The endocannabinoid system has been in the limelight recently and people are coming up with all sorts of theories about how this system functions. Most recently, attention has been focused on endocannabinoid deficiency and how it affects some chronic diseases. Is this a myth, or is there scientific evidence that proves this theory? This article explains why endocannabinoid deficiency is central to some disease processes as well as how it can be regulated to improve the outcomes of these diseases.
What is the Endocannabinoid Tone?
The human body operates under certain physiological parameters. When these parameters are in place, we can say that homeostasis has been achieved.
For homeostasis to be achieved, the endocannabinoid system (ECS) may function optimally. The ECS is made up of endocananbinoids, receptors, and metabolic enzymes. The endocannabinoid tone is a description of how well these components are working together to promote homeostasis in the body. The endocannabinoid system helps to sustain the endocannabinoid tone. When there is a deficiency of endocannabinoids, the endocannabinoid tone is compromised.
What is Clinical Endocannabinoid Deficiency (CECD)?
The endocannabinoid system (ECS) regulates vital processes of the body, such as pain sensation, mood, fertility, memory, hunger, sleep, and learning among others. It has also been implicated in chronic diseases such as diabetes and cancer. A deficiency in the ECS will lead to instability in the above processes, which may lead to disease. This is what is referred to as an endocannabinoid deficiency.
The term clinical endocannabinoid deficiency was coined by the great cannabis researcher Ethan Russo. He first presented this theory in 2001 and based his argument on links between the ECS and comorbidities existing in affected patients.
In 2004, this theory was further explored and a few observations were made. First, a deficiency in endocannabinoids is linked to chronic disorders that present with similar clinical features. The cause for the deficiency in endocannabinoids was not apparent, though it was speculated that genetics played a role. Infections and external injuries could also be a contributing factor. Some critics have disputed the validity of this theory. However, Russo revisited this theory in 2016 and found even stronger evidence. He concluded that CECD was linked to migraines, fibromyalgia, irritable bowel syndrome, and other treatment-resistant illnesses.
Endocannabinoid Deficiency and Chronic Illness
Based on Russo’s argument, CECD has been linked to the etiology of fibromyalgia, irritable bowel syndrome (IBS), migraines, and post-traumatic stress disorder (PTSD). Let us look at how these chronic illnesses relate to CECD:
Fibromyalgia is a painful neuropathic condition that has unknown causes. Patients suffering from this condition will experience random pain that is severe and may be spread across many parts of the body. They may also suffer from migraines or IBS.
Fibromyalgia has been linked to the feeling of increased sensitivity to pain (hyperalgesia), Further research has also shown that hyperalgesia is associated with central endocannabinoid deficiency, while yet another study showed that low endocannabinoid levels may also lead to increased sensitivity to pain. This all adds up to the theory that CECD could have a critical role to play in the development of fibromyalgia.
Migraines are severe headaches that are associated with changes in serotonin levels in the body. There are many theories that may explain the role of the ECS in the development of migraines. One of the important theories analyses the relationship between serotonergic receptors and the ECS. A study conducted in 2007 found that the cerebrospinal fluid (CSF) of 15 patients with migraines had deficient amounts of endocannabinoids. This study supports the argument for clinical endocannabinoid deficiency.
Irritable Bowel Syndrome (IBS)
IBS is also known as spastic colon. It presents as painful stomach cramps and is often accompanied by anxiety attacks. It is also associated with symptoms of diarrhea, constipation, and severe abdominal cramps.
IBS and endocannabinoid deficiency theory is based on the Microbiome-Gut-Brain Axis. In simpler terms, the gut has a nervous system that is known as the enteric nervous system. IBS is triggered following hyperalgesia of the enteric system. As mentioned above, hyperalgesia is linked to endocannabinoid deficiency.
The ECS has also been shown to play a significant role in inhibiting the contraction of the large bowels. A deficiency in endocannabinoid levels may lead to spasticity of the colon.
PTSD, motion sickness, multiple sclerosis, clinical depression, and anxiety are among other conditions that have been linked to CECD.
Myth or Reality?
From the research evidence cited above, endocannabinoid deficiency is a reality and is possibly linked to the development or progression of certain chronic illnesses. Current studies have been highly suggestive of the existence of CECD even though the evidence is not sufficient.
As life expectancy around the globe continues to get higher, the burden of chronic diseases becomes greater. Even with the advances in science that we have witnessed in the last fifty years, it is unfortunate that we are yet to find answers for most chronic illnesses. As it is, patients are left to grapple with the overarching consequences of the increasing burden of disease, even as they await a medical miracle.
It seems like the endocannabinoid system may have the answers that we all looking for. But as it is, there not enough evidence to back this claim. Hopefully, in the next few years, there will be larger clinical studies to point us in the right direction.
- NCBI (2016): Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576607/
- Research gate (2004): Clinical endocannabinoid deficiency (CECD): Can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? https://www.researchgate.net/publication/297462110_Clinical_endocannabinoid_deficiency_CECD_Can_this_concept_explain_therapeutic_benefits_of_cannabis_in_migraine_fibromyalgia_irritable_bowel_syndrome_and_other_treatment-resistant_conditions
- NCBI (1998): Hypoactivity of the spinal cannabinoid system results in NMDA-dependent hyperalgesia. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9412521
- NCBI (2007): The endocannabinoid anandamide and 2-arachidonoylglycerol inhibit cholinergic contractility in the human colon. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/17706636
- NCBI (2007): Endocannabinoids in chronic migraine: CSF findings suggest a system failure. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/17119542