The Complete Guide to Medical Cannabis and IBS | cannabisMD

The Complete Guide to Medical Cannabis and IBS

Irritable Bowel Syndrome IBS and Medical Marijuana

Irritable Bowel Syndrome (IBS), a disease that affects the large intestine, is grouped into four kinds depending on the symptoms: IBS-C (IBS with constipation), IBS-D (IBS with diarrhea), IBS-M (both constipation and diarrhea are common), and IBS-U (neither is frequent). They require different treatments, and one treatment that works for someone with IBS-C may not work even for someone else who also has IBS-C, much less someone who has IBS-D. IBS affects anywhere between 7 to 21% of the population and is twice as common in women than men. While IBS is serious, it does not lead to other intestinal diseases such as intestinal cancer, inflammatory bowel disease (IBD), or Crohn’s Disease which is a form of IBD, not IBS.

Because this family of diseases can be difficult to treat, you shouldn’t do it on your own. If you have IBS, you need support from a trained medical professional. With treatment, most cases can be successfully managed. You should see a doctor if any of the following symptoms are present:

  • Nighttime diarrhea
  • Difficulty with swallowing
  • Deficiency of iron (anemia)
  • Persistent change in bowel movements
  • Persistent severe pain or discomfort that passing gas or a bowel movement does not help
  • Bleeding from the rectum
  • Unexplainable vomiting
  • Loss of weight
  • Mucus in the stool
  • Nausea or vomiting
  • Loss of appetite

Obviously, some of these symptoms are present in other diseases and are also symptoms of indigestion, and sometimes IBS overlaps with other diseases like functional dyspepsia. Your doctor’s examination to determine whether you have IBS will not be invasive. It is common for people with IBS to experience emotional stress in addition to physical symptoms, so mental health disorders including major depression, anxiety, and chronic fatigue are commonly present alongside IBS, although they are not part of the disease itself. Although IBS’s cause is not totally clear to researchers and it has no known cure, your doctor can help you to make the symptoms manageable.

IBS with Constipation

IBS-C is characterized by constipation that lasts over three days in addition to other IBS symptoms including intense abdominal pain, stomach aches, cramping, gas, and bloating. A web page published by the National Institute of Diabetes and Digestive and Kidney Diseases, which is a division of the U.S. National Institute of Health (NIH), uses this test to determine whether your IBS is of the IBS-C type: If, on the days when you have an abnormal bowel movement, more than a quarter of your stools are hard or lumpy and fewer than a quarter are loose or watery, then you may have IBS-C. Most people with IBS have days when their bowel movements are normal and days when they are abnormal. So, if you do have IBS and you seem to be having more constipation than diarrhea, you probably have IBS-C.

Because constipation can create a lot of pressure and pain in the lower or upper abdomen, and this pain is often relieved by bowel movements, some people with IBS-C may be tempted to self-medicate by regularly taking laxatives. However, this is not recommended. While laxatives can be used occasionally, they don’t treat other symptoms of the disease, like stomach aches or bloating. According to the IBS Treatment Center, regular use or overuse of laxatives can be harmful to your health and create complications like stretching of the colon. The IBS Treatment Center defines regularity in bowel movements as once per day, while WebMD says you shouldn’t be worried unless you’re going fewer than three times per week.

Effective treatments for constipation will likely involve the following:

