CBD for Irritable Bowel Syndrome (IBS)

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In recent years many people have turned to CBD as a way to treat the pain associated with irritable bowel syndrome (IBS).

Approximately 15% of the populations in developed countries have some form of IBS. In the United States alone, approximately 45 million people suffer from IBS. Out of these, 2 out of 3 are women. The disease is also prevalent in South America and is found less often in Southeast Asia.

Diagnosing IBS

A definitive test for IBS doesn’t exist. Physicians usually use one of the following methods to determine if a person has IBS:

  • Rome IV Criteria – These criteria looks at pain and the changes in stool that a patient may have. The physician investigates any abdominal pain and/or discomfort lasting on average at least one day a week in the last three months, associated with at least two of these factors:
    • Pain and discomfort are related to defecation
    • The frequency of defecation is altered
    • The stool consistency is altered.
  • Manning Criteria – This criteria asks questions of the patient and focuses on the solidity of the stool and pain associated with it. For a diagnosis of IBS, a patient will usually have met 2 to 4 of the following criteria:
    • Diarrhea with mucus more than 25% of the time
    • Looser stools associated with the onset of pain
    • Noticeable abdominal bloating
    • The onset of pain linked to more frequent bowel movements
    • Pain relieved by passage of stool
    • The sensation of incomplete evacuation more than 25% of the time

IBS symptoms can also be a sign of a more serious condition as these symptoms can also present in:

  • Bacterial overgrowth
  • Bile acid malabsorption
  • Carcinoid syndrome
  • Celiac disease
  • Colon cancer
  • Dyssynergic defecation
  • Eosinophilic gastroenteritis
  • Giardiasis
  • Inflammatory bowel disease
  • Microscopic colitis
  • Thyroid disorders

To avoid misdiagnosis, a physician may run tests to see if the patient has other symptoms, especially if the IBS symptoms start presenting after the age of 50. These tests are to find if the patient is experiencing:

  • Abdominal pain, especially if it’s not completely relieved by a bowel movement, or occurs at night
  • Anemia related to low iron
  • Diarrhea that is persistent or awakens the patient from sleep
  • Fever
  • Nausea or recurrent vomiting
  • Rectal bleeding
  • Weight loss

CBD for IBS

CBD, or cannabidiol, is one of 113 known chemical compounds called cannabinoids that are found in the cannabis plant and in many animals including humans.

The CBD works naturally with the body’s endocannabinoid system or ECS. The ECS is comprised of neurotransmitters and neuroreceptors located in the brain, the central nervous system, and the peripheral nervous system and is specifically activated by cannabinoids.

The ECS regulates cognitive and physiological functions such as

  • Appetite
  • Fertility
  • Memory
  • Mood
  • Pain sensation
  • Postnatal development
  • Pregnancy
  • Prenatal development
  • Processing the absorption of cannabinoids

CBD has been found to have several properties that help in healing and maintaining overall health. These properties include:

  • Analgesic
  • Anti-anxiety
  • Antibacterial
  • Antidepressant
  • Antifungal
  • Anti-psychotic
  • Neuroprotective

CBD works with the 2 known cannabinoid receptors the cannabinoid receptor type 1 (CB1) and the cannabinoid receptor type 2 (CB2).

The CB1 receptors are located in throughout the body, but in relation to IBS, they’re found in the brain and in the digestive tract. CBD acts as an antagonist to these receptors, inhibiting the processing of neurotransmitters to allow them to pass through evenly without depleting them rapidly.

Regarding IBS, the CB2 receptors control:

In this case, CBD acts as an agonist binds with CB2 receptors to allow the neurotransmitters to process quickly. This is particularly beneficial when it comes to IBS as CBD can stimulate appetite and sooth pain.

Clinical Studies and Reports

While studies that directly relate to the use of CBD and IBS are lacking, there are several studies that look at the use of cannabinoids, including CBD on intestinal and bowel issues. These studies provide a promising look at the use of CBD for IBS.

