Cannabinoids and the Gut Microbiome

If you have been using medical cannabis, you are familiar with the positive psychoactive and physical effects that cannabinoids can provide. You may have also seen symptoms such as nausea and conditions like Crohn’s Disease and Cachexia as eligible diagnoses for medical cannabis.

Surprisingly, there is a strong relationship between cannabinoids and your gut health. Learn how cannabinoids interact with your digestive tract and gut microbiome (good bacteria) and how cannabis may benefit your immune system.

We will also discuss why cannabinoid hyperemesis syndrome symptoms are gastrointestinal-related and the harm that CHS can do to your digestive tract.

Why Are There Cannabinoid Receptors in the Gastrointestinal Tract?

Did you know that as much as 70% of your immune system functioning starts in your digestive tract? There are many different roles that cannabinoids play because the endocannabinoid system actively works with every part of digestion and absorption.

The CB2 receptors are abundant in the gastrointestinal tract. Those receptors are responsible for:

• Regulating motility (pushing food through digestion, absorption, and elimination).
• Moderating inflammation in your digestive tract.
• Regulating appetite (now you know why you get the munchies sometimes).
• Protection of GI Mucosa (mucosa lining of the GI tract).

When you consume medical marijuana, the drug can alter the time it takes for the stomach to empty. It can slow down or speed up digestion and either impede or improve digestion. The esophageal sphincter (a band of muscle that opens the hatch between the esophagus and the stomach) is also reactive to cannabinoids.

Responsible use of cannabis can help reduce problems with digestion. But most importantly, THC increases the variety and abundance of a good bacteria called Akkermansia muciniphila. That bacteria is responsible for fat storage and metabolizing adipose tissue, which helps with healthy weight management.

Some clinical studies have also suggested that major cannabinoids like THC may help improve digestive health by strengthening the gut barrier function. Add that to the list of potential wellness benefits that cannabinoids can provide!

Using Cannabis to Combat Nausea and Problems With Appetite

Some types of diseases can drastically affect the immune system and digestion. Many gastrointestinal problems are caused by excess inflammation. Cannabidiol (another major cannabinoid) is very effective at reducing inflammation in the body.

Most states have qualifying conditions for medical marijuana that include gastrointestinal conditions such as Crohn’s disease and IBS.

A recent survey collected via the Releaf App found that over 96% of individuals who consumed cannabis found it effective at relieving symptoms of nausea. The respondents stated, on average, that cannabis reduced the severity of nausea by 4 points on the visual analogue scale (0-10) one hour after THC consumption.

For patients suffering side effects of cancer or AIDS, cannabis has also shown the ability to stimulate appetite by reducing nausea and vomiting. More research to understand exactly how the endocannabinoid system responds to cannabis as an antinauseant is needed, however.

GI Disorders and Cannabinoid Hyperemesis Syndrome

When you think of a drug overdose adverse event, you may think of the tragic consequences of types of controlled substances that can result in fatalities. Some types of Schedule 1 drugs, like methamphetamines and heroin, can be deadly the first time they are used or in combination with medications, other drugs, or alcohol.

But if you asked someone whether it was possible to overdose on cannabis, they would probably say “no.” Not all overdose scenarios cause a loss of life. In medical science, any substance that you consume has the potential to cause adverse effects. Abnormal changes in your body can be caused by consuming too much of anything, including something as harmless as water.

Just as cannabis may be helpful in reducing symptoms of nausea and vomiting, in cases where the body is exposed to excessive quantities and THC potency, it can also trigger very severe gastrointestinal upset.

People who use high concentrations of cannabis have a higher risk of developing Cannabinoid Hyperemesis Syndrome (CHS). In plain terms, your body decides that it has “had enough” THC and rejects it, similar to a severe allergy.

Unfortunately, once your body’s cannabinoid tolerance has been breached, there is no cure for CHS. They are consuming cannabis after developing CHS results in severe symptoms. For some people, being in a room where cannabis is consumed (while they abstain) can also trigger unpleasant symptoms.

What Are the Symptoms of Cannabinoid Hyperemesis?

When you consume cannabis, it impacts a variety of different functions in your body, from the central nervous system (CNS) to the immune system, where THC can help moderate pain and inflammation. You may also know that there are two different types of cannabinoid receptors, CB1 and CB2, located throughout your body.

