Symptoms of Crohn’s and Ulcerative Colitis
Both share a malfunctioning immune system responding to an imaginary threat, with resulting chronic inflammation at their core. In the case of Ulcerative Colitis this inflammation is contained within the bowel, whereas in Crohn’s it can affect the entire Gastrointestinal tract. Symptoms include abdominal pain and cramping, excessive bowel movements, rectal bleeding, fatigue and extreme weight loss.
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Many IBD patients use cannabis
Something else that the conditions have in common is the high level of cannabis use amongst sufferers. In a study of almost 200 patients with Ulcerative Colitis and Crohn’s, between 33-50% reported to have used cannabis to “relieve IBD-related symptoms, including abdominal pain, diarrhoea and reduced appetite.” And in many of the countries or states where medical cannabis is legal, Crohn’s Disease is considered a qualifying condition, based mostly on what would seem to be anecdotal evidence.
Cases like Coltyn Turner, the American teen with Crohn’s who turned to medical cannabis after the immunosuppressant and anti inflammatory medication prescribed by the doctor did little to abate his illness. Coltyn believes the significant improvement in his health is thanks to the cannabis plant, with his days of being wheelchair bound and wracked by abdominal pain a thing of the past.
Fellow Crohn’s sufferer Shona Banda wrote the book ‘Live Free or Die’ chronicling her return to health after making her own cannabis oil. She became so ill with the disease that she describes herself as ‘waiting to die.’ As soon as she began taking cannabis Shona saw a marked improvement in her symptoms, eventually being able to wean herself off the pharmaceutical medication she’d been prescribed.
Spanish research scientist takes cannabis for his own IBD
It’s an experience shared by Spanish scientist, Ekaitz Agirregoitia, a researcher specialising in the Endocannabinoid system in the reproduction of humans and animals.
Fourteen years ago Ekaitz was diagnosed with Ulcerative Colitis.
“I weighed 10kg less, and was very tired and weak,” says Ekaitz. “I had a fever, as my body thought there must be some bacterial invader to be causing the inflammation. When I went to the toilet, there was blood in my faeces. I had anemia, ulcers in my bowel and was very tired all the time. And then I had bowel movements at least 10 times a day, including at night. You don’t know when. All of which affects your quality of life.”
Despite working in the field of cannabinoid research, Ekaitz didn’t immediately turn to the cannabis plant, but about a year and a half ago after the conventional medicine was failing to halt his illness, he started smoking marijuana before moving on to cannabis oil.
For Ekaitz it wasn’t the immediate miraculous relief that some of the headline grabbing stories claim, but more a gradual improvement of symptoms over 6 months to a year.
“Now, I haven’t had a temperature for a year and a half, I’ve put on the weight I’d lost. Normally I go to the bathroom 3 or 4 times a day, and not at all at night. It’s made a big difference to my life.”
Why cannabis helps IBD – the endocannabinoid system
As a cannabinoid research scientist, it’s no surprise to Ekaitz that the cannabis has eased his symptoms, due to the plant’s ability to stimulate the endocannabinoid system – the network of receptors and natural cannabis like chemicals in the body that modulate sleep, appetite, mood, inflammation and the immune system.
“I’m convinced that in all illnesses the endocannabinoid system is out of balance, because if it were working correctly, your body would be in homeostasis,” he says.
This makes perfect sense for IBD when one considers that the gut contains at least 70% of the body’s immune cells and is even considered as a second brain due to its extensive network of neurons, chemicals and hormones constantly relaying messages back and forth about the state of our digestive system and warning about any microbial attacks.
The lining of the colon also contains CB1 and CB2 endocannabinoid receptors, with a higher preponderance of CB2 receptors in IBD patients suggesting that a heightened anti-inflammatory response. That’s not to discount the role of the CB1 receptors that control gut motility (bowel movements) and secretions, but more on that later.
For an IBD sufferer the endocannabinoid system’s natural anti-inflammatory chemicals alone cannot bring the immune system back into equilibrium again, and they may benefit from an extra helping hand in the form of some plant cannabinoids.
Can cannabis help Crohn’s and Ulcerative Colitis?
According to Dr. Jeffrey Hergenrather in a talk entitled ‘Cannabis in Primary Care’, “activating the CB1 receptor, down-regulates intestinal motility and intestinal secretions while decreasing inflammation, pain and the risk of tumors.” He goes on, “activating the CB2 receptor decreases visceral pain and inflammation, and also down-regulates intestinal motility. This has a huge effect on patients with Crohn’s disease.”
THC the most abundant cannabinoid in the cannabis plant, has a strong binding affinity with the CB1 receptors, and has been found to be effective in reducing the excessive level of bowel movements and diarrhea. IBD sufferers often find it hard to absorb the nutrients in their food and have little appetite. But with greater CB1 activation slowing these movements down, plus the classic ‘munchies’ effect of THC , there is more time for nutrient absorption, and patients tend to put back the weight they’ve lost during the illness.
