The rising interest in cannabis as a therapeutic tool has meant that this powerful plant has captured the attention of researchers all over the world. We are already beginning to see people reap the benefits of cannabinoids in Western medicine, but a more recent avenue of research is the use of cannabis or CBD to manage symptoms of Crohn’s disease.
In the UK, there are currently over 115,000 people living with Crohn’s disease. Could cannabinoids be the answer to managing the uncomfortable symptoms of this inflammatory bowel disease?
What is Crohn’s disease?
Crohn’s disease is a chronic inflammatory bowel disease (IBD), characterised by patches of inflamed tissue in the gastrointestinal (GI) tract. Those living with Crohn’s disease experience lifelong symptoms, including:
- Stomach pain and cramps
- Severe diarrhoea
- Appetite and weight loss
- Rectal bleeding
Crohn’s is what is known as a relapsing-remitting condition, meaning that symptoms come and go in the form of flare-ups. There is currently no known cause or cure, so the treatment of Crohn’s disease aims to relieve symptoms and prevent future relapses.
Current treatments include steroids, immunosuppressants, biological therapies, and even surgery; they all target inflammation in the gut. But many people living with Crohn’s disease have also turned to cannabis products or CBD to alleviate their symptoms. Due to the anti-inflammatory properties of this powerful plant, cannabis may prove to be an effective novel treatment for IBD.
The ECS and gut health
The human body has a complex and fascinating cell-signalling network called the endocannabinoid system (ECS). Through the activity of our natural endocannabinoids and cannabinoid receptors, the ECS is responsible for regulating a myriad of biological processes. Our mood, sleep, immune activity, appetite, energy levels, and even our gut health are all influenced by the ECS.
Like many other inflammatory bowel conditions, Crohn’s disease is associated with the disruption of the ECS. IBD patients with inflamed gut tissue exhibit lower levels of anandamide, an endocannabinoid, than healthy people. Since there is evidence to suggest that the activity of cannabinoid receptors in the GI tract can modulate inflammation, cannabis plant-derived cannabinoids could help to alleviate Crohn’s symptoms.
Cannabis & Crohn’s disease
The two main active ingredients in cannabis are cannabidiol and tetrahydrocannabinol, more commonly known as CBD and THC. These cannabinoids can have potent therapeutic action, both alone and in combination.
According to the Crohn’s & Colitis Foundation, 15-20% of IBD patients currently use cannabis to manage their symptoms, and over 50% would be interested in using cannabis if its legal status were to change. Anecdotal reports suggest that cannabis can improve pain and sleep, reduce nausea and anxiety, and stimulate the appetite of people living with Crohn’s disease. But what does the science say?
There hasn’t been a huge amount of research into the effects of cannabis on Crohn’s disease, but there is some promising preliminary evidence.
In a randomised controlled trial of 21 patients with Crohn’s disease, 45% of the participants achieved clinical remission after 8 weeks of smoking cannabis twice a day, compared to only 10% of the placebo group. Cannabis also reduced steroid dependency in 3 participants.
In a similar study of hemp oil, containing 160/40 mg/ml CBD/THC, 65% of patients with moderate to severe Crohn’s disease were in full remission after 8 weeks. In the placebo group, this was only seen in 35% of participants. Dr Timna Naftali, the study’s lead author, told Healthline that “cannabis oil can slow the movement of food through the gut and reduces intestinal secretions, which reduces diarrhoea”.
In both of these studies, no significant changes to inflammatory marker levels were observed. This means that cannabis did not reduce levels of inflammation in the gut, so there is not yet enough evidence to say whether cannabis simply masks the symptoms of Chron’s, or if they treat the inflammatory nature of the disease.
It should also be noted that several review papers have highlighted a risk of bias in these studies. Although the evidence looks good, many experts still urge caution. The research is still in its early stages, and more rigorous investigation is needed into the effects of cannabis on the symptoms of Crohn’s disease.
Can CBD help with Crohn’s?
In countries with restrictions on THC, there are legal barriers that may prevent or dissuade many people from experiencing the therapeutic benefits of cannabis. In the UK, however, cannabis-based products are legal if they contain less than 0.2% THC. So, it might be worth trying CBD to help with your Crohn’s symptoms.
CBD is a non-psychoactive cannabinoid found in the Cannabis sativa plant. Unlike THC, it cannot get you high. It can, however, have potent therapeutic action in the body. CBD is already a recognised treatment for rare forms of epilepsy and it shows huge promise in the treatment of anxiety disorders, sleep disorders, Multiple Sclerosis, and much more.
CBD has not received much attention in IBD research, so it’s hard to say for certain if it can alleviate the symptoms of Crohn’s disease. In a trial of CBD-rich cannabis oil, with 15% CBD and 4% THC, improvement to Crohn’s symptoms was significantly greater than in the placebo group. However, due to the presence of THC in the oil, it may be that the positive effects seen were due to CBD and THC working together.
