Can CBD improve gut health?
Michael is a 15 year old high school student who came to my office with his parents. When he was just four 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 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 marijuana, lists of recommended varieties and dispensaries or recipes for pot- brownies. The sources of information and mis-information 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? Why do you run to the bathroom before speaking in front of an audience? These are clear examples of how your gut responds to stress. There is a gut-brain connection that links the nervous system to the gastrointestinal system.
There are two competing components to your nervous system: the sympathetic and parasympathetic system. The sympathetic system is the fight or flight response. This system kicks into gear when you have to perform public speaking, meet a deadline, or when you're exercising. The sympathetic system causes your pupils to dilate, heart rate increases, blood pressure rise, and sweat. The parasympathetic system helps you digest your food, sleep, dream, relax. These days, many of us stressed out people are living in a perpetual state of a fight or flight. 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, or ECS, is a system that modulates and interfaces with all of the other systems throughout your body. It regulates physical functions, such as movement, pain sensation, and immune responses, and cognitive or mental capacities, like perception, mood, and memory. The ECS naturally produces cannabinoid-like molecules that stimulate the body's cannabinoid receptors. These receptors are in many areas of the body, such as the brain, muscles, fat (adipose tissue), and the GI tract. There is a galaxy of cannabinoid receptors in the digestive system.
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 gastrointestinal 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 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 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 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 the 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 IBD 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 hemp 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.
Aiden is 7 years old. He has special needs and uncontrolled epilepsy. For the last several years, I have been part of the team of health practitioners caring for Aiden. Aiden’s parents, Osiris and Nina found relief for their child with cannabis medicine.
Check out Osiris & Nina's podcast " Love & Cannabis".
Aiden's parents fight to raise awareness, educate the public, and share their journey with raising a son with epilepsy.
Treatment of Seizures with Cannabis Medicine
Documented cannabis use for the treatment of seizures dates back centuries and can be found in Sumerian texts. In the U.S. epilepsy is at an all-time high. During the past decade, we have seen a lot of developments in epilepsy therapy from new devices and new medications and the advancement of dietary therapies, yet despite all of those advances, we still have approximately 30% of people, both children, and adults with epilepsy, whose seizures cannot be fully controlled despite available therapies.
Epilepsies have an extraordinary impact on a patient’s quality of life. Not only does it affect cognitive and behavioral functions, but if uncontrolled, it can lead to permanent disability. Patients lose the ability to work and earn a living. There are two major constituents in medical cannabis, CBD (Cannabidiol) and THC. Cannabidiol is the major, non-psychoactive ingredient or compound. CBD as a treatment option for seizures represents a challenge and a unique opportunity.
In my medical practice patients come to seek my advice after they have exhausted all pharmaceutical options (anti-seizure medications), and even very aggressive treatments – brain surgery, special restrictive diets (ketogenic/paleo-type diets). Patients who come to me have usually tried over a dozen medications that have failed them.
On June 25, 2018, Epidiolex became the first cannabis-derived pharmaceutical approved by the FDA in the U.S. Made from CBD extract, the drug is not psychoactive and has been approved for two rare forms of epilepsy: Lennox-Gastaut syndrome and Dravet syndrome. Dr. Orrin Devinsky, the principal investigator of the study behind Epidiolex, stated that “the CBD binds with a novel receptor in the brain and thereby dampens down too much electrical activity. CBD seems to be a relatively unique mechanism of action that’s not shared by any of the existing seizure medications.” CBD is thought to act on specific brain receptors and likely modulates calcium activity in neurons.
For the last 15 years, I have been treating children and adults who have treatment-resistant epilepsy. I work as a team with their neurologists to help integrate medical cannabis safely. Over 50% of my patients have a reduction in seizures after a trial of various CBD extracts. Many patients report decreased frequency, severity, and duration of the seizures. And interestingly, they report back that where the patient had a seizure before and it would take all day to get over that groggy and “hungover” feeling, the patient feels they can recover faster and feel like themselves again.
CBD can interact with prescription medications, especially current anti-epilepsy medications as well as increase liver enzymes. It is best to consult your specialist and a physician who is experienced in integrative cannabis medicine before you try CBD for seizures. To assess safety and efficacy patients should be continually monitored and re-assessed to develop a personalized care plan tailored to their needs.
Sleep and Seizures: A Complex Interplay
Research shows that there is a significant relationship between sleep and people with epilepsy. Sleep is especially important if you have epilepsy. Most types of seizures are affected by sleep.
If you have epilepsy, lack of good, restorative, sleep makes most people more likely to have seizures. It can even increase the intensity and length of seizures. Some forms of epilepsy are especially prone to sleep problems. Children and young adults with epilepsy require more sleep than adults.
Sleep is crucial to our physical and mental functioning. The most recent research indicates that sleep is essential to all of the body's repair and restore functions. When we are at rest, the body learns what's wrong and physically "relearns" how to contend with the complexities and stressors of everyday life. Restful sleep has been proven to improve memory recall, regulate metabolism, and reduce mental fatigue.
During sleep, the brain reorganizes and recharges itself, and the body removes waste byproducts that have accumulated throughout the day. It's almost as if our dream life represents our struggle to get back to balance.
When people are sleep deprived, they suffer. Their cognitive abilities decline, their behavior, and their judgment becomes erratic. Fatigue makes us more emotional, anxious; more strung out, more on edge.
Anxiety, stress, and chronic sleep deprivation all inhibit GABA, a naturally occurring brain chemical that directs neurons to slow down or stop firing. This neurotransmitter also helps to induce sleep, relax muscles, and calm down. In essence, GABA directs the body to chill out.
Medical cannabis is not a silver bullet. Patients and the medical community need objective and unbiased data on safety and efficacy to endorse cannabis to treat epilepsy. Patients are looking for reliable information, but have few trusted healthcare-provided resources.
Wishing you all the best in health.
Dr. June Chin