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Info on Cannabinoid Hyperemesis Syndrome

paddyod11

New member
I've been researching CHS for several years. I started getting prodromal CHS symptoms after just a few months of smoking .5-1 gram of flower a day. Late at night, and by that I mean early in the morning before I went to bed I'd occasionally get nauseous. Eventually I started to notice that I was getting indigestion, and it started happening more frequently. Then I started to notice the symptoms coming on after I smoked, sooner and sooner until I made the connection and learned about CHS.

This was in mid 2016, and at the time there was no information on the cause of CHS. The only information I could find was from Douglas Curtis. I took his azadirachtin theory seriously and worked on finding some cleanly grown cannabis. It still upset my stomach. Then I read that Doug also had an H. Pylori infection which he treated, as well as eating a bunch of probiotic foods. I decided that Doug didn't have CHS, he just had an infection, and that pesticides had nothing to do with his condition or the CHS he thought he had. I was wrong, and his H. Pylori infection was actually a big clue as to the real cause of CHS.

Now for a few things that I can't verify because I saw them over the years and didn't keep track of them, but there's a common theme among them. In a thread on grasscity, somebody claimed that their CHS symptoms stopped after they removed a bunch of foods from their diet. I saw the same thing in the comments of a NYT article about CHS. In another thread on grasscity somebody with CHS claimed they they went to an allergist and were allergic to lots of things. The allergist told them that when you have food allergies, cannabis makes them worse in some way. They didn't elaborate beyond that. Somebody on reddit said that they had morning sickness after smoking while they were taking zantac, and after they stopped taking zantac it stopped.

Now for something that I can verify but I'm not going to unless somebody really wants me to because I don't want to dig up the thread. In a thread about CHS on a forum called fuckcombustion, somebody claimed to have had pancreatic cancer. They said that smoking made them sick, and after they had the cancerous part of their pancreas removed the problem stopped. Apparently cannabis stimulates your pancreas to release enzymes, maybe the same way it stimulates hunger or just to digest the cannabinoids.

Now we get to the real good information. I saw a post on reddit by u/blackcIoud talking about CHS. He said he'd cured his symptoms by taking a betaine HCl supplement. Betaine HCl is a form of hydrochloride which turns into hydrochloric acid when ingested. Hydrochloric acid is the main component of gastric juices, it is stomach acid. Betaine HCl is used as a supplement for people with hypochlorhydria, or low stomach acid. Cannabis itself lowers stomach acid secretion, but it can't be the predominant factor because I've seen people who say they've developed CHS symptoms within weeks of beginning to smoke. blackcIoud also claims that butane poisoning from BHO leads to hypochlorhydria but I don't have any evidence of that. The low stomach acid is the important part. He posted about it twice, almost a year ago. Check out his profile if you want to see the posts.

Recently I began browsing the subreddit CHSinfo. I saw a thread linking to a video in which someone was claiming to have cured CHS by taking a supplement called Pangrol 20,000. I dunno if links are allowed here but here is the URL https://www.youtube.com/watch?v=_JlQ_a74MdE

I googled Pangrol 20,000, turns out it is a pancreatin supplement, which is a combination of 3 pancreatic enzymes which are used in digestion. A couple people on r/CHSinfo were trying it. I knew from my knowledge of digestive health that pancreatic enzymes are released to digest food only when there is a proper level of stomach acid. Food is eaten, stomach acid is produced, then pancreatic enzymes and bile are released during digestion to further digest the food once it reaches the duodenum. If the stomach doesn't produce enough acid for whatever reason, pancreatic enzymes and bile are not released and food is obviously not digested properly. Then I remembered blackcIoud's claims, and I messaged him.

He told me that he started out taking a plain betaine HCl supplement, but then tried something called Super Digestive With Ox Bile & Activated Charcoal by Sunshine Naturals. He said that worked better for him and completely stopped his CHS symptoms. He takes it occasionally for a few days if his stomach starts feeling funny. I looked it up, and besides HCl and the titular ingredients, it also contains pancreatin. Bingo. Low stomach acid leads to low pancreatic enzymes, and somehow this leads to CHS. I started telling people on r/CHSinfo about this and many people have been trying pancreatin and HCl supplements with positive results. One person I talked to is even dabbing 2 grams a day while taking pancreatin, but still having occasional morning sickness and not eating as much as he should. I suspect his recovery would be much faster if he slowed down his intake but it seems he's unwilling.