One study, conducted in 2017 was to determine the anti-inflammatory effects of CBD and palmitoylethanolamide (PEA) on the colon. For the study, they used patients with “acutely and chronically inflamed colon(s), using inflammatory bowel disease and appendicitis explants.” The results of the study found “PEA and CBD were anti-inflammatory in IBD and appendicitis explants. PEA and CBD are anti-inflammatory in the human colon. Appropriately sized clinical trials should assess their efficacy.” (https://www.ncbi.nlm.nih.gov/pubmed/28954820)

A 2016 study in mice was conducted to see if CBD reduced intestinal inflammation. The study referred to CBD as CBD BDS for cannabidiol botanical drug substance. The study induces colitis “in mice by intracolonic administration of dinitrobenzenesulfonic acid (DNBS). Motility was evaluated in the experimental model of intestinal hypermotility induced by irritant croton oil. CBD BDS or pure CBD were given – either intraperitoneally or by oral gavage – after the inflammatory insult (curative protocol). The amounts of CBD in the colon, brain, and liver after the oral treatments were measured by high-performance liquid chromatography coupled to ion trap-time of flight mass spectrometry. CBD BDS, both when given intraperitoneally and by oral gavage, decreased the extent of the damage (as revealed by the decrease in the colon weight/length ratio and myeloperoxidase activity) in the DNBS model of colitis. It also reduced intestinal hypermotility (at doses lower than those required to affect transit in healthy mice) in the croton oil model of intestinal hypermotility.” The study concluded that “CBD BDS, given after the inflammatory insult, attenuates injury and motility in intestinal models of inflammation. These findings sustain the rationale of combining CBD with other minor Cannabis constituents and support the clinical development of CBD BDS for IBD treatment.” (https://www.ncbi.nlm.nih.gov/pubmed/27757083)

Another study from 2009 looked at the issue of CBD on colitis (inflammation of the colon). In the study, the researchers “investigated the effect of cannabidiol in a murine model of colitis. Colitis was induced in mice by intracolonic administration of dinitrobenzene sulfonic acid. Inflammation was assessed both macroscopically and histologically. In the inflamed colon, cyclooxygenase-2 and inducible nitric oxide synthase (iNOS) were evaluated by Western blot, interleukin-1beta and interleukin-10 by ELISA, and endocannabinoids by isotope dilution liquid chromatography-mass spectrometry.” The study found that “Cannabidiol reduced colon injury, inducible iNOS (but not cyclooxygenase-2) expression, and interleukin-1beta, interleukin-10, and endocannabinoid changes associated with 2,4,6-dinitrobenzene sulfonic acid administration. In Caco-2 cells, cannabidiol reduced reactive oxygen species production and lipid peroxidation. In conclusion, cannabidiol, a likely safe compound, prevents experimental colitis in mice.” (https://www.ncbi.nlm.nih.gov/pubmed/19690824)

Another idea behind the cause of IBS and some other conditions was that the disease was caused by clinical endocannabinoid deficiency (CECD). A preliminary study was done in 2003 and subsequent studies were done and reviewed. A review of these studies found that “subsequent research has confirmed that underlying endocannabinoid deficiencies indeed play a role in migraine, fibromyalgia, irritable bowel syndrome, and a growing list of other medical conditions. Clinical experience is bearing this out. Further 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.” (https://www.ncbi.nlm.nih.gov/pubmed/24977967)

These are just some of the examples of studies done on CBD as a treatment for the bowl and intestinal tract. All signs show that CBD’s anti-inflammatory, analgesic, and neuroprotective properties acted to suppress pain and inflammation.

Although more study is needed, CBD thus far has been found safe and effective for bowel and intestinal issues.

Traditional IBS Treatments

Treatment for IBS includes medication, change in diet, exercise, supplements, and stress reduction. Many homeopathic remedies can also be considered.

