Cannabis Puts Crohn’s Patients Into Remission

A fascinating new study has emerged which shows an unexpectedly favorable response to cannabis in those that suffer from one of the most common disorders seen in the gastroenterologist’s office – Crohn’s disease. Crohn’s disease (CD) and ulcerative colitis (UC) are flip sides of the same coin. They fall under the broader heading of inflammatory bowel disease or IBD.

Definition

From the Mayo Clinic:

Inflammatory bowel disease (IBD) involves chronic inflammation of all or part of your digestive tract. IBD primarily includes ulcerative colitis and Crohn’s disease. Both usually involve severe diarrhea, pain, fatigue and weight loss. IBD can be debilitating and sometimes leads to life-threatening complications.

Ulcerative colitis is an inflammatory bowel disease that causes long-lasting inflammation and sores (ulcers) in the innermost lining of your large intestine (colon) and rectum.

Crohn’s disease is an IBD that cause inflammation of the lining of your digestive tract. In Crohn’s disease, inflammation often spreads deep into affected tissues. The inflammation can involve different areas of the digestive tract — the large intestine, small intestine or both.

The exact cause of inflammatory bowel disease remains unknown. Previously, diet and stress were suspected, but now doctors know that these factors may aggravate but don’t cause IBD.
One possible cause is an immune system malfunction. When your immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too. Heredity also seems to play a role in that IBD is more common in people who have family members with the disease. However, most people with IBD don’t have this family history.

I have treated patients with Crohn’s disease and UC using an integrative approach, combining western medicine with Chinese herbs and acupuncture. These tactics helped immeasurably but they fell short of inducing a remission. Patients were usually left taking some form of prescription drug and often times were steroid dependent. Meaning they could never stop taking for example, prednisone. If they were to stop, symptoms would escalate very quickly requiring the drug again to quell the inevitable pain.

Medical Management

From a purely western medical slant, treating patients often involves using several drugs at the same time. The safest and least harmful tactic is to use the less potent preparations first such as the aminosalicylates which are similar in action to aspirin. These drugs are taken orally and act both locally on bowel tissue and systemically. They carry little risk in the long-term management of IBD.

Next are the powerful corticosteroid preparations like prednisone. These have dozens of injurious side effects like massive weight gain, weak bones, high blood sugars, poor wound healing, and many others. If at all possible I avoided prescribing drugs of this class for extended periods of time since the side effects were disastrous. However, sometimes its use was unavoidable.

The next course is much more potent, and they carry numerous toxic side effects. Drugs like Remicade fall into this category. Patients who take Remicade report excellent symptom control but it comes with a huge price tag. These drugs block certain key immune responses which can re-activate latent infections such as hepatitis B or TB, and even generate cancers such as lymphoma after prolonged use. They can also lead to an overwhelming infection, called sepsis, which can be fatal.

Lastly, surgery is indicated for refractory cases. For UC this sometimes means removal of your entire colon and an ileoanal anastomosis: connecting your distal small bowel to the back door so to speak. Or a colostomy bag might be indicated in other cases. At least one surgery is expected for Crohn’s disease sufferers on average. This may not be as extensive as UC surgery, and it only involves the small bowel. Therefore a colostomy is not needed. However, disease frequently springs up months or years later right at the surgical borders of the bowel anastomosis (connection).

Alternatives: Cannabis and LDN

Given these measures it comes as no surprise that the IBD community would embrace a novel drug that had no toxic side effects, had minimal adverse drug effects, and produced a remission in many patients.

Did I just describe a miracle drug? Enter cannabis and LDN or low dose naltrexone. It’s beyond the scope of this article to detail the powerful healing effects of LDN, a safe alternative to more toxic pharmaceuticals. Simply search LDN and see for yourself. I have seen this medication work wonders. Sadly many gastroenterologists dismiss its curative effects as internet tripe. That’s sad and completely inaccurate.

If you have IBD find someone who will prescribe it for you. Give it a fair trial regardless of what your GI doc tells you. You can thank me later.

Now, in spite of the dismissal of LDN we have a new contender for inducing remission in IBD patients. That candidate is cannabis.

A remarkable study was published recently (in 2013) from an Israeli team that clearly showed cannabis smoking not only suppressed many Crohn’s symptoms but it induced remission in 45% of the treatment group of patients. Even more shocking was that these patients were selected because they were treatment failures-no modern drugs were helping them.

From Tel Aviv University, Kfar Saba, Israel, Cannabis induces a clinical response in patients with Crohn’s disease: a prospective placebo-controlled study by Naftali et al:

In their introduction section the author reminds us of the vacancy of controlled clinical trials using cannabis in treating IBD. They undertook a prospective trial to determine whether cannabis can induce remission in patients with Crohn’s disease.

In the purpose section of their study application under ClinicalTrials.gov they had this to say:

…there are no major immune events which do not involve the endocannabinoid system. Cannabinoids shift the balance of pro-inflammatory cytokines and anti-inflammatory cytokines towards the T-helper cell type 2 profiles (Th2 phenotype), and suppress cell-mediated immunity whereas humoral immunity may be enhanced. They are therefore used for various inflammatory conditions including rheumatoid arthritis and asthma. In a mouse model of colitis cannabinoids were found to ameliorate inflammation and there are many anecdotal reports about the effect of cannabis in inflammatory bowel disease.

In other words, marijuana acts by suppressing runaway inflammation which is responsible for the numerous symptoms of IBD.

RESULTS:
Complete remission…was achieved by 5 of 11 subjects in the cannabis group (45%) and 1 of 10 in the placebo group (10%; P = .43). A clinical response…was observed in 10 of 11 subjects in the cannabis group… and 4 of 10 in the placebo group. Three patients in the cannabis group were weaned from steroid dependency. Subjects receiving cannabis reported improved appetite and sleep, with no significant side effects.
CONCLUSIONS:
…a short course (8 weeks) of THC-rich cannabis produced significant clinical, steroid-free benefits to 10 of 11 patients with active Crohn’s disease, compared with placebo, without side effects.[ref]Clin Gastroenterol Hepatol. 2013 Oct;11(10):1276-1280.e1[/ref]

The authors comment that their end point of “remission free” was NOT achieved yet clearly almost half DID achieve that goal!
Based on my own clinical experience with IBD this trial really rocked my world. What it suggests is nothing short of astonishing: smoking marijuana twice daily, in the form of cigarettes containing 115 mg of Δ9-tetrahydrocannabinol, gives the average Crohn’s patient a 50/50 chance of never having to deal again with the “stomachache that never goes away.”

Three Points

Three things need mentioning. One is that the research hails from Israel, the only nation living in the twenty-first century regarding marijuana research. We would not have this information were it not for the courage of the Israelis to open up their science benches to clinical study of cannabis in human disease.

Secondly, this trial was only 8 weeks long, and very small involving only 21 patients, 11 of which were in the experimental group. We will need a larger followup trial aimed at reproducing these results. But if subsequent studies conclude anything close to the findings in the above trial we will have much to celebrate.

Thirdly, these patients were all traditional medication failures. This suggests that cannabis is even more powerful than the shopping list of current pharmaceuticals.

Here’s a few suggestions. A trial involving oral cannabis capsules to directly bathe the GI tract in cannabinoids in the same way that we use the aminosalicylates. Cannabis enemas for UC could also be tried in the same way patients receive prednisone enemas now. Add to that LDN therapy to help modulate the defective immune system that these patients have. I predict that these measures would outperform current drug therapy and significantly alter disease outcomes.