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The role of the endocannabinoid system (ECS) and cannabinoids in the digestive tract

Date: 09.10.2020

The digestive system is very complex. It is roughly divided into the digestive tract and the organs involved in digestion, such as the pancreas and liver. The food we eat travels through the digestive tract, where vital substances are absorbed that supply the body with energy and nutrients for cell function. The digestive tract begins in the mouth. By chewing and salivating food we prepare it for the passage into the stomach through the esophagus. The stomach secretes stomach acid and other digestive juices, which begin to break down food and prepare it for the process of resorption of active substances in the intestine. In the initial part of the small intestine, digestive enzymes are secreted from the pancreas and bile from the liver, while in the small and large intestine the process of nutrient resorption and the formation of feces from undigested parts of food takes place. Various disease processes can affect the gastrointestinal tract and cause many problems, most common are inflammations, tumors, and autoimmune conditions.

Endocannabinoid system (ECS) is an internal regulatory system consisting of cannabinoid receptors (CB1, CB2, etc.), endocannabinoids produced in the body, and enzymes that form and break down the endocannabinoids. It plays an important role in many processes in the body and affects the functioning of all bodily systems. It affects, for example, brain plasticity, learning and memory, cell death, neuronal development, regulation of stress, feelings and addiction, regulates pain sensation, inflammatory processes, appetite and digestion, energy regulation, sleep cycle, thermogenesis and mobility. As a homeostatic system, it is activated when our balance is challenged, e.g. in physical injury, contact with pathogens, inflammation, or emotional reactions, so we say that the ECS is the governing defense system in our body. When it does not work optimally or in the case of a long-term harmful factor, e.g. stress, inflammation, etc., becomes depleted, this can lead to damage at the cellular level, proceeding to organs and organ systems and lead to various symptoms in acute and chronic diseases.

Cannabinoid receptors are an important component of the enteric nervous system, which is crucial for gastrointestinal function. Through them, ECS participates in regulating the motility of the digestive tract and the secretion of digestive juices. There are several data on the beneficial effect of cannabinoids on abdominal pain, nausea, appetite, peristalsis, and frequency of bowel movements, but research is limited and based on a smaller number of patients. Studies in animal models have shown that cannabinoids have an anti-inflammatory effect in inflammatory bowel diseases and reduce hypermotility and gastrointestinal cramps via the ECS. Several studies have shown a beneficial effect of taking cannabinoids in patients with chronic inflammatory diseases such as Crohn's disease and ulcerative colitis. There are no official results in terms of achieving remission of the disease or cure, but the use of cannabinoids has helped to better control the symptoms, there are fewer exacerbations and complications. In animal models, endocannabinoids and their receptors have been shown to play a role in liver disease, but we do not have adequate clinical studies in patients with liver disease to demonstrate the benefit of cannabinoid therapy.

Phytocannabinoids are substances from plants and are most abundantly found in cannabis. They are similar in action to endocannabinoids, but in clinical practice we use only a few out of more then 140 phytocannabinoids. We mostly use the ones that are researched most thoroughly, e.g. cannabidiol (CBD), delta-9-tetrahydrocannabinol (THC) and cannabigerol (CBG). Due to their action on ECS, (phyto) cannabinoids have become an important factor in the development of drugs and therapies. Non-psychoactive CBD and psychoactive THC stand out in particular. The latter has an analgesic effect, accelerates the healing of wounds in the gastrointestinal tract and increases appetite. CBD has many effects, e.g. anti-inflammatory, antioxidant, neuroprotective, and helps to re-establish a healthy barrier in leaky gut and reduces scarring in the gut during healing.

A healthy lifestyle and a proper diet are also important for gut health. When considering the use of cannabinoids to improve the health of our intestinal tract, potential interactions with other drugs and possible side effects should be considered. Untested cannabinoid preparations can be dangerous and harmful, so the use of cannabinoids should be monitored by health professionals with adequate knowledge on cannabinoids.