How fasting affects medical cannabis patients

One of the more recent re-introductions to the health and wellness movement is fasting, and intermittent fasting in particular (along with cannabis-based treatment).

But fasting is far, far more than a fad diet, a quick weight-loss solution, or even a lifestyle shift. Thanks to its central role in many religious and cultural practices for thousands of years, it is an integral part of many people's lives.

With Ramadan just around the corner (and fasting, in general, becoming so popular), we thought it was a great time to answer a question we hear quite often - which is:

"How does fasting impact medical cannabis treatment and the body’s endocannabinoid system (ECS)?"

How does fasting affect the endocannabinoid system (ECS)?

If the term "The endocannabinoid system (ECS)" is new to you, don't worry - it's relatively new to science, too.

Only first discovered in 1988, the ECS is actually the largest receptor system in the human body and is involved in a somewhat surprising range of neurological and physiological functions, such as pain, mood and stress levels, the immune response, and hunger regulation.

To learn more, feel free to head to "What is the endocannabinoid system?" for a quick and easy-to-understand overview of this vital and fascinating system before continuing on with this article.

Now, to address the question, "What happens to the ECS during a fast?"

That depends on how long you fast, but we do have some general facts that are backed by emerging research.

Fasting seemingly increases endocannabinoid levels

Our bodies produce two endocannabinoids (anandamide and 2-AG) on demand, so to speak. This means that they are produced whenever the body needs them for some physiological or neurological function. They bind to the cannabinoid receptor sites CB1 and CB2, which are found throughout the body but particularly in the brain and immune system.

From an outside perspective, it would seem to make sense that fasting would decrease endocannabinoid production, as the body would be in "survival mode" and need to conserve more energy. Interestingly, the early evidence seems to show the exact opposite.

That said, there is very little in the way of human studies (yet) into the interaction between fasting and endocannabinoid production, but as with most emerging areas of research, animal models are showing us a lot.

When we fast (and especially when we extend our fast for an extended period of time), a study from 2013 involving rats suggests that the "when-needed" endocannabinoid switch flips to the "always on" position and endocannabinoid levels increase significantly. The authors conclude that:

"endocannabinoid levels increase significantly within the hypothalamus and accumbens in response to fasting, returning to normal after refeeding, without changing in brain areas not involved in feeding"

Fasting may enhance ECS-triggered pain relief

We now know that the ECS plays a significant role in how we perceive and process pain. One of the more common reasons for people to legally receive a medical cannabis prescription in the UK is for chronic pain. It can act as a highly effective analgesic with far fewer of the serious side effects relating to pharmaceutical pain relief options, especially opioids.

One study, titled "Involvement of cannabinoid type 1 receptor in fasting-induced analgesia", this time using mice, once again points to fasting having a direct impact on the ECS.

Now, this isn't the easiest study to interpret, but essentially the authors found that fasting appears to enhance pain relief in mice via a CB1 receptor (one of the main sites where the endocannabinoids we produce bind), but it does so in a bit of a round-about way.

When scientists blocked CB1 receptors, the pain-relief effect disappeared, meaning the CB1 receptors were responsible.

But here's the interesting part:

• Blocking the CB1 receptors in the nerves didn’t stop the pain relief.
• Blocking CB1 receptors in the gut did stop the pain relief.

What does that mean?

Well, this is still a theory that needs further confirmation, but it appears that fasting forces our gut to produce more endocannabinoids to signal increasing hunger. These are sent to our central nervous system (our spinal cord and brain), where the CB1 receptors are activated, which in turn reduces pain perception.

Can fasting change how the body absorbs and metabolises cannabis?

Yes, it can. That said, the actual changes are dependent on how you take your prescribed medical cannabis treatment option.

Medical cannabis oil and fasting

For patients prescribed medical cannabis oil, there are a few things to consider. First is how you are actually taking the oil.

Most patients take their medical cannabis oil sublingually, or under the tongue. Taking it this way allows the cannabinoids to enter your bloodstream quickly through the veins found in the tissue under your tongue. Others prefer to mix their oil with food or drink, but doing so means that it needs to pass through the digestive system.

Without getting overly technical, for those taking their oil orally, medical cannabis oil is absorbed slower and less effectively when taken without food or drink. THC and CBD are both fat-soluble compounds, so taking them with food can increase their absorption rate and intensity.

