By James Brent, DDS
There are numerous references to the quote attributed to Hippocrates, “All disease begins in the gut”. Our postnatal bodies are built from the air we breathe, the water we drink, and the food we eat. Our food influences the body’s hormones, immune system, brain chemistry, microbiome, detoxification and structure. According to Dr. Ethan Russo, endocannabinoid deficiency could be the root of diseases such as irritable bowel syndrome, fibromyalgia, migraine, and other treatment resistance syndromes. 1,2
Many physicians believe that gastrointestinal (GI) insults such as food poisoning, antibiotic use, and some prescription medications may create an ongoing imbalance of microbes in the GI system. It is possible that patients may develop a worsening of physical and psychological symptoms. GI dysbiosis has been associated with anxiety and depression. To put it simply, your body’s rest and digest activity is reduced with stressful situations. As a result, stress is a component of many chronic diseases. Stress in the early stages of life is associated with epigenetic changes leading to GI hypersensitivity. Thus childhood experiences can adversely affect adult health and resilience.3,4
Gut health relies on a complex interplay between diet, gut bacteria (microbiome), and endocannabinoid balance. Interaction between the microbiome-gut-brain axis is highly dependent on the hypothalamic-pituitary-adrenal (HPA) axis. It has been postulated that chronic stress causes down regulation of CB1 receptors and the activation of HPA stress response induces hyperalgesia. The stress response involves not only elevation of the stress hormone cortisol, but also sympathetic nervous stimulation. This causes blood to be redirected from the digestive system to the skeletal muscles. Digestive secretions are reduced to prepare the body to fight or run. The result is impaired digestion. It also occurs when someone is angry or upset, therefore it is better to avoid eating during these times. Targeting the endocannabinoid system (ECS) is a promising strategy to modulate gut motility, pain, and low grade inflammation. 3,4
Stress modulation is dysregulated in irritable bowel syndrome (IBS) patients. There may be a correlation between the endocannabinoid system, stress, and pain associated with the disease. As such, cannabis may benefit those impacted by the disease. From an herbalist perspective, a whole flower extract of cannabis rather than cannabinoid isolates is more advantageous. This is due to the synergetic effects of botanical preparations as opposed to single molecule cannabinoids. 5
A protocol for supplementation with Palmitoylethanolamide (PEA), peppermint oil, CBD, and THC has been suggested as a potential treatment regimen. Endogenous PEA is synthesized in various body fluids and cells in order to maintain homeostasis. PEA is found in extracts of egg yolk, peanut oil, and soybean lecithin. It is said to provide pain relief and neuroprotection, and act as an antidepressant and anti-inflammatory. 5,6
PEA increases CB2 receptor expression. It activates levels of anandamide (one of the body’s own endocannabinoids), by inhibiting FAAH (the enzyme that breaks down cannabinoids). It also potentiates 2AG (another endocannabinoid) and anandamide which activates the TRPV1 receptor located on cells thereby mediating anti-inflammatory and analgesic actions.3 The result is a reduction in pain and inflammation. According to Rosalie De La Foret and other herbalists, peppermint is an herb that can aid digestion, alleviate pain and have a calming effect. 7 The alliance of cannabis, peppermint, and PEA may provide a synergy that has beneficial effects on the digestive system.
The correlation between hypothalamic–pituitary–adrenal (HPA) axis, the gut-brain-axis, and maintenance of Vagal (parasympathetic) tone is worthy of further research. The Vagus nerve is the largest component of the parasympathetic nervous system. This system controls our ability to relax, digest food, and repair our bodies. It sends signals to, and receives information from, every organ in the body.8
Vagal stimulation also decreases inflammation. Habit changes in sleep, diet, exercise and mental relaxation can promote health and reverse disease. The common denominator is their contribution to the Vagal (parasympathetic) tone. According to a meta analysis published in 2018, the global burden of cardiovascular disease, cancer, and chronic obstructive pulmonary disease (COPD) can be reduced by improving the parasympathetic balance of the Vagus nerve. This nerve may also play a role in Parkinson’s disease.8,9
The best way to measure Vagal tone is through heart rate variability (HRV). HRV is a measure of the time between heart beats. A high HRV is a sign of wellbeing and health. A high HRV corresponds to optimal overall physical and mental function. A low HRV indicates decreased function. Heart Math is a solid source of information for increasing HRV. Here are some other ways to also stimulate the Vagus nerve and improve its tone:
- Slow diaphragmatic and nasal breathing
- Massaging behind the ear
- Daily vigorous gargling for 4-6 weeks
- Regular massage or gentle chiropractic or osteopathic manipulation of the neck.
