Taking CBD for Crohn’s Disease

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Alphagreen | CBD Blog | Educate, Empower, Enhance

13 min readMay 12, 2021

Crohn’s disease is one of two types of inflammatory bowel disease. In our world today, this disease has become a problem on a global scale.

According to the Crohn’s & Colitis Foundation (CCF), three million Americans have inflammatory bowel disease, while 780 000 of them are diagnosed with Crohn’s disease. It was also found that about 11% of people with this condition will experience a chronic form of the disease. Besides that, the Crohn’s & Colitis Foundation (CCF), together with the Centers for Disease Control and Prevention (CDC), also report that:

People who smoke have twice increased risk to be diagnosed with Crohn’s disease
If the disease is treated, around half of all the people with Crohn’s disease will go into remission or experience only mild symptoms of the disease within five years of their diagnosis
The average patient diagnosed with Crohn’s disease spends between $8,265 and $18,963 annually to treat or manage their condition
Annually, more than a million doctors’ office visits are for the treatment and care of Crohn’s disease

According to the data provided by the CDC, in 2015, an estimated 1.3% (3 million) of adults in the US have been diagnosed with IBD (ulcerative colitis or Crohn’s disease), which is a large increase from 1999, when 0.9% of US adults (2 million) have been diagnosed with this condition. It is also reported that some people are more likely to report having ulcerative colitis or Crohn’s disease than others. The main risk groups for this condition include:

The disease may occur at any age, although Crohn’s disease is most often diagnosed in adolescents and adults between the ages of twenty and thirty
According to studies, up to 28% of the population with IBD have a first-degree relative, such as a parent, sibling, or child, who was diagnosed with ulcerative colitis or Crohn’s disease
Crohn’s disease can affect people of all ethnic backgrounds, though the disease is more common in Caucasians, Asians, and Hispanics

Even though there is a genetic component associated with the risk of being diagnosed with Crohn’s disease, it is impossible to predict who may get IBD based only on family history.

Crohn’s disease was named after Dr Burrill B. Crohn, who was the first who described this condition in 1932. Although the disease was discovered almost ninety years ago, and major treatment advances were made in the last thirty years, there is still no cure for this condition, and global research is ongoing. Researchers aren’t sure how Crohn’s disease begins, who is most likely to develop it, and what are the most effective ways to manage its symptoms. More research about this condition is necessary, as well as more animal and human trials are necessary to find out the most effective and safe treatment for its symptoms.

In most cases, Crohn’s disease occurs in the colon and small intestine. This condition may affect any part of our gastrointestinal tract. The severity of Crohn’s disease may be from mild to debilitating, while its symptoms vary and can change over time. In severe cases, the disease can lead to serious complications and life-threatening symptoms.

Today, it still isn’t clear what are the main causes for this condition, although researchers state that such factors as our genes, immune system, and environment may influence the risk of getting it. In addition to this, a study held in 2012 evaluated factors affecting outcomes in Crohn’s disease and highlighted things that can affect the severity of the disease symptoms. They include:

Age of the patient
Whether the patient smokes
Length of time the patient had Crohn’s disease
Whether or not the rectum is affected by the condition

People diagnosed with Crohn’s are also more likely to develop intestinal infections, such as viruses, parasites, bacteria, and fungi, which can affect the severity of symptoms and create serious complications. In addition to this, according to CDC, in comparison with adults without IBD, people with Crohn’s disease or ulcerative colitis are more likely to have such chronic health conditions as:

Arthritis
Cardiovascular disease (CVD)
Respiratory disease
Kidney disease
Liver disease
Cancer

Crohn’s disease doesn’t pass by itself and requires correct diagnosis and timely treatment to minimise possible complications. Some of the modern treatments for this condition can also affect our immune system, making intestinal infections worse. Yeast infections are also common in the case of Crohn’s disease and can affect both the intestinal tract and the lungs. It’s important that these infections are diagnosed on time and treated properly with antifungal medications to prevent further complications.

The five types of Crohn’s disease — what are the differences?

Crohn’s disease usually affects different regions of intestines, bowel, and stomach, causing inflammation and erosion.

Depending on the affected part of the gastrointestinal tract, there are five types of Crohn’s disease. Each of these types involves a specific region of the gastrointestinal tract and has its own symptoms. If the patient is diagnosed with Crohn’s disease, it’s important to know which part of the gastrointestinal tract is affected as the type of the disease impacts the symptoms and complications he may experience.

