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Nausea: A Reflection of an Underlying Medical Condition

Nausea is a weird feeling in the stomach, and it is often accompanied by the urge to vomit. That is why both nausea and vomiting are used simultaneously. Nausea and vomiting are symptoms of many medical diseases that can range from mild gastric upset after the ingestion of contaminated food to cancer. Therefore, it is of great importance to determine the underlying cause of nausea. It is usually relieved by the intake of certain drugs; however, in order to treat it completely, the underlying medical condition must first be diagnosed and treated.

The nauseating feeling that people get starts from an area in the central nervous system called the brainstem, specifically the medulla. This region of the brain is involved with the regulation of many physiological processes, including breathing, sneezing, and vomiting. In the case of nausea, this part of the brain activates the vomiting center, which results in the attempt to expel all of the content of the stomach. This mechanism is normally protective because vomiting does not only cause the expulsion of the important nutrients in the stomach, but it also expels any toxic digested toxic compounds or infectious agents.

The diagnosis of the underlying cause for nausea is very challenging to most physicians because there are literally over 100 conditions that may cause nausea and vomiting, the most common of which is food poisoning, which affects nearly 37% of patients. In a minority of cases, nausea is often a side-effect of a drug, and in up to 10% of cases, the cause of nausea is unknown.

The most commonly known causes for nausea

Although nausea can occur at any age, children of school age are the most commonly affected population, while the elderly appear to be affected the least. Herein, we will mention the most commonly known causes for nausea, which include the following:

  1. Anorexia nervosa
  2. Anxiety or psychological stress
  3. Intracranial tumors (tumors inside the brain)
  4. Severe pain: it is often associated with nausea and vomiting, as in people with acute cholecystitis, toothache, and migraines.
  5. Chemotherapy or radiotherapy
  6. Infections that affect the gastrointestinal tracts
  7. Toxic compounds
  8. Meningitis, which is the inflammation of the membranes that cover the brain
  9. Surgery
  10. Pregnancy
  11. Stroke
  12. Traumatic brain injury
  13. Vertigo or middle ear disorders

Causes of nausea

How is Nausea Treated?

Since nausea can be caused by a wide variety of medical disorders, the optimum treatment of nausea is by treating the underlying cause. That being said, there are many approaches that can be attempted to alleviate nausea, such as drugs, herbal agents, and lifestyle modifications.

The following treatments are the most commonly used ones in nausea:

  1. Drugs, such as Zofran
  2. Ginger root
  3. Peppermint
  4. Chamomile
  5. Antibiotics, if nausea is caused by gastrointestinal infection
  6. Opioids, if nausea is caused by severe pain

The Regulation of Nausea Via the Endocannabinoid System

Cannabinoids, which are known for their therapeutic potential in treating many symptoms and diseases, normally exist in our bodies in a system known as the endocannabinoid system (ECS). This ECS includes the following: (1) endocannabinoids, (2) cannabinoid receptors: type 1 (CB1) and type 2 (CB2), and (3) enzymes. This system is known to modulate many physiological processes, including pain perception, sleep, temperature, and many others. Based on this, it was hypothesized that the ECS is also incorporated in the regulation of nausea and vomiting. Normally, CB1 receptors are mainly expressed in the central nervous system, which includes the brain and the spinal cord. On the other hand, CB2 receptors are mainly expressed on the cells of the immune system.

An increasing body of evidence suggests that the modulation of the ECS can result in the regulation of nausea and vomiting, both in humans and in animals. Various cannabinoids have been shown to have potent antiemetic (against nausea and vomiting) effects. These cannabinoids include both cannabidiol (CBD) and tetrahydrocannabinol (THC). Of note, these cannabinoids have been shown to be very effective in treating severe nausea and vomiting that are irresponsive to other medications in patients undergoing chemotherapy.

In animals, CBD has been shown to successfully alleviate nausea within a very limited dose range. This effect is initiated through the indirect activation of certain autoreceptors, which results in the reduction of the release of serotonin (5-HT1A), which causes stimulated nausea and vomiting. Preclinical data suggest that the use of CBD can be clinically effective for treating nausea, particularly in cancer patients undergoing chemotherapy. In the following section, we will highlight the results of human trials that investigated the efficacy of both THC and CBD in treating nausea and vomiting.

Clinical Trials Investigating the Effectiveness of CBD in Nausea

A recent randomized, double-blinded, placebo-controlled clinical trial was conducted to study the effectiveness of an oral cannabis extract containing both THC and CBD in 81 patients with chemotherapy-induced nausea and vomiting. Patients in the intervention group received one cycle of oral THC 2.5mg and CBD 2.5 mg three times a day, starting from day 1 to day 5 in chemotherapy sessions. On the other hand, other patients were treated with a placebo. Treatment with THC/CBD was associated with a better response rate (14% at baseline vs. 25% after treatment). THC/CBD was also associated with the complete absence of nausea and vomiting. However, 31% of patients experienced some side-effects, such as sedation, dizziness, or disorientation. These side effects are probably related to the use of THC. It was further illustrated that none of the patients that took THC/CBD experienced serious side effects. Finally, it should be noted that these patients were given both THC and CBD, so it is not yet clear whether the beneficial effects on treating nausea and vomiting were due to THC alone, CBD alone, or both.

In a recent systematic review and meta-analysis of clinical trials investigating the efficacy of various pharmaceutical cannabinoids in treating nausea and vomiting in patients with chemotherapy-induced nausea, the researchers recommended not to use these cannabinoids (dronabinol, levonantradol, nabilone, and nabiximol) as first or second-line therapy for nausea. Instead, some guidelines recommended the use of these cannabinoids, including CBD as third-line options in the treatment of severe nausea and vomiting.

In conclusion, CBD and THC have been proven effective in patients with chemotherapy-induced nausea and vomiting. However, they should not be used as first-line medications, and it is always recommended to consult your treating physician prior to taking THC/CBD for your condition.

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