Last Updated: 24 November 2022

CBD For IBS – Does It Help Diarrhea, Constipation & Gut Health?

Researched & Written By:
CBD, short for “Cannabidiol,” is a plant compound from the Cannabis Sativa plant. Its popularity has grown recently, fueled by its therapeutic potential, popular health claims (many yet to be validated), and low risk of abuse. S With such a spotlight, it’s not surprising that folks in the IBS community have caught wind of CBD, which is reflected by up-trending google search queries for its use in treating IBS. All of this search engine hype piqued our interest in this common but not-so-well-understood plant compound. Naturally, we had to take a deeper look into what, if any, evidence supported this excitement. And here's what we found.
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Table of Contents

    What Is CBD?

    Cannabidiol (CBD) is a compound – called a phytocannabinoid – found in Cannabis sativa. CBD is just one of the 100+ different phytocannabinoids in Cannabis sativa.

    Phytocannabinoids are cannabinoids found specifically in plants, but there are also cannabinoids found in the body (endocannabinoids) and synthetic cannabinoids that are made in a lab. 1234 In the table below, you can see some examples of them.

    All cannabinoids have chemical similarities to the phytocannabinoids found in the Cannabis plant5(S). 

    3 types of cannabinoids

    Endocannabinoids
    Phytocannabinoids
    Synthetic Cannabinoids
    Found in the brain
    Found in plants
    Made in laboratories
    Examples:
    - Anandamide (AEA)
    - 2-Arachidonylglycerol (2-AG)
    Examples:
    - Cannabidiol (CBD)
    - Tetrahydrocannabinol (THC)
    - Cannabigerol (CBG)
    Examples:
    - Dronabinol
    - Nabilone

    CBD vs THC - what's the difference?

    While we may think of Cannabis sativa as the ‘marijuana’ plant, it’s actually also considered to be the hemp plant. That’s right, hemp and marijuana are the same plant species. What differentiates marijuana from hemp is the phytocannabinoid content.

    CBD oil for IBS
    CBD often comes in oil form, but the 1 study we found on CBD for IBS used chewable gum as the delivery mechanism

    The two main (and most studied) phytocannabinoids in Cannabis sativa are tetrahydrocannabinol (THC) and cannabidiol (CBD).

    Marijuana typically has 20-30% THC, whereas hemp must have less than 0.3% THC (or <0.2% in some countries) to be considered ‘hemp.’1235

    The difference between these plants is important because THC is known for its psychoactive intoxicating effects. In contrast, CBD is non-intoxicating and does not affect motor function.1

    What health issues is CBD currently approved for?

    Even with CBD being non-intoxicating, it is still regulated by the Food and Drug Administration (FDA). 

    In 2018, the FDA approved Epidiolex, a prescription that is 98% CBD, for the treatment of Dravet and Lennox-Gastaut syndromes (two seizure disorders).2

    Although epilepsy is the only FDA-approved diagnosis for using CBD, CBD continues to be studied for a variety of ailments like Alzheimer’s disease, Parkinson’s disease, pain, anxiety, depression, cancer, nausea, inflammatory disease, rheumatoid arthritis, inflammatory bowel disease, and cardiovascular disease.3

    FDA currently approves CBD for treatment of seizure disorders

    Quick Summary

    Does CBD Help With IBS?

    2022 study - IBS patients

    This one study we found on IBS and CBD evaluated 32 women with IBS who were given chewing gum with 50mg of CBD or a placebo. The women could have up to 6 pieces of gum per day and were told to chew each piece for at least 30 minutes.

    The researchers found no statistically significant differences in any of their measured outcomes, like pain reduction and improvement in quality of life.17

    We never want to make recommendations based on 1 study result, so the big takeaway here is that we can’t say if CBD could be helpful for IBS or not because no one really knows.

    Potential reasons why CBD may help IBS

    While we only found 1 study on how CBD may affect IBS, there are quite a few theories on how CBD could be helpful; they just haven’t been tested in humans yet.

    CBD is said to have the potential to aid in inflammation, gut motility, nausea, visceral hypersensitivity, pain, and anxiety18 – all things that play a role in the pathophysiology or symptom management of IBS.  And in the next section, we’ll dive in deep to explore these potential pathways.

    Quick Summary

    IBS, The Endocannabinoid System (ECS) & CBD

    In our article on the causes of IBS, we explained how the pathophysiology of IBS is still unclear and that several different factors contribute to the development of IBS and the presentation of symptoms. Something we didn’t go over in that article, because the research is still very much in its infancy, is the Endocannabinoid System (ECS), which some researchers think may play a role in the pathophysiology of IBS.