Without parasympathetic tone, someone is in a constant state of stress response. Fortunately, nature can provide the tools to restore this balance. A therapeutic target could be the integration of herbs that heal the digestive tract and modulate stress response at the same time. These herbs have both carminative and nervine effects which can aid in digestion and aid in calming. Some examples are Chamomile (Matricaria chamomilla), Blue Vervain (Verbena officinalis), Hops (Humulus lupulus), and some members of the mint family such as Lemon Balm (Melissa officinalis) and Peppermint (Mentha species).11
CBD (cannabidiol), one of the cannabinoids in cannabis, has been shown to reduce fear and anxiety. It may also aid people in letting go of past traumatic events. This provides a rationale for those suffering from post traumatic stress disorder (PTSD).10 Facing a perceived threat can trigger a stress response, slowing or even stopping digestion. Persistent gastrointestinal problems can also trigger the stress response. Reducing anxiety and fear (resulting from either a real or perceived threat) can lower the body’s stress response and contribute to improved digestion.12
The anxiety reducing effects of cannabis are well established, especially from anecdotal reports by those suffering from PTSD. According to a 2017 study, a majority of patients reported using fewer medications to treat anxiety, migraines, and sleep disturbances after initiating the use of medical cannabis.13 Considering the potential stress reducing effects of cannabis and previously described actions of Peppermint and PEA, supplementing with this combination may provide health restoring benefits.
As stated earlier, digestion requires a relaxed mental state. Other herbs when used in combination with cannabis are more effective when the energetics of the plant and the tissue states of the patient are understood prior to making a recommendation. This is a concept that is part of the Western Herbal Tradition, offered by the herbalist Matthew Wood. According to Wood, body tissues can have six states which affect their function. These tissue states describe the environment surrounding the cells which need to be maintained in an optimum temperature range. This enables them to be supplied with the right nutrients and remove metabolic wastes.14
Any of these suboptimal states can contribute to inflammation. The causes of chronic systemic inflammation include: infections, poor diet, physical inactivity, visceral obesity, intestinal dysbiosis, social isolation, psychological stress, disturbed sleep, and environmental toxins. Herbal medicine may help reverse these abnormal conditions.
Herbalists consider cannabis to be a bitter tasting herb with cooling properties. Bitter herbs are generally stimulating to the digestive system. A cooling herb is one that helps reduce heat, slows the pulse, or reduces metabolism or nervous system activity. This may explain the anti-inflammatory properties of cannabis as well as it acting as a digestive aid.15,16
Herbs are combined in formulas to synergize therapeutic benefit or counter unwanted effects. Cannabis may not be appropriate for a patient that is atrophied, unless it is combined with moistening and nourishing herbs such as mullein (Verbascum thapsus) and milky oats (Avena sativa) to balance its drying effects. It may also need to be balanced with a warming herb for patients that have an under functioning metabolism. Small amounts of cayenne (Capsicum annuum) or ginger (Zingiber officinale) added to a cannabis tincture could improve results. Both cayenne and ginger produce heat and stimulate digestion.17
Someone’s perception of their life situation is important for an improved medical outcome. A healthy lifestyle and environment are priorities in promoting a positive mood. Nutritional supplements, herbs, mind-body therapies, massage and acupuncture can also be effective.18
Adding cannabis to address a patient’s digestive health issues could potentially address a variety of disease states. Supplementing with whole flower extracts of cannabis as well as other herbs and natural substances such as PEA may be beneficial for patients. Those coping with stress may wish to consult with an herbal practitioner to learn how to supplement with cannabis and other herbal remedies for their particular situation. The Society of Cannabis Clinicians Locator Map and the American Herbalist Guild can help patients find practitioners.
When it comes to holistic wellbeing for stress management, cannabis and other herbs may provide a helpful boost when used in combination with mindfulness practices and physical exercise. Since stress is a common way of life for almost everyone, natural approaches seem like a logical arena to explore.
James Brent DDS is an SCC member who practiced dentistry for 43 years. He also studied alternative healing techniques including naturopathy, chiropractic, physical therapy, nutrition, and herbal therapy. Check out his blog for further exploration on these topics and more.
More by James Brent, DDS
- Van Den Elsen LW, Poyntz HC, Weyrich LS, Young W, Forbes‐Blom EE. Embracing the gut microbiota: the new frontier for inflammatory and infectious diseases. Clinical & translational immunology. 2017 Jan;6(1):e125.
