CBD for Crohn's disease

What is Crohn's Disease

Crohn’s disease is a subcategory of inflammatory bowel disease and is characterized by chronic inflammation of the gastrointestinal tract. Doctors have identified five types of Crohn’s disease. They are:

Ileocolitis - The most common type of Crohn’s disease, ileocolitis affects the small intestine (or ileum) and the colon. Common symptoms include diarrhea, cramping, and considerable weight loss.

Ileitis - This subtype affects only the small intestine or ileum. Common symptoms include diarrhea, cramping, inflammatory abscesses in the lower right side of the abdomen, and considerable weight loss.

Gastroduodenal Crohn’s disease - This subtype affects the stomach and duodenum, which is the first part of the small intestine. Common symptoms include nausea, vomiting, loss of appetite, and weight loss.

Jejunoileitis - This subtype causes areas of inflammation in the jejunum, which is the middle part of the small intestine. Common symptoms include abdominal pain, cramps after meals, and diarrhea.

Crohn’s colitis - This subtype affects only the colon. Common symptoms include rectal bleeding, diarrhea, skin lesions, and joint pain.

Symptoms of Crohn's Disease

The symptoms of Crohn's range from mild to severe, differing among patients. They include:

Crohn's Disease Medications & Treatment

To date, doctors don’t know what causes Crohn’s and there is currently no known cure. Treatment focuses mainly on symptom management through a combination of lifestyle and dietary changes as well as drug interventions.

Pharmaceutical Interventions
The first step in the treatment of inflammatory bowel diseases such as Crohn’s Disease is for a doctor to prescribe a series of anti-inflammatory drugs. In acute cases, or cases where anti-inflammatories alone do not provide relief, antibiotics are prescribed. Antibiotics can reduce inflammation by targeting harmful bacteria that may play a role in activating the intestinal immune system.

In severe cases where all other interventions have been unsuccessful, surgery is recommended. Nearly half of all Crohn’s disease patients require at least one surgery, during which a surgeon removes the damaged portion of the digestive tract and reconnects the healthy sections. The benefits of surgery are usually only temporary.

Non-Pharmaceutical Interventions
For less severe cases, or as an adjunct to medications, dietary and lifestyle changes are advised for those suffering from Crohn’s disease. It is recommended that sufferers experiencing a “flare up” avoid foods high in insoluble fiber, sugary foods, high-fat foods, alcohol, caffeine, spicy foods and lactose. In addition, it is also helpful to get adequate exercise, stop smoking, and supplement their diet with vitamins and minerals to avoid malnutrition.

CBD in Crohn's Disease

Research & Scientific Evidence

Several studies regarding cannabidiol (CBD) for treating and managing the symptoms of Crohn’s disease have left scientists feeling optimistic about the efficacy as a potential and promising treatment option. Researchers now believe that CBD may interact at extra-cannabinoid system receptor sites as well as on the gastrointestinal system itself to help reduce inflammation as well as other gut disturbances.

A review study published from 2013 published in Phytotherapy Research highlights the importance of CBD as a non-psychotropic cannabinoid intervention for inflammatory bowel diseases (IBD’s) such as Crohn’s disease.

From the literature, the reviewers concluded that a huge amount of data produced in recent years demonstrates that CBD appears to possess anti-inflammatory, anti-oxidant and anti-apoptotic effects in the central nervous system. Similarly, CBD displays potent anti-inflammatory and immune-modulatory properties, making it a promising therapeutic candidate for inflammatory and pain-associated disorders such as Crohn’s disease. Moreover, CBD also shows to have a beneficial effect of CBD in gut disorders themselves, possessing many protective and anti-oxidant functions, relieving oxidative stress, increasing intestinal motility and selectively inhibiting intestinal hypermotility.

The conclusion was that CBD is a beneficial and immunomodulatory compound that has been widely evidenced in experimental animal models of IBD. According to what they found in the literature, CBD also possesses an “extraordinary range of beneficial effects that may slow the course of the disease, ameliorate symptoms and potentially increase the efficacy of the drugs actually available for the therapy of invalidating gut disorders such as ulcerative colitis or Crohn’s disease.”

Publishing their results in 2017 in the journal Clinical Science, researchers attempted to quantify the anti-inflammatory effects of two cannabinoid drugs, one being CBD. The researchers used ex vivo human tissue obtained from colonic samples of patients with IBD undergoing elective bowel resection. To determine the efficacy of CBD, media concentrations from the cell or colonic cultures were measured for specific proteins to determine the presence of inflammation. They found that CBD shows a significant anti-inflammatory action in experimentally as well as clinically inflamed colon cells while also down regulating pro-inflammatory intracellular pathways.

From the data, they concluded that CBD is well tolerated in humans, has few side effects, and is clinically effective for treating inflammatory bowel disease.

In a randomized control trial published in 2017 in the journal Digestive Diseases and Sciences, the researchers found that, although low-dose CBD is safe, it is not an effective treatment for Crohn’s disease.

In this placebo-controlled trial, 20 patients aged 18–75 years diagnosed a Crohn’s disease were randomized to receive 10 mg of CBD isolate or placebo, administered orally, twice daily. Their Crohn’s disease activity index (CDAI) and laboratory parameters were assessed during 8 weeks of treatment and 2 weeks thereafter. The data showed no statistically significant difference between the CBD and the placebo groups.

The researchers concluded that CBD was safe but had no beneficial effects in patients with moderately active Crohn’s disease. However, they also admitted that the results could be due to the low dose of CBD, the small number of patients in the study and/or a lack of the necessary synergism with other cannabinoids found in full- and broad-spectrum CBD extracts.

Anecdotal Evidence

Anecdotal evidence suggests that CBD as well as medical cannabis can have therapeutically beneficial effects for patients with IBD conditions such as Crohn’s disease. However, the effects of continuous use over long periods of time is rarely discussed.

Although not CBD-specific, an observational study from the European Journal of Gastroenterology and Hepatology set out to investigate the real-life experiences of dose and mode of consumption, side effects and the use of other medications in patients with IBD that use cannabis to control their symptoms.

Significantly, they found that patients experienced significantly fewer symptoms and needed less medications at doses of around 30 g a month. The also noted that there were no negative effects of cannabis use on the patients’ social or occupational status, and in fact, found that employment rates actually increased.

CBD as a complementary treatment for Crohn's disease

In addition to its anti-inflammatory and anti-oxidant properties that show potential as providing effective symptom relief for patients suffering from Crohn’s disease, CBD can provide benefits as a complementary treatment.

CBD has repeatedly been shown as having the ability to inhibit and control pain while also suppress pain processing and reduce chronic pain by suppressing α3-GlyRs receptors. This can help reduce the abdominal pain and cramping Crohn’s patients often experience.

Similarly, many patients also tend to suffer from anxiety and depression as a side effect of having to deal with the disease. Again, CBD boosts the production of “happy” endocannabinoids such as anandamide (aka bliss molecule) while also binding to the 5-HT1A serotonin receptors implicated in anxiety disorders.

Bottom Line

Crohn’s disease can be painful and, if untreated, debilitating. However, judging from the scientific evidence we have so far, it is clear that the anti-inflammatory and anti-oxidant effects of CBD can help patients suffering from Crohn’s Disease help manage their symptoms, that could eventually result in remission. However, research is still in the early stages. Before using CBD to help treat the symptoms of Crohn’s disease, always consult a medical practitioner first. Not only can CBD interact negatively with other medications, but your physician can monitor dosage, symptom severity and other clinical parameters to ensure that the CBD treatment protocol is both safe and effective.