    If you haven’t heard of the ECS, it’s because it’s a relatively new concept that was introduced around the 1990s.

    What does ECS do for your body?

    The basic role of the ECS is summarized as maintaining ‘homeostasis’ for relaxation, sleep, eating, memory, and protective mechanisms like immunity. 19What we know about the ECS so far is mostly from in vitro or animal studies, but scientists are still discovering the interworkings of what is being called the ‘endocannabinoidome’ 20and it’s overall role in homeostasis and disease. 
    Endocannabinoid System (ECS) and IBS
    Endocannabinoid System (ECS) is summarized as maintaining ‘homeostasis’ for relaxation, sleep, eating, memory, and protective mechanisms like immunity.

    The 4 parts of the endocannabinoidome

    1. Endocannabinoids: cannabinoids made within the body
    2. Cannabinoid receptors: receptors within the ECS, primarily located in the brain and throughout the nervous system19
    3. Endocannabinoid-like mediators: compounds that can stimulate the cannabinoid receptors but are not cannabinoids
    4. Non-ECS Receptors: receptors outside of the ECS that can be stimulated by cannabinoids

    To give a clearer picture on how parts of the ECS can affect IBS, we’ll just touch on some of the specifics of endocannaboinds and the endocannabinoid receptors.

    Endocannabinoids
    Endocannabinoid
    Function
    N-arachidonoylethanolamine (AEA)
    Controls regular appetite and energy balance
    Maintains immunological health in the gut (S)
    2-arachidonoyl glycerol (2-AG)
    Plays a role in general hunger signal (S)
    Endocannabinoid Receptors
    Receptor
    Functions
    CB1
    Effects large and small bowel muscle tone, inhibits GI motility, inhibits spontaneous ileal contractions, reduces intestinal peristalsis (S)
    CB2
    Decreases inflammation, controls intestinal motility, and slows gut transit. Decreases pain when stimulated. (S)

    How can ECS affect your IBS?

    Now, with some background knowledge on the ECS, we can start discussing some of the theories on how the ECS can affect IBS. The ECS is thought to influence a number of factors involved in IBS like nausea/vomiting, mood, anxiety, inflammation, the gut-brain axis, pain and altered visceral sensations, and even alterations in the microbiome.1921

    One way dysfunction in the ECS may be influencing IBS symptoms is through a condition called, ‘clinical endocannabinioid defiiciency syndrome’ (CEDS). Correcting this deficiency in endocannabinoids could be remedied by a few ways; 19one of those ways is to supplement with external cannabinoids (like THC, CBD, or synthetic cannabinoids). While this is mostly theoretical, THC has shown to inhibit intestinal motility, delay gastric emptying, and decrease gastric secretions by potentially activating CB1 receptors. So for example, if CEDS is causing dysfunction with gut motility, then THC may be able to help relieve it by affecting ECS receptors.22

    CBD may be able to affect the ECS in other ways. In our causes of IBS article we discussed the role of the hypothalamic-pituitary-adrenal (HPA) axis in our body’s response to stress. Dysfunction in the HPA axis is thought to be partially responsible for the development of IBS. 

    Researchers think that the ECS is related to the stress response. During stress, CB1 receptors are down regulated. This, in turn, can activate the HPA stress response and is thought to induce anxiety and visceral pain sensations. It is proposed that CBD may be able to treat hypersensitivity and pain in IBS by affecting the HPA axis; however, there is no real evidence for this quite yet.182223

    An aspect of the gut-brain axis that may affect IBS via the ECS is how dysbiosis and endocannabinoid signaling may influence each other. CB1 has been shown to be involved in dysbiosis-induced intestinal permeability, inflammation, and the modulation of the gut microbiome. Meanwhile, the CB2 receptor may be involved in the visceral pain pathways that are affected by certain probiotics20. This suggests that the ECS is somehow intertwined with the gut-brain axis and microbiome, but it’s still unclear how taking CBD would affect these systems.

    Where CBD is an isolated phytocannabinoid, marijuana contains THC, CBD, and numerous other cannabinoids and plant compounds which may be more useful than a single compound24. Marijuana has shown to be beneficial in managing Inflammatory Bowel Disease (IBD). IBD and IBS may share some common pathways in their development, so the possibility of marijuana being helpful in IBS is being considered–but to be clear: the evidence isn’t even close to being there yet.25

    So, for now, know that there’s excitement around the potential of CBD helping IBS symptoms through its many proposed effects on the ECS. But with that said, we can’t recommend CBD or any other cannabinoids until more research has demonstrated its efficacy. 

