Meds Nausea The Monster

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Why Does Cannabis Work So Well To Combat Nausea?

Cannabis does not actually calm the digestive tract. Instead, this is how it treats nausea.​

People around America more and more are using cannabis as a treatment for nausea, from cancer patients trying to combat the nausea that follows chemotherapy to expecting mothers trying to keep food down in the months before birth.

As more is discovered about the endocannabinoid system, scientists are coming closer to pinpointing exactly why cannabis helps to reduce nausea.

Nausea is a necessary function of the body, used primarily to alert the body that something it ate might be poisonous or rotten and should be avoided now and in the future, or that the body is experiencing an illness or imbalance and needs treatment or rest. For example, dehydration can trigger nausea because the body is trying to send a signal that it’s unbalanced and needs more water.

But there are other factors, like motion or certain medications, that will also increase the signals being sent to the brain from the rest of the body, many of which the brain interprets as nausea.

Cannabis, when used to treat nausea, is not itself calming the digestive tract but rather controlling and reducing the signals that are being sent to the brain by certain receptors in the endocannabinoid system. This is the system in the body that responds to cannabis, regulating different things including appetite, memory and nausea. CBD and THC target different receptors in that system, to differing results.

Chemotherapy, for example, can trigger some receptors to send a signal to the brain that tells the body it is nauseous. Cannabis, when it interacts with the CB1 receptor in the endocannabinoid system, can reduce some of the signals CB1 receptors in the digestive tract send to the brain. Reducing those signals, in turn, reduces nausea and vomiting.

Synthetic CBD, in the form of the medicines Nabilone and Dronabinol, has been used to treat nausea for the last twenty years. Both products are approved by the FDA.

 

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Managing Nausea With Cannabis: What You Need To Know

Laura was a physician who spent much of her clinical time treating substance abuse disorders, and she had no recent experience with cannabis herself. Her aversion to using cannabis when she was going through chemotherapy for breast cancer did not surprise me. Nausea, and the anxiety that preceded its inevitable occurrence, were disabling. I trained with Laura in family medicine, and I had appreciated the beneficial effects of cannabis used by my cancer patients, but it was hard getting Laura to accept my advice.

Finally, I introduced her to a calibrated vaporizer – a method of administration that could provide quick relief, but was different than the ‘smoke a joint out behind the barn’ approach she had imagined. She started with a CBD-rich herb that had a ratio of 2:1 CBD:THC, hoping that the resulting intoxication would be mild enough to tolerate.

I received a call from Laura three days after her latest chemo, and quickly answered it to see if her trial of cannabis had been helpful to her. At first, I was concerned because she was crying into the phone, but when I could understand her words I was thrilled. She reported, “It worked faster, better, and more completely than any of the prescriptions my oncologist gave me.”


If even reading about nausea and vomiting will make you queasy, you may want to jump to the end of this article and skip the potentially nauseating details. Nausea is like that – easy to feel if you are so inclined.

Nausea and vomiting are each distinctive, different problems – clearly related, but quite different when it comes to cause and treatment. Those who suffer know that nausea is worse to live with than vomiting because it is a continuous sensation, and is harder to control.

What Is Nausea?​

Nausea and vomiting are protective defense mechanisms in the human body, and short-term episodes can be therapeutic, though miserable. But what if nausea is not short-term? What if it is an unavoidable side effect, or chronic, with no relief in sight?

If there is no clear trigger for nausea, a patient should work with their doctor to discover the underlying problem. This is true especially if the nausea does not resolve within a day or two because that may be a sign of more serious problems.


Possible Causes of Nausea:

• Migraine
• Head injury
• Seizures
• Ear disorders, including infections
• Motion sickness
• Gastrointestinal disorders
• Appendicitis
• Hepatitis
• Pancreatitis
• Bacterial or viral infections
• Medications–chemotherapy and others
• Toxins – arsenic, pesticides, ricin
• Pregnancy
• Heart attack
• Pain
• Psychiatric or emotional disorders

How Does Nausea Work?​

What is happening in the body when we get nauseated? The brain, the GI system, and the nervous system all have a part in this. We know more about the physiology of vomiting than we do about nausea, so we have better available therapies for its relief.

One key to controlling symptoms seems to be receptors in parts of the brain and in the GI tract that produce and bind with serotonin, a neurotransmitter. Zofran, a well-known anti-emetic (anti-vomiting) medication, works by blocking the nauseating effects of serotonin release.

Cannabinoids To Manage Nausea​

The non-intoxicating cannabinoid CBD interacts with serotonin releasing receptors, and when given in relatively small doses has been shown to help alleviate both nausea and vomiting. CBD can also be effective in easing anxiety, which can help patients manage the angst of chronic nausea.

THC also works well for many as an anti-nausea cannabinoid. When THC binds to the CB1 receptors in specific parts of the brain, it acts to reduce vomiting. The potentially uplifting side effects of THC can also be therapeutic in this case if not too intense. Creating a more positive state of mind is helpful for anyone going through chemotherapy, or for anyone experiencing difficult-to-treat, chronic nausea.

CBDA, the acidic, raw form of CBD, is even more active at the serotonin receptors, and preclinical (animal) studies indicate that CBDA is a potent anti-emetic, stronger than either CBD or THC. CBDA is the form of CBD that exists in the growing CBD-rich plant, before the plant has been dried or heated. With heating, CBDAbecomes CBD, just like THCA decarboxylates to become THC. Currently, the best source of CBDA would be juice from fresh, high-CBD plants, but in the future dispensaries may be able to offer CBDA products for patients with need.

Nausea Related To Cancer Treatment​

State of mind during chemotherapy can include the “nocebo effect” – negative expectations of treatment – that leads to anticipatory nausea. Just the thought of inevitable side effects can be overwhelming. This is especially true if the first round of chemo is not treated effectively. Prescription antiemetics are not helpful for anticipatory nausea, but cannabis shows promise. Prof. Linda Parker, a behavioral neuroscientist at the University of Guelph in Ontario, Canada, has found that several phytocannabinoids including THC, CBD, and CBDA alleviate anticipatory nausea in conditioned lab animals. Clinical trials on humans are needed.

Where To Start​

For patients who have nausea caused by chemotherapy, radiation, or other identifiable reasons, cannabis can provide relief. THC, CBD, and CBDA all show promise in research labs and have already proven themselves in the homes of patients who have experience. Whole plant medicine is more effective than any isolated cannabinoid, but which cannabinoid profile should you start with if this is your goal?

That depends somewhat on your experience with the medicine. If you have never tried this before, it might be best to start with a CBD-rich medicine that still has some THC in the mix, like Laura did. As you get used to the medicine, you can increase the amount of THC as needed. And if you have access to the non-intoxicating CBDA, that would be a very good one to include.

The use of cannabis for nausea, and for vomiting due to chemotherapy or radiation, is accepted by many physicians who do not otherwise recommend cannabis. It is effective, well-tolerated, and while we may not understand all the mechanisms of action we do know it works. Patients should know where their medicine is grown and prepared, and use only lab analyzed cannabis that is free of contaminants. With quality medicine, the chances of relieving nausea may be a single dose away, just like it was for Laura.

 

[Vitolo]