By Dr. Erica Roberson, a Gastroenterologist at MNGI Digestive Health
Why IBS matters. And marijuana, for that matter
Fact 1: IBS is common! Approximately 25-45 million Americans have IBS.
Fact 2: 24 states have now legalized marijuana, including Minnesota in 2023.
Up to 40% of visits to gastroenterologists are for IBS. That means we – GI doctors – are always looking for ways we can help folks suffering from IBS. And patients are always looking for alternative non-medical (non-pharmacologic, that is) ways to manage their IBS. Sometimes that means meditation, elimination diets, or even hypnotherapy. And sometimes it that means herbal supplements such as marijuana. So, the question arises: can marijuana help IBS symptoms?
Of course…It’s never simple.
IBS, or irritable bowel syndrome, is a disorder of abdominal pain or discomfort and a bowel symptom. Some people with IBS have constipation, while others have diarrhea, and others have both! Bloating is common as well.
When thinking about treatments for IBS, we need to think about the physiology of IBS. Because then we can understand what treatments might work, and what treatments might not. Simply put, IBS is a disorder of the gut-brain axis – that is, the nerves in the gut interact with the nerves in the brain excessively. This may cause pain or discomfort. But that’s not all. Often, the motility of the intestine can be too fast…or toooo slowwww. And not to make things complicated, but those buggers in your gut (aka the microbiome), your immune system, and stress response (hello, cortisol!) can all play a role. And of course, we don’t want to forget about nutrition and food intolerances.
Have we put you to sleep yet?
And what about marijuana?
The term marijuana refers to the plant, less commonly known as Cannabis sativa. Usually, folks mean the plant used for smoking, vaping, or edibles. Importantly, there are several active ingredients in marijuana, also called cannabinoids. You have probably heard of several: THC (tetrahydrocannabinol) and CBD (cannabidiol). In the body, these molecules target receptors, a type of protein present in cells in the brain, nervous system, and – you guessed it – the gastrointestinal tract. Through these receptors, cannabinoids can trigger certain basic functions of the intestine, including motility, barrier integrity, secretion, and immune response. Thus, cannabinoids can – theoretically – have an effect on the gut. This could, again theoretically, result in decreased abdominal pain and diarrhea in patients with IBS. This is all based on lab data, not on studies including humans.
Theories aside: Does marijuana actually work to decrease pain and diarrhea in IBS?
Unfortunately, studies so far have NOT shown that THC or CBD decreases IBS symptoms. That means, the lab data did not translate into any clinically significant improvement in IBS symptoms, including pain. Additionally, there are potentially significant psychoactive side effects.
But the story doesn’t end there.
Other cannabinoids (besides THC and CBD) that target cannabinoid receptors in the intestine but not the brain are being investigated – these have the advantage of avoiding psychoactive side effects. And there is some promising data in humans. One such cannabinoid, called palmitoylethanolamide or polydatin, was effective in reducing pain in a small study of patients with IBS compared to a placebo. Olorinab is another cannabinoid that has also been shown to reduce abdominal pain in a small trial.
So what is the bottom line?
Marijuana is not effective in reducing pain or improving bowel patterns in IBS. Additionally, marijuana has some significant potential side effects. But stay tuned, as medications that target the cannabinoid receptors in the gut but not the brain are on the horizon.
So what do I do about my IBS symptoms if I don’t want to take medications?
Some general lifestyle recommendations have been shown to improve IBS symptoms. And some of these are quite simple!
- Limit caffeine
- Limite alcohol
- Improve physical activity
- Make sure to eat regular meals
- Adequate hydration.
Additionally, fiber plays a significant role in IBS. Specifically, increasing SOLUBLE fiber (psyllium, partially hydrolyzed guar gum)while decreasing insoluble fiber (bran) in the diet or in supplemental form.
What if I want to manage my IBS through my diet?
A low FODMAP diet has been shown to reduce symptoms of IBS. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These fermentable molecules are poorly absorbed and can cause pain, bloating, gas, and diarrhea. Eating a diet low in FODMAPs reduces symptoms of IBS, especially in those with diarrhea. MNGI has dieticians who can help you implement a low FODMAP diet to determine which of these molecules triggers your IBS symptoms. But this is not an easy elimination diet! MNGI has dieticians that can help you on your low FODMAP journey!
What other non-pharmacologic options work for IBS?
Behavioral-based therapies, specifically cognitive behavioral therapy (CBT), have been shown in more than 30 studies to improve symptoms of IBS. CBT helps to retrain that gut-brain connection so the gut sends fewer signals to the brain, which reduces symptoms of IBS.
Gut-directed hypnotherapy is another option – it uses guided imagery to retrain the gut-brain connection. More than 11 studies have demonstrated that hypnotherapy works to reduce IBS symptoms.
And lest we forget…..
There are pharmacologic options to help target symptoms of IBS. Your friendly gastroenterologist can help guide you through the options.
Let’s wrap this up!
IBS is common. If you have IBS, there are non-pharmacologic and pharmacologic options for you! Right now, marijuana is not the answer for your IBS – and can have potential side effects! But stay tuned – medications that target cannabinoid receptors in the gut are on the horizon.
Disclaimer: This blog post is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
