Nausea and vomiting go hand in hand. You can’t have nausea without feeling like you’re about to vomit; and you can’t vomit without feeling nauseated.
But they’re different. Nausea is an uncomfortable feeling in the upper stomach accompanied by the urge to vomit; while vomiting is the act of throwing up.
There are many causes of nausea and vomiting – pain, stress and anxiety, problems in the digestive system, problems in the middle and inner ear, and head injuries affecting the lower regions of the brain and the major artery that supplies this area. You should know that the lower region of the brain is where the regulatory centers for nausea and vomiting are located.
Medications, especially those used in chemotherapy, also induce nausea and vomiting because they can stimulate their regulatory centers in the brain as well as irritate the digestive system.
So if you’re undergoing chemotherapy and then having to struggle with nausea and vomiting, then you might also be having problems with anorexia and weight loss.
This is definitely not good if you’re trying to get better.
So how can nausea and vomiting be controlled?
A Common Medication for Nausea and Vomiting
If you’re healthy, you might not experience any side effects from taking nausea and vomiting medications like bismuth subsalicylate (i.e. Pepto-Bismal), so go ahead and take them.
The worst you can experience is some constipation and darkened stools. Or your tongue might appear darker, or you might develop some ringing sounds in your ears.
But don’t worry. These common side effects go away pretty soon once you stop the medication.
Rare but more serious side effects, nonetheless, from this medication include dizziness, headache, confusion, increased anxiety, depression, stomach pain, diarrhea, problems with breathing, slurred speech, thirstiness, profuse sweating, vision problems.
And yes, this medication that aims to control nausea and vomiting can sometimes produce side effects of nausea and vomiting!
Cannabinoids and How They Work to Reduce Nausea and Vomiting
There are two cannabinoids that can help control nausea and vomiting, tetrahydrocannabinol (THC) and cannabidiol (CBD).
Let me tell you a little bit about how they work to stop nausea and vomiting.
THC controls nausea and vomiting[i] by stimulating the CB1 receptors in the brain, especially the CB1 receptors found in the regulatory centers for nausea and vomiting.
Additionally, THC also stimulates the CB1 receptors in the gastrointestinal tract to reduce intestinal motility. Activating this receptor also improves appetite. As you know, recreational marijuana users often consume large amount of food and blame it on the “munchies”.
Well recreation aside, the “munchies” can be a remarkable thing for someone suffering from cancer. Food is not only a medicine but it has a major emotional impact on one’s sense of well being. Many cancer patients rely on cannabis to provide the motivation for them to get food down into their body.
CBD, on the other hand, controls nausea by influencing the serotonin receptors[ii] as well as decreasing the release of serotonin so there’ll be less stimulation of the vomiting center in the brain. CB2 receptor activation may also play a role in preventing nausea and vomiting, but how it does this is not as well-established compared to the role CB1 receptors play in emesis.
Anandamide, an endogenous cannabinoid produced by our body, also stimulates the CB1 receptors[iii] to produce their antiemetic effects. Unfortunately, its action is short-lived since it’s easily degraded by an enzyme. However, CBD has the ability to help anandamide stay longer in the system[iv] by helping prevent its degradation.
You might be wondering then, are THC and CBD safe to use for nausea and vomiting?
Well, according to the McGill University Health Centre who conducted a study on the safety profile of long-term medical cannabis use for chronic pain, herbal cannabis seems to have a safety profile that’s reasonable and well-tolerated[v].
But, of course, there are precautions in using medical cannabis[vi], too, as one study explains and should not be given to vulnerable populations like pregnant women, people with mental illness, adolescents, and people with heart, lungs, and immune system problems.
CBD alone, on the other hand, has a better drug safety profile[vii], is nontoxic, and is very well-tolerated even at high doses.
Which Cannabinoid Works Best for Which Symptom?
Both CBD and THC seem to work well to control nausea and vomiting, but according to the Handbook of Cannabis[viii], written by Roger Pertwee, if you are going to treat nausea alone, Dronabinol (a synthetic THC and approved by the FDA and commonly referred to as Marinol) works best to control mild to even moderately-severe chemotherapy-induced nausea. However, Dronabinol doesn’t seem to work that well in controlling vomiting induced by the stronger chemotherapy drugs.