The five types of Crohn’s disease include:

Ileocolitis

Ileocolitis is considered the most common form of Crohn’s disease. As the name implies, this type causes inflammation and irritation of the end of the small intestine, which is known as the terminal ileum, and the large intestine, which is also called the colon. People with this form of Crohn’s disease may experience such symptoms as:

Pain in the middle or lower right quadrant of the abdomen
Diarrhoea or cramping
Significant weight loss
Ileitis

Similarly to ileocolitis, ileitis affects the ileum. Although in this case, the colon remains unaffected. Symptoms of this type of Crohn’s include:

Diarrhoea
Weight loss
Pain in the lower right quadrant of the abdomen
Fistulas or inflammatory abscesses in the right lower part of the abdomen
Gastroduodenal Crohn’s disease

This type of Crohn’s affects the stomach at the beginning of the small intestine, which is called the duodenum. Most common symptoms of this type of disease include:

Nausea
Vomiting
Weight loss
Loss of appetite
Jejunoileitis

This type of the disease occurs in the jejunum, the second part of the small intestine, where it causes patchy areas of inflammation. People with jejunoileitis may experience the following symptoms:

Diarrhoea
Fistulas (fistulas may form after prolonged periods of inflammation)
Abdominal pain of varying severity
Cramps following meals
Crohn’s (granulomatous) colitis

The last type of Crohn’s disease affects only the large intestine, which is also known as the colon. This form of the disease can cause ulcers, abscesses, and fistulas around the anus, as well as the following symptoms:

Skin lesions
Joint pain
Rectal bleeding
Diarrhoea

Both ulcerative colitis and Crohn’s disease share similar symptoms, but they are not the same illness, as they affect different parts of the gastrointestinal tract. Let’s check the main signs of each of these conditions and find out the main differences between them.

Crohn’s disease

Affects any area of the gastrointestinal tract from mouth to anus, while skipping some of the parts
Affects the entire thickness of the bowel wall
Age of onset varies from 15 to 35 and from 55 to 70 years
Malnutrition is common
Symptoms depend on the part of the GI affected and may include diarrhoea, abdominal pain, fatigue, and weight loss
Bloody stool is variable

Ulcerative colitis

Affects only the colon and rectum
Affects the innermost lining of the large intestine
Age of onset varies from 15 to 35 and from 55 to 70 years
Malnutrition is less common
Symptoms may include fatigue, increased bowel movements, abdominal pain, and stool urgency
Bloody stool is common

Both of these conditions affect the gastrointestinal tract and require proper diagnostics and treatment to avoid complications. However, even when defined as one group of diseases known as IBD, these are two different conditions with their own symptoms, causes, and methods of treatment.

Crohn’s disease — diagnosis and treatment

Today, there is no single test that can be used to confirm the presence of Crohn’s disease reliably, and its symptoms are often similar to other conditions, such as bacterial infection, that may complicate the diagnostics.

The first step to diagnosis and treatment of Crohn’s disease is a standard physical exam of the body. Usually, healthcare providers ask questions about the overall health of the patient, his diet, nutrition, and family history. Besides the physical exam, the doctor may also order diagnostic testing to check for the signs of Crohn’s disease and exclude other possible conditions. Several types of tests may be used to make a diagnosis:

Endoscopy: An endoscopy procedure allows getting a detailed look at the inside of the colon by using a small camera mounted to the end of a lighted tube
Biopsy: While performing the endoscopy procedure, the doctor may want to get a biopsy of a certain area of the gastrointestinal tract. During the biopsy, the small piece of tissue is removed from the patient’s intestine for further testing
Chromoendoscopy: This procedure allows for detecting polyps or precancerous changes. During chromoendoscopy, a blue liquid dye is sprayed into the patient’s colon in order to highlight and detect any changes in the lining of the intestine
Small intestine imaging: Not all parts of the intestine can be easily seen by endoscopy or colonoscopy. Procedures such as a fluoroscopic X-ray, magnetic resonance imaging (MRI), or computer tomography (CT) can be additionally required

Prior to performing these procedures, laboratory tests of blood and stool are usually required. Once the doctor has reviewed the results of all necessary tests and excluded all other possible causes for the patient’s symptoms, the final diagnosis of Crohn’s disease is made. Some of the tests may be required several times to determine disease progression.

When all other possible conditions are excluded, and the final diagnosis is made, a doctor will prescribe one of the treatment methods, which would be most effective for the patient’s particular case. It was already mentioned in this review that currently, there is no cure for Crohn’s disease, although the symptoms of this condition can be well-managed. Today, there are several treatment options that can lessen the severity and frequency of the Crohn’s disease symptoms.

There are three most common treatments usually recommended for patients with Crohn’s disease diagnosis. They include:

Medications
Dietary changes
Surgery

Several types of medications are used nowadays to treat Crohn’s disease. Most common of them include antibiotics and anti-inflammatory drugs, while more advanced options may also include biologics, which use the patient’s immune system to cope with the disease symptoms. The necessary medications or combination of medications is chosen based on the patient’s symptoms, disease history, and the severity of his condition. Medications may include:

Immunomodulators
Antibiotics
Biologic therapies

Besides medications, dietary changes are also often recommended to reduce the Crohn’s disease symptoms. Although food can’t cause Crohn’s disease, it can trigger flares, and it is critical to exclude all the products that may worsen the patient’s condition. Usually, when dietary changes are needed, a doctor suggests a consultation from a registered dietitian, who will be able to choose what diet changes may help in each particular case, and create eating guidelines.

The primary goal of all the dietary changes is to help the patient absorb more nutrients from food, as well as limiting any negative effects food may be causing. For example, a patient may need to limit the dairy and fat intake, drink more water, and adjust the fibre intake.

