I’ve recently finished a 3.5-hour exclusive video series for my clients outlining the latest research on supplements and herbs in Inflammatory Bowel Disease for the IBDCoach program. To my knowledge, it’s the most compressive and accessible overview of this specific subject ever created.

In recent years, one herb that has received the lion’s-share of attention has been used as long ago as 3500 BCE by Proto-Indo-Europeans in a ceremonial context. Additionally, more recently over the last 3 decades, it has arguably revealed more about human biology than any other plant.

Yes: it’s time to talk about the promise and pitfalls of marijuana and it’s truly extraordinary interactions with the body, gut, and brain. 

Examining the Evidence of Cannabis in IBD

In respect to other herbs, there has been a moderate amount of science directly related to cannabis and Inflammatory Bowel Disease. When examining its use in human IBD patients, the data has been mixed at best. 

One thing is for sure: a significant portion of IBD patients use cannabis. In a recent academic summary on the low end, it’s probably around 10% and on the high it’s as much as 50%. [1]

IBD animal studies with cannabis have demonstrated promising results, however, even with widespread, mainstream acceptance, few randomized-controlled trials or even observational studies have taken place directly with human IBD patients. In a recent review paper published last year, the authors determined that the data was mixed. Of 5 academic publications, only 2 demonstrated a positive correlation in disease activity, while the remaining 3 showed little to no benefit in the probability of achieving remission.[2]

The evidence does seem clear however that IBD patients’ quality of life improved in addition to other secondary symptoms of IBD like the quality of sleep and significant increases in appetite. 

In 4 survey studies with 273 UC and 595 CD patients conducted between 2013 – 2017 the majority of patients reported significant reductions in pain, appetite, and nausea. 

Most interestingly, Dr. Christian Turbide at a recent Crohn’s Disease and Ulcerative Colitis Canada Conference reported on a nationwide inpatient survey of 3.3 million American IBD patients that had some pretty interesting results: 

Mortality: 1.4% non-users, 0.3% users

Colectomy: 6.7% non-users, 2.8% users

Blood Transfusions: 9.6% non-users, 4.5% users

Hospital Stay: 5.6 days non-users, 5.2 days users

Obviously, there is only so much we can gather from this data, however, given the number of participants in the study, it does raise curiosities about why there is such a discrepancy between users and non-users. [3]

Cannabis and Human Biology

The endocannabinoid system, only discovered in the early 1990s, is a widespread receptor system throughout the body and is involved with more functions than we could possibly review: inflammation, appetite, mood, pain, cognition, nausea, and vomiting and multiple interactions in the GI system among others. The two primary endocannabinoid neurotransmitters are called anandamide, and 2-AG[4], and these two molecules among some others that are still being uncovered and understood may also possibly even play modulatory roles on the microbiome[4] and the gut-brain axis.[5]

Anandamide
2-Arachidonoylglycerol (2AG)

Additionally, the plant itself is extraordinarily complex with many classes of molecules (483 in total) many of which are believed to have a biological effect. Two of the main compounds are called cannabinoids and terpenes.  Cannabinoids include THC, CBD, THCV, CBC, CBG, CBN (66 known) and while THC and CBD are best-known others have also demonstrated therapeutic potential especially in modulating inflammation.[6] Terpenes including Myrcene, Caryophyllene, Linalool, Pinene, Humulene, Limonene (120 are known) – are responsible for the floral and aromatic qualities of marijuana flowers. [7] 

Canibionid Guide Source: www.thcsd.com

Terpene Guide Source: www.leafly.com

There are two main receptor types, CB1 and CB2. They were both discovered in the early 1990s. The CB1 receptor is primarily located in the central nervous system and affects memory processing, motor regulation, appetite, pain sensation, mood, and sleep. CB2 is primarily found in the periphery and is involved with the immune response.  Multiple in-vitro studies (meaning in the lab) demonstrated CB1 and CB2 rector agonists (activating agents) ameliorated GI inflammation in murine (mouse) models while CB1 and CB2 antagonists (blocking agents) had the inverse effect. [2]

Cannabis and Intestinal Inflammation Source: Insights into the Management of Inflammatory Bowel Disease [2]

With IBD, Context Matters

Things as always, however, become less straightforward in the context of human beings in the real-world context. 