Diet is usually the first line of defense for those suffering from IBS. The diet will include drinking plenty of fluids, specifically water, to help with digesting. In addition, the following changes may be recommended:

  • Eliminating foods that can cause gas – This can include carbonated beverages such as soda and beer as well as caffeine, raw fruit, and some cruciferous vegetables such as cauliflower, cabbage, broccoli, Brussels sprouts, and collard greens.
  • Eliminating gluten – By eliminating barley, rye, and wheat, some patients show improvement in diarrhea symptoms.
  • Eliminating a class of foods known as Fermentable Oligo, Di, Mono-saccharides, And Polyols (FODMAPs) – These foods can provide short-term improvement of IBS, but shouldn’t be completely eliminated as they help avert digestive discomfort because they produce beneficial alterations in the gut flora. Many times doctors will totally eliminate these foods initially from a patients diet and add them slowly back one by one to see the effects they have on the patient. These foods can include certain grains, vegetables, fruits, and dairy products.
  • Addition of fiber supplements – Taking an over the counter fiber supplement such as Benefiber, Citrucel, or Metamucil to help with constipation issues related to IBS

In addition to diet, many doctors will prescribe medications to help with IBS. Some of these include:

  • Laxatives – Either over-the-counter or prescription laxatives may be ordered by a doctor. These can be common like Phillips Milk of Magnesia, Ex-Lax, or they can be prescriptions like Linzess or Amitiza.
  • Anti-diarrheal medications – As with laxatives, doctors can recommend over-the-counter medication or prescribe medication. Some over-the-counter option includes Imodium and Pepto Bismol. Some prescription medications that may be ordered are Prevalite or Welchol.
  • Pain medications – Medications for abdominal pain and bloating may be prescribed such as Neurontin or Lyrica.
  • Antidepressants – Some doctors prescribe low dose antidepressants for abdominal pain and issues with constipation and diarrhea. This is more likely if the patient also suffers from depression. Some medications include Paxil, Prozac, Norpramine, and Pamelor.
  • Anticholinergic medications – These medications block the neurotransmitter acetylcholine in the central and the peripheral nervous system. These agents inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells. These are used to stop painful bowel and intestinal spasms. One of the more common anticholinergic medications is Bentyl.
  • Medications specific to IBS – There are some medications that are specifically designed to help with the issues related to IBS. These are:
    • Alosetron – An investigational medication that’s designed to relax the colon and slow the movement of waste through the lower bowel. It is only approved for use by women.
    • Eluxadoline – This medication can ease diarrhea by reducing muscle contractions and fluid secretion in the intestine, and increasing muscle tone in the rectum.
    • Rifaximin – An antibiotic can decrease bacterial overgrowth and diarrhea.
    • Lubiprostone – Limited to only women, this medication can increase fluid secretion to the small intestine to help with the passage of stool.
    • Linaclotide – This medication also can increase fluid secretion in the small intestine to help pass stool. It can be used by men and women.

In addition, other holistic approaches can be taken including:

  • Taking probiotics – Studies have found that adding probiotic foods such as yogurt can relieve some symptoms such as abdominal pain, bloating, and diarrhea. Probiotics add healthy bacteria to help gut flora.
  • Reducing Stress – Yoga, meditation, and for those inclined, prayer can help reduce stress. Stress is one of the factors that may cause IBS.
  • Acupuncture – Treatment in which thin needles are inserted into the body have been found to help improve symptoms for people with IBS.
  • Hypnosis – Being guided to relax by a trained professional teaches may reduce abdominal pain and bloating.
  • Peppermint – A natural antispasmodic that relaxes smooth muscles in the intestines can provide short-term relief of IBS symptoms. Pharmaceutical companies are testing medications that consist of tablets coated in peppermint oil to study the effects.

Conclusion

IBS can be a crippling disease for some that can make life miserable. The stomach pain, the switching from constipation to diarrhea, and the other symptoms can cause some people to shut down.

Because of a lack of testing for the disease, it can be an average of up to 4 years until a person is officially diagnosed with IBS. And when they’re, the treatment can be overwhelming. The prospect of someone having to take an antidepressant for issues with their stomach can be a bit of a turn-off.

CBD could be a way to clear up confusion over the treatment process. With properties that fight inflammation and depression, doctors who view IBS as having a psychological component may be more willing to adopt CBD as an IBS treatment. Especially since the side effects are mild.