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Introduction

For hundreds of years, cannabis has been used to control nausea and vomiting caused by a variety of ailments. This has led to a lot of investigations which have revealed a crucial role that cannabinoids, especially cannabidiol (CBD), and their receptors play in regulating nausea and vomiting. With the discovery of the endocannabinoid system, scientists have been able to isolate novel ways to regulate both vomiting and nausea through the production of endogenous cannabinoids that act centrally. In this article, we will look at any relevant studies that involve the use of CBD for nausea and emesis.

A closer look at nausea and vomiting

Nausea can be described as a distinct uneasiness of the stomach that is often experienced before vomiting. Vomiting is the involuntary or forcible voluntary emptying of the contents of the stomach via the mouth. Nausea has many causes, and in many cases, it can be prevented.

The activation of nausea and vomiting is normally handled by a specific part of the brain known as the area postrema of the dorsal vagal complex (DVC). The postrema receives chemical inputs from hormones and medications, and responds to the digestive system by either suppressing or initiating nausea. The postrema is also responsible for handling any conflicts in vision and balance that may be as a result of motion sickness.

What Causes Nausea?

Nausea and vomiting are not illnesses but rather, symptoms to a wide range of conditions and causes. For instance, some people may become nauseated due to motion or after eating certain foods. Some of the medications and medical conditions that can cause nausea include:

  • Heartburn or gastroesophageal reflux disease (GERD)
  • Infections or viruses – food-borne bacteria can cause stomach discomfort through food poisoning. Viral infections in the stomach also cause nausea and vomiting
  • Medications – some medications such as chemotherapy may upset the stomach and cause nausea and vomiting
  • Motion and sea sickness – motion and sea sickness is normally caused by a bumpy vehicle or voyage. The movement can contribute to nausea, dizziness and even vomiting.
  • Diet – certain foods such as high-fat or spicy foods are known to upset the stomach and cause nausea. Allergy to some foods can also lead to nausea.
  • Ulcers – sores, also known as ulcers, in the stomach or the small intestines can lead to a burning sensation in the stomach and then nausea.

Nausea can also be an indication of other medical complications such as:

  • Heart attack
  • Ear infections
  • Meningitis
  • Migraines
  • Benign paroxysmal positional vertigo
  • Liver failure of cancer of the liver

Should I seek medical help for my nausea?

In most instances, nausea can be prevented by avoiding the trigger of the nausea in the first place as we shall see below. Nonetheless, if your nausea is an indication for a more serious condition, you should seek medical attention immediately. These include instances where nausea is accompanied with symptoms of heart attack such as crushing chest pain, migraines, jaw aches, sweating and pain in the left arm.

You should also see a physician immediately if your nausea is combined with migraines, stiff neck, confusion and breathing difficulties. If you suspect that you have eaten or ingested bad food, seek medical help immediately. Lastly, as a general rule, you should see your doctor in case your nausea doesn’t reduce 24 hours after trying over-the-counter treatments.

Preventing Nausea

It turns out that avoiding anything that prompts nausea can be your best defense against the discomfort. These include staying away from:

  • Flickering lights
  • Sea voyages and long trips for people who are highly sensitive to motion
  • Strong odors
  • High heat and humidity

Changing your diet and eating habits can also help your nausea subside. These include eating small but frequent meals and avoiding intensive physical activity after a heavy meal. Changing your medication to better alternatives that cause less nausea may also be an option for some patients suffering from drug-induced nausea.

Current treatments for nausea

Since nausea is not a disease by itself, controlling it is highly dependent on its cause. For example, sitting in front of the car has proven to be an effective way of relieving the nausea caused by motion sickness. Medications such as antihistamine, dramamine or applying a scopolamine patch before traveling may also help with seasickness.

Taking medications that treat the underlying cause of the nausea is also an efficient way of relieving the discomfort. Some examples include taking pain-relieving medication for intense migraines or taking acid-reducing tablets for GERD. Interestingly, staying hydrated by taking frequent sips of water or beverages that contain electrolytes also help minimize nausea.

Unfortunately, nausea, especially anticipatory nausea, still remains a huge problem for many people, especially those undergoing chemotherapy and other medications that induce the discomfort. As such, scientists have been trying to look for even better ways to treat nausea, and that is where cannabidiol shines. As we shall see below, CBD holds great potential as an anti-nausea treatment. Take a look below:

The Endocannabinoid System (ECS) and the use of CBD for Nausea and Emesis

Since the discovery of the endocannabinoid system (ECS), scientists have been able to gather significant proof demonstrating that manipulating the ECS can help in regulating nausea and vomiting in both humans and other animals. More interestingly, recent evidence from animal models now suggests that cannabinoids such as cannabidiol (CBD) and even THC may be especially valuable for treating the much harder to control nausea and anticipatory nausea common in chemotherapy patients. These types of nausea have proven difficult to control by the conventional medicine that is currently available.

The endocannabinoid system is a complex signaling network composed of endogenous ligands known as cannabinoids, their receptors, and other compounds that control a wide array of bodily processes. The cannabinoids are normally produced by the body, on-demand, to interact with receptors in the ECS, that is, CB1 and CB2 receptors. The receptors then activate a chemical response that seeks to achieve homeostasis. Cannabinoids that bind directly to these receptors (CB1 agonists) have been shown to suppress nausea and vomiting effectively while inverse agonists of the CB1 receptors bind and encourage nausea.

