Medical marijuana and Inflammatory Bowel Disease (IBD)
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Inflammatory Bowl Disease affects roughly 1 in 350 people around the world but there still is no real cure. However, new research into cannabis shows the plant may play a key role in both managing and preventing symptoms of IBDs like Crohn's disease and ulcerative colitis. Could cannabis be the future of IBD treatment?
UNDERSTANDING INFLAMMATORY BOWEL DISEASE
Inflammatory bowel disease (IBD) is a condition characterized by chronic inflammation of the digestive tract. The two primary types of IBD are Crohn’s disease and ulcerative colitis.
Crohn’s disease produces inflammation that can affect the entire digestive tract. The inflammation caused by this disease usually penetrates deep into the bowel tissue, producing a variety of symptoms, including abdominal pain, severe diarrhea, fatigue, weight loss and more.
Ulcerative colitis (UC), on the other hand, produces both inflammation and ulcers and only affects the colon or large intestine. Ulcerative colitis mainly produces strong abdominal pains and bloody diarrhea, but can also produce other symptoms.
Both Crohn’s disease and ulcerative colitis can be extremely painful and debilitating, affecting a patient's ability to go about their daily life. The exact causes behind Crohn's disease and UC are unknown, but professionals speculate that they could be related to environmental factors, changes to bacteria in the gut, and even genetics.
These factors cause a malfunction in the immune system, causing it to attack healthy tissue in the digestive system. This ultimately leads to the inflammation.
Other types of inflammatory bowel disease include collagenous colitis and lymphocytic colitis. They are both characterized by excessive non-bloody watery diarrhoea and tend to affect people over the age of 50. The causes of collagenous and lymphocytic colitis are also unknown.
WHAT ARE THE SYMPTOMS OF IBD?
The exact symptoms of IBD vary depending the individual patient and the type of IBD they suffer from. However, symptoms do tend to overlap and generally include:
- Abdominal pain.
- Abdominal cramps.
- Frequent, unpredictable, and urgent bowel movements.
- Weight loss.
- Decreased appetite.
- Night sweats.
The symptoms of IBD can come and go over time. This means that patients may experience periods of severe symptoms (also known as flare ups) and periods of remission (characterized by few to no symptoms at all).
Severe Crohn’s disease can cause large patches of inflammation throughout the digestive tract as well as ulcers. Crohn's disease can also cause a thickening of the wall of the intestines, making it difficult for digested food to pass through. In some cases, the deep ulcers caused by Crohn’s disease can break through the walls of the intestine and cause infection outside the bowel which can easily spread.
IBD can sometimes also produce inflammation of other parts of the body, including the eyes, skin, liver and joints. Because ulcerative colitis only affects the inner lining of the colon, one of its distinguishing symptoms is stool with blood or mucus. Crohn’s disease, on the other hand, may or may not produce blood or mucus in the stool and is generally characterized by abdominal pain, nausea, and vomiting. Both diseases can stunt the growth of children.
To determine the individual type of IBD affecting a patient, doctors generally ask the patient to describe their symptoms, assess their family history, and use blood tests, stool samples, and x-rays/scans to better understand what is going on in their gut.
TREATMENTS FOR INFLAMMATORY BOWEL DISEASE
There is currently no cure for IBD. Instead, it’s treatment is concerned with treating and managing symptoms.
The most effective treatments for IBD target the immune system. Corticosteroids and immunosuppressants are commonly used to treat patients and manage inflammation. Medicines known as biologics, on the other hand, rely on specially designed antibodies to block the effects of the molecules that cause the inflammation. These medications, rather than focusing on symptom management, aim to heal the lining of the digestive tract to promote remission and prevent relapses.
Most patients with Crohn’s disease will have to undergo surgery at some stage in order to remove an inflamed part of the digestive tract. Surgery isn’t as common in patients with UC and can often be avoided with early detection and effective treatment.
Dietary changes are an important part of managing, treating, and preventing the symptoms caused by inflammatory bowel disease. Patient’s are encouraged to follow a balanced diet and pay special attention to what foods and dietary habits set off their symptoms. Staying hydrated is also very important for IBD patients as they tend to lose a lot of water during bowel movements.
There are also some alternative therapies for treating IBD, which can include herbal therapies, acupuncture, mind-body therapy, and more. The effectiveness of these treatments isn’t clear.