    Outside of phytocannabinoids, the ECS is also affected by things like sleep, stress, and diet, to name a few22. So if you’re not quite ready to test out CBD yet, there’s still other ways of affecting your ECS and ultimately your IBS symptoms by means of rest, stress management, and a healthy diet.

    Quick Summary

    Is CBD Legal?

    Federal level

    The legalities of CBD are complicated. First, anything taken from the marijuana plant is considered illegal at the federal level in the United States, as marijuana is still classified as a schedule 1 drug. However, CBD derived from hemp is considered legal as hemp is not a controlled substance. 

    It gets more complicated from here. While hemp-derived CBD is legal at a federal level, when the FDA approved Epidiolex as a seizure medication, it automatically disallowed CBD from being sold as a supplement or food source.26

    State level

    State laws are frequently being updated, but currently seem to be slightly more clear regarding CBD. Below is a picture that indicates where CBD and other cannabis products are legal and the circumstances for their legality. 

    As you can see, 3 states–Idaho, South Dakota, and Nebraska–still do not have any Cannabis sativa access laws, making cannabis-derived products illegal to sell or consume there. For all other states, CBD and other cannabis-derived products are legal under varying circumstances.227

    A map showing where CBD and THC are legal in the USA - Courtesy of NCSL

    Quick Summary

    Is CBD Safe?

    As far as safety goes, CBD seems to be pretty safe. A 2020 systematic review and meta-analysis on adverse effects of CBD found that outside of childhood epilepsy studies, the only major adverse effect for CBD was diarrhea. These studies combined used an average dose of 918 mg/day of CBD. Other possible effects were drowsiness/sluggishness and decreased appetite.28

    Overall, excluding epilepsy studies, dosing for CBD varies across the board. For example, a review article on CBD and anxiety showed CBD being studied in as little as 25 mg/day to up to 900 mg/day. 6This variance in dosing makes it difficult to give specifics on dose-effect responses or dosage strength. With that being said, most commercially available CBD products offer CBD in relatively low doses, generally around 10mg-50mg per mL. In clinical trials, the doses being tested are generally well over 100 mg, with some studies giving doses of over 1000 mg per day.

    Is CBD safe?
    Overall CBD is considered to be fairly safe, with diarrhea being the most common reported adverse effect

    Something to keep in mind if you are considering starting CBD is that it is known to have interactions with other prescription drugs. More adverse effects, such as elevated liver enzymes, have been seen in epilepsy patients on certain medications. So if you are thinking about starting CBD, it is especially important to talk to your doctor about it beforehand.6

    With all of this being said, the FDA has not approved the marketing of CBD as a dietary supplement or food due to the unknowns around long-term safety concerns. 26Likewise, the European Food Safety Authority (EFSA) has not approved CBD as a ‘novel food’ product due to concerns with safety, particularly around reproduction. 7Although clinical trials haven’t shown CBD to cause many adverse effects, neither government institutions are ready to give it the green light for safety.

    Quick Summary

    How To Choose A CBD Product

    When it comes to choosing a product, an article from the Mayo Clinic had a pretty good summary table on what to look for in a supplement:

    1. Does it meet the following quality standards?
      • Current Good Manufacturing Practices (CGMP) certification from the US Food and Drug Administration
      • European Union (EU), Australian (AUS), or Canadian (CFIA) organic certification
      • National Science Foundation (NSF) International certification
    2. Does the company have an independent adverse event reporting program?
    3. Is the product certified organic or eco-farmed?
    4. Have their products been laboratory tested by batch to confirm THC levels <0.3% and no pesticides or heavy metals?2

    This article also noted that importing CBD from Europe may be a good idea considering the unclear regulations in the US, in addition to Europe’s more established regulatory system for hemp and more stringent THC guidelines (<0.2% dry weight). 

    Another thing to be aware of when buying CBD is that there are a few different products that could be confused for CBD: hemp oil, full spectrum phytocannabinoid oils, or broad spectrum cannabinoid oils.

    Hemp oil is made from the seeds of hemp plants, and while they offer omega-3 fatty acids, they don’t contain phytocannabinoids. Full spectrum oils haven’t been studied and generally contain other phytocannabinoids, including THC. Broad spectrum oils don’t contain THC but will contain a variety of cannabinoids other than CBD.

    Quick Summary

    Summary & Verdict

    IBS ebook

    Which Foods Really Trigger Your IBS?

    Discover exactly which foods you should and shouldn’t eat using our IBS Food Journal.

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