The endocannabinoid system (ECS) supports many vital bodily processes, including metabolism, sleep, immunity, and memory. A wide range of stressors can disrupt cellular function, from pathogens and toxins to extreme temperatures. With its ability to restore homeostasis (internal balance) after cellular stress, the ECS is essential for survival.1Hillard CJ. Circulating Endocannabinoids: from whence do they come and where are they going? Neuropsychopharmacology. 2018 Jan;43(1):155-172. https://doi.org/10.1038/npp.2017.130
The ECS, hunger, and metabolism
The ECS is named after the cannabis plant, which inspired its discovery. There are four main cannabis chemotypes: Cannabis afghanica, C. indica, C. sativa, and C. ruderalis. One of the plant’s most well-known compounds, tetrahydrocannabinol (THC), binds directly to the ECS’s two primary receptors. In contrast, cannabidiol (CBD) may influence the ECS more indirectly, without activating those receptors.
The ECS supports survival by stimulating hunger, increasing the appeal of food, and helping regulate energy use.2Watkins BA, Kim J. The endocannabinoid system: directing eating behavior and macronutrient metabolism. Front Psychol. 2015 Jan 6;5:1506. https://doi.org/10.3389/fpsyg.2014.01506 This system is also involved in hedonic eating (better known as “the munchies”)—a strong craving for food driven by pleasure rather than nutritional need. While this response can be helpful for people with low appetites, such as those undergoing cancer treatment, it can also pose challenges in other contexts.
Marinol, an FDA–approved pharmaceutical form of THC, is sometimes prescribed for people with HIV/AIDS or cancer to address appetite loss.3Tramèr MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ. 2001 Jul 7;323(7303):16-21. https://doi.org/10.1136/bmj.323.7303.16
Sleep benefits
The ECS plays a key role in regulating circadian rhythm. Endocannabinoid levels naturally fluctuate over a 24-hour period, helping to shape our sleep–wake patterns.
Research on cannabis and sleep has produced mixed results. For example, one study found that taking 300 mg of CBD nightly for two weeks improved insomnia. Another study using the same dose reported no significant effect.4Wang M, Faust M, Abbott S, Patel V, Chang E, Clark JI, Stella N, Muchowski PJ. Effects of a cannabidiol/terpene formulation on sleep in individuals with insomnia: a double-blind, placebo-controlled, randomized, crossover study. J Clin Sleep Med. 2025 Jan 1;21(1):69-80. https://doi.org/10.5664/jcsm.11324 THC has more evidence for sedative effects; however, high doses may interrupt REM sleep. These discrepancies highlight the complexity of cannabis’s impact on sleep and the need for more high-quality research. Survey data strongly support THC’s ability to promote sleep.5Kaul M, Zee PC, Sahni AS. Effects of cannabinoids on sleep and their therapeutic potential for sleep disorders. Neurotherapeutics. 2021 Jan;18(1):217-227. https://doi.org/10.1007/s13311-021-01013-w
Stress reduction
The ECS is a central regulator of the body’s stress response. It helps maintain internal stability when external pressure escalates.
For many people using cannabis for medical purposes, anxiety is the second most commonly cited reason after pain. Data indicate that cannabis may help reduce reliance on prescribed anti-anxiety medications.
One reason cannabis may ease anxiety is that THC mimics the body’s natural endocannabinoids, activating both primary cannabinoid receptors. However, THC is far more potent than the cannabinoids our body produces. This can lead to biphasic (dose–dependent) effects on anxiety. That is, low doses may ease anxiety, but higher doses could potentially worsen it.6Crippa JA, Zuardi AW, Martín-Santos R, Bhattacharyya S, Atakan Z, McGuire P, Fusar-Poli P. Cannabis and anxiety: a critical review of the evidence. Hum Psychopharmacol. 2009 Oct;24(7):515-23. https://doi.org/10.1002/hup.1048
In this way, THC can be viewed as a short-term “hack” for anxiety, offering immediate relief. But long-term recovery requires building true stress resilience in addition to symptom management. That’s where the concept of “toning” the ECS comes in, gently upregulating its function to promote balance over time.
