Crohn’s Disease and Pot – a review

A reader with Crohn’s who is trying to alter gut bacteria research on this site sent me a link about cannabidiol and Crohn’s disese, Since I view Crohn’s as one possible outcome of IBS that is associated with CFS, I thought that a review would be appropriate since cannabidiol is becoming more and more available legally in the US and Canada.

  • A pharmacological modulation of the endocannabinoid(eCB) system might be beneficial for widespread diseases such as gastrointestinal reflux disease, irritable bowel syndrome, inflammatory bowel disease, colon cancer, cystitis, and hyperactive bladder. Drugs that inhibit endocannabinoid degradation and raise the level of endocannabinoids, non-psychotropic cannabinoids (notably cannabidiol), and palmitoylethanolamide, an acylethanolamide co-released with the endocannabinoid anandamide, are promising candidates for gastrointestinal and urinary diseases.” [2015] Speculation
  • “CBD is a very promising compound since it shares the typical cannabinoid beneficial effects on gut lacking any psychotropic effects. For years, its activity has been enigmatic for gastroenterologists and pharmacologists, but now it is evident that this compound may interact” [2013Speculation
  • “It is unclear if either CB (cannabinoid) receptor has a dominant role in modification of sensory signals or if differences exist at peripheral and central nervous sites.” [2014]

  • “By interfering with the eCB system using CB(1) agonist and antagonist in lean and obese mouse models, we found that the eCB system controls gut permeability and adipogenesisThese data indicate that gut microbiota determine adipose tissue physiology through LPS-eCB system regulatory loops and may have critical functions in adipose tissue plasticity during obesity.“. [2010]

  • “In this review we will discuss how the endocannabinoid system, intestinal microbiota and the brain-gut axis are involved in the regulation of energy balance and the development of obesity-associated systemic inflammation.” [2012]
  • “cannabis produces significant clinical benefits in patients with Crohn’s disease.” [2014] “in agreement with the ancient use of Cannabis in intestinal disturbances and one decade of animal research, Cannabis was shown in a clinical trial to reduce symptoms in patients with CD.” [Full Text]
  • “CBD reduced the expression of S100B and iNOS proteins in the human biopsies confirming its well documented effect” [2011]
  • “Cannabinoids also reduce gastrointestinal motility in randomized clinical trials. Overall, modulation of the gut endogenous cannabinoid system may provide a useful therapeutic target for disorders of gastrointestinal motility.” [2008]

  • “The extent to which the effects on gastrointestinal function of cannabinoid receptor agonists or antagonists/inverse agonists can be exploited therapeutically has yet to be investigated as has the extent to which these drugs can provoke unwanted effects in the gastrointestinal tract when used for other therapeutic purposes.” [2001]
  • “Complete remission was achieved in 5 of 11 subjects in the cannabis group and 1 of 10 in the placebo group. Yet, in an additional study, low-dose cannabidiol did not have an effect on CD activity. In summary, evidence is gathering that manipulating the endocannabinoid system can have beneficial effects in IBD, but further research is required to declare cannabinoids a medicine…. We need to establish the specific cannabinoids, as well as appropriate medical conditions, optimal dose, and mode of administration, to maximize the beneficial effects while avoiding any potential harmful effects of cannabinoid use.” [2014] It was “tetrahydrocannabinol-rich cannabis with the placebo having littletetrahydrocannabinol”[2013]

So what is the bottom line?  This blog is striving for remission not symptom moderation. There is clear evidence that cannabinoids result in symptom moderation. This chart has cannabinoids with many desirable characteristics as does this report on clinical studies which include this report that 60% of Crohn’s patients improved. The not reproducible success above was not with cannabinoids but with cannabis high in tetrahydrocannabinol.  There is some evidence that it can help in remission, nor, how it impacts gut bacteria is unclear (a concern for this blogger). It does impact gut permeability.