BY KASANDRA BRABAW
If you’ve spent months, maybe even years, dealing with gas, frequent diarrhea or nausea, painful bowel movements, cramps, and abdominal pain, finally gone to see a doctor, you might receive a disappointing diagnosis: You have Irritable Bowel Syndrome (IBS). Sure, it’s great to put a name to how you’ve been feeling, but IBS has no cure.
Unlike Inflammatory Bowel Disease (IBD), which includes Crohn’s Disease and Ulcerative Colitis and is marked by measurable auto-immune changes, IBS isn’t visible. We don’t know what causes it. Some factors that may be involved include: muscle contractions in the intestine, abnormalities in the nerves of your digestive system, inflammation in your intestines, a severe infection, or changes in the bacteria that live in your gut, according to the Mayo Clinic.
Regardless, because the cause is unknown and because IBS presents differently for each patient — some have mostly diarrhea, some mostly bloating, and some mostly pain — treatment differs greatly. Your doctor might put you on an IBS-specific medication, like Eluxadoline, which can ease diarrhea. But their main advice is often to manage your symptoms through stress reduction and changes in your diet and lifestyle.
Yet, as medical marijuana becomes legal in more and more states, many patients are now wondering if cannabis can be an effective part of an IBS treatment plan. Unfortunately, you may be hard-pressed to find a gastroenterologist who will refer you to a medical marijuana doctor. Brian E. Lacy, Ph.D., M.D., FACG, Senior Associate Consultant at Mayo Clinic in Jacksonville, FL, doesn’t suggest his IBS patients use marijuana. “Right now we don’t have any data evaluating the efficacy or safety of medical marijuana for IBS patients,” he says.
That doesn’t mean that cannabis won’t work for someone with IBS, but just that we don’t have any scientific proof that it does, or what dosages or forms of cannabis would be best. And so it’s extremely difficult for doctors like Dr. Lacy to feel comfortable prescribing marijuana.
“We’re not sure which IBS patient might respond. Is it someone with diarrhea or with mostly bloating or with mostly pain? And what levels of symptoms? There are lots of questions to be answered, and they should be answered in a prospective placebo controlled trial, not based on anecdotal experience,” he says.
Still, roughly 15 to 20 percent of his patients ask about using cannabis to treat their IBS symptoms. And when they do, he talks to them about both the potential benefits and the risks. Presumably, cannabis could help ease GI tract pain, he says. We know that our bodies have cannabinoid receptors in both the brain and in the gut. “Thus, there is some biologic plausibility that binding to CB1 receptors might improve abdominal (visceral) pain. But, in whom? What dose? What delivery method? How frequently? No one knows,” Dr. Lacy says.
What we also know is that many patients who have IBS have dyspepsia, which are symptoms in the upper GI tract that feel like fullness and pressure, but also cause nausea and sometimes vomiting. Cannabinoids like THC and CBD might help those symptoms, but doctors have the same dilemma of not knowing the right form or dosage—how much THC versus CBD is helpful? And they also know that THC can delay stomach emptying, which can make nausea and vomiting worse. “So, chronic use can worsen GI symptoms in some patients,” Dr. Lacy says.
Overall, it’s risky to attempt using cannabis to treat IBS symptoms, he says. But, that doesn’t mean you can’t. Many of the states that allow medical marijuana accept both chronic pain and chronic nausea as qualifying conditions, which may apply to some IBS patients.
However, IBD, which shares many of the symptoms of IBS, is often a qualifying condition for medical marijuana. Oliver Park, MD, a doctor in Brooklyn who helps patients get medical marijuana cards, often treats patients who have IBD. The gastrointestinal system has a vast number of receptors that react to both THC and CBD, he says, and both cannabinoids have been shown to decrease symptoms like diarrhea, abdominal pain, and poor appetite.
It would stand to reason that cannabis could do the same for people who have IBS and experience the same symptoms. But, again, IBD and IBS are different—mainly because we know what causes IBD. So it’s wise to talk with your doctors before attempting to self medicate with marijuana. While many doctors like Dr. Lacy may warn against using cannabis for IBS, a medical professional like Dr. Park could help you track how your symptoms react if you’re set on trying.
Typically, Dr. Park starts IBD patients on low doses of THC and CBD, only 5 to 10 milligrams combined. Then, he’ll have the patient slowly take more and record how each dose makes them feel. Regardless of condition, how medical marijuana affects you is highly personal. So it’ll always take some figuring out to see what works best for your body.
Right now, the science hasn’t caught up. And so we don’t really know how IBS reacts to marijuana. “There are so many types of marijuana. No one knows. And is natural better than synthetic? What about cannabidiol that targets just CB receptors (as opposed to marijuana which has THC but lots of other chemicals). No one knows,” Dr. Lacy says. We need large, well-established studies to help answer these critical questions.