This synthetic THC can also improve appetite[ix] and help with weight loss problems.
Unfortunately, Dronabinol also has side effects similar to THC. It can produce a “high”, it can cause paranoia, it can trigger mood changes and confusion, and it can increase anxiety.
Plus, Dronabinol can also cause nausea and vomiting, which is frustrating when you think about it because you’re using Dronabinol to control nausea and vomiting in the first place.
And using THC alone to control nausea and vomiting would seem to be counter-productive because of its psychoactive effects.
Lab synthesized, single molecule CBD, while it can also control nausea and vomiting, only does so within a limited dose range[x] as shown in a study. Keep in mind this only goes for single molecule CBD; CBD as part of a full plant extract has a far greater therapeutic window.
Still then what’s the best way to use cannabinoids to control nausea and vomiting?
It would seem that the best way to control these symptoms is to use equal parts of both THC and CBD with the two cannabinoids working synergistically to control nausea and vomiting.
If an equal ratio of THC to CBD results in discomfort from the psychoactivity of the THC, you can try a remedy which contains THC but slightly less THC than CBD. One of CBD’s properties is that it can reduce some of the psychoactivity users experience with THC. Again, this all depends on whether or not the psychoactivity of THC is problematic for you. It may not be but only you know for yourself.
The ideal medicine to use would not be a lab synthesized THC or CBD product but rather a full plant extract which contained both THC and CBD as well as other beneficial components of the cannabis plant. This way the patient will get the most entourage effect.
THC works to activate the CB1 receptors and produce their antiemetic effects and, at the same time, improve appetite; while CBD works to help control THC’s side effects[xi].
Using THC, CBD, and THC/CBD Combinations for Nausea and Vomiting
THC, although it does produce a “high,” is very effective against nausea and vomiting induced by chemotherapy. This study involved 22 patients who were given both oral THC and placebo. When they were given oral THC, 14 of them reported significant improvement in their symptoms; while the placebo gave no antiemetic effects. The study proved that not only can THC reduce chemotherapy-induced nausea and vomiting[xii], but it can also improve appetite as reported by some of the patients. Unfortunately, THC also caused a “high” with other psychoactive effects like mood changes, elation, mild motor problems. In some of the patients, THC elicited fear, paranoia, visual hallucinations, panic attacks, and increased stress and apprehension.
But what if THC and CBD are combined?
Sativex, an oromucosal spray used in the treatment of multiple sclerosis that has a combination of THC and CBD at a ratio of 1:1 per spray[xiii], also works very well to control nausea and vomiting. And it has been proven, too, in a study involving patients suffering from chemotherapy-induced nausea vomiting. In the study, seven of them were given the THC-CBD combination, and nine were given placebo. Five out of the seven patients from the THC-CBD group reported significant improvement in their symptoms, while only two out of the nine patients from the placebo group reported some improvement.
If you’re interested in knowing their dosage and frequency, their mean daily dose were about 5 sprays per day, with each spray containing 1:1 THC to CBD ratio or 2.7mg THC to 2.5mg CBD.
A mom will do anything for her child.
Let me share with you a story[xiv] I read.
Dr. Lester Grinspoon, a Harvard researcher who authored a book entitled “Marihuana Reconsidered,” has a son who is suffering from childhood leukemia. One time at a dinner party, one of his colleagues mentioned that he knew of a patient who used cannabis to control chemotherapy-induced nausea.
He must have told the story to his wife, Betty, because she suggested that they find their son some marijuana. But Dr. Grinspoon would not consider the idea though because it was considered illegal.
Undeterred, Mrs. Grinspoon sought cannabis for her son and found some from one of her son’s friend.
After the next chemotherapy session, Mrs. Grinspoon gave the marijuana to his son.
The effects were very good. The boy was relaxed, in a better mood, and wasn’t suffering from any nausea.
