Cannabis for Crohn's and Ulcerative Colitis: What IBD Research Shows

Cannabis is not a cure for inflammatory bowel disease (IBD), but research suggests it may ease some of its symptoms: in surveys and small trials, patients with Crohn's disease and ulcerative colitis report less abdominal pain, cramping and diarrhea. IBD affects millions of people worldwide, and its symptoms, from chronic diarrhea to weight loss, can be seriously debilitating.

Standard IBD treatment often relies on immunosuppressants and anti-inflammatory drugs, which can come with significant side effects. That's why medical cannabis has drawn attention as a promising complementary option for managing IBD symptoms.

What are the symptoms and causes of inflammatory bowel disease?

IBD mainly affects the digestive tract, especially the intestines and the colon. The most common symptoms include chronic diarrhea, abdominal pain and cramping, unintended weight loss, fatigue and fever. That said, not everyone diagnosed with IBD will experience all of them.

Common IBD symptoms:

1. Chronic diarrhea: One of the most frequent symptoms, and it can be persistent and draining.
2. Abdominal pain and cramping: Painful sensations in the belly that can range from mild to severe.
3. Unintended weight loss: Caused by poor nutrient absorption and loss of appetite.
4. Fatigue: A constant feeling of exhaustion that rest doesn't fix.
5. Fever: In some cases, IBD can cause a fever.

What causes IBD?

Nobody knows the exact cause of IBD, but most doctors agree that genetics plays a big role. Diet and lifestyle are crucial for keeping symptoms under control, but it's still debated whether they directly contribute to the disease showing up in the first place. Since IBD is an inflammatory condition, a malfunctioning immune system may also be part of the picture.

How cannabis may help with inflammatory bowel disease

Cannabis compounds, especially THC and CBD, have shown anti-inflammatory properties in research. They interact with the endocannabinoid system (ECS), the body's network of cannabinoid receptors and messengers, which is heavily concentrated in immune cells and helps regulate immune function. Some researchers suggest IBD could be linked to an ECS imbalance, which would make cannabis a possible treatment option.

The rationale for using cannabis in IBD rests on its potential to reduce inflammation and modulate the immune response. It's an avenue that's getting more and more attention, given the results seen in some studies and in clinical experience.

Exogenous and endogenous cannabinoids: how they regulate gut inflammation

Numerous studies point to the endocannabinoid system playing a key role in regulating gut inflammation. Both endogenous cannabinoids (the ones your body makes) and exogenous cannabinoids (the ones that come from outside, like plant cannabinoids) can influence inflammation in the stomach and intestines, which hints at a potential therapeutic use for plant-derived cannabinoids.

IBD research: a study of CB receptors and colitis in mice

In a 2004 study, researchers looked at the role of CB receptors in mice with induced colitis. Mice lacking the CB1 receptor developed more severe inflammation.

On top of that, mice treated with a CB antagonist (a compound that blocks the receptor) showed symptoms similar to those of the receptor-deficient mice. Mice treated with a CB agonist (a compound that activates it), on the other hand, were better protected against induced colitis. These findings suggest that boosting endocannabinoid signaling may help during colitis.

A 2014 study: FAAH inhibitors and colitis in rodents

In another rodent study from 2014, researchers gave the FAAH inhibitor PF-3845 to mice with TNBS-induced colitis. The FAAH inhibitor reduced the induced colitis and showed anti-inflammatory properties tied to changes in the levels of certain bioactive lipids.

MAGL inhibitors showed positive results as well. FAAH is the enzyme that breaks down anandamide, while MAGL breaks down 2-AG, both endocannabinoids produced by the body's own endocannabinoid system.

What conditions can cannabis oil help with?

Research suggests that raising the levels of endocannabinoids may protect against colitis or slow its progression. Notably, CBD has been shown to inhibit FAAH, which is one example of how an outside cannabinoid can influence the endocannabinoid system to get a desired therapeutic effect.

The takeaway from the lab

The scientific literature points to a clear connection between the endocannabinoid system and gastrointestinal inflammation. The studies above suggest that targeting this system with endogenous and exogenous cannabinoids could open new avenues for treating inflammatory bowel disease, which highlights cannabis's therapeutic potential in this area.

Clinical trials and research on cannabis and IBD

Cannabis has been used as medicine for centuries, and one of its earliest uses in Europe was for stomach pain linked to cholera, thanks to Dr. William Brooke O'Shaughnessy, who brought it over from India.

After almost 100 years of prohibition, modern science is starting to catch up with those early observations, and there's a growing body of evidence suggesting cannabis can help with certain symptoms of inflammatory bowel disease.

How many IBD patients use cannabis?

In a questionnaire given to 292 IBD patients, almost 52% said they had used cannabis at some point to manage their symptoms. Of those, 16.4% used it specifically to treat medical symptoms, mostly abdominal pain. That suggests a significant number of patients are self-medicating with cannabis to find relief.

In another cohort study, 313 IBD patients were surveyed. Of those, 17.6% used cannabis to relieve symptoms related to their disease.

Patients who used cannabis reported significant improvements in abdominal pain (83.9%), abdominal cramping (76.8%), joint pain (48.2%) and diarrhea (28.6%). However, the study also found a higher risk of needing surgery among those who had used cannabis for six months or longer.

Observational studies and clinical trials on Crohn's disease

An observational study of 30 patients with Crohn's disease, a form of IBD, was published in the journal of the Israel Medical Association. Of those patients, 21 improved significantly after cannabis treatment, and their need for other medications dropped considerably. Unlike the cohort study above, the researchers saw fewer surgeries among the patients using cannabis.

In 2013, the journal Clinical Gastroenterology and Hepatology published a randomized, placebo-controlled clinical trial, the first of its kind, on the effect of THC in people with Crohn's disease.

The study included 21 patients who hadn't responded to standard treatments like steroids, immunomodulators or anti-TNF-α drugs. Patients in the cannabis group smoked cannabis cigarettes twice a day, each containing 115 mg of THC, while the placebo group got cannabis flower with the THC removed.

Promising results

Five of the 11 subjects in the cannabis group reached complete remission, compared with just 1 of the 10 in the placebo group. Three patients in the cannabis group were also able to cut back their dependence on steroids. These results suggest THC has real potential for Crohn's disease, although the researchers stress the need for further studies with larger groups of patients to confirm them.

Bottom line

The growing evidence suggests cannabis may help with certain IBD symptoms. But while the early studies are promising, more research is needed to fully understand cannabis's therapeutic potential for IBD and to establish safe, effective treatment guidelines. If you have Crohn's or colitis, talk to your gastroenterologist before adding it to your routine.