Can Cannabis Help Celiac Disease?
Cannabis has long been used as a natural remedy for gastrointestinal disorders. One digestive disorder that’s attracted much attention in recent years is celiac disease, a condition characterized by an immune response to gluten, a type of protein found in grain products.
Early research indicates that the body’s endocannabinoid system is involved in celiac disease, suggesting an explanation for how some people find relief of abdominal pain, nausea, weight loss, diarrhea, and other symptoms of the condition by using cannabis. At this point, it’s far too early to say anything conclusive, and gluten-free diets remain the only known cure for the disease.
The good news is there’s a good deal of evidence that the endocannabinoid system is involved in maintaining a healthy gut, while its dysfunction is associated with a wide range of inflammatory and autoimmune conditions, including celiac disease.
In addition, there is solid evidence that CBD, THC, and other cannabis preparations can improve pain, nausea, weight loss, and other issues that happen to be symptoms of celiac disease.
Medical cannabis is a relatively safe treatment and many celiac sufferers have reported significant improvements.
The Endocannabinoid System
The endocannabinoid system is composed of cannabinoid receptors, endocannabinoids, and the enzymes that help build and break down these compounds. This system plays a major role in maintaining homeostasis — a healthy state of balance in our bodies. To that end, the endocannabinoid system helps regulate a wide variety of processes, including inflammation and gut function.
The two currently known cannabinoid receptors are called CB1 and CB2. CB1 is mainly found in the central nervous system, whereas CB2 is chiefly present in immune system cells. However, both receptors are also present in the gastrointestinal tract (which is protected by gut-associated lymphoid tissue (GALT), the largest component of the immune system).
These receptors are activated by two main endocannabinoids produced by our bodies: anandamide and 2-AG. Phytocannabinoids — cannabinoids derived from the cannabis plant — also interact with the endocannabinoid system. The two main phytocannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD). Although both of these cannabinoids have beneficial effects, THC is also known to cause intoxication.
The ECS and Gut Disorders
A growing volume of research evidence indicates that the endocannabinoid system is involved in the healthy functioning of the gastrointestinal tract and that its dysfunction is involved in such gut disorders as inflammatory bowel disease (IBD), diverticulitis, and irritable bowel syndrome (IBS).
For example, genetic variations of the genes responsible for the endocannabinoid system, such as the genes for the CB1 receptor and FAAH — an enzyme that breaks down endocannabinoids — have been linked to IBS.
More importantly, research suggests that endocannabinoids and cannabinoid receptors change from their normal levels in IBD, IBS, and other digestive disorders. For example, one study found that anandamide levels were elevated in people with ulcerative colitis, one of the two main types of IBD.
Meanwhile, another investigation reported that people with diarrhea-dominant IBS had higher levels of 2-AG, but lower levels of OEA and PEA, two compounds closely related to endocannabinoids.
There is evidence that targeting the endocannabinoid system with cannabis preparations and other compounds that activate cannabinoid receptors or reduce the breakdown of endocannabinoids can provide relief to people suffering from gut disorders.
Most notably, a 2013 study in patients with Crohn’s disease, one of the two main types of IBD, showed that most participants experienced significant improvements from taking THC-rich cannabis over the course of eight weeks.
The ECS and Celiac Disease
Similar to the findings on gut disorders, studies of celiac disease also report altered endocannabinoid system function.
For starters, a 2007 study found that people with celiac disease had higher levels of anandamide and CB1 receptors, which returned to normal after the patients followed a gluten-free diet and the disease went into remission.
Meanwhile, a 2012 study by Italian researchers found that a genetic variant of the CB2 receptor gene called Q63R increased the risk of celiac disease by six times.
The researchers hypothesized that this meant the endocannabinoid system is upregulated in celiac disease as the body’s attempt to counteract the intestinal inflammation.
These findings were matched by a similar 2013 study where patients with active celiac disease had higher levels of both CB1 and CB2 receptors, which returned to normal levels matching those of healthy individuals after the disease went into remission.
These studies clearly show that the endocannabinoid system plays a part in celiac disease. Nonetheless, researchers are not yet sure whether it plays a role in causing Celiac disease vs. a sequelae in the inflammation as a result of the disease.
This raises the question: Can cannabis help?
Cannabis & Celiac
No study to date has examined the use of cannabis in the treatment of celiac disease. This is in part due to the legal environment surrounding cannabis until recently and the difficulty conducting studies as a result. The only research evidence we currently have is that cannabis preparations can help with specific issues that happen to be symptoms of celiac disease, including abdominal pain, nausea, weight loss, and migraines.
Similarly, the anti-nausea effects of cannabis are backed by decades of research. For example, a 2015 systematic review of 23 clinical trials on the use of cannabis-based medicines for chemotherapy-related nausea and vomiting concluded that “Cannabis‐based medications may be useful for treating refractory chemotherapy‐induced nausea and vomiting.” In fact, the evidence is strong enough to warrant the use of a THC-only drug Marinol for chemotherapy-related nausea.
Meanwhile, the appetite-boosting effects of cannabis are well-documented and already used to help patients suffering from weight loss associated with cancer, HIV, and other conditions.
Also, there is research showing that cannabinoids have immuno-suppressive properties that can help with some autoimmune conditions. Because celiac disease is considered an autoimmune disorder, this provides another possible way that medical cannabis could help.
Lastly, there are many anecdotal reports of people with celiac who report improvement when using cannabis medicines.
The bottom line is that although we don’t yet have direct proof that cannabis can help with celiac disease, evidence shows that it can relieve many of its symptoms and perhaps even the underlying causes, such as autoimmunity.