Even Dr. Grinspoon noted the huge difference. He remarked that, without marijuana, his son would have been in bed dealing with nausea and vomiting. But on that day, not only was their son better, but he had an appetite that he even requested to stop and get a sandwich before going home.
Using THC and CBD for Nausea and Vomiting Control is Worth a Try
Nausea and vomiting can be very debilitating, especially in people recovering from cancer and chemotherapy side effects, so if you’re going to use THC and CBD to control these symptoms, you can start with low dosages of equal parts THC and CBD and then slowly titrate the dosage until you find one that works for you.
But if you find you’re sensitive to THC or don’t like its psychoactive effects, remember that medical cannabis is a therapy that you can personalize[xv]. You can try a low-dose THC and a high-dose CBD medicine or equal parts of both for control of nausea and vomiting…it’s all really about what works best for you.
The important thing is for you to find a balanced ratio of THC and CBD that will work for you.
But remember: before you buy THC and CBD products, always check the reputation of the manufacturer/provider. A manufacturer using good practices will be producing a full plant, cannabinoid and terpene rich cannabis oil. You should be able to get in contact with the manufacturer and directly ask them questions. Communication is very important.
A good provider will show you recent lab results of the product to ensure it is free from toxins, mold, and pesticides. After all, this is medicine. The products must be clean and safe for a sick person to use.
It’s always a good idea to read reviews before buying, and while you’re at it, do check the FDA’s site[xvi] for info on some of these providers. Reddit is a good place to start for reading about other peoples’ experiences with specific cannabis products.
[i] Linda A Parker, et al. August 2011.
The National Center for Biotechnology Information, Regulation of nausea and vomiting by cannabinoids.
[ii] Keith A. Sharkey, et al. January 5, 2014.
The National Center for Biotechnology Information, Regulation of nausea and vomiting by cannabinoids and the endocannabinoid system.
[iii] Keith A. Sharkey, et al. January 5, 2014.
The National Center for Biotechnology Information, Regulation of nausea and vomiting by cannabinoids and the endocannabinoid system.
[iv] Matthew W. Elmes, et al. April 3, 2015.
The National Center for Biotechnology Information, Fatty Acid-binding Proteins (FABPs) Are Intracellular Carriers for Δ9-Tetrahydrocannabinol (THC) and Cannabidiol (CBD).
[v] McGill University Health Centre. September 29, 2015.
Science Daily, Multicenter study examines safety of medical cannabis in treatment of chronic pain.
[vi] Jane Sachs, et al. August 13, 2015.
The National Center for Biotechnology Information, Safety and Toxicology of Cannabinoids.
[vii] MM Bergamaschi, et al. September 1, 2011.
The National Center for Biotechnology Information, Safety and side effects of cannabidiol, a Cannabis sativa constituent.
[viii] Roger Pertwee. 2014.
Handbook of Cannabis.
[ix] Cancer.org, Marijuana and Cancer.
[x] EM Rock, et al. February 9, 2007.
The National Center for Biotechnology Information, The effect of cannabidiol and URB597 on conditioned gaping (a model of nausea) elicited by a lithium-paired context in the rat.
[xi] R B Laprairie, et al. October 13, 2015.
The National Center for Biotechnology Information, Cannabidiol is a negative allosteric modulator of the cannabinoid CB1 receptor.
[xii] Stephen E Salan, et al. 1975.
UK Cannabis Internet Activist, The New England Journal of Medicine: Antiemetic effect of Delta-9-Tetrahydrocannabinol in patients receiving Cancer Chemotherapy.
[xiii] Marta Duran, et al. November 2010.
The National Center for Biotechnology Information, Preliminary efficacy and safety of an oromucosal standardized cannabis extract in chemotherapy-induced nausea and vomiting.
[xiv] Gooey Rabinski. October 6, 2015.
MassRoots, Cannabis for Nausea and Vomiting.
[xv] Project CBD. July 13, 2016.
Project CBD, CBD User’s Manual.
[xvi] US Food and Drug Administration, 2016 Warning Letters and Test Results for Cannabidiol-Related Products.