Conventional therapy using steroids, disease-modifying drugs, and biological drugs remains the cornerstone of treatment for patients with CD. Unfortunately, not all patients react to these medications; some develop severe side-effects, while others experience only partial remission, leaving them longing for more treatment options.
In recent years, the research of the possible therapeutic properties of cannabis in patients with CD has been on the rise, showing promising results, and giving patients seeking to supplement their treatment plan a possible way to improve their quality of life.
Reducing GI inflammation is crucial in treating Crohn’s disease. New insights into the effect of the ECS on GI inflammation and current clinical research lead us to the notion that cannabis may reduce GI inflammation and improve patient’s quality of life in CD patients, although more clinical research is required in order to obtain clearer and more conclusive results.
Cannabis is recommended to adult CD patients in order to relieve pain and symptoms, and can be used as a supplementary treatment at a relatively low cost, high safety profile, and may even act synergically with conventional therapy to reduce inflammation.
Cannabis is not recommended for children, according to the Canadian Association of Gastroenterology, due to possible structural changes in the developing brain.
- Acts as a pain reliever: Under conventional therapy, treating inflammation in CD may take time, requiring the use of analgesics in order to relieve acute pain
- Nausea, bloating, diarrhea – Cannabis has been to alleviate many of the symptoms that patients with Crohn’s suffer from.
- Increases appetite: Patients with CD suffer from decreased appetite, often due to nausea.
- Safety: Cannabis is generally considered safe. Serious adverse effects are rare and there’s never been a recorded fatality directly secondary to use.
- Cost: Although the cost of medicinal cannabis varies depending on the country, type of insurance and strain, its price is often much cheaper than some CD medications such as biological drugs. It is important to keep in mind that at this point, cannabis is used as a supplementary treatment
- Mind-altering: Impaired problem-solving abilities, memory, and balance in the short term, and possibly in the long-term.
- Smoke-induced lung and airway disease: Any type of smoking damages the lung, trachea, and mouth. This could be overcome by using other means of delivery other than smoking, such as using edible cannabis.
- Increases the risk of heart attack, chronic cough, and mental disorders.
- Possible addiction: Chronic and heavy use of cannabis may lead to addiction and dependence.
The Endocannabinoid System
The endocannabinoid system (ECS) consists of cannabinoids, their receptors, and certain metabolic enzymes. It participates in countless biological processes, and is a major player in the regulation of different bodily functions such as normal brain activity, sleep, and digestion, just to name a few.
The ECS is an important player in the regulation of the gastrointestinal (GI) tract, ranging from simply controlling the rate of digestion to complex interactions with the gut flora and cells of the immune system. The wall of the GI is saturated with cannabinoid receptors, and we now know that many GI disorders are linked to dysregulation of the ECS which more often than not is associated with a decrease in the endocannabinoids.
The ability of the ECS to interact with the gut’s microbiome, immune cells, and functional
epithelium allows it to partake in the course of GI inflammation.
Both animal and observational studies have highlighted the importance of ECS dysregulation in
inflammatory bowel disease (IBD) such as Crohn’s disease (CD), as well as the benefits gained
from cannabinoid supplementation by using their anti-inflammatory effects.
Crohn’s & Cannabis
Cannabis has long been known for its therapeutic value in treating various symptoms and conditions, many of which are related to the GI tract. The plant’s effects are due to cannabinoids acting as an external supplementation, and exerting an inhibitory effect on many metabolic processes, such as the suppression of nausea, regulation of gut motility and reduction of smooth muscle contraction, and control of acid secretion.
The idea that cannabis may combat inflammation in CD stems from preclinical experiments that investigated the effect of the loss of cannabinoid receptors, the activity of cannabinoid receptor antagonists (blockers), and the effect of reduced number of endocannabinoids — all of which resulted in increased activity of the immune system, which was related to gastric inflammation.
A series of preclinical studies have demonstrated the protective effects of cannabis in intestinal inflammation.
- Although the “standard” cannabinoid receptors are thought to be exclusively CB1 and CB2 receptors, we now have evidence that cannabinoids can interact with other receptors as well; for example, GPR55 which is responsible for intestinal inflammation.
- Cannabis has been shown to have a protective effect against intestinal inflammation, as it acts as an inhibitor on such key regulators of intestinal inflammation.
- Cannabinoids help maintain the integrity of the intestinal barrier, making it less permeable to foreign matter
Cannabis has shown its effectiveness in clinical studies as well; unfortunately, however, most of these studies are statistically underpowered due to the low number of participants.