THE PSYCHOLOGICAL IMPACT OF IBD
As with many chronic conditions, it is important to realize that the stress of IBD goes far beyond particular symptoms. The simple fact of dealing with IBD symptoms for prolonged periods of time and juggling them along with other life commitments can be very stressful on patients.
IBD can have a profound effect on a person’s life, both physically, emotionally, and socially. It can affect their ability to go about basic tasks, and can affect their life at home, in the workplace, school, or elsewhere.
CANNABIS AND IBD: WHAT DOES THE SCIENCE SAY?
To understand whether cannabis can help in the treatment and/or management of IBD it’s important we understand how cannabis affects our bodies.
Cannabis interacts with our bodies via the endocannabinoid system. This system is made up of a variety of receptors (known as CB1 and CB2 receptors) which are located throughout the brain as well as parts of the body, including the gastrointestinal tract. It plays a key role in managing a variety of our body's processes, including everything from appetite and memory to pain management.
Cannabis contains over 100 cannabinoids and a complex mix of terpenes, both of which are known to have a variety of medicinal properties. The cannabinoids found in cannabis are similar molecules to the endocannabinoids produced by our body, and therefore interact with CB1 and CB2 receptors and trigger specific reactions that heighten or lower the levels of neurotransmitters, ultimately altering the way the brain communicates with the rest of the body.
The body of research into marijuana and inflammatory bowel disease is limited but has shown some promising results. Most of the research is done on animals or human tissue taken from biopsies, and is mainly concerned with the anti-inflammatory properties of some cannabinoids.
A 2010 study published in the British Journal of Pharmacology explored the effects of THC (tetrahydrocannabinol) and CBD (cannabidiol) on colitis in rats. The researchers induced intestinal inflammation in rats and then tested the effectiveness of both cannabinoids in treating/managing that inflammation compared to sulphasalazine, a long used anti-inflammatory medication.
The study found that THC was the most effective drug when dosed correctly. While CBD was ineffective on its own, it was able to improve the effectiveness of THC, essentially lifting the power of an ineffective dose of THC to an effective one. THC, both on its own and when used together with CBD, also helped to protect cholinergic nerves. Sulphasalazine wasn’t as effective as THC and also didn’t protect cholinergic nerves.
It is interesting to note that the study found that lower doses of THC combined with CBD were more effective at fighting the inflammation than higher doses of THC alone. Unlike sulphasalazine, THC both alone and combined with CBD also improved the function of colonic muscle movement.
Another study, published in 2011 by researchers at the Department of Experimental Pharmacology at the University of Naples, Italy, looked at the effectiveness of CBD in treating intestinal inflammation. It found that administering CBD after inducing inflammation reduced it and that administering CBD before inducing inflammation prevented it from occurring at all.
The study also found that CBD worked as an effective anti inflammatory agent on biopsy tissue taken from patients with ulcerative colitis. CBD was effective both on tissue taken from patients during remission and active phases of the disease.
Finally, an observational study conducted by researchers from the Meir Medical Center in Israel found that the use of medicinal cannabis helped patients with Crohn’s disease manage their symptoms. The patients generally smoked cannabis, and the average daily dose consisted of 1-3 joints.
The study was conducted by asking 30 patients with Crohn’s disease a variety of questions regarding their symptoms, medical treatments or past surgeries, and reasons for using medical cannabis.
The study found that medical cannabis helped patients wean off other medications they’d normally use to manage their symptoms. 2 patients were also able to give up their regular medication altogether. The study also found that medical cannabis use helped reduce the average number of bowel movements in patients down from 8 to 5.
CANNABIS AND IBD: A CALL FOR MORE RESEARCH
The above research is compelling, but it isn’t enough to make a clear conclusion about cannabis and its role in managing Crohn’s disease or ulcerative colitis. However, it does warrant for further research.
Cannabis interacts with our bodies in very complex ways, and while it seems like new studies about its use as a medicine are making headlines every day, there is still plenty we don’t know about the plant and how it affects us.
Luckily, as cannabis laws change around the world it will become easier for scientists to investigate cannabis further and come to concrete conclusions about its place in modern medicine.
Note: We have taken the utmost care and precaution whilst writing this article. That being said, please take note of the fact that we are not medical professionals of any kind. Cannabis.info is strictly a news and information website. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.