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Inflammatory Bowel Diseases (IBDs, e.g. Irritable Bowel Syndrome (IBS), Crohn’s, Ulcerative Colitis) and Medical Cannabis

Inflammatory Bowel Diseases (IBDs) such as Irritable Bowel Syndrome (IBS), Crohn’s, Ulcerative Colitis etc. and Medical Cannabis

Definition

IBDs are conditions that are characterized by the inflammation of the gastrointestinal (GI) tract.

Potential Efficacy / Quality of Evidence (Low, Average, High) of Medical Marijuana for IBDs (Crohn’s, Irritable Bowel Syndrome (IBS), Ulcerative Colitis)

High, due in part to the huge number of endocannabinoid receptors in the gut. Whilst rare and anecdotal, there is some evidence that long-term cannabis use may inflame the pancreas (pancreatitis), which can make some IBDs worse.

Cannabinoids, Terpenes/Terpenoids, Strains and Ratios that May Help

THC, CBD, CBG, CBC and CBN may all be useful for IBDs.

Terpenes such as myrcene, beta-caryophyllene, limonene, gingerol and myrcene may also be useful.

Medical Cannabis Pros

May prevent colitis [1].

Cannabinoids can help modulate the immune system and prevent inflammation of the gut.

Stimulates appetite, which can become greatly diminished in those with IBDs as they feel like not eating.

Could help reduce the number of pills needed to control the various symptoms of IBDs, including pain.

Cannabis may possibly “reduce the increase of intestinal motility [2] induced by inflammatory stimuli”.

Medical Cannabis Cons

May increase nausea and decrease appetite in some people after long-term use (cannabinoid hyperemesis syndrome), but this is rare.

Although there is no definitive evidence and reports are rare, long-term cannabis use may inflame the pancreas (pancreatitis).

More About the Condition

IBDs of all types can be extremely debilitating. Sadly, they are also very difficult to treat. Loperamide hydrochloride may be of help for IBS sufferers, but they are not always recommended for Crohn’s sufferers. who are more likely to be prescribed corticosteroids, antibiotics and immune system suppressants. In about half of cases [3], Crohn’s sufferers will undergo surgery to remove inflamed parts of the bowel. However, this doesn’t stop the inflammation. This suggests there is an underlying cause to IBDs of various types, and that the cause cannot be removed by surgery.

There are likely to be a variety of factors that can cause IBDs of various types to develop. The body’s immune system attacking elements of its own digestive system (in Crohn’s); a lack of biodiversity of intestinal gut microbiota, which can further exacerbate intestinal permeability and induce an uncontrolled immune response; genetics; and stress and anxiety (in IBS in particular). For ulcerative colitis and Crohn’s disease in particular, rectal bleeding can occur, which can lead to extreme fatigue and vitamin deficiencies.

Diet changes, exercise, vitamin supplements/shots, steroid-based anti-inflammatory drugs (NSAIDs such as ibuprofen are not recommended), anti-diarrheals, antibiotics, immune system suppressants and acetaminophen for pain can treat the symptoms of many IBDs, but not the cause. For those who may have gone through surgery due to Crohn’s, where inflamed parts of the gut are removed, opioid-based painkillers may be prescribed to help with pain. Unfortunately, such painkillers are highly addictive and have many other deleterious side-effects.

Interestingly, there are a huge number of endocannabinoid receptors in the gut, playing an important role in its functioning [4]. This includes the control of intestinal inflammation.Some even suggesting that phytocannabinoids can help overcome an “endocannabinoid deficiency” [5], which could potentially one cause of the out-of-control immune system responses in those with autoimmune conditions of various types. Although the evidence is anecdotal [6] at the moment, it does not seem surprising that cannabis is particularly helpful in managing IBDs [7] due to the fact that there are such a huge number of endocannabinoid receptors in the gut.

o make matters more interesting still, Crohn’s disease and type 1 diabetes share the involvement of a common gene [8]: PTPN2, which is involved in regulating the immune system. Some types of arthritis are also associated with PTPN2 [9] as well. There are theories that variations (or, more scientifically, single nucleotide polymorphisms) of the NPSR1 gene are associated with varying types of IBS. The enzyme fatty acid amide hydrolase (FAAH), which is responsible for breaking down anandamide (and THC), also seems to play a role in intestinal motility [10]. This suggests that learning how to regulate the immune system via the ECS may be one way in which to help treat the underlying causes of various kinds of IBDs.