As mentioned already, studies have been carried out, and there is proof that supplementing natural cannabinoids in our bodies with plant-based cannabis such as CBD may help suppress symptoms of nausea. The following is a summary of some of these studies:

Studies showing the efficacy of CBD for Nausea and Vomiting Treatment

Animal studies

Even though mice cannot vomit, they exhibit a distinct and observable conditioned gaping response (nausea) after being re-exposed to nauseating cues coupled with treatment. One study found that cannabinoid agonists, THC and FAAH inhibitor, suppress nausea in rats as well as vomiting in other emetic species. They also found that the main non-psychoactive compound in cannabis, cannabidiol (CBD) also suppresses nausea and emesis within a specific dosage. In this study, the scientists noted that anti-emetic/anti-nausea effects portrayed by CBD may be caused by the indirect activation of somatodendritic 5-HT(1A) receptors which reduce the release of 5-HT in terminal forebrain sections. The authors concluded that cannabinoids, especially CBD, may form an effective treatment for controlling both nausea and vomiting caused by medications such as chemotherapy without inducing any psychoactivity or adverse effects.

Meanwhile, another investigation led scientists to evaluate the ability of a slightly different cannabinoid called cannabidiolic acid (CBDA) to inhibit nausea and vomiting. They also tested its ability to enhance the activation of 5-HT(1A) receptors in animal models composed of rats and shrews as has been observed in related studies.

The researchers found out that CBDA was able to reduce both toxin-and- motion-induced nausea and vomiting as well as increase the time it takes for the first motion-induced emetic episode to occur. In rats, CBDA was able to reduce drug-and-context induced conditioned gaping (nausea). The scientists concluded that compared with other cannabinoids, CBDA exhibits distinctively greater efficiency at suppressing nausea and vomiting in rats and shrews. It is also better at enhancing 5-HT(1A) receptor activation, an action that may explain its ability to reduce nausea in rats. This implies that CBDA holds great promise as novel treatment for nausea and vomiting, even for anticipatory nausea which doesn’t have any specific cures as we speak.

Human trials

Despite the success achieved in anti-emetic treatment, many patients still suffer from emesis that’s more difficult to treat such as chemotherapy-induced nausea and vomiting (CINV). With this as the background, another study carried out a pilot, randomized, double-blind, placebo-controlled clinical trial (phase II), to assess the tolerability, efficacy, and pharmacokinetics of an acute dose of a whole-plant cannabis-based treatment (CBM). The CBM was made by combining delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). The medication was taken in together with standard treatments in the control of CINV. The study lasted 120 days.

During the study, nine patients were randomized to take placebo and seven to take CBM. However, one patient in the CBM group withdrew due to adverse effects. The results showed that a bigger proportion (71% or 5/7) of patients in the group that took CBM experienced a complete response during the observation period compared to only22.2% or 2/9 patients who took placebo. No serious adverse effects were reported. The researchers concluded that compared with placebo, CBM taken with standard anti-emetic medication is well-tolerated and provides better regulation against delayed chemotherapy-induced nausea and vomiting.

A similar study set out to determine the effect of combining oral doses of THC and cannabidiolic acid (CBDA) on anticipatory and acute nausea in rat models via intragastric (i.g) administration.

The results showed that for acute nausea, i.g. administration of subthreshold doses of THC or CBDA inhibited acute nausea-induced gaping significantly, higher individual doses of both THC and CBDA were also maximally effective. When combined, i.g. administration of higher doses of THC and CBDA, suppressed contextually elicited conditioned gaping for anticipatory nausea. THC seemed effective on its own at doses ranging from 1-10 mg/kg, however CBDA was effective only at 10 μg/kg. in conclusion, the reseachers noted that i.g. administration of subthreshold doses of THC and CBDA may represent an effective novel treatment for anticipatory and acute nausea as well as appetite enhancement in cancer patients undergoing chemotherapy.

How cannabidiol works in the body to reduce nausea and vomiting

So far, scientists have been grappling with the newly discovered endocannabinoid system in order to understand its full mechanism of action, and what these may mean for our well-being. In a quest to find out how cannabidiol  (CBD) is able to produce its anti-emetic/anti-nausea effects, a group of researchers evaluated its effects in shrews (a type of mole-like creatures). After evaluating the results, the authors concluded that CBD exhibited its anti-emetic/anti-nausea effects by indirectly activating somatodendritic 5-HT(1A) autoreceptors in the dorsal raphe nucleus (DRN).

A different research studied the interaction between cannabidiol and cannabigerol (CBG), another non-psychoactive cannabinoid derived from the cannabis plant. CBD has been reported to act as a 5-HT(1A) agonist while CBG is known to be its antagonist. The researchers evaluated whether CBG could reverse the anti-nausea/anti-emetic effects caused by CBD. The results showed that 5 mg/kg of CBD was able to suppress conditioned gaping (nausea) in rats and vomiting in shrews. As expected, pre-treatment with all doses of CBG was able to reverse these effects. The authors noted that interactions between modest doses of CBG and CBD may act against each other at the 5-HT(1A) receptor in the control of nausea and emesis, hence proving that CBD interacts with the body to reduce nausea and emesis by activating the 5-HT(1A) receptors indirectly.

Conclusion

Nausea and emesis (vomiting) are natural responses that animals have evolved with as a defensive or protective strategy against digestion or ingestion of substances that are potentially harmful. Nonetheless, sometimes these responses, which are controlled by the brain, may manifest as a sign of illness. They will be often observed after taking a wide variety of modern medicine, most commonly in drugs used to treat cancer such as chemotherapy among many other causes. As shown by this introduction, CBD has a true potential in treating even the most difficult types of nausea. 

There is dire need for more systematic studies to establish the exact extent of benefits that can be accrued from CBD with regards to nausea and emesis. 

Below is a full list of the relevant case studies, reviews, research and anecdotal reports concerning the effects of CBD on nausea and emesis. We update the information on this page regularly, so, come back and you will be the first to know in case of any new updates or developments in this field.


Research and Case Studies on the effects of Cannabis to treat Nausea: