It’s no accident that GERD Awareness Week aligns each year with the food-focused celebrations of Thanksgiving. Occasional acid reflux is common and not considered serious, but for the millions of Americans who suffer from the more severe and chronic condition known as gastroesophageal reflux disease (GERD), the copious servings of rich, fatty foods filling dining tables across the country can make for a weekend of regret.
Luckily, in addition to the classic over-the counter antacids and prescription proton pump inhibitors like Prilosec, cannabinoids may help to alleviate, even heal, the uncomfortable symptoms associated with this disease.
What is GERD?
In a 2014 systematic review of the disease, researchers reported that upwards of 28% of the North American population experience the chronic form of heartburn and indigestion known as GERD. By comparison, East Asian populations show estimates of occurrence consistently lower than ten percent.
This gastrointestinal disorder is defined as a condition where acidic stomach content frequently back-flows into the esophagus due to weak or improper lower esophageal sphincter (LES) relaxation causing symptoms of heartburn and regurgitation that can result in chronic complications. This is especially common after the ingestion of highly acidic and greasy foods.
The ECS in the GI Tract
The endocannabinoid system (ECS) is a neurotransmitter network that helps to maintain homeostatic health and wellness throughout the body. The gastrointestinal (GI) tract is no exception.
According to a 2016 review, the abundant distribution of cannabinoid receptors (CB1, CB2) and endocannabinoids (2-AG, AEA) that engage with these receptors in the GI system heavily regulate GI motility (movement), intestinal and gastric acid secretion, as well as the maintenance of delicate esophageal lining. Other endocannabinoid-responsive receptors like TRPV1 (transient receptor potential cation channel subfamily V member 1, aka the capsaicin or vanilloid receptor), PPARα (peroxisome proliferator-activated receptor alpha) and GPR55 (G-protein coupled receptor 55) also play a key role in the actions of cannabinoids in the gut, particularly in relation to inflammatory responses.
A 2017 summary on the role of cannabinoids in esophageal function reported five key results relevant to the suppression of GERD symptoms:
- CB1 agonism mediates antisecretory effects on gastric acid (Adami et al, 2004)
- Implicated in mitigating inflammation and mucosal damage in GERD (Calabrese et al, 2010)
- CB1 activation (via THC) can reduce transient LES relaxations and acid reflux rates in humans (Beaumont et al, 2009)
- Anti-inflammatory effects in esophageal reflux disease (Calabrese et al)
- CB2 receptor downregulates inflammation and associated hypermotility in disease state (Izzo, 2007)
How Can Cannabis Help?
Cannabis has a long history as a traditional therapeutic agent for the treatment of abdominal pain and gut dysfunction. But with so many products on the market in a dizzying array of cannabinoid formulations and ratios, what does the research mean for consumers and what might work best? And for those outside of legal cannabis markets, will hemp-sourced CBD be enough to find relief?
Beyond safe access, the first consideration should always be one of comfort. While a light buzz can ease anxieties around the family dinner table and make for lively conversation when approached responsibly, a ‘high holiday’ may not be everyone’s cup of tea—or slice of pie. For anyone looking to engage the ECS without intoxication, a CBD (cannabidiol) -rich product may do the trick.
Cannabidiol works through peripheral pathways to upregulate natural cannabinoids in the body like Anandamide (AEA) which, in turn, engages CB1 receptors and 2-AG, which interacts with CB2 inflammatory responses. This darling of the burgeoning hemp market also activates the other prevalent cannabinoid-responsive receptors in the GI tract, including: TRPV1 to reduce pain and GPR55 to reduce GI inflammation.
Adding some THC may help increase the ability of CBD to engage more directly with classic cannabinoid receptors like CB1, but individual dosing tolerance must be carefully considered as unwanted outcomes from ‘too much’ of this intoxicating compound can make the effects of the tryptophan in your turkey look mild by comparison.