What many people don’t know is that your digestive tract has a high volume of cannabinoid receptors as well. The human brain, for example, has the highest number of CB1 receptors. However, the digestive tract, which works as part of the microbiota-gut-brain axis, has a large quantity of CB2 receptors.

This accounts for the symptoms of cannabinoid hyperemesis. There are three phases of cannabinoid hyperemesis:

1. Prodromal Phase

Individuals experience a variety of symptoms, from nausea to occasional vomiting, often in the early part of the day or morning. It may also cause mild to severe abdominal pain and discomfort. The onset of these symptoms can be mistaken for a stomach flu or normal food-related gastrointestinal upset and may be missed as an early warning sign of CHS.

2. Hyperemetic Phase

Stage two of cannabinoid hyperemesis results in severe and persistent vomiting, often several times per day. The abdominal pain can intensify during the hyperemetic phase, and compulsive bathing may occur. The nausea symptoms are so severe that patients may take hot baths or showers, which can be the only thing to provide relief. Often, antinauseants are not effective.

3. Recovery Phase

The only way to address CHS is to abstain from tetrahydrocannabinol (THC). For most people, that means zero cannabis use for the rest of their lives. However, cannabidiol (CBD) may still be an option and can help with some of the nausea, pain, and other associated symptoms of CHS.

What Happens After You Develop CHS?

There is still more research required to understand cannabinoid hyperemesis syndrome. Still, it is understood that at high and sustained potency levels, THC can do severe damage to the gut barrier function, the balance of gut microbiota (gut bacteria), immune cells, and intestinal permeability.

Sustained or untreated CHS can also result in more serious long-term health complications like inflammatory bowel disease and more. Once the body has determined that THC is a threat and unwanted, the brain sends signals through the enteric nervous system (neurotransmitters), which causes very uncomfortable results.

There are other symptoms and health risks that can be caused by CHS, including:

• Muscle spasms or seizures.
• Fatigue and weakness.
• Kidney damage.
• Heart rhythm abnormalities.
• Cerebral edema.

The gastrointestinal disorders that can be caused by cannabinoid hyperemesis syndrome only go away after the individual has stopped absorbing THC. Endocannabinoid signaling (brain-gut axis) becomes very sensitive to the presence of even the smallest amounts of THC.

What Kind of Cannabis May Be Best for Gut Health?

Strains that have a high cannabidiol ratio (CBD) would provide the best potential benefits. That is because, while CBD is non-psychoactive, it is easily absorbed and can help lower inflammation. Most gastrointestinal issues and chronic diseases are related to chronic inflammation.

Cannabis strains that have the highest CBD ratios include:

• Pennywise.
• ACDC.
• Sweet and Sour Widow.
• Suzy Q.
• Painkiller XL.
• Lemon Auto CBD.
• Amnesia Haze.
• Critical Mass.
• Royal Medic.

In terms of cannabis routes or intake methods, the best choices may be edibles or cannabis tinctures. A cannabis tincture (administered correctly) can enter the bloodstream directly within 15-30 minutes. An edible must pass through the digestive tract before the cannabinoids are absorbed, and it can take 90 minutes or more before effects are felt.

Make DocMJ Your Cannabis Healthcare Provider

Whether you have been using cannabis for a long time or you have just received your medical card, you may have questions for medical marijuana doctors. At DocMJ, our friendly physicians spend the time to answer any questions you may have and provide suggestions for strains, potencies, and intake methods that can help you reach your wellness goals.

Schedule your appointment today with America’s leading cannabis healthcare providers and develop an effective treatment plan that gives you the relief you need.

Dr. Jack Rothman

Dr. Rothman is a diplomate of the American Board of Obstetrics and Gynecology.  He has received multiple special awards and recognitions, including Physician of the Year, from the Pinellas County Medical Association (2014 – 2015) and the President’s Service Award from the Pinellas County Medical Society.

He attended medical school at State University of New York Upstate Medical Center in Syracuse, New York, where he also completed his Obstetrics and Gynecology residency. In addition to practicing medicine, Dr. Rothman’s professional career includes being an Assistant Professor at the University of South Florida and Clinical Instructor at the University of Tampa’s College of Nursing.

Dr. Rothman received his Florida Medical Marijuana Physicians Certification in 2016 and was one of the first recommending physicians through DocMJ in the state and is loved by many of those early patients today.