Could there be a polymorphism in a gene or set of genes that codes for the production of a particular endocannabinoid receptor be one cause of a variety of autoimmune conditions, including Crohn’s, type-1 diabetes and some kinds of arthritis? It’s a possibility. However, genetics is rather complicated, and we should not necessarily fall down the rabbit hole of trying to explain different conditions with one explanation – that of a single gene – especially when different conditions can be caused by a variety of different factors.

There is a possibility, though, that endocannabinoid-based treatments may work for some parts of the population, where endocannabinoid deficiency and/or dysregulation may be a factor in the development of IBDs and some autoimmune conditions. Only clinical trials and studies on larger sets of the population will give us more of an indication as to who cannabinoid-based treatments will work for, as well as which cannabinoid-terpenoid ratios are most effective.

Although there is no definitive evidence and reports are rare, long-term cannabis use may inflame the pancreas [11] (pancreatitis). On the other hand, other studies suggest cannabis may be of use in treating chronic pancreatitis pain [12]. Age may play a factor in this, as most reports of pancreatic inflammation are from those who are aged under 35. Other factors such as the type of cannabis used (not all cannabis is the same) and ingestion method may also play a role. Just as with any medication, these are issues we should be aware of when using cannabinoid-based medications.

 

Quotes from Experts

“Cannabis oil relieved symptoms

They studied 46 people whose Crohn’s disease was moderately severe by randomly assigning them to two groups that received an 8-week treatment.

In one group, the treatment consisted of cannabis oil, comprising 4 percent tetrahydrocannabinol and 15 percent cannabidiol. The other group took a placebo.

The scientists used assessment tools that have been validated for research purposes to measure quality of life and severity of symptoms. They assessed gut inflammation by means of endoscopic exams and markers in blood and stool samples.

After the treatment, there was a significant reduction in Crohn’s disease symptoms in the cannabis oil group compared with the placebo group.

The results showed that 65 percent of the cannabis oil group met “strict criteria for clinical remission” of Crohn’s disease, compared with only 35 percent of the placebo group.” Source: https://www.medicalnewstoday.com/articles/323403.php#4

Case Studies – Patient Stories

https://www.medpagetoday.com/blogs/celebritydiagnosis/76736

 

References

[1] https://www.ncbi.nlm.nih.gov/pubmed/19690824

[2] https://www.ncbi.nlm.nih.gov/pubmed/18924447

[3] https://www.mayoclinic.org/diseases-conditions/crohns-disease/diagnosis-treatment/drc-20353309

[4] https://www.ncbi.nlm.nih.gov/pubmed/27133395

[5] https://www.ncbi.nlm.nih.gov/pubmed/18404144

[6] https://www.ncbi.nlm.nih.gov/pubmed/24356243

[7] https://www.ncbi.nlm.nih.gov/pubmed/22815234

[8] https://www.cam.ac.uk/research/news/type-1-diabetes-and-crohns-disease-genes-identified

[9] https://www.genecards.org/cgi-bin/carddisp.pl?gene=PTPN2

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056499/

[11] https://www.ncbi.nlm.nih.gov/pubmed/28796137

[12] https://www.healio.com/gastroenterology/pancreatic-disorders/news/online/%7B5b7a7874-0298-4db9-b31a-b4958903da8a%7D/cannabis-could-be-used-to-treat-chronic-pancreatitis-pain

[13] https://www.medicalnewstoday.com/articles/323403.php#4

[14] https://www.medpagetoday.com/blogs/celebritydiagnosis/76736

 

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Possible Efficacy

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