such as steroids are indicated for use in flare-ups and acute inflammation: these drugs are not intended for intermediate- or long-term use due to the adverse reactions they cause.

Other less common biologic drugs like Adalimumab (Humira) are identical to the antibodies that our own cells (should) have, which mark our native cells so that our immune system knows they’re a friend, not a foe like a germ or virus that needs to be isolated and removed. Humira and other drugs like it inhibit a specific chemical released by the immune system called tumor necrosis factor-alpha (TNF-alpha), and may be successful at treating IBD that is resistant to steroids.

However, because of their inhibition of an important anti-tumor cytokine, these drugs increase the risk that a patient develops blood cancer. Therefore, physicians usually refrain from using these kinds of drugs, which have a very high risk to benefit ratio and can cost hundreds of thousands of dollars.

While pharmaceutical companies are spending billions creating drugs that increase your risk of blood cancer by an order of magnitude, more and more researchers have joined the push to study the effects of cannabinoids as an alternative. Cannabinoids, like CBD, are compounds that act on your endocannabinoid system’s CB1 and CB2 receptors, present in the central nervous system and the immune system, respectively. It is their action on CB2 receptors in gut epithelial cells (part of the immune system that forms all barriers between our body and the outside world) that interests researchers trying to understand the mechanisms by which cannabinoids induce their anti-inflammatory effects against IBS and IBD alike.

Recent research on cannabinoids and their activity in the gut has suggested that they may be useful in the treatment of gastrointestinal dysfunction including infections, chronic inflammation, and problems of intestinal motility. Other studies have linked endocannabinoids (compounds produced within the body that activate cannabinoid receptors) to selective, limited inhibition of various inflammatory cytokines such as interleukins, TNF-alpha, and even nitric oxide, a vasodilator that widens blood vessels to allow blood to flood a region and produce inflammation. This finding infers that if endocannabinoid activation of cannabinoid receptors is our body’s way of inhibiting the immune system and decreasing inflammation, then activating these same receptors with phytocannabinoids (cannabinoids produced in plants, like CBD) might confer the same benefits.

Aside from CBD, other cannabinoids have been subject to research including cannabichromene (CBC) and tetrahydrocannabinol (THC). THC has been noted for its interaction with CB1 receptors in the gut and its protectivity against inflammation and motility issues. Cannabichromene has been noted for its ability to restore normal motility function in the smooth musculature of the gut, and to balance the microbiota that aids in our digestion. Moreover, researchers have also studied whether providing these cannabinoids in combination with each other may increase the anti-inflammatory and other effects through synergistic mechanisms, known as the entourage effect. This is especially of interest in the pairing of CBD and THC for IBS symptoms in animal models.

Finally, other studies have looked at whether providing cannabinoids along with pharmaceutical treatments (glucocorticosteroids, antibiotics, biologics etc.) may help in the ways mentioned above in addition to reducing the risk profile of “conventional” drugs. It is not surprising that some patients have opted out of using traditional pharmaceutical treatments for their IBS symptoms and have instead started a regimen of cannabinoids, both under the recommendation of a doctor and as a form of self-medication. A report on Cannabis use among patients with inflammatory bowel disease states that between one third and one half of individuals suffering from IBS have used cannabis for relief.

While THC is the only cannabinoid that directly activates CB1 receptors, and thus the only cannabinoid which causes the typical signs of cannabis intoxication (euphoria, anxiety, as well as motor, cognitive, and memory impairments), it is the most abundant cannabinoid found in cannabis thanks to selective breeding as a result of prohibition. This explains why the majority of cannabis-based treatments, the vast majority of which include THC, are not commonly recommended by physicians and often do not advance to the clinical stage of testing despite their success in preclinical studies. Hence, CBD and products with no to negligible amounts of THC have been proposed as a solution to this problem.

CBD: is it the solution?

In the early 2000s, an overview of the pharmacological aspects of CBD pointed out that CBD does not have psychoactive effects, and that it instead essentially recalibrates the endocannabinoid system, a system that controls many biological activities, including digestion. CBD has been considered the most promising of all cannabinoids and Cannabis constituents for clinical use due to its considerable therapeutic properties coupled with its lack of any psychotropic effects.

CBD’s efficacy as an anti-inflammatory agent has been traced to its ability to extensively inhibit chemotaxis and proliferation of white blood cells in animal models, as well as to inhibit an enzyme, COX-2, which produces the first signal in the chemical cascade that triggers prostaglandin-mediated inflammation, the most common type of inflammation (the same mechanism as NSAIDs, like Advil and Aleve). White blood cells (neutrophils) are cells of the innate immune system that are mainly responsible for migrating to areas of tissue damage and producing an immune response against potential germs or injury, by releasing the prostaglandins that CBD and NSAIDs inhibit.

The job of a neutrophil also includes calling on the other cells of the immune system to create a complete, effective, and long-lasting response to repair the damaged tissue and protect against future invaders. It does this by releasing cytokines that attract the secondary immune cells (a process known as chemotaxis; literally “movement of a cell toward a chemical”) and increase blood flow to the area of damage. However, an improper response from neutrophils and other immune cells can create a perpetual state of inflammation that does more harm than good.

Even though CBD shows to be a truly revolutionary compound, there is still much research to be done on the long term effects of its usage. In addition, research is needed regarding routes of administration (oral, sublingual, etc.). Dose-response studies must be performed to elucidate at what concentrations CBD is most effective, as it generally follows a bell-shaped curve with neither low or high doses being as effective as a range in the middle that produces the greatest response. This research will advance existing knowledge on the relationship between CBD and digestive disorders, which will ultimately encourage common-sense legislation governing the use of CBD as a therapeutic agent for conditions of many varieties.