Personally, I currently have gastritis as a result of whatever this root cause of CHS is, and from continued smoking. I had gastritis before I even knew what CHS was, and it healed while I was taking prilosec so I figured the same would be true a second time. Not so. I started taking a supplement called zinc carnosine and it seems to have helped significantly but I'm still not 100%. I've recently stopped smoking completely, hopefully my gastritis will be healed soon. Until then I can't try betaine HCl myself because I assume the acid would be very irritating to my already inflamed stomach. I've been taking pancreatin for a few days now but I can't really say how it's working because my stomach doesn't get particularly upset unless I eat too much or eat something I'm not supposed to, and I'm not smoking. I will try smoking relatively soon but I have to be careful because it can adversely affect my digestion for a while.

Where does Douglas come in, and how does hyperemesis happen? I thought of Douglas when I remembered his H. Pylori infection. H. Pylori causes low stomach acid. I am certain that this was the cause of his CHS. I also remember him talking about eating lots of probiotic foods, and that brings me to hyperemesis. I have a theory that the hypochlorhydria in CHS leads to a condition called histamine intolerance. I'll give a quick rundown but you can google it if you need more info. It's not actually an intolerance, but an inability to eliminate histamine from the body. Histamine is contained in and produced by tons of foods we eat, and remember the elimination diets curing CHS that I mentioned earlier. We're putting it in our bodies all the time. If we lack enough of the diamine oxidase enzyme (DAO enzyme) we can't break it down and eliminate it. It builds up and makes us sick. Gastrointestinal symptoms are extremely common, with diarrhea being the most common symptom. More severe symptoms are possible as it builds up, including nausea and vomiting. I have heard tons of CHS cases with diarrhea in the prodromal phase.

If you have low stomach acid, your intestinal microbiome will be affected. Things won't be balanced properly. Your enzymes will be all out of wack, including possibly your DAO enzyme. Douglas' intestinal microbiome was definitely inbalanced after years of H. Pylori infection, I believe he said 6 years. He balanced it out with probiotic foods, yogurt and kimchi I think he said. So probiotics are important to treating CHS also.

Remember that an anonymous source told me that an allergist told them that cannabis worsens food allergies. Assuming this is true, I know that cannabis interacts with histamine in some way. And there's one more detail that supports my theory. The hot showers. They relieve the nausea, but why? When your body is exposed to high temperatures, it produces something called heat shock proteins. These proteins perform various functions throughout the body. Some people believe that there are health benefits to increasing your heat shock protein levels, and use saunas to do so. Somebody on reddit even told me recently that they used saunas to treat their CHS, I'll try to find the post if someone wants it.

So here's a bit of information on histamine,

https://en.wikipedia.org/wiki/Histamine#Storage_and_release

"Most histamine in the body is generated in granules in mast cells and in white blood cells (leukocytes) called basophils."

Histamine is stored in mast cells. When I learned about histamine intolerance, I googled "heat shock proteins histamine" and found this: https://www.ncbi.nlm.nih.gov/pubmed/16038788

"RESULTS:
Using BMMC [bone marrow mast cells], we found that heat shock inhibits degranulation of BMMC without affecting leukotriene production."

Heat shock prevents mast cells from degranulating and releasing histamine. Less histamine means less nausea. Therefore, hot showers treat nausea from CHS.

That's just a theory I have but I think it's pretty promising. I don't have every bit of the picture filled in, but I think with this information, anybody who wants to cure their CHS can do so. As long as they don't have gastritis like me, haha. I want to say that's everything I know about CHS but I'm sure I've forgotten something. I'm sorry for any spelling/grammar errors and I hope everyone finds this interesting or useful.
 

exploziv

pure dynamite
Administrator
Veteran
Nice post. I personally gone through a lot of what you are describing, and I was prescribed the things you say help, and also found that probiotics help in the long run. Sometimes I don't take them and I soon am reminded by coming back symptoms that I should.
 

