Can cannabis be used to effectively treat inflammatory bowel disease (IBD)?
Like many topics in science, the answer isn’t entirely clear-cut.
In this article, we’ll dive into what the current research tells us about treating IBD with cannabis.
What is IBD?
First things first — what is IBD?
IBD (not to be confused with the condition IBS or irritable bowel syndrome) is a chronic condition that causes inflammation in the gastrointestinal (GI) tract.
It’s caused by a complex interplay between genetics, the gut microbiome, an individual’s unique immune response, and environmental factors.
According to the U.S. Centers for Disease Control and Prevention, symptoms can include:
- Persistent diarrhea
- Abdominal pain
- Rectal bleeding/bloody stools
- Weight loss
As you can imagine, these symptoms severely impact a person’s quality of life.
IBD is broken down into two distinct diseases, Crohn’s disease (CD) and Ulcerative Colitis (UC). CD can affect any part of the GI tract, while UC usually only occurs in the large intestine.
The Need for Better IBD Treatments
More and more people are suffering from IBD in both Western and Asian populations. Researchers think the increase in IBD prevalence is caused by environmental factors such as antibiotic exposure, diet, and lifestyle. With an increase in the number of people suffering from this debilitating disease, the need for effective treatments is more critical than ever.
Today, advances in treatment mean fewer people require surgery than in past decades. However, there is still a significant unmet need for novel therapies to help people cope with the symptoms of IBD.
That’s where cannabis comes in.
Cannabis, Inflammation, and IBD
Cannabis has been used for hundreds of years as a medicinal herb. But only recently have researchers started to scratch the surface on the mechanisms that make this plant such a powerful therapeutic.
For IBD, the primary disease characteristic is inflammation. We now know from the research that cannabis that has anti-inflammatory properties. We also know that the endocannabinoid system (ECS) is an important player in the process of inflammation.
The ECS is a biological network present throughout the entire human body. It’s made up of receptors and molecules that bind the receptors, like keys that fit into a lock. The ECS controls many of our body’s important functions like inflammation, appetite, immunity, sleep, memory, and mood.
Interestingly, researchers have uncovered a link between IBD and the ECS. Stimulating the ECS through cannabinoid receptors 1 and 2 has anti-inflammatory effects in the intestine. There’s also evidence that people suffering from IBD may have genetic mutations in ECS genes.
Cannabis-derived cannabinoids like cannabidiol (CBD) and tetrahydrocannabinol (THC) bind and stimulate ECS receptors when you ingest cannabis.
This makes cannabis a promising therapy for treating inflammation associated with IBD.
As is often the case with cannabis, there is quite a bit of anecdotal evidence suggesting that cannabis can ease IBS related symptoms.
Questionnaire studies show that up to 16 percent of adults with IBD use cannabis. Patients report that cannabis helps relieve abdominal pain, diarrhea, and lack of appetite associated with IBD.
A small, open-label clinical trial using inhaled cannabis also showed very positive results. The researchers concluded that the cannabis treatment “improves quality of life measurements, disease activity index, and causes weight gain and rise in BMI in long-standing IBD patients.”
This tells us that cannabis has the potential to significantly improve the quality of life for those suffering from IBD.
Clinical Results: Promising but Uncertain
So far we’ve covered why cannabis has the potential to effectively treat IBD and how anecdotal evidence backs up the research.
Now on to the meat and potatoes — the randomized, controlled clinical trials. These represent the crème de la crème of clinical trials and are the standard for evaluating novel drug therapies.
Open-label clinical trials like the one mentioned above are not considered scientifically rigorous. Without a placebo control and proper blinding, both the researchers and the patients know that they are receiving the drug treatment. This can introduce bias and affect the outcome of the study.
When these strict criteria are applied, the researchers found only 5 published studies. This highlights the need for more rigorous, medical cannabis-focused clinical research.
In four of the five studies, the participants showed only modest positive improvements in quality of life and some disease symptoms. However, the researchers did not observe any direct positive effect on inflammation markers or disease remission rates after cannabis treatment.
Promising, but not exactly a slam dunk. Cannabis consistently improves the quality of life to varying degrees for people suffering IBD, but the results fail to show a convincing cannabis-related effect on inflammation.
As a side note, these studies once again demonstrate the relative safety of cannabis and CBD — clinical trial participants only experienced mild to moderate adverse side effects.
The bottom line is that, while cannabis remains a promising drug therapy for IBD, there’s simply not enough data out there to reach a firm conclusion. So far, the available research points to cannabis helping to relieve the symptoms of IBS, but doing little to effect the actual inflammation.
More trials are needed that test different cannabis formulations in varying doses. That being said, cannabis clearly improves the quality of life for many IBD sufferers and should not be discounted.