A low, consistent dose of full-spectrum hemp (containing trace THC) may help stimulate receptor activity, especially in people whose ECS function has been weakened by chronic stress, trauma, or post-traumatic stress disorder. Other plants, foods, and lifestyle interventions also contain cannabinoid-like compounds that may contribute to this effect. Examples include beta-caryophyllene found in cloves and black pepper, alkylamides in echinacea, and diindolylmethane (DIM) in broccoli—all of which bind to the CB2 receptor. Acupuncture, massage, and osteopathic manipulation have been shown to elevate endocannabinoid levels.
Protection Against inflammation
When the immune system springs into action, the body also needs a mechanism to resolve inflammation. One of the ECS’s most important jobs is ending the immune response and jumpstarting recovery.
During inflammation, endocannabinoid levels rise, primarily activating the CB2 receptor. This reduces immune cell migration and suppresses inflammatory signals (cytokines), promoting tissue repair and a return to homeostasis.
Cannabis contains multiple immune-modulating compounds that help regulate immune activity without suppressing it. Contrary to some concerns, it has not been shown to cause immune suppression when taken in therapeutic (not recreational) doses. Cannabis may offer special benefits for people with autoimmune conditions by calming an over-reactive immune response.7Kotschenreuther, K., Waqué, I., Yan, S. et al. Cannabinoids drive Th17 cell differentiation in patients with rheumatic autoimmune diseases. Cell Mol Immunol. 2021 Mar;18(3):764-766. https://doi.org/10.1038/s41423-020-0437-4,8Cabral GA, Rogers TJ, Lichtman AH. Turning over a new leaf: cannabinoid and endocannabinoid modulation of immune function. J Neuroimmune Pharmacol. (2015) 10:193–203. https://doi.org/10.1007/s11481-015-9615-z
CBD, more commonly found in hemp-derived products, has anti-inflammatory potential. In preclinical studies, CBD lessened inflammation in an arthritis model.9Malfait AM, Gallily R, Sumariwalla PF et al. The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis. Proc Natl Acad Sci USA. 2000 Aug 15;97(17):9561-6. https://doi.org/10.1073/pnas.160105897 However, effective anti-inflammatory doses of CBD in people remain unclear, and most over-the-counter CBD products likely fall short of the therapeutic threshold tested in clinical studies.
Memory, pain, cognitive health
One of the ECS’s lesser-known functions is helping the brain filter and prioritize memory by retaining what’s essential and discarding what’s not.
Cannabis may offer neuroprotective benefits, particularly in older adults. This is especially relevant as rates of cognitive decline, dementia, and Alzheimer’s disease continue to rise. Beyond brain health, cannabis could help relieve common dementia-related symptoms, such as agitation, restlessness, anxiety, insomnia, and depression.10Maroon J, Bost J. Review of the neurological benefits of phytocannabinoids. Surg Neurol Int. 2018 Apr 26;9:91. https://doi.org/10.4103/sni.sni_45_18,11Eubanks LM, Rogers CJ, Beuscher AE 4th, Koob GF, Olson AJ, Dickerson TJ, Janda KD. A molecular link between the active component of marijuana and Alzheimer’s disease pathology. Mol Pharm. 2006 Nov-Dec;3(6):773-7. https://doi.org/10.1021/mp060066m
Forgetfulness also plays a role in certain types of chronic pain, especially neuropathic and nociplastic pain. These pain syndromes involve faulty signaling in the brain and nervous system, often in the absence of ongoing physical injury. The brain becomes wired to experience pain, even when the original source has healed.
Cannabis can serve as a harm-reduction tool for managing chronic pain. Some people find it allows them to space out or taper down opioid doses, reducing overall reliance. Others may even transition off opioids altogether. This is no small accomplishment, as long-term opioid use can disrupt nearly every system in the body, leading to hormonal imbalance, immune dysfunction, sleep disorders, constipation, cognitive decline, and more.
The ECS and menopause
The female brain is shaped by cycles, and estrogen is the current that moves it. Estrogen influences brain structure, chemistry, and function throughout a woman’s life. During menopause, as estrogen declines, correlated shifts in mood, perception, and cognition often intensify.