  • Dietary changes: Fiber’s stool-softening effects are usually very helpful to people who have IBS-C. When stools are softer, they pass more easily. Unfortunately, if you aren’t paying attention to your diet, you’ll likely receive only a fraction of your daily recommended value of fiber. High-fiber foods include whole grains, beans, vegetables, and fruits. However, if you do discover you aren’t getting the recommended daily value of fiber, be careful not to go overboard and add a lot of fiber all at once. Incorporate fiber into your diet gradually. Here is an IBS-C-specific guide for changing your diet to pinpoint the cause of irritation and get you eating the right foods for you. Finally, it should be mentioned that people with digestive tract issues are often dehydrated, so make sure you’re drinking plenty of water.
  • Fiber Supplements: Sometimes fiber just from food isn’t enough to get it moving. Your doctor may also have you take fiber supplements, also known as bulking agents. Common fiber supplements include calcium polycarbophil (Fibercon), corn fiber, psyllium (Fiberall, Metamucil, Perdiem, and others), and wheat bran. But these do not treat other symptoms of IBS like bloating and gas, so you may have to take something else for non-constipation symptoms.
  • Doctor-recommended laxatives: There are two main kinds of laxatives. Stimulant laxatives get the muscles of the colon to contract and push it all through. Bisacodyl (Correctol, Dulcolax), cascara (a plant), sennosides (Ex-Lax, Senokot), and good old-fashioned castor oil are stimulant laxatives. The other kind of laxative are osmotic laxatives, which pull water back into the colon via osmosis (hence the name). These include the prescription drug Lactulose and the nonprescription drug polyethylene glycol (Miralax). Both stimulant and osmotic laxatives can have side effects, including diarrhea and may or may not be right for you, so ask your doctor.
  • Prescription Medication: Linaclotide (Linzess) is a prescription drug for people who have not gotten relief from other drugs. Lubiprostone (Amitiza) has been shown to treat IBS effectively for some women. Both of these may have the side effect of diarrhea.

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Foods to Avoid with IBS

In all kinds of IBS, balancing the levels of fiber intake will help to control symptoms; too much fiber all at once can cause diarrhea, while not enough fiber can cause constipation. As discussed above, high-fiber foods include beans, whole grains such as flax, vegetables, and fruits, including prunes and prune juice which may be helpful. Foods you may want to avoid because they may exacerbate symptoms include dairy, coffee, and alcohol. Coffee and alcohol tend to dehydrate the body, and dehydration is both a cause of constipation and in extreme cases potentially life-threatening diarrhea. So, if you’re not properly hydrated, you may have all kinds of problems. Like the doctor always says, drink plenty of fluids. An alkaline diet has been suggested as helpful to people with IBS.

Recently, scientists have been exploring the link between digestive health and the endocannabinoid system (EC system or ECS), a system of enzyme receptors found throughout the body that produces compounds similar to those found in the often maligned marijuana plant, Cannabis sativa. In 2014, a review of literature found evidence that clinical endocannabinoid deficiency (CECD) is related to a number of ailments including IBS, migraines, fibromyalgia, and other treatment-resistant diseases. If these diseases are caused by cannabinoid deficiency, then natural cannabis-derived compounds such as delta-tetrahydrocannabinol (THC) and its non-psychoactive counterpart cannabidiol (CBD) may replenish the endocannabinoid levels to treat or cure them. The researchers who present this information advocate for further testing of this evidence, concluding that “[f]urther research and especially, clinical trials will further demonstrate the usefulness of medical cannabis. As legal barriers fall and scientific bias fades this will become more apparent.” Their optimism is surely encouraging for the many people who suffer from these problems as well as for their loved ones and caretakers.

The endocannabinoid system also plays a role in what is known as the brain-gut axis. According to a 2016 paper published in Gastroenterology, the ECS’s role is quite central to the signaling and messaging that controls the gut. The paper points out that genetic problems in cannabinoid receptors are linked to IBS and claims that “[i]ncreasing our understanding of the ECS will greatly advance our knowledge of interactions between the brain and gut and could lead to new treatments for gastrointestinal disorders.” That is, an increase in understanding of the ECS may demonstrate the effectiveness of new cannabis-based treatments for IBS and other gastrointestinal disorders like Crohn’s, IBD, and even cancer.

