NEW YORK (Reuters Health) – Recreational marijuana use is associated with decreased odds of constipation, according to findings from the National Health and Nutrition Examination Survey (NHANES).

The endogenous cannabinoid system in the gastrointestinal tract mediates various physiological bowel activities, which might thus be modulated by cannabinoid compounds from recreational cannabis use. Previous studies of the effects of recreational marijuana use on constipation and diarrhea have yielded conflicting results.

Dr. Kyle Staller of Massachusetts General Hospital and Harvard Medical School, in Boston, and colleagues used NHANES data from 2005 through 2010 on more than 9,600 adults aged 20-59 years to examine the effect of recreational marijuana use on self-reported bowel function (based on the Bristol Stool Form Scale (BSFS) and weekly bowel-movement frequency).

They defined constipation as BSFS type 1 and type 2 or less than three bowel movements per week. Diarrhea was defined as BSFS type 6 and type 7 or more than 21 bowel movements per week.

The frequency of constipation (defined by BSFS criteria) was lowest among recent marijuana users (5.2%), intermediate among past users (6.7%), and highest among never users (8.1%, P=0.02), the researchers report in The American Journal of Gastroenterology.

In multivariate analysis, recent marijuana use was associated with 36% lower odds of constipation and past marijuana use was associated with 17% lower odds of constipation compared with never users, both significant risk reductions.

The association remained significant after adjustment for demographic factors, comorbidities and diet, but there was no longer a difference between past users and never users.

There was no relationship between marijuana use and diarrhea in either univariate or multivariate analyses.

Marijuana use was not associated with constipation or diarrhea as defined by bowel-movement frequency.

“Further studies are needed to identify how use of whole cannabis, different marijuana strains, and frequency of marijuana use exert their apparent effects on constipation,” the authors conclude.

Dr. Raquel Abalo Delgado of Universidad Rey Juan Carlos, in Madrid, who recently reviewed cannabinoid pharmacology and therapy in gut disorders, told Reuters Health by email, “This seems to be in contradiction with the well-known constipating effects of marijuana, its derivatives, and synthetic cannabinoids, particularly those acting upon CB1 receptors. However, these results can be due to different factors, most, if not all, related with the observational design of the study and the relatively little information obtained from the questionnaires.”

“Since use of recreational and medical marijuana (or other cannabinoids) is likely to increase worldwide, it is necessary to clarify its impact on all health issues, including gastrointestinal-tract function, many times overlooked compared with other ‘more vital’ body systems,” she said. “To what extent constipation (and other motility disorders, like hyperemesis) induced by cannabis may be considered aversive by marijuana users and may contribute to reduce heavy marijuana consumption has not been studied.”

“Likewise, the pharmacology of the different compounds present in the plant and how they contribute to the final effect on gut function need to be clearly determined,” said Dr. Abalo, who was not involved in the study.

Dr. Michael Camilleri of Mayo Clinic, in Rochester, Minnesota, who also was not part of the study, recently reviewed cannabinoids and gastrointestinal motility in humans. He told Reuters Health by email, “No definite conclusions should be drawn from these epidemiological studies which constitute useful hypothesis-generating data.”

“Further studies with selective CB1 and CB2 receptor modifying medications should be further explored before any conclusions regarding the potential benefits of marijuana in gastrointestinal diseases,” he said.

Dr. Staller did not respond to a request for comments.

SOURCE: https://bit.ly/2Pxlw00 The American Journal of Gastroenterology, online November 22, 2019.

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