THC also binds to the CB2 receptors, bringing about an anti-inflammatory effect, but scientists have found that when it works alongside its non-psychoactive cousin, Cannabidiol (CBD), this inflammation reducing effect is potentiated.
Spanish scientist Ekaitz Agirregoitia explains how this cannabinoid anti-inflammatory mechanism works.
“Cytokines (proteins active in cell signalling and the immune response) appear from T cells. TH-1 is proinflammatory and TH-2 is not proinflammatory. It is suggested that cannabinoids change TH-1 to TH-2, thus bringing about an anti-inflammatory effect.”
“CBD,” he goes on, “can inhibit COX enzyme which is responsible for the inflammatory effect.”
Indeed it’s CBD’s anti-inflammatory action that has particularly peaked the interest of the scientific community because it comes unaccompanied by the often unwanted feeling of being high. Its therapeutic action is more difficult to pinpoint as CBD doesn’t bind directly with either receptor in the endocannabinoid system, instead showing an affinity with other non-endocannabinoid receptors.
Take for instance the Vanilloid receptor (TRPV-1), known to mediate pain perception, inflammation and body temperature. CBD is a TRPV-1 agonist, meaning it stimulates the receptor, explaining why it can be helpful for modulating pain and inflammation.
In the paper ‘Cannabidiol in Inflammatory Bowel Diseases: A Brief Overview’ published in 2012, the authors state that “the beneficial and immunomodulatory effects of CBD have been widely evidenced in experimental animal models of IBD. This compound possesses an extraordinary range of beneficial effects that may slow the course of the disease, ameliorate symptoms and potentially increase the efficacy of the drugs actually available for the therapy of invalidating gut disorders such as ulcerative colitis or Crohn’s disease.”
In practice the whole cannabis plant is best for IBD
While in countries where cannabis preparations containing THC is illegal, CBD can provide welcome relief to the IBD symptoms associated with chronic inflammation, anecdotal evidence suggests that whole plant medicine containing a combination of the two cannabinoids is best.
Something that scientist Agirregoitia can attest to.
When he began treating his ulcerative colitis he used a combination of both THC and CBD. While he found the psychoactive effects of THC hard to tolerate, the combination of the two cannabinoids reduced the inflammation and pain, but also the excessive visits to the bathroom and diarrhoea. For the last few months he been on a CBD only regimen, that while continuing to relieve the inflammation related symptoms, has seen a worsening of his ‘gut motility’ and the need to visit the bathroom.
Human studies show promising results for Crohn’s
But in scientific terms, for medical cannabis to be taken seriously, it’s hard facts and clinical trials that are called for.
As ever, anecdotal evidence far outweighs stringent clinical trials. In 2005 a pilot study examined the experiences of 12 cannabis consuming Crohn’s patients and their IBD symptoms post treatment.
The authors wrote “the patients described marked improvements with the use of cannabis. Beneficial effects were reported for appetite, pain, nausea, vomiting, fatigue, activity, and depression. Patients also reported that cannabis use resulted in weight gain, fewer stools per day and fewer flare-ups of less severity.”
Many of the participants found that they could reduce the amount of immunosuppressant drugs they were taking.
Similar results were found in a slightly larger study in 2012 in which 30 cannabis consuming patients were evaluated. A crucial improvement noted was the reduction in IBD related surgeries needed following treatment with cannabis.
But to date, the nearest research has come to a clinical trial was a small placebo study conducted on 21 patients with Crohn’s at the Department of Gastroenterology and Hepatology at Tel Aviv University in 2013.
Participants, whose condition had been unresponsive to other medication, were divided into two groups, one receiving 115mg of THC smoked twice daily and the control group cannabis with the THC removed.
Complete remission was achieved by 5 of 11 subjects, 10 out of 11 patients showed a clinical response with improvement in their symptoms, and during the study, 3 patients were “weaned off their steroidal dependency.”
The authors state, “although the primary end point of the study (induction of remission) was not achieved, a short course (8 weeks) of THC-rich cannabis produced significant clinical, steroid-free benefits to 10 of 11 patients with active Crohn’s disease, compared with placebo, without side effects.”
A positive outcome indeed, and one that judging from the personal experience of Spaniard Agirregoitia, might only improve further if the treatment is extended for a longer period and uses the whole cannabis plant.
If you are an Inflammatory Bowel Disease patient and take cannabis to manage your disease, we would love to know about your experiences. What strains or delivery methods work best for you? Has there been a gradual improvement or did you see changes immediately? Please leave your thoughts in the comments section below. They may just help someone who is considering medicinal cannabis for their own IBD condition.