Michael is a 15-year-old high school student who came to my office with his parents. When he was just four-years-old, Michael had a “nervous tummy.” For years doctors thought he was lactose and gluten intolerant. He was fatigued and his body ached constantly. He was embarrassed because of his constant diarrhea and constipation forced him to plan his life around the restroom. After batteries of endoscopies and colonoscopies, he was finally diagnosed with Colitis. In the next few years, Michael tried every medication; anti-inflammatory, steroids, anti-diarrhea, pain meds, and antibiotics.
Nothing stopped his deep, penetrating stomach cramps and bleeding colon. After all conventional therapies failed, his gastroenterologist recommended a bowel resection — removal of his colon. Michael was so frustrated; he began searching online for help. He came across thousands of websites where patients talked about how they cured Colitis or managed their symptoms by smoking pot. Some of these patients had detailed instructions on growing cannabis, lists of recommended strains and dispensaries, or recipes for pot- brownies. The sources of information and misinformation were endless.
Three months ago Michael admitted to his parents that smoking cannabis helped him tremendously with the pain and cramping. Before cannabis, he would wake up five times a night, sitting on the toilet with searing cramps, trying not to wake his parents in the room next door. After only a month of cannabis use, he started sleeping through the night and he noticed that the blood and mucus in his stools lessened significantly. His parents realized that Michael was going to use cannabis with or without their consent, which is when they appeared in my office in search of medical guidance.
I see a lot of Michaels in my practice. According to a cross-sectional study presented at Digestive Disease Week, approximately one-third of patients with inflammatory bowel disease report actively using cannabis, and 45% report using cannabis for the management of their IBD (Irritable Bowel Disorder) related symptoms.
Many others anecdotally report that medical cannabis helps in managing stomach pain, bloating, nausea, and appetite. Unfortunately, due to US federal laws that block medical cannabis research, large studies for the efficacy of cannabis and IBD are lacking. But early studies have shown that cannabis can indeed help people with digestive diseases and few patients with these symptoms have the time or patience to wait for large clinical trials.
The Cannabinoid Connection
Have you ever wondered why you have butterflies in your stomach when you are stressed or why you have to run to the bathroom before speaking in front of an audience? There is a gut-brain connection that links the nervous system to the digestive system and these are clear examples of how your gut responds to stress.
There are two competing components to your nervous system: the sympathetic and parasympathetic system. The sympathetic system is the fight or flight response. It kicks into gear when you have to take the stage, meet a deadline, or when you’re exercising. It makes your pupils dilate, your heart pumps harder, your blood pressure rises, and causes you to sweat. The parasympathetic system helps you digest food, sleep, dream, relax. These days, many of us are living in a perpetual state of sympathetic overdrive. We are overworked, overtired, anxious about the future. This constant stress results in digestive issues such as bloating, irregular bowel movements, reflux, and rapid weight gain/loss. Stress may cause a decrease in blood flow and oxygen to the stomach, which could lead to cramping, inflammation, or an imbalance of gut bacteria.
The endocannabinoid system (ECS) modulates and interfaces with all of the other systems throughout your body. It regulates physical functions, such as movement, pain sensation, immune responses, and cognitive or mental capacities, like perception, mood, and memory. The ECS naturally produces cannabinoid-like molecules that stimulate the body’s endocannabinoid receptors. These receptors are in the brain, muscles, and fat (adipose tissue). There is a galaxy of cannabinoid receptors in the digestive system.
CBD, IBS and COVID
This past April, Michael’s father caught and survived COVID. His father is a healthy, active 57-year-old with no history of any heart or lung disease. However, he does have IBS. His GI disorder is not as serious as his son’s. As an IBS sufferer, he does have to be mindful of what he eats and he knows that stress exacerbates inflammation in his gut that lasts for months.
Luckily, his COVID symptoms were mild and he did not require hospitalization. He quarantined in a spare bedroom and was able to manage the mild fever, fatigue, and body aches with rest and hydration. The majority of his complications were not lung-related, but gut-related. His IBS got considerably worse — diarrhea, abdominal cramping, and bloating.
His symptoms are under-reported but not uncommon. According to the American Journal of Gastroenterology, half of the patients hospitalized for COVID-19 have digestive symptoms and develop gastric problems. In fact, many patients complain about nausea, diarrhea, and stomach pain before they complain about coughing, shortness of breath, and COVID fever.
NOTE: Coronavirus can be detected in the stool. This makes hand washing crucial to prevent fecal/oral transmission. Scrub your hands for at least 20 seconds.
Michael’s father is now fully recovered from COVID, but his digestive system has not returned to normal, even 3 months later. He is managing his IBS with a mix of CBD, probiotics, prebiotics, meditation, and a low FODmap diet that eliminates certain carbohydrates from wheat and beans.
From my vantage point, there is a connection between CBD, IBD, and COVID that deeper research would certainly shine some light on. CBD (cannabidiol) is a potent anti-inflammatory and pain reliever and it may potentially be useful in the treatment of IBS and related gastrointestinal conditions. It appears to reduce inflammation in the digestive tract and help relieve the anxiety and stress linked to GI disorders. CBD and hempseed oil (which is not the same thing as CBD, but which is a rich source of omega fatty acids) are two good ways to reduce inflammation and help an unhappy gut. If you are thinking about integrating CBD for digestive issues, do not stop taking your prescribed medications, talk to your healthcare provider, and try the LowFODmap diet.
Artemis Medical Digest is a journal featuring clinical perspectives from one of the world’s leading cannabis physicians – Dr. Junella Chin extensive and groundbreaking work has been profiled in Forbes, CNN, The New York Times, Cornell University, St. Jude’s Medical Center and more. She is a board member of the American Academy of Cannabinoid Medicine and Artemis’ Chief Medical Advisor.