What Is Clinical Endocannabinoid Deficiency?

In light of modern research, a nearly 20-year-old theory about the endocannabinoid system is getting new traction. The theory suggests a common underlying component to many common, treatment-resistant pain syndromes such as migraine, IBS, and fibromyalgia. That observation is now being called Clinical Endocannabinoid Deficiency (CED), and is characterized by an imbalance in the amount and state of cannabinoid receptors in a given body. The initial early 2000s studies, spearheaded by Director of Research and Development at the International Cannabis and Cannabinoids Institute, Dr. Ethan Russo, are supported by subsequent decades’ research into cannabinoid treatment for these and other pain syndromes, painting a supportive view of what was formerly anecdotal evidence. Further, researchers are now examining other possible pain-related conditions that may call for a CED classification.

Conditions like migraine, IBS, and fibromyalgia are treatment-resistant because they are highly subjective: there are limited conclusive lab tests to diagnose them, no associated tissue evidence to examine in the body, and a lack of language for patient-doctor dialogue. This all commonly leads to ineffective treatment for those suffering with issues of chronic pain. What is known, however, is that human biology has an endocannabinoid system and an associated endocannabinoid called anandamide, known colloquially as “the bliss molecule,” which is considered to be the body’s natural antidepressant.

But what happens when a person does not product enough endocannabinoids, or their ECS is not being adequately signaled? When not kept in balance, or in a state of homeostasis, any or all of the patterns overseen by the ECS like sleep, mood, and pain processing, can become out of alignment. When it comes to the symptoms of IBS, fibromyalgia, and migraine, successful treatment with cannabis-derived cannabinoids (as opposed to the naturally occurring) has shown enough improvement that researchers are now aligning CED with other disorders with misfiring neurotransmitters: Dopamine in Parkinson’s, Serotonin and norepinephrine in depression, acetylcholine in Alzheimer’s, and Anandamide in CED.

The findings of the early research indicates that supplementing the endocannabinoid system with hemp-derived cannabinoids can be an effective treatment for migraine, IBS, fibromyalgia, and potentially many other clinical conditions. While study of  the three syndromes named here provide the strongest evidence for the link between therapeutic endocannabinoid signaling and cannabis, other conditions being examined for the CED classification include post-traumatic stress syndrome, cystic fibrosis, menstrual pain, and multiple sclerosis. Even though these all are considered treatment-resistant, taking an informed, strategic approach to triggering and balancing your ECS can improve related symptoms. With the caveat that you should always speak with your physician before making drastic changes in your wellness routines, you may notice a ripple effect of improvements once you begin to directly address your diet and exercise patterns, prioritizing getting better rest and gut health, and taking efforts to keep a balanced mood.

McPartland, John M et al. “Care and feeding of the endocannabinoid system: a systematic review of potential clinical interventions that upregulate the endocannabinoid system.” PloS one vol. 9,3 e89566. 12 Mar. 2014, doi:10.1371/journal.pone.0089566

Pisani V, Moschella V, Bari M, Fezza F, Galati S, et al. (2010) Dynamic changes of anandamide in the cerebrospinal fluid of Parkinson's disease patients. Movement Disorders 25: 920–924.

Russo, Ethan B. “Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes.” Cannabis and cannabinoid research vol. 1,1 154-165. 1 Jul. 2016, doi:10.1089/can.2016.0009