In addition, researchers stress that cannabinoids and drugs that raise the levels of endocannabinoids have already shown benefits in gut disorders and will become increasingly prominent in the coming years as the research progresses.
Generally speaking, clinical research indicates that cannabis is a safe substance. Although it is associated with some side effects, the vast majority of these are considered mild and non-serious.
In addition, it’s important to remember that the side effects of medical cannabis vary depending on the particular preparation used.
Most notably, THC is known to cause short-term psychoactive effects, such as anxiety, paranoia, memory impairment, and slowed reaction time, as well as increased heart rate and red eyes.
On the other hand, CBD is not psychoactive, but it can cause other side effects, such as fatigue, low blood pressure, diarrhea, and dry mouth. As such, these effects are more likely when using low-THC, CBD-rich preparations such as full-spectrum CBD oil.
About Celiac Disease
Celiac disease (also spelled coeliac) is an autoimmune disease that affects the digestive tract. When you have celiac disease, your body’s immune system attacks your digestive system every time that you eat gluten. Gluten is a protein that’s found in wheat, barley, and rye flour.
Over time, these attacks can damage the villi, which are tiny parts of the small intestine that stick out from the intestinal walls and absorb nutrients from your food. When the villi are damaged, they can’t absorb nutrients properly and your body starts to suffer.
Celiac is a fairly common illness. One out of every 100 people worldwide has celiac disease, including 3 million Americans. In Europe, prevalence varies widely between different countries: in Sweden the prevalence of celiac disease is at 3.5%, in Finland it’s at 2.4%, but in Germany, fewer than 0.3% of the population are estimated to have celiac disease.
The symptoms of celiac disease can be different in each person. Like other autoimmune diseases where the immune system attacks the body, patients can have practically no symptoms at all, or alternatively, can be completely incapacitated and disabled. It also has very different symptoms for adults than for children.
In adults, the main symptoms of celiac disease are related to the digestive tract and abdomen, including:
- Diarrhea, sometimes with particularly foul-smelling stools
- Pain in the abdomen and indigestion
- Bloating and gassiness
- Nausea and vomiting
Adults can also show other symptoms that aren’t directly related to the digestive system. These are typically caused by a lack of nutrients, due to the damaged villi. Secondary symptoms of celiac disease include:
- Tiredness and fatigue, often due to malnutrition
- Weight loss
- Anemia, generally because of iron deficiency
- Osteoporosis or osteomalacia (loss of bone density or bone hardness)
- An itchy skin rash (dermatitis herpetiformis)
- Joint pain
- Ulcers in the mouth
Celiac disease can also end up causing nerve damage, which causes symptoms of pain, tingling, and numbness of the hands and feet. It can also cause difficulties with speech, balance, and cognition. Women with celiac disease often have difficulty getting pregnant, and both women and men can find that their spleen doesn’t work properly (hyposplenism). Also, like other chronic diseases, long-term suffering can cause mood problems such as anxiety and depression along with poor sleep.
Children with celiac disease are more likely to show digestive symptoms, including nausea and vomiting, constipation or diarrhea, bloating and gas, abdominal pain, a swollen belly, and particularly smelly stools. Because they can’t absorb the nutrients they need at a time when they are growing fast, they can also show the following symptoms:
- Unusually short in their stature
- Delayed puberty
- In infants, a failure to thrive
- Weight loss
- Damaged tooth enamel
- Neurological symptoms like ADHD, learning difficulties, lack of muscle coordination, seizures, and headaches
- General irritability
When to see a doctor
Indigestion can be common, so it can be hard to know when a stomach complaint is serious. In general, you should go to the doctor if you or your child has had diarrhea, constipation, or nausea and vomiting for two weeks or more. Children who are not growing, have a pot belly, and have grown pale should also be taken to the doctor.
Celiac disease can’t be cured, but it can be treated in order to reduce your symptoms. The most effective treatment is avoiding gluten altogether. It can take time to learn what foods you can and can’t eat and to adjust to a gluten-free diet. Gluten is found in wheat, barley, and rye flour, but it can also be present in processed foods, some herbal, mineral, and nutritional supplements, some medications, and even in lipstick.
For most people, a strict gluten-free diet stops their immune system from attacking the small intestine so that the gut can heal. Generally, it takes about three-to-six months for children’s intestines to recover, but it can take adults up to several years.
As part of the healing process, some people need other treatments to help reduce the inflammation in their intestines. These can include:
- Medication like steroids, azathioprine (Azasan, Imuran) or budesonide (Entocort EC, Uceris) to reduce inflammation.
Because celiac disease damages the villi and affects your ability to absorb nutrients, many people with celiac disease also need to take vitamins, minerals, and nutritional supplementation to manage the side effects of a lack of nutrients. These frequently include:
- Vitamin B12, D, and K
If you have the itchy skin rash dermatitis herpetiformis as a result of your celiac disease, you will probably be given medication like dapsone to help it clear up.
A small number of people have refractory celiac disease, which is celiac disease that can’t be managed by a gluten-free diet. There’s no effective treatment for refractory celiac disease.
If you ignore the symptoms of celiac disease or continue to eat gluten, you greatly increase your risk of experiencing serious complications. These include:
- Severe malnutrition and anemia
- Osteoporosis, which makes your bones brittle and break easily
- Infertility and frequent miscarriages
- Persistent lactose intolerance
- A greater risk of developing cancer, particularly cancers of the digestive tract
- Neurological disorders, including epilepsy, ataxia (balance and coordination problems), early dementia, and nerve pain
- A malfunctioning gallbladder and/or pancreas
- Anxiety and depression
- Chronic fatigue