For those who choose to take their oil sublingually, fasting should not have a huge effect on absorption or metabolism, as the cannabinoids are already being absorbed directly into the bloodstream.

Medical cannabis flower and fasting

Medical cannabis flower is always prescribed to be taken through a vaporizer, as smoking medical cannabis is illegal in the UK (there are just far too many health risks associated with smoking).

As with sublingual oil application, vaporising medical cannabis flower means that the cannabinoids are absorbed directly into the bloodstream through the lungs, bypassing the digestive system totally.

Fasting should not have much of an effect on how the body absorbs and metabolises vaporised medical cannabis flower, but there is some clinical evidence suggesting that fasting may actually increase the psychoactive and therapeutic effects of cannabinoids.

Why would fasting make the effects of inhaled medical cannabis potentially stronger?

There are two main theories as to why this could be the case.

• Fasting forces our body to start breaking down fat stores to be used as energy. Cannabinoids, such as THC and CBD, are stored in our body's fat cells. As the fat cells are broken down during fasting, the stored cannabinoids are released back into our bloodstream.
• Lower blood sugar levels caused by fasting may also impact the way our body metabolizes cannabinoids, potentially leading to increased therapeutic effectiveness.

Is medical cannabis use permitted during religious fasting periods such as Ramadan?

We simply don't have enough room on the page to go over all the different religious fasting periods of all religions and different sects, as well as the various ways medical cannabis can be consumed.

But since Ramadan is starting this week, let's have a look at the consensus around medical cannabis application during Ramadan. Most Muslims are required to refrain from taking any food, beverages, or oral drugs, as well as from sexual intercourse, between dawn and sunset.

They are also advised not to smoke in general, but this can vary depending on the personal beliefs of an individual.

To help Muslim leaders and medical professionals navigate these issues, a religious/medical seminar entitled “An Islamic view of certain contemporary medical issues” was held back in 1997. The panel included distinguished Muslim jurists and religion experts, medical practitioners, pharmacologists, and specialists in other human sciences.

They agreed unanimously that the below routes of medical administration do not "break Ramadan fasting": 

• Eye and ear drops
• All substances absorbed into the body through the skin, such as creams, ointments, and medicated plasters
• Insertion into the vagina of pessaries, medical ovules, and vaginal washes
• Injections through the skin, muscle, joints, or veins, except intravenous feeding
• Oxygen and anaesthetic gases
• Nitroglycerin tablets placed under the tongue for the treatment of angina
• Mouthwash, gargle, or oral spray, provided nothing is swallowed into the stomach.

The majority of participants added:

• Nose drops, nose sprays, and inhalers
• Anal injections
• Surgery involving general anaesthesia, if the patient decided to fast.

This begs the question, "Where does medical cannabis inhalation or sublingual administration fall under this list?" 

Based on the consensus of religious and medical experts, it appears that using a vaporiser to inhale medical cannabis during Ramadan would not break any rules regarding fasting during Ramadan. Taking medical cannabis oil either sublingually or orally may.

If you are worried about where you stand with your medical cannabis journey and fasting, it is best to consult with your religious leader and/or medical professional for guidance.

The wrap-up

While most agree that fasting is an extremely healthy addition to any health and wellness journey, it's important to be aware of how fasting may interact with your medical cannabis treatment. It appears that fasting may potentially increase the effectiveness of inhaled medical cannabis but could also reduce the absorption rate and intensity of oral medical cannabis oil application.

For those observing fasting for religious reasons, we strongly advise that you have an open, honest chat with your religious leader. Doing so will not only give you peace of mind but also help your religious leader understand the complexities involved in medical cannabis treatment and potentially help reduce the stigma around medical cannabis.

For those who are not observing a religious fast, adding intermittent fasting into your daily routine could potentially enhance the therapeutic benefits of your medical cannabis treatment, but again, it's important to consult with your prescribing specialist for guidance.

Whether or not you choose to incorporate fasting into your medical cannabis journey is a personal choice, and one that should be made through open communication and maybe a little experimentation to find what works best for your unique health needs.

To find out if you may be potentially suitable for medical cannabis treatment, head over to our fast and free medical cannabis eligibility checker - it takes less than 30 seconds to complete, and you'll find out if you potentially qualify for a medical cannabis prescription in the UK instantly.

Start your journey to better health today with Releaf.