IBS, IBD, Chrohn's and Colitis: Let's talk cannabis and the gastrointestinal system
Limonene, a cannabis terpene that is also present in citrus fruit rinds and other everyday items, may also promote healing of the mucosal cells in the gastrointestinal tract.
By Annie Conner, PharmD
Edited by Terri Kroh and Rebekkah Ranallo
In Pennsylvania, there are a number of gastrointestinal conditions that may qualify patients for a medical marijuana card. In this article, we’ll dive into the difference between IBS, IBD, Crohn’s and Colitis, and the anecdotal and clinical evidence available about how cannabis may alleviate symptoms of each.
IBS ≠ IBD
IBS and IBD are medical abbreviations that are often used interchangeably, but in fact represent two distinct conditions. IBS (Irritable Bowel Syndrome) is a collection of non-specific gastrointestinal symptoms, such as nausea, abdominal pain, bloating, diarrhea, and/or constipation, which cannot be explained by a different, more specific diagnosis. This condition, which affects up to 15% of adults in the US, can be triggered by such stressors as certain foods, hormonal changes, anxiety, and medications. IBS does not cause inflammation in the GI tract, and while imaging (such as a colonoscopy or endoscopy) may be done to rule out other diseases, patients with IBS do not show signs of disease or abnormality upon imaging.
IBD (Inflammatory Bowel Disease) on the other hand is an autoimmune condition affecting about 1.3% of adults in the US, which can lead to inflammation, ulcers, and permanent intestinal damage, which can be seen on imaging. In addition to symptoms also seen in IBS, IBD is also associated with rectal bleeding, weight loss, joint pain, and extreme fatigue.
Where do Chrohns and Colitis come in?
While there are several subtypes of IBD, the two most common types are Crohn’s Disease and Ulcerative Colitis. Crohn’s Disease can cause inflammation and ulcers any part of the GI tract, from the mouth to the anus. Further, Crohn’s Disease can affect body parts outside of the GI tract, including the joints, liver, skin, and eyes. On the other hand, Ulcerative Colitis is confined to the colon, also known as the large intestine.
Chrohn’s, Colitis, and Cannabis
The Crohn’s and Colitis Foundation acknowledges that use of cannabis has helped with IBD symptoms “including pain, nausea, and decreased appetite” and have expressed their support for federal policy changes to improve clinical research. In Pennsylvania, patients with IBD are eligible for medical marijuana. So how can medical marijuana be used to alleviate the symptoms of Crohn’s and Colitis?
In addition to the general anti-inflammatory, analgesic, and appetite-stimulating effects of THC and CBD, activation of the CB1 and CB2 receptors in the brain and GI tract has targeted benefits in IBD. For example, THC activates CB1 receptors that regulate gut motility, causing decreased contractions, slowed gastric emptying, and reduced acid secretion. The net effect is that food moves more slowly through the GI tract, improving absorption and reducing diarrhea. Conversely, CBD speeds gut transit, which may be beneficial for patients with constipation-dominant IBD.
When choosing between different medical marijuana products for IBD, it is beneficial to also consider the effects of the terpenes and minor cannabinoids. For example, myrcene and CBG can be beneficial for pain, limonene promotes healing of the mucosal cells in the GI tract, and beta caryophyllene protects gastric cells through CB2 receptor stimulation. Conversely, a patient with Crohn’s or colitis suffering from lack of appetite may want to avoid products high in THCV or humulene, as these can suppress appetite.
Dosing
· Appetite stimulation: start with 2.5mg THC
· Nausea: up to 20mg THC
· Decreased gastric emptying: 5mg THC twice daily
Resources
https://www.healthline.com/health/crohns-disease/crohns-ibd-uc-difference#diagnosis
https://www.crohnscolitisfoundation.org/what-is-ibd/ibs-vs-ibd
https://www.crohnscolitisfoundation.org/complementary-medicine/medical-cannabis