Inflammatory Bowel Disease (IBD) and Cannabinoid-Based Therapies
Cannabinoid-based therapies are gaining significant attention, particularly for conditions with limited treatment options. Inflammatory Bowel Diseases (IBD) exemplify such conditions. IBD is an umbrella term that encompasses Crohn's Disease (CD) and Ulcerative Colitis (UC), two autoimmune disorders that share a range of similar symptoms. These include diarrhea, fatigue, weight loss, malnutrition, bloody stools, abdominal pain, and chronic inflammation within the gastrointestinal tract (Long, 2024).
Conventional treatments for CD and UC are similar and typically include anti-inflammatory drugs like aminosalicylates (5-ASA), corticosteroids (e.g., prednisone, budesonide), immunosuppressive medications (e.g., thiopurines, methotrexate), TNF-α inhibitors, antibiotics (e.g., metronidazole, ciprofloxacin), and nutritional support. However, the challenge with IBD lies in its multifaceted nature and the fact that the pathophysiology remains poorly understood. Growing concern surrounds the potential progression of these chronic conditions into cancer or even mortality (Long, 2024).
Drawbacks of Conventional Treatments
While conventional treatments can provide short-term relief, they come with significant drawbacks. For example, aminosalicylates are often ineffective for long-term management and can lead to gastrointestinal complications, headaches, liver toxicity, bone marrow suppression, fertility issues, and allergic reactions (Understanding IBD Medications and Side Effects, n.d.). Corticosteroids, though common, have long-term side effects such as weight gain, diabetes, hypertension, osteoporosis, immune suppression (leading to increased infection risk), GI issues (e.g., ulcers, bleeding, indigestion), and eye problems (e.g., cataracts, glaucoma) (Understanding IBD Medications and Side Effects, n.d.). Immunosuppressive drugs can also cause liver toxicity, lung damage, folic acid deficiency, and bone marrow suppression, while TNF-α inhibitors carry risks of infections, pancreatitis, allergic reactions, and even cancer (e.g., lymphoma) (Understanding IBD Medications and Side Effects, n.d.). Furthermore, antibiotics can disrupt the gut microbiome, leading to increased intestinal permeability, antibiotic resistance, and infections like C. difficile or Candida, which exacerbate GI issues. These complications highlight the need for safer, more effective treatment options.
The Potential of Cannabinoid Therapy
Cannabinoid-based therapies have recently emerged as a promising alternative due to their natural anti-inflammatory and antioxidant properties, as well as their ability to modulate the immune system via the endocannabinoid system (ECS). While the medicinal use of cannabis in treating gastrointestinal disorders dates back centuries, modern research has reignited interest in its potential therapeutic applications. A recent meta-analysis of five studies on CD showed a statistically significant reduction in clinical disease activity following cannabinoid treatment (Kang, Schmoyer, Weiss, & Lewis, 2024). Though the clinical disease activity for UC did not show a significant decrease, both CD and UC patients reported improvements in quality of life (QOL) (82.8%). However, no substantial changes were noted in endoscopic disease activity or inflammatory markers, suggesting that while cannabinoids may help alleviate symptoms, the underlying causes of IBD—such as increased intestinal permeability or "leaky gut"—require further exploration.
Despite the limited research on cannabinoids in treating IBD, preliminary findings are promising. Cannabinoids like CBD, for example, stimulate CB2 receptors on immune cells, directly modulating their activity. This is especially important for autoimmune diseases like CD and UC, as the ECS plays a key role in regulating immune function. By targeting the ECS, it may be possible to downregulate an overactive immune response without causing immunosuppression, a significant concern for patients already vulnerable to infections (Luz-Veiga, Azevedo-Silva, & Fernandes, 2023).
Moreover, the ECS helps maintain gastrointestinal tract homeostasis. CB1 receptors, located in enteric cholinergic neurons, can inhibit neuronal activity and reduce GI motility and secretion—potentially beneficial for managing IBD symptoms (Luz-Veiga, Azevedo-Silva, & Fernandes, 2023). In animal models, CBD has shown anti-inflammatory effects, reducing mucosal inflammation and lowering levels of pro-inflammatory cytokines like TNF-α, which is a target of conventional treatments.
While research on cannabinoid therapies for CD and UC is still in its infancy, ongoing studies may provide deeper insights into the pathophysiology of IBD, allowing for more definitive answers regarding the therapeutic potential of cannabinoids in treating these challenging conditions.
Bee Well,
Brandon Farless
*This information is for educational purposes only. I am simply sharing information pertaining to these studies. No medical advice or claims are being made on my behalf.
References
1. 1. Hansol Kang, Christopher J Schmoyer, Alexandra Weiss, James D Lewis, Meta-analysis of the Therapeutic Impact of Cannabinoids in Inflammatory Bowel Disease, Inflammatory Bowel Diseases, 2024;, izae158, https://doi.org/10.1093/ibd/izae158
2. 2. Long D. (2024). Crohn's Disease and Ulcerative Colitis: From Pathophysiology to Novel Therapeutic Approaches. Biomedicines, 12(3), 689. https://doi.org/10.3390/biomedicines12030689
3. 3. Luz-Veiga, M., Azevedo-Silva, J., & Fernandes, J. C. (2023). Beyond Pain Relief: A Review on Cannabidiol Potential in Medical Therapies. Pharmaceuticals (Basel, Switzerland), 16(2), 155. https://doi.org/10.3390/ph16020155
4. 4. Understanding IBD medications and side effects. (n.d.-c). https://www.crohnscolitisfoundation.org/sites/default/files/2019-10/understanding-ibd-medications-brochure-final-online2.pdf