There is, however, some experimental evidence in support of the use of CBD in treating inflammatory bowel diseases. In cultured human cells, CBD has been shown to reduce gastrointestinal inflammation. Similarly, in an animal model of colitis (another IBD) CBD has been shown to protect the colon against inflammation.
More research is needed, but CBD may provide therapeutic relief for Crohn’s disease in a way that is similar to cannabis, but without the mind-altering effects.
How does it work?
CBD can modulate the activity of immune cells and inflammatory molecules and has been shown to have anti-inflammatory properties. By this token, researchers believe that CBD could relieve some of the inflammatory pain experienced by those with Crohn’s disease.
In animal models, CBD has been shown to suppress nausea and vomiting by indirectly activating serotonin receptors in the brainstem, where the brain’s ‘vomiting centre’ resides. The effect of CBD on our appetite is less clear cut than THC. Cannabis is known to stimulate our appetite – often called the ‘munchies’ – whereas studies of CBD have produced mixed results. There is, however, some evidence to suggest that CBD can stimulate appetite. So, like cannabis, CBD may help to reduce nausea and increase appetite in people living with Crohn’s disease.
In terms of the nitty-gritty science, CBD’s mechanisms of action are not yet fully understood. Although CBD can activate cannabinoid receptors, it tends to work in more indirect ways. By inhibiting the FAAH enzyme and subsequently preventing the breakdown of anandamide, CBD can increase endocannabinoid levels in the body. Since other FAAH inhibitors have been shown to effectively treat IBD, CBD could hold promise in the treatment of Crohn’s disease.
This is just one of the many ways in which CBD is thought to have therapeutic action, but far more research is needed to fully understand this powerful cannabinoid.
How to use CBD for Crohn’s
There are a huge variety of cannabis-based products available, so the CBD market can be a confusing place. To get started, take a look at our beginner’s guide to CBD.
There hasn’t been a huge amount of research into which products work best in the treatment of Crohn’s disease. One study found that low (10 mg) doses of CBD isolate were ineffective at treating Crohn’s symptoms, which could suggest that CBD works best in higher doses or alongside other cannabinoids.
In this instance, your best bet is to try a broad-spectrum or full-spectrum CBD. These contain some or all of the other cannabinoids, terpenes, and flavonoids found in cannabis. These compounds have been shown to have a complementary relationship; this is known as the entourage effect. So, broad-spectrum and full-spectrum products may have some additional health benefits in comparison to CBD isolate.
In countries without restrictions on THC, full-spectrum CBD does contain THC. Keep this in mind when shopping for CBD online to avoid any legal issues.
There are also many ways to take CBD, so it’s important to choose a product that caters to your needs:
Pills & capsules
CBD pills and capsules are taken orally as a consistent daily dose. They’re a great option for anyone who isn’t keen on the taste of CBD oil. Oral CBD products tend to contain lower doses and can take a while for the effects to kick in, so they may be best at preventing flare-ups, rather than managing pain.
There is a bit more flexibility with CBD oil. You can control how much you take and how often you take it, so oils are a great way to up your dosage on days when your symptoms are worse. CBD oil is dropped under the tongue and enters the bloodstream quickly, so the benefits can be felt almost immediately.
CBD vapes also have a rapid onset of action and, since they are portable, vapes are good for fast relief during sudden Crohn’s flare-ups. However, approach this method with caution, as the long-term effects of vaping are not fully understood.
Is CBD safe?
According to the World Health Organisation, CBD is a safe and well-tolerated substance. Unlike cannabis, the side effects of CBD are both rare and mild. These can include nausea, appetite changes, and fatigue. Since these potential side effects are similar to the symptoms of Crohn’s disease, it would be wise to start with a low CBD dose and build your way up.
It is also important to consider the reputability of the brand you choose to buy your CBD product from. Trustworthy brands will disclose their lab reports so that you know exactly how much of each cannabinoid you are getting. Similarly, a brand should be transparent about the traceability of its cannabis plant. If this information is not available, they’re unlikely to be a reliable brand.
With CBD and cannabis being such popular complementary treatments for IBD, the Crohn’s and Colitis Foundation have released an official position statement on medical cannabis use. They state that “patients and providers considering the use or recommendation of medical cannabis, CBD or marijuana need to be aware of the unique state laws pertaining to prescribing and use of cannabis”.
They also commissioned a review paper on the role of cannabis in IBD, published in Inflammatory Bowel Diseases in 2018. The authors confirm that animal model evidence suggests a role for cannabinoids in reducing inflammation, diarrhoea and pain in IBD. Though human studies have shown that cannabis-based products can improve symptoms, there is currently no evidence to say whether they can modify the progression of Crohn’s disease.
Like many areas of medical cannabis research, the science is still in its very early stages. But it is an exciting and promising avenue, nonetheless. Cannabis has already transformed the lives of many people living with chronic inflammatory diseases, so it might be worth giving CBD a go to see if it could help you to manage symptoms of Crohn’s disease.