If you’ve been getting stuck into the practitioners guide to CBD, then you’ll have an idea about what the endocannabinoid system (ECS) is and what it does.

The reason I bring this up with relation to IBS, is because its a perfect example of how widespread the effects of the ECS are.

As you’ll know very well, there’s imbalances across various functional systems in IBS, which present themselves as a variety of symptoms.

Anxiety, motility disruption like constipation and/or diarrhoea, insomnia and pain are usually the key players.

There’s good reason to believe that all these symptoms are underpinned by dysregulation of the universal conductor of the body – the ECS.

Ethan Russo is one of the most prolific cannabinoid researchers, and he has posited that IBS is a condition which is underpinned, in part by an Endocannabinoid deficiency (Russo 2016).

This makes sense, if you look at the mechanisms by which the ECS operates with relation to IBS:

• Endocannabinoids regulate intestinal inflammation
• Endocannabinoids control intestinal permeability
• There’s cross talk between endocannabinoids and the intestinal microbiome
• Endocannabinoids initiate and sustain sleep
• Endocannabinoids put the brakes on the HPA axis, as part of a negative feedback loop to resolve stress
• Endocannabinoids are involved in pain signalling
• Endocannabinoids regulate GI motility

Surveys of CBD users report significant improvements with relation to IBS (projectCBD.org), which I believe is due to the fact that CBD is a tonic regulator of the ECS.

• CBD has been found to act as both an intestinal anti pro-kinetic (Abalo et al.,2012) and pro-kinetic (Izzo et al.,2009). I suspect that whether CBD acts in one direction or the other depends upon the activity of an individuals own ECS.
• CBD is an antibacterial and antifungal agent (Van Klingeren and Ham 1976), so using it internally could help arrest microbial imbalances such as SIBO and dysbiosis.
• CBD can reduce intestinal permeability, reducing the impact of a leaky gut (Gigli et al. 2017).
• CBD can modulate the HPA axis, and may help resolve stress (Viudez-Martínez et al,, 2018).
• CBD can increase the time spent in deep, restorative REM sleep (when appropriately dosed) (Babson et al., 2017).
• CBD is able to modulate sensitivity to pain

Dosing will be an important consideration with your IBS patients, since the ECS can be tonically regulated and may vary for constipation vs diarrhoea predominant IBS. Use ascending doses and start low, and go slow. Get your clients to use the dose and symptom tracker to find where they’ve had the best results.

References

Abalo, R. et al. (2012) ‘The Gastrointestinal Pharmacology of Cannabinoids: Focus on Motility’, Pharmacology, 90(1–2), pp. 1–10. doi: 10.1159/000339072.

Babson, K. A., Sottile, J. and Morabito, D. (2017) ‘Cannabis, Cannabinoids, and Sleep: a Review of the Literature’, Current Psychiatry Reports. Current Medicine Group LLC 1. doi: 10.1007/s11920-017-0775-9.

Gigli, S. et al. (2017) ‘Cannabidiol restores intestinal barrier dysfunction and inhibits the apoptotic process induced by Clostridium difficile toxin A in Caco-2 cells’, United European Gastroenterology Journal. SAGE Publications Ltd, 5(8), pp. 1108–1115. doi: 10.1177/2050640617698622.

Izzo, A. A. et al. (2009) ‘Non-psychotropic plant cannabinoids: new therapeutic opportunities from an ancient herb’, Trends in Pharmacological Sciences. Elsevier Ltd, pp. 515–527. doi: 10.1016/j.tips.2009.07.006.

van Klingeren, B. and ten Ham, M. (1976) ‘Antibacterial activity of Δ9-tetrahydrocannabinol and cannabidiol’, Antonie van Leeuwenhoek. Kluwer Academic Publishers, 42(1–2), pp. 9–12. doi: 10.1007/BF00399444.

Russo, E. B. (2016) ‘Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes’, Cannabis and Cannabinoid Research. Mary Ann Liebert Inc., pp. 154–165. doi: 10.1089/can.2016.0009.

Viudez-Martínez, A., García-Gutiérrez, M. S. and Manzanares, J. (2018) ‘Cannabidiol regulates the expression of hypothalamus-pituitary-adrenal axis-related genes in response to acute restraint stress.’, Journal of psychopharmacology (Oxford, England), 32(12), pp. 1379–1384. doi: 10.1177/0269881118805495.