- Russo EB. Clinical endocannabinoid deficiency reconsidered: Current research supports the theory in migraine, fibromyalgia, irritable bowel, and other treatment-resistant syndromes. Cannabis and cannabinoid research. 2016 Jul 1;1(1):154-65.
- Brugnatelli V, Turco F, Freo U, Zanette G. Irritable Bowel Syndrome: Manipulating the Endocannabinoid System as First-Line Treatment. Frontiers in neuroscience. 2020 Apr 21;14:371.
- Liu S, Hagiwara SI, Bhargava A. Early‐life adversity, epigenetics, and visceral hypersensitivity. Neurogastroenterology & Motility. 2017 Sep;29(9):e13170.
- Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid‐terpenoid entourage effects. British journal of pharmacology. 2011 Aug;163(7):1344-64.
- Costa B, Comelli F, Bettoni I, Colleoni M, Giagnoni G. The endogenous fatty acid amide, palmitoylethanolamide, has anti-allodynic and anti-hyperalgesic effects in a murine model of neuropathic pain: involvement of CB1, TRPV1 and PPARγ receptors and neurotrophic factors. Pain. 2008 Oct 31;139(3):541-50.
- de la Forêt R, Han E. Wild Remedies: How to Forage Healing Foods and Craft Your Own Herbal Medicine. Hay House; 2020 Apr 7.
- Gidron Y, Deschepper R, De Couck M, Thayer JF, Velkeniers B. The vagus nerve can predict and possibly modulate non-communicable chronic diseases: introducing a neuroimmunological paradigm to public health. Journal of clinical medicine. 2018 Oct;7(10):371.
- Walter U, Tsiberidou P, Kersten M, Storch A, Löhle M. Atrophy of the Vagus nerve in Parkinson’s disease revealed by high-resolution ultrasonography. Frontiers in neurology. 2018 Sep 27;9:805.
- Papagianni EP, Stevenson CW. Cannabinoid regulation of fear and anxiety: an update. Current psychiatry reports. 2019 Jun;21(6):1-0.
- Popham, Sajah. “Vitalist Herbal Practitioner Program”, page 27.
- Stress and and-the-sensitive-gut sensitive gut; Harvard Mental Health, Newsletter Updated August 2019 https://www.health.harvard.edu/newsletter_article/stress-and-the-sensitive-gut
- Kemper KJ, Shannon S. Complementary and alternative medicine therapies to promote healthy moods. Pediatric Clinics of North America. 2007 Dec 1;54(6):901-26.
- Steven Horne; The Six Tissue States, The School of Modern Herbal Medicine (2014) https://modernherbalmedicine.com/articles/the-six-tissue-states.html
- Rebecca Veenstra; Bitter Herbs, Michigan Marijuana News and Information (2015) http://mmmrmag.blogspot.com/2015/11/bitter-herbs-by-rebecca-veenstra.html
- Lisa Ganora; The Action Formula, American Herbalist Guild, 2015 https://www.americanherbalistsguild.com/sites/default/files/the_action_formula_-_ganora_-_ahg_2015_1.pdf
- Papagianni EP, Stevenson CW. Cannabinoid regulation of fear and anxiety: an update. Current psychiatry reports. 2019 Jun;21(6):1-0.
- Furman D, Campisi J, Verdin E, Carrera-Bastos P, Targ S, Franceschi C, Ferrucci L, Gilroy DW, Fasano A, Miller GW, Miller AH. Chronic inflammation in the etiology of disease across the life span. Nature medicine. 2019 Dec;25(12):1822-32.
- Breit S, Kupferberg A, Rogler G, Hasler G. Vagus nerve as modulator of the brain–gut axis in psychiatric and inflammatory disorders. Frontiers in psychiatry. 2018 Mar 13;9:44.
- Schmid K, Schönlebe J, Drexler H, Mueck-Weymann M. The effects of cannabis on heart rate variability and well-being in young men. Pharmacopsychiatry. 2010 Jun;43(04):147-50.
- Bonaz B, Sinniger V, Pellissier S. Vagal tone: effects on sensitivity, motility, and inflammation. Neurogastroenterology & motility. 2016 Apr;28(4):455-62.
- Davidson, Sarah. (2017). Why Microdosing Is Taking Over Medical Marijuana: Interview with Dr. Dustin Sulak. Rolling Stone Magazine. https://www.rollingstone.com/culture/culture-features/why-microdosing-is-taking-over-medical-marijuana-114462/