Cvh

Well-known member
Supermod
Be sure to also look into Capsaicin the active ingredient in Chili Peppers. It's been scientific proven to bring relief for CHS sufferers and it is also used in topical cream form in the ER room in several hospitals to treat patients with CHS.

(Full length article: https://acgcasereports.gi.org/succe...-hyperemesis-syndrome-with-topical-capsaicin/ )
(Google also for: Capsaicin CHS)

Successful Treatment of Cannabinoid Hyperemesis Syndrome with Topical Capsaicin

Andrew M. Moon, MD, MPH1, Sarah A. Buckley, MD2, and Nicholas M. Mark, MD3

1Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC
2Hematology/Oncology Fellowship Program, University of Washington, Seattle, WA
3Division of Pulmonary and Critical Care, University of Washington, Seattle, WA

ACG Case Rep J 2018;5:e3. https://dx.doi.org/10.14309/crj.2018.3. Published online: January 3, 2018.

Abstract
Cannabinoid hyperemesis syndrome (CHS) is a clinical entity in which marijuana users develop nausea, vomiting, and abdominal pain that improves with hot water bathing or cannabis cessation. Previous models suggest that CHS arises solely from the derangement of cannabinoid receptor type 1 signaling. However, involvement of transient receptor potential vanilloid subtype 1 (TRPV1) receptor, which is activated by marijuana, capsaicin, and heat, could fill gaps in existing models, including the enigmatic role of hot water bathing. We propose that chronic cannabis use decreases TRPV1 signaling and alters gastric motility, and we report the case of a CHS patient whose symptoms improved after topical capsaicin.

Introduction
Cannabinoid hyperemesis syndrome (CHS) is a clinical entity characterized by chronic marijuana use, intractable vomiting, and relief of symptoms with hot-water bathing, exemplifying the enigmatic role of temperature in attenuating symptoms.1–3 A recent review proposed that transient receptor potential vanilloid subtype 1 (TRPV1) receptor, which is involved in gastric motility and is activated by cannabinoids, high temperatures, and capsaicin, is centrally involved in the pathogenesis of CHS (Figure 1).4

Case Report
A 47-year-old man with a decade-long history of marijuana use of up to several grams daily presented to the gastroenterology clinic with 8 years of abdominal pain, nausea, and vomiting relieved by up to 4 hours of hot-water bathing daily. Computed tomography (CT) of the abdomen and pelvis showed an unremarkable liver, no biliary duct dilatation, normal gallbladder, normal pancreatic body and head, normal spleen, and no bowel obstruction or inflammation. Abdominal ultrasound revealed a liver with normal size and echotexture, antegrade portal flow, non-dilated bile ducts, and a gallbladder without gallstones, wall thickening, or pericholecystic fluid. Upper endoscopy demonstrated a normal esophagus, normal gastric mucosa, and normal examined duodenum. Biopsies were negative for Helicobacter pylori. Colonoscopy showed normal colonic mucosa and terminal ileum. The patient had no improvement with dicyclomine, ranitidine, and twice-daily omeprazole. He was diagnosed with CHS and encouraged to discontinue marijuana.

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Figure 1. Proposed pathophysiology of cannabinoid hyperemesis syndrome. TRPV1 is expressed in area postrema of the medulla, along gastric enteric and vagal nerves, and on cutaneous receptors in the dermis and epidermis. Prolonged exposure to cannabinoids inactivates TRPV1, potentially resulting in central nausea, altered gastric motility, and abdominal pain. Exposure to nociceptive heat, such as with compulsive hot-water bathing, may transiently augment cutaneous TRPV1 firing and restore gastric motility, temporarily mitigating symptoms. Use of another TRPV1 agonist, capsaicin, may also provide relief. Cessation of marijuana use gradually leads to normalization of TRPV1 function and fully ameliorates symptoms.