Menopause can mark the beginning of a positive transformation—a uniting of head, heart, and soul that offers a broader perspective on life and self. Yet, this process is rarely without challenges. Past trauma, poor relationships, and overmedication for anxiety, depression, or pain can disrupt the natural process.
With reproduction no longer a concern, menopause may be an ideal time to explore the benefits of cannabis. Potential advantages include relief from hot flashes, insomnia, joint pain, mood fluctuations, and bone support (a lesser-known function of the ECS). Thoughtful approaches such as psychotherapy, somatic therapies, and integrative medicine also help unearth and resolve long-buried issues.
Cannabis safety guidelines
Cardiovascular conditions
- Unstable angina and heart failure are relative contraindications, especially with inhaled cannabis.
- Oral cannabis may be used cautiously under medical supervision.
Older adults
- Cannabis with THC may cause or worsen dizziness.
- THC may affect balance and increase fall risk.
- Patients at risk of falling should use a walking aid.
Immunocompromised patients
Inhaled cannabis should be avoided due to potential fungal contamination and risk of lung infection.
Cognitive effects
Cannabis may cause short-term memory impairment and reduced executive function. These effects are typically temporary.
Drug interactions
- Cannabis can interact with certain medications.
- Patients should consult their healthcare provider before use.
Footnotes
- 1Hillard CJ. Circulating Endocannabinoids: from whence do they come and where are they going? Neuropsychopharmacology. 2018 Jan;43(1):155-172. https://doi.org/10.1038/npp.2017.130
- 2Watkins BA, Kim J. The endocannabinoid system: directing eating behavior and macronutrient metabolism. Front Psychol. 2015 Jan 6;5:1506. https://doi.org/10.3389/fpsyg.2014.01506
- 3Tramèr MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ. 2001 Jul 7;323(7303):16-21. https://doi.org/10.1136/bmj.323.7303.16
- 4Wang M, Faust M, Abbott S, Patel V, Chang E, Clark JI, Stella N, Muchowski PJ. Effects of a cannabidiol/terpene formulation on sleep in individuals with insomnia: a double-blind, placebo-controlled, randomized, crossover study. J Clin Sleep Med. 2025 Jan 1;21(1):69-80. https://doi.org/10.5664/jcsm.11324
- 5Kaul M, Zee PC, Sahni AS. Effects of cannabinoids on sleep and their therapeutic potential for sleep disorders. Neurotherapeutics. 2021 Jan;18(1):217-227. https://doi.org/10.1007/s13311-021-01013-w
- 6Crippa JA, Zuardi AW, Martín-Santos R, Bhattacharyya S, Atakan Z, McGuire P, Fusar-Poli P. Cannabis and anxiety: a critical review of the evidence. Hum Psychopharmacol. 2009 Oct;24(7):515-23. https://doi.org/10.1002/hup.1048
- 7Kotschenreuther, K., Waqué, I., Yan, S. et al. Cannabinoids drive Th17 cell differentiation in patients with rheumatic autoimmune diseases. Cell Mol Immunol. 2021 Mar;18(3):764-766. https://doi.org/10.1038/s41423-020-0437-4
- 8Cabral GA, Rogers TJ, Lichtman AH. Turning over a new leaf: cannabinoid and endocannabinoid modulation of immune function. J Neuroimmune Pharmacol. (2015) 10:193–203. https://doi.org/10.1007/s11481-015-9615-z
- 9Malfait AM, Gallily R, Sumariwalla PF et al. The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis. Proc Natl Acad Sci USA. 2000 Aug 15;97(17):9561-6. https://doi.org/10.1073/pnas.160105897
- 10Maroon J, Bost J. Review of the neurological benefits of phytocannabinoids. Surg Neurol Int. 2018 Apr 26;9:91. https://doi.org/10.4103/sni.sni_45_18
- 11Eubanks LM, Rogers CJ, Beuscher AE 4th, Koob GF, Olson AJ, Dickerson TJ, Janda KD. A molecular link between the active component of marijuana and Alzheimer’s disease pathology. Mol Pharm. 2006 Nov-Dec;3(6):773-7. https://doi.org/10.1021/mp060066m