- The first study to investigate the direct effects of cannabis on CD, observed a great improvement in 21 of the 30 patients who participated in the study; the participants required less CD-specific medication, and the number of surgeries during the years of cannabis treatment reduced dramatically compared to previous period.
- A second study showed a significant improvement in the quality of life of IBD patients using cannabis during a 3-month trial. Patients reported less pain, depression, and overall better well-being, along with a decrease in disease activity.
- A study aimed to compare the effects of THC-rich versus THC-rich strands of cannabis as a treatment in patients with CD that did not respond to conventional treatment. The results showed reduced disease activity in both groups, with an advantage in the THC-rich group in which a few of the patients weaned off steroids and showed complete remission.
Children & Cannabis
A 2019 review published by the Canadian Association of Gastroenterology has made a strong recommendation against the use of cannabis as a treatment of CD in pediatric cases. According to experts, although cannabis is associated with several benefits in CD, the evidence was inconclusive. Also, the risks associated with the usage of cannabis during adolescence and its linked effects on the developing brain outweigh the potential benefit in children.
In most of the world, the use of cannabis still carries a social stigma and in some cases even legal repercussions; however, in some countries, especially the US — it has been legalized in many states for medical and in some states even recreational use.
There are many conditions for which patients can ask their physician for a cannabis recommendation. These countries and states consider CD as a valid condition for patients can receive cannabis:
Australia — Victoria, New South Wales, Queensland, South Australia, Western Australia
Asia — Israel
Europe — Belgium, Netherlands
North Atlantic Ocean — Bermuda
South America — Argentina, Uruguay
North America — Canada, Alberta, and British Columbia
- Delaware (does not specifically state CD)
- Maryland (does not specifically state CD)
- Nevada (does not specifically state CD)
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Dakota
- Oregon (does not specifically state CD)
- Rhode Island
- South Carolina
- Virginia (does not specifically state CD)
- West Virginia
Crohn’s disease is an elevated and more intense type of inflammatory bowel disease (IBD), which causes inflammation of the digestive tract. Inflammation caused by Crohn’s disease can affect any area of the body’s digestive track, anywhere from the anus to the mouth area. Symptoms range from mild to severe, leading to minor digestive frustrations, chronic pain, multiple surgeries and complete disability.
Also called ileitis or enteritis, Chron’s disease can affect any part of the gut, but in most cases, it affects the lower part of the small intestine—the ileum. In Crohn’s all the layers of the intestinal tissue from superficial to deep might be affected, whereas, in another IBD condition called ulcerative colitis (UC), only the large colon is affected.
A new estimate released by the Center for Disease Control and Prevention (CDC) states that about 780,000 Americans have Crohn’s in the United States. Two out of three individuals with Chron’s will be diagnosed before the age of 40. The disease is just as prevalent in men as in women, but smokers are twice as likely to receive a diagnosis. About 11% of people who have Crohn’s will experience active, chronic symptoms, which means they will have severe symptoms over a long period of time.
Crohn’s disease has a wide variety of symptoms, ranging from mild to severe, and they tend to develop over time. The most common symptom of Crohn’s is abdominal pain, diarrhea and constipation. Other signs and symptoms of active disease may include:
- Mouth sores
- Reduced appetite
- Blood in stool
In the case of a severe condition, patients might also experience:
- Liver inflammation or of the bile ducts
- Skin, eyes, or joints inflammation
- Delayed growth in children
Individuals with Crohn’s disease are more prone to developing intestinal infections from viruses, bacteria, and fungi, which can result in more complications of their condition. In addition, yeast infections are common, and can have a negative effect the intestinal tract and the lungs.
Rectal bleeding caused by Crohn’s can lead to anal fissures, as well as anemia. Crohn’s symptoms can also cause weight loss as a result of a loss of appetite and diarrhea, along with further inflammation (in the eyes, skin, in the liver or in the bile duct). Often, people with Chron’s may also have a concomitant autoimmune.
You should see a doctor following any persistent change in bowel habits or if you show symptoms of Crohn’s disease-like abdominal pain, blood in the stool, unexplained fever that lasts more than a day and ongoing diarrhea that doesn’t respond to over-the-counter (OTC) medications.
None of the theories of what causes Crohn’s disease has been proven. However, scientists associate the condition with a certain gene which is involved in how the body reacts to certain microbes. If the gene misleads the reaction due to a mutation or other sort of change, the body may react to microbes abnormally. The mutated gene is found in people with Crohn’s disease twice as often as in other people, according to research. However, it is unclear whether the condition affects the gene, or if the defective gene contributes to the development of the condition.