It’s clear that the Cannabis Sativa plant is incredibly complex and one strain of cannabis could be completely different from another. This is due to the unique chemical composition of each. Each strain contains a unique cannabinoid and terpene profile often producing at times radically different psychotropic and biological responses. The most obvious example is in the context of CBD dominant strains. CBD has demonstrated unique anti-inflammatory properties, is not psychoactive, and actually interacts with the CB1 receptor in an opposite fashion when compared to THC in its dual antagonizing (blocking) and inverse agonistic (causes inverse chemical cascade) mechanisms of action. [8]  

Further, terpenes are responsible for different biological effects also and vary in their ability to attenuate inflammation, reduce anxiety, or demonstrate anti-microbial activities.[7]  

The research has not really studied specific strains with specific cannabinoids and terpene profiles that even in theory would be most appropriate and efficacious in addressing the disease mechanisms. And to make matters worse in the United States its much easier to conduct research with drugs like cocaine or methamphetamine than with cannabis. Why? Well, it’s because cannabis is still archaically considered a “Schedule 1” controlled substance by the federal government – the highest level of abuse potential with no medical benefit, and the National Institute of Drug Abuse (NIDA) is the sole supplier of all marijuana utilized in US research. The supply literally all comes from the same crop on the campus of the University of Mississippi and its been like this for decades. [9]   

My Personal Experience with Cannabis for Crohn’s Disease 

My personal experience with cannabis has been positive, especially when flaring. Sometimes when nothing else is working for me, cannabis, especially a mixture of CBD and THC dramatically reduces symptoms for me. When I am flaring I can often feel tightness, muscle spasms, and pain in my lower right abdominal quadrant. Vaping or smoking a small amount of a THC/CBD combination for me almost instantly takes the tightness away. I do however wonder about the longer last effects. I feel that other interventions such as diet, other herbs and supplements, and even lower-end medications may have longer-lasting and more robust effects on inflammation. If it wasn’t for the next day’s “washed” out feeling and negative effects on both my memory and motivation, I’d probably use cannabis more often. I do however notice some increases in creativity and well being.

Tips on Working with Your Health Team on if and how You can Incorporate Cannabis

If you do decide to explore cannabis I have some tips: 

> Be open and honest with your GI and other health team members about your cannabis use. If they judge you (unlikely) or you don’t feel listened to, this is probably an indication of a deeper issue, and might also be an indication to work on refining your health team.

> Consider reaching out to a cannabis specialist who not only has experience in just “recommending” cannabis generally, but will actually offer guidance on use and strain. 

> Study your local state or country laws around cannabis and make sure you are in compliance. If, heaven-forbid, cannabis is inaccessible to you, don’t sweat it. Cannabis, like anyone variable discussed in our blog posts, will not “make-or-break” your protocol. 

> If visiting a cannabis dispensary, obtain lab data on any product you buy and understand cannabinoids or/and terpene concentrations.  You will undoubtedly find some strains work better for you than others, and are suited for different purposes. i.e. Indica at night / Sativa during the day. If you can’t find the strain for a second time that helped the most, then you will have the lab data and can find something with a similar chemical profile. 

> Monitor side effects and possible interactions. Make sure you are staying motivated, are happy, are keeping up with work, etc. Sometimes with cannabis, less is more. A small amount can often go a long way. 

> Lastly understand that this is a mysterious, under-researched drug – perhaps the most interesting drug of all time given its complex composition and interactions. Don’t just pay attention to what type you are using, but also pay attention to context. What setting works best for you? What time of day? Where? What type of mood is most suitable for you to be in to get the most benefit? What type of IBD symptoms does it work best for and which not? 

In conclusion as is stated in pretty much every study, review paper, and meta-analysis is that more research is needed on this subject. I think researchers may consider joining forces with advanced cannabis growers to develop strains specifically targeted at IBD in their cannabinoid and terpene profiles and then they should study their efficacy in randomized placebo controlled clinical trials. Hopefully, as a more sensible drug policy is enacted in the United States and around the world, the specific medicinal benefits or lack-there-of will be elucidated in IBD.

Thanks for reading!

Work Cited

1) Scott FI. Marijuana Use in Inflammatory Bowel Disease: Understanding the Prevalence and the Potential Pitfalls. Crohn’s Colitis 360. 2020;2. doi:10.1093/crocol/otaa016

2) Picardo S, Kaplan GG, Sharkey KA, Seow CH. Insights into the role of cannabis in the management of inflammatory bowel disease. Therap Adv Gastroenterol. 2019;12: 1756284819870977.

3) Cannabis and Inflammatory Bowel Disease. 2019. Available: https://www.youtube.com/watch?v=TIMh2R49HgQ

4) Lu HC, Mackie K. An Introduction to the Endogenous Cannabinoid System. Biol Psychiatry. 2016;79. doi:10.1016/j.biopsych.2015.07.028

5) Keith A. Sharkey JWW. The role of the endocannabinoid system in the brain-gut axis. Gastroenterology. 2016;151: 252.

6) Cannabinoids. Academic Press; 2014. pp. 261–308.

7) Terpenes in Cannabis sativa – From plant genome to humans. Plant Sci. 2019;284: 67–72.

8) Peres FF, Lima AC, Hallak JEC, Crippa JA, Silva RH, Abílio VC. Cannabidiol as a Promising Strategy to Treat and Prevent Movement Disorders? Front Pharmacol. 2018;9. doi:

9) 10.3389/fphar.2018.004829. Marijuana Research | The University of Mississippi. [cited 30 Jun 2020]. Available: https://pharmacy.olemiss.edu/marijuana/