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The Body

Got Gut Problems?

Getty/Mariya Nikonova

IBS? Leaky gut? CBD products can help with many digestive ailments.

In most traditional medicine systems, including Chinese traditional medicine and ayurveda, the gastrointestinal system is the star of the show, and when a symptom arises, it is the first thing to treat.

In the past few years, modern research connecting gut health to overall health has finally caught up with what Indian and Chinese medicine doctors have known for over a thousand years.

Years before I started prescribing cannabis, many of my patients were already using it to self-medicate their gut issues. Back before medical cannabis was mainstream, this self-medication was a guessing game, since black market and home-grown cannabis was not tested for THC, CBD, or terpene content (which still remains tricky to test for in big batches). When I started prescribing cannabis, we were able to target the type of product to the symptom, getting impressive results on gut symptoms where drugs had failed miserably on their own. I wasn’t reinventing the wheel, since cannabis for gut issues is one of the oldest recorded uses. I was just rediscovering and honing it for the modern era.

The missing piece of the puzzle for gut-brain health was the discovery that the overarching regulatory system that appears to control the entire gut-brain axis and protect the gut is our endocannabinoid system. The gut is full of cannabinoid receptors, which plant cannabinoids like CBD and THC interact with. The endocannabinoid system functions in the gastrointestinal system are wide-reaching in how they control everything from gut motility (how quickly food moves through the gut) to inflammation and pain.

The current preliminary evidence in the published research supports the idea that cannabinoids can help in a variety of gut illnesses, including IBS, inflammatory bowel diseases such as Crohn’s and ulcerative colitis, chronic nausea, and chronic abdominal pain. Cannabinoids can also help ease gut side effects of chemotherapy drugs in cancer treatment and help reduce the need for other pain drugs such as opioids, which often have severe gut side effects (such as constipation).

Leaky Gut

Leaky gut is an issue where the gut lining starts to become more permeable, or porous, allowing many things that shouldn’t be able to leave the gut into the rest of the body. The cycle of leakiness and inflammation is thought to be fueled by proteins from certain foods, toxins, bacteria, and other material such as inflammatory chemicals and growth factors from the bowel contents entering the rest of the body through the gut wall, gaining access to the blood and lymphatic system and causing immune reactions—setting the scene for a systemic chronic disease state that may manifest as anything from IBS to major depression, brain fog, and chronic fatigue.

According to recent preliminary research by leading brain health researchers Dr. Dale Bredesen and Dr. David Perlmutter, leaky brain, if left untreated, may contribute to the development of brain problems ranging from depression to Alzheimer’s. For this reason, they believe patients with unexplained neurological and mental health symptoms such as major depression should be tested and treated for leaky gut as well. The science of how this works is still in quite an early stage, but I have certainly seen some big shifts in patients over the years who incorporate a gut health approach for symptoms seemingly unrelated to the gut, especially in the mental health realm.

Cannabinoids may play a role in helping reduce leaky gut, inflammation, and gut symptoms. I have found it to be an incredibly useful tool for my patients and clients who are going through a gut healing protocol. So far, there are no large published studies in humans, but in vitro studies have shown that both THC and CBD can reduce leaky gut or intestinal permeability from inflammation. Generally I recommend a high-CBD oil or capsule taken two or three times a day to help with leaky gut.

IBS

The worst thing about getting a diagnosis of IBS is that there are no solutions offered by Western medicine that are effective for most people and have a low side-effect profile. People are often told just to live with it.

I have been treating IBS using an integrative medicine framework for almost a decade and have an entire IBS pro- gram I put patients on. This includes many of the leaky gut methods as well as evidence-based mind-body approaches. In addition, I have found that medical cannabis can alleviate symptoms as part of this more holistic approach. In many cases cannabis can replace the pharmaceutical drugs patients have been put on.

One of the reasons why cannabis works on these symptoms is that IBS may be a form of CEDS, or clinical endo- cannabinoid deficiency syndrome, a concept pioneered by Canadian medical doctor and cannabis medicine researcher Dr. Ethan Russo and others. Recent research has also found that cannabinoids can block gut pain signals, and that a deficiency of cannabinoids (low cannabinoid tone) may contribute to chronic pain syndrome as well as problems with gut motility, which are both seen in IBS. If this is the case, it may help explain why current drug approaches are usually ineffective, since we lack drugs that can rebalance endocannabinoid levels.

For IBS, I generally recommend using a high-CBD oil or capsule by mouth as the mainstay of treatment.

How to Use CBD Wellness Products for Gut Issues and Gut Health Support

CBD on its own has been found to have a profound anti-inflammatory effect, so may be helpful in a number of gut conditions where inflammation is playing a role. Many people who cannot access medical cannabis have reported a reduction in symptoms after using a CBD hemp oil.

Try a full-spectrum or broad-spectrum CBD oil. Look for the anti-inflammatory terpene called beta-caryophyllene. This terpene is also found in black pepper and has a woody/spicy aroma.

Starting doses for gut health and gut symptoms can vary from person to person, but in general try starting with 5–10 mg of CBD two or three times a day with meals for a total of 10–30 mg/day, which is still quite a low dose. I always advise the start low, go slow approach. Gradually increase the dose every few days depending on your symptoms and preference, using a symptom tracker to test how you feel:

What symptoms specifically do you want to track, and is each one improving?

Are there other non-gut symptoms you want to work on, such as stress, anxiety, energy, etc.?

Are symptoms related to eating (worse/better after food)?

You can slowly keep increasing the dose each week until symptoms improve, or just stay at a lower dose as part of a more general gut-health routine. CBD tends to work best when used consistently over weeks and months, not as a one-off rescue remedy. If you reach 60 mg total per day, stay there for another four to six weeks before increasing again, which will avoid increasing the dose unnecessarily and saves money.

For inflammatory pain, higher doses may be needed, especially if you are not adding any THC from a prescription cannabis product and you have gut inflammation as a primary issue.

There is no specific, perfect dose that works for everyone exactly the same. Each person’s endocannabinoid system balance is unique, so self-titration is the name of the game with CBD.