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IBS Treatment

Above, we have gone through many treatments for IBS-C, but other forms of IBS will require different treatments. For example, laxatives will obviously be ineffective and potentially dangerous if you have IBS-D. The only drug specifically approved for IBS-D is alosetron, but other drugs treat symptoms. These drugs include loperamide, bile acid binders, antidepressants (which show potential analgesic effects), probiotics, and others. Here is a peer-reviewed source on IBS-D pharmacology.

  • Mental Health Treatment for IBS: It is common for people with IBS to feel anxious or depressed. In some cases, these mood disorders can become severe, so seek mental health therapy or counseling if you’re feeling down. Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) have shown promise in this area. Both therapies are designed to give you coping strategies and skills for stress management and dealing with upsetting situations in the moment. These two increasingly popular forms of therapy involve tasks like journaling, grounding (observing immediate experiences of sight, sound, thoughts, etc.), and meditation. DBT borrows somewhat from eastern spirituality, so if you’re open-minded enough to be reading an article about medical marijuana, you may be attracted to DBT.
  • Alternative Treatments: Because IBS is treatment-resistant, it is common for frustrated patients to seek alternative treatments. Peppermint oil, hypnotherapy, and probiotics have shown encouraging results. Acupuncture has shown positive results for some patients but not enough to be considered significant. Cannabis was used in ancient times to treat bowel disorders, and researchers are exploring cannabis and the endocannabinoid system’s role in gut health. We will discuss cannabis in greater detail below.

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Cannabis and Potential Treatment Avenues

According to a 2017 paper published in the European Journal of Gastroenterology and Hepatology, cannabis has been used to treat symptoms such as abdominal pain and diarrhea. The ECS protects tissue in the gastrointestinal tract (GI) and “presents a promising therapeutic target against various GI conditions such as inflammatory bowel disease (especially Crohn’s disease), irritable bowel syndrome, and secretion and motility-related disorders,” and confirms that “the current literature supports the use of marijuana for the treatment of digestive disorders.”

Dr. Ethan Russo, a neurologist and medical scientist, in an interview discussing the health benefits of medical cannabis, specifically mentions IBS and the bowels as a promising target for medical cannabis.

The GI has long been understood as being receptive to cannabis treatments, even in ancient times. In 2016, an article in Neurogastroenterology and Motility detailed how the ECS is linked to the GI and how homeostasis (balance) in one system can help to create balance in the other, going so far as to say “after many anecdotal reports suggested beneficial effects of cannabis in GI disorders, it was not surprising to discover that the GI tract accommodates and expresses all the components of the ECS,” which means there was a demonstrated link between the two systems. Anecdotal evidence of cannabis helping people who suffer from gastrointestinal disorders such as IBS has been supported by scientific findings. A 2010 Pharmacology and Therapeutics article confirms that cannabinoids have therapeutic potential in this area. The U.S. state of Illinois has approved cannabis for IBS treatment. A Dutch company has begun clinical trials, testing whether CBD chewing gum could treat IBS. The field of research into medical cannabis for IBS treatment is indeed ripe and full of possibilities.

Unfortunately, though, not all the news is good. Politically, at least at the federal level, the United States is ignoring the evidence and moving in decidedly the wrong direction on the issue of legal medical marijuana. Attorney General Jeff Sessions has recently said he wants to harshly prosecute medical marijuana distributors and users. If you’ll indulge me in a bit of editorializing, regulatory and law enforcement officials would do well to heed scientists on the issue of medical marijuana laws in both research and treatment. Sessions’ move is absurd and wrongheaded. The scientific evidence cited above shows that cannabis has many medical benefits. Rather than drag us back down into the costly and inhumane drug war that has resulted in the racially biased incarceration of millions of nonviolent offenders, we should focus on researching potential treatments, especially for diseases like IBS that are difficult to treat and discouraging to live with. The compounds in the Cannabis sativa plant belong in our medicine cabinets, not in the same legal category as heroin.

If you’re American, call the U.S. Capitol switchboard to reach your senators and representative to ask them politely but in no unclear terms to change the laws on medical marijuana: (202) 224-3121.

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