The patient continued marijuana use and presented several weeks later to the emergency department with severe, periumbilical, stabbing pain associated with nausea and vomiting. He had a temperature of 37.1°C, heart rate 86 beats/min, blood pressure 146/74 mm Hg, and oxygen saturation 98% on ambient air. Labs showed a white blood cell count 14,000 cells/µL, potassium 3.1 mEq/L, and normal hemoglobin, creatinine, blood urea nitrogen, aspartate aminotransferase, alanine aminotransferase, total bilirubin, albumin, lipase, and urinalysis. Abdominal CT scan was unchanged from the previous scan. He was treated with intravenous fluids, potassium, ondansetron, metoclopramide, prochlorperazine, fentanyl, viscous lidocaine, aluminum hydroxide/magnesium hydroxide/simethicone, and pantoprazole without improvement of symptoms. We applied capsaicin cream (0.075%) to a 15 × 25 cm area in the periumbilical region, with reapplications every 4 hours. The patient reported burning of the skin and improvement in the intensity of his stabbing abdominal pain and nausea a few hours after the first application of capsaicin. After the second dose, he noted complete resolution of his nausea. He received 2 more doses, which resulted in complete improvement of his abdominal pain. He was discharged the following day with a prescription for topical capsaicin. Over the following 3 months, the patient had no visits to our hospital system or any other providers included in Epic Care Everywhere within Washington State.

Discussion
The efficacy of capsaicin in CHS in our case lends credence to the role of TRPV1 in this syndrome. Previous models suggesting that cannabinoid receptor type 1 (CB1) is solely responsible for CHS are unsatisfying for several reasons. First, peripheral activation of CB1 slows gastric transit, but a case series of CHS patients described normal or increased transit time and no gastroparesis symptoms.5,6 Second, previous models suggested that hot-water bathing is an adaptive response to the hypothermic effects of cannabinoids. However, activation of CB1 should lead to hot-water bathing in all marijuana users, not just CHS patients who seem to engage in hot-water bathing as a learned behavior to treat symptoms. Finally, this model fails to explain why only some patients are susceptible to CHS, why there is latency from onset of marijuana use to symptoms, and why only chronic users are affected.

TRPV1 is a nonselective cation channel activated by noxious heat and capsaicin. This receptor is expressed throughout the gastrointestinal tract, including vagal sensory neurons, intrinsic enteric neurons in the myenteric plexus, and gastric epithelial cells.7,8 Within the central nervous system, there is a high density of TRPV1 in the area postrema, known as the chemoreceptor trigger zone. Activation of TRPV1 has potent anti-emetic effects, which may be mediated by depletion of substance P from neural circuits traveling to the nucleus tractus solitarius.9,10

Exogenous cannabinoids, including delta-9-tetrahydrocannabinoil, activate both CB1 and TRPV1.11 In vitro studies demonstrate that exogenous cannabinoids lead to dephosphorylation of TRPV1 and subsequent receptor desensitization.10 Therefore, chronic exposure to cannabinoids could downregulate or desensitize TRPV1 signaling, explaining how prolonged exposure to cannabinoids might lead to decreased TRPV1 signaling, altered gastric motility, and emesis. The learned behavior of compulsive hot-water bathing may be an attempt to normalize diminished TRPV1 activity by deliberate exposure to another TRPV1 agonist, nociceptive heat. Therefore, TRPV1 agonists such as topical capsaicin, which has a longer half-life than oral capsaicin, might augment TRPV1 activity and provide a less burdensome approach to treating CHS.12

One published case report and 2 case series have described successful treatment of 15 CHS patients with topical capsaicin.13–15 In all cases, patients with heavy marijuana use presented to the emergency department with nausea, vomiting, and abdominal pain improved by application of topical capsaicin preparation (0.075%). Some have questioned the lack of advanced diagnostics, such as endoscopic studies and CT imaging in these cases. In addition, these patients had a short period of observation in the emergency department with unclear clinical courses after discharge.16 These weaknesses do not apply to our case, given the extensive workup and prolonged inpatient observation.