Scientists believe that Crohn’s disease is caused by a combination of factors:
- Immune system problems – These occur when the immune system accidentally eliminates microbes that are considered helpful for digestion as if they were infections. The response causes inflammation in the “infected” area that can be chronic and lead to ulcers and other injuries to the intestines.
- Genetics – Between 1 – 2 individuals out of 10 with Crohn’s disease have at least one family member who already has the disease. The chances rise to 70% in the case of an identical twin. The condition is more common among Jews and is generally more prevalent in Caucasians.
- Environmental factors – Substances that are edible or breathable, as well as cigarette smoke, can be potential triggers for a Crohn’s outbreak. Other possible triggers might be infecting microbes, such as bacteria or viruses (like E. coli)
No single test can diagnose Crohn’s with certainty but there are tests that may indicate you have the condition. If the doctor suspects that you have it, he/she will begin by ruling out other possible causes for your symptoms and look for telltale signs of the disease. The process includes tests such as:
- Blood tests — This test checks for anemia, infection, vitamin deficiencies, metabolic abnormalities, or other conditions.
- Fecal occult blood test — This test is used to check for blood in the stool.
- Colonoscopy – A medical examination which allows the physician to view the very end of the ileum (terminal ileum), as well as the colon. This procedure may include a biopsy (sample tissue) to confirm the diagnosis.
- Upper Endoscopy – Similar to a colonoscopy only it enters the mouth and allows for visualization of the mouth, esophagus and stomach and beginning of the small intestine
- Computerized tomography (CT) – A more detail-oriented X-ray machine, the CT scan find important details from the entire bowel that a regular X-ray cannot. It also can see tissues that are outside of the bowel.
- Magnetic resonance imaging (MRI) — An MRI scanner creates detailed images of organs and tissues using a magnetic field and radio waves
- Capsule endoscopy – The patient swallows a capsule with a very small camera within it to take pictures of the small intestine. The images taken are then displayed on a screen and inspected for signs of Crohn’s.
- Balloon-assisted enteroscopy – Here, the physician will take a look in the small bowel where the standard endoscopes cannot reach. They do this by using an endoscope with a balloon on the end of it.
The doctor will also carefully examine your medical history, paying special attention to the family tree and to diseases with similar symptoms that might be hereditary.
Currently there is no known cure for Crohn’s, and therefore, no one treatment will work for everyone. Present treatment is focused on reducing the inflammation that triggers symptoms, and suppressing the immune system.
Medical treatment includes:
- Anti-inflammatory drugs – including Corticosteroids and Oral 5-aminosalicylates
- Immune system suppressors – Aimed at reducing inflammation and additionally targets the immune system as a whole, as the immune system produces the substances that cause inflammation.
- Biological therapies – These immunosuppressive therapies are often given by injection and infusion and target specific immune pathways involved in Crohn’s disease.
- Antibiotics – Used to reduce the amount of drainage, and can sometimes heal fistulas and abscesses.
- Other medications – doctors may recommend antidiarrheals, pain relievers (not ibuprofen or naproxen sodium, which are likely to worsen the symptoms), iron supplements, vitamin B-12 shots (in case of developing anemia), calcium, and vitamin D supplements (to reduce the risk of osteoporosis).
In addition to the above, doctors possibly will recommend a specific low-fiber diet in order to reduce the risk of intestinal blockage. Doctors also recommend avoiding foods that could cause inflammation. This includes spicy foods, alcohol, and possible allergens. It is recommended to avoid dairy products due to lactose intolerance, which is highly common, potentially worsening symptoms.
If symptoms continue or worsen, despite all the therapies above, surgery may be indicated to repair or remove disease digestive tissue. Almost half of those who have Crohn’s disease will require surgery at some point in time. The idea is to remove a damaged portion of the digestive tract and reconnect the healthy sections. Unfortunately, sometimes the disease continues on the sections of the tissue adjacent to where the surgery was performed. Risk of recurrence after surgery can be minimized with medication.
Lifestyle changes and healthy habits are a cornerstone of living with Crohn’s disease. Other recommended habits which may significantly help with dealing with the disease include:
- Stress management – avoid stressful situations as much as possible and use exercise and breathing exercises to manage stress levels.
- Drink plenty of water
- Consider alternative medicine – although their efficiency is not backed by science, many patients with Crohn’s benefit from herbal and nutritional supplements, probiotics, fish oil, acupuncture, and prebiotics.
- Exercise – moderate exercise can help deal with practically all chronic diseases, including Crohn’s.
- Support Groups – learning and communicating with others suffering from the condition also may help deal with the disease and improve the quality of life.
Get help – even if its symptoms are mild, Crohn’s is a difficult disease to manage. Stay informed on research, join a support group and talk to a therapist, if needed.