In the case, if lifestyle changes and medication treatment don’t improve the symptoms of Crohn’s disease, surgery may be necessary. According to the Crohn’s & Colitis Foundation, up to 75% of people diagnosed with Crohn’s will require surgical intervention at some point in their lives. Some types of surgery prescribed for patients with Crohn’s disease include removing damaged parts of the digestive tract and reconnecting its healthy sections, while other procedures may be aimed at repairing damaged tissue, treating deep infections, and managing scar tissue.

Taking CBD for Crohn’s disease — effects and recommended dosage

Besides medications, dietary changes, and surgical procedures, in recent years, there has been a growing interest in managing the disease symptoms with medicinal cannabis, namely cannabidiol (CBD), an active compound found in the cannabis plant.

Together with tetrahydrocannabinol (THC), CBD represents the most studied and promising compounds of the Cannabis sativa plant. However, unlike THC, CBD doesn’t have psychoactive properties, which means it can’t get us high. This property of CBD significantly simplifies its research and a range of potential therapeutic uses. CBD has been studied as a potent therapeutic agent for different conditions ranging from chronic pain, anxiety and depression, to side effects of certain types of cancer.

To date, research of this compound is limited, and evidence of its effectiveness is mixed, although, according to the World Health Organisation, it appears to be generally safe for adults. People with IBD and Crohn’s disease, in particular, report improvement in their symptoms and quality of their life after using CBD, although more studies and clinical trials are needed to determine whether this chemical can effectively treat the disease symptoms and be considered as a replacement for traditional Crohn’s disease treatment.

To understand how medicinal cannabis can be beneficial for Crohn’s disease treatment, we should have a basic knowledge of our endocannabinoid system. The endocannabinoid system (ECS) helps our bodies regulate pain, stress response, memory, mood, appetite, gastrointestinal motility, immune function, and other processes.

The endocannabinoid system represents a complex combination of cannabinoids naturally produced by our bodies, which are known as endocannabinoids. Endocannabinoids stimulate the cannabinoid receptors located in many areas of our bodies, such as muscles, fat, brain, and the entire gastrointestinal tract. The molecules of CBD and THC have a similar shape to endocannabinoids, and thus, can bind to the same receptors, triggering reactions that result in either very high or very low levels of neurotransmitters — specific molecules that our brain cells use to communicate with one another. In a range of studies, it was suggested that the functioning of ECS (or any malfunctions in its work) has an important relationship to the wide range of diseases and conditions, including Crohn’s disease.

For today, most research investigating the effects of CBD and THC on Crohn’s disease has involved animal studies or studies with biopsied human tissue. The results are promising, although additional human studies are necessary before any final conclusions can be made on how effective these compounds might be. In one of the studies, researchers induced colitis (intestinal inflammation) in rats and then investigated the effectiveness of CBD and THC compared to sulphasalazine (one of the most common and longest-used anti-inflammatory medications) on relieving the inflammation. The results of the research showed that THC was the most effective of all three options, while sulphasalazine was slightly effective, and CBD was ineffective on its own. In addition to this, researchers revealed a synergic effect when they combined CBD with a low dose of THC (dose, which was ineffective on its own). When working synergically, CBD and THC provided even higher effectiveness than the previously noted dose of THC alone. Such a result means that further treatment, which will combine CBD and a low dose of THC might be not only more effective, than treatment with a higher dose of THC but safer as well. As CBD belongs to cannabinoids that don’t cause intoxication effects, such treatment might have less side effects for patients.

As for the possibility of using CBD alone, another animal study was performed to test the effectiveness of CBD when taken alone at reducing inflammation in colitis. Results of this research showed that administering CBD after inducing inflammation on mice reduced it. Moreover, it was also revealed that administering this cannabinoid before inducing inflammation prevented it from occurring at all. The researchers found that such a beneficial effect of CBD is due to its interaction with enteric glial cells — cells, that are responsible for the defence of our body against harmful pathogens. These cells normally manufacture a specific protein to stimulate the inflammatory process, but CBD can modulate the production of this protein, thereby reducing inflammation in the gastrointestinal tract.

The bottom line

The results of the studies performed to investigate the potential of CBD as an anti-inflammatory agent for Crohn’s disease treatment are promising. However, currently, there is still a lack of studies and human trials to fully evaluate the effectiveness of this cannabinoid in IBD treatment and consider it as an independent remedy for these conditions. The primary goal of all studies today is to reach the “gold ratio” of CBD and THC, maximally reducing the intoxicating effects provided by THC and increasing the effectiveness of this combination.

The question of using CBD alone (i.e. without THC) is still doubtful as in a range of studies, for it showed less effective results when compared with common medications for Crohn’s disease. In perspective, the possibility of treating such conditions as ulcerative colitis and Crohn’s disease with the use of cannabinoids sounds tempting as this natural treatment will cause significantly less adverse effects in comparison with medication treatment prescribed for these diseases, especially if considering opioids. The number of anecdotal evidence for using cannabinoids for a range of conditions, including IBD and Crohn’s disease, in particular, is increasing, although additional research is needed to get officially confirmed results of CBD effectiveness and all possible side effects that may occur during treatment.