Marijuana is the most frequently used illicit drug in the United States. Its recent legalization in many states has raised concerns of increased use and a resulting rise in CHS incidence.17,18 For these reasons, a better understanding of CHS pathogenesis and novel treatment strategies are increasingly important. Our case lends further credence to the role of TRPV1 in CHS, although only limited conclusions can be drawn from this single case with incomplete confirmed follow-up. We believe a prospective study, such as the planned randomized controlled trial examining capsaicin in cyclic vomiting syndrome, could adequately assess the efficacy of capsaicin for CHS.
 

paddyod11

New member
Nice post. I personally gone through a lot of what you are describing, and I was prescribed the things you say help, and also found that probiotics help in the long run. Sometimes I don't take them and I soon am reminded by coming back symptoms that I should.

Interesting. you were prescribed HCl and pancreatin? by an MD or a functional medicine doctor? also, have you been taking specific probiotics?
 

exploziv

pure dynamite
Administrator
Veteran
I was prescribed PREbiotics and pancreatin by a GI specialist (MD). Then i read more into it and ended up feeling better after the treatment and I started taking probiotics, i settled with the one that has the best variety of strains and lots of CFU. When my stomach is well, I don't have any allergies, when something is off, usually when I don't take probiotics for a while, I see some sensibilities and allergies. Doctor said I should do some invasive procedures to investigate my gi tract if I want to find out more (or if his prescribed treatment doesn't work), but I was kinda reticent about it. And I still am, as long as I feel good.
 

Douglas.Curtis

Autistic Diplomat in Training
Awesome information for those with CHS, thank you so much! :D

I don't have CHS though. Sorry, but I haven't had issues because I completely avoid neem/azadirachtin cannabis, not because I 'cured' my CHS. I've had aza tainted cannabis in the last 3 years and, as long as the aza concentration is high enough, my guts start churning and burbling within minutes.

Since the aza causes almost the identical symptoms, could it be possible there's a similar reaction going on? The azadirachtin impacting the pancreas in a similar way?

Thank you SO MUCH for taking the time to track this down, this is really awesome news for CHS sufferers!! :tiphat:
 

paddyod11

New member
Awesome information for those with CHS, thank you so much! :D

I don't have CHS though. Sorry, but I haven't had issues because I completely avoid neem/azadirachtin cannabis, not because I 'cured' my CHS. I've had aza tainted cannabis in the last 3 years and, as long as the aza concentration is high enough, my guts start churning and burbling within minutes.

Since the aza causes almost the identical symptoms, could it be possible there's a similar reaction going on? The azadirachtin impacting the pancreas in a similar way?

Thank you SO MUCH for taking the time to track this down, this is really awesome news for CHS sufferers!! :tiphat:

Say what you will, but the causes of your problems line up perfectly with others who have/had low stomach acid. I wouldn't be surprised if aza consumption lowered your stomach acid at all. I have seen one other person who said that their CHS symptoms stopped after they stopped using aza and they did not have an H. Pylori infection. But I know that an H. Pylori infection does the same. I think Everybody who is taking hot showers to stop puking their guts out has the same syndrome, regardless of the cause. Maybe Cannabinoid Hyperemesis Syndrome isn't a suitable name since it's only one of the triggers, you know? But I'm glad you're feeling well.

Actually, your instant reaction to aza is interesting because if you do have an allergy to azadirachtin, that supports my histamine intolerance theory even further. Heat shock would theoretically reduce the histamine release whether you were having symptoms from histamine intolerance or a genuine allergic reaction. Maybe aza affects the gut microbiome in a way that destroys the DAO enzyme, too. Could be anything. But your symptoms are obviously linked to whatever "CHS" is because of the relief from hot showers, so you giving me this information makes me more confident about my histamine theory like I just said. Thanks for the info. :biggrin:
 

Douglas.Curtis

Autistic Diplomat in Training
My pleasure, and thank you again. The histamine response makes a lot of sense as well. There really are only two differences in symptoms between CHS and aza sensitivity. Aza causes constipation, where CHS generally results in diarrhea. The single symptom which stands out for azadarachtin sesnsitivity, are occasional periods of rapid onset hypothermia.

The rest of the symptoms match up perfectly, which does add weight to your theory. I'm all for any 'label' which gets cannabinoid out of the title, especially if it's not isolated to THC. :)
 
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