By Dr. L Tennant, Ph.D
Irritable Bowel Syndrome (IBS) is an increasingly prevalent health issue in Canada, with over 5 million Canadians affected. It is a chronic, functional bowel disorder characterized by predominant diarrhea (IBS-D types), constipation (IBS-C types) or alternating patterns of both (IBS-M). Patients experience abdominal pain, cramping, bloating, gas and nausea with episodes that can last from days to months. In addition to uncomfortable and sometimes debilitating symptoms, many patients suffer anxiety and depression associated with the syndrome, which is known to exasperate the gastrointestinal symptoms.
Despite significant research efforts, the underlying physiological cause of IBS is not fully understood. Theories include previous GI infection, food poisoning, previous medication, hormonal or neurotransmitter imbalances. More recent research points to visceral sensitivity as the root cause of the painful symptoms associated with the syndrome, due to abnormal endogenous pain processing. In order to manage IBS, patients can be prescribed an array of medications including anti-spasmodic, anti-diarrheal or laxatives, pro-secretory agents (to increase the amount of fluid in the bowels), analgesics and antidepressants (at low doses for diarrhea and cramping, at higher doses for anxiety or depression relating to the disorder).
In lieu of or as an adjunct to these treatment regimens, many patients turn to medical cannabis for symptomatic relief.
Medical cannabis has been used by humans for centuries to alleviate abdominal pain and gastrointestinal dysfunction. The theory is that cannabis products contain active molecules that can interact directly with the receptors of the Endocannabinoid System (ECS), and provide relief by modulating it’s activity. The ECS is made up of families of receptors located throughout the brain and central nervous system of mammals that, through interaction with endogenous, natural or synthetic molecules, control a number of physiological processes including pain sensation, appetite, mood and memory. In the mammalian gut, the ECS produces endocannabinoid compounds “on demand” in order to auto-regulate and restore gut function and this regulation is mediated via the cannabinoid receptors. The cannabinoid molecules found in medical cannabis have been found to act in the same way as the ‘auto-regulatory’ or endogenous molecules and act thorough the same receptors. The most predominant and widely studied receptors of the ECS are CB1 and CB2. CB1 receptors are expressed in the central nervous system and in the enteric nervous system of the gut whereas CB2 receptors are located on peripheral tissues and some types of immune cells.
In the gastrointestinal system, CB1 is involved in a number of important processes that are implicated in IBS including:
Gut motility and transit: Studies in several mammalian species have shown that activation of CB1 receptors slows down gut motility and inhibits muscle contraction transit, and that blocking CB1 receptors has the reverse effect, suggesting a role for cannabinoids with stimulating (agonist) or blocking (antagonist) effects for treatment of motility disorders. Furthermore, in a study of IBS-D patients, drobinol was shown to effectively reduce colonic motility and that this effect is mediated by the CB1 receptor.
Visceral pain relief: Studies in rodents demonstrated that treatment with certain cannabinoids had an analgesic effect on artificially induced visceral pain, again via stimulation of the CB1 receptor.
There is a growing body of data that suggests that subtle fluctuations in the levels of endocannabinoids in the gut are implicated in IBS. Studies in rodent models showed that low levels of endocannabinoids contribute to hyperalgesia and abdominal pain as well as changes in gastrointestinal mobility and that both were improved by increasing levels of endocannabinoids (endogenous or synthetic).
Furthermore, in humans, a study from the University of Calgary in 2013 showed a correlation between pain-related symptoms and the levels of endocannabinoids and endocannabinoid-like fatty acids in the blood of IBS-C and IBS-D patients.
Here at Plants Not Pills, we have received excellent patient feedback from two strains from the Peace Naturals Project. The first is Raphael, a high THC (18.7%) Indica dominant strain which many of our patients claim to be strong and to work well on cramping. This product also provides a little bit of appetite stimulation. Another strain offered by the Peace Naturals Project is Infiniti, which again works on the bloating/cramping feeling and pain that comes with the illness. For more information on either strain, please call the client care team at the Peace Naturals Project at 1-(888) 64-PEACE (73223)
For help with medical cannabis licensing or to sign up for a free medical cannabis consultation, please register on our website using the promo code RELIEF16