Sunday, July 9, 2017

Cannabis for Inflammatory Bowel Disease

In 2011, a team of researchers in Israel published the results of a remarkable study of the use of marijuana in treating Crohn’s disease.  They did not find that smoking marijuana “cured” Crohn’s disease, but they did find that it was remarkably helpful in most cases.
Among the 30 volunteers in the study:

  • Before starting marijuana, 30 out of 30 study participants needed some other kind of medication to control symptoms. After the study, only 9 did.
  • Before starting marijuana, 27 out of 30 study participants were on 5-aminosalicylic acid (5-ASA). After the study, only 5 were.
  • Before starting marijuana, 26 out of 30 study participants were taking prescription steroid drugs. After the study, only 4 were.
  • Before starting marijuana, 20 out of 30 study participants were using prescription thiopurate. After the study, only 10 were.
  • Before starting marijuana, 6 out of 30 study participants were on methotrexate. After the study, none were.
  • Before starting marijuana, 12 out of 30 study participants were taking a prescription TNF antagonist. After the study, only 4 were.
 Among the study participants, the average number of bowel movements decreased from 8 to 5 per day. Fifteen of the patients had 19 surgeries during the nine years before the study, but only 2 required surgery during 3 years of marijuana use. Most of the patients in the study smoked their government-provided marijuana in the form of joints, but 4 used a bong, and 1 took marijuana in an oral form. Every patient in the study reported better health and quality of life as a result of using marijuana.

Naturally, the scientific community attacked the results. A Canadian study reported that although 28 percent of Crohn’s patients who smoked marijuana reported less diarrhea, 48 percent reported less joint pain, 77 percent reported less cramping, and 90 percent reported improved abdominal pain, and there was no relationship between marijuana use and frequency of hospitalization, using marijuana was, according to their study, actually harmful. The Canadian researchers found that users of marijuana were 5 times more likely to have to have surgery. However, they surveyed patients at a surgical center.

The general consensus was that the results of this first clinical trial of marijuana in the treatment of Crohn’s disease were “predictable” (which begs the question of why other doctors hadn’t tried it), and that since cannabidiol (CBD), cannabigerol (CBG), and tetrahydrocannabivarine (THCV), all of them non-psychotropic components of cannabis, all have proven antiinflammatory effects, research should be looking into using them as treatments instead of the whole herb.

In other words, the scientific community begrudgingly admitted that marijuana is helpful in Crohn’s disease, but they didn’t want people to enjoy their treatment too much.

What Is the Evidence That Cannabis Treats Crohn’s Disease?

Two years after their first study, the Israeli researchers ran a second, smaller clinical trial of marijuana for Crohn’s disease. One pro-marijuana publication ran the byline “(People with) Crohn's disease, one of several inflammatory bowel diseases, achieved "complete remission" in nearly half the subjects of one study that were exposed to smoking medical marijuana on a regular basis. ” However, that wasn’t what the study actually reported. In fact, the study said none of the patients achieved remission:

“Although the primary end point of the study (induction of remission) was not achieved, 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. ” In this study, patients smoked two joints a day.
In other words, what the state of scientific research is really telling us is:
  • Marijuana can be really helpful but eight weeks isn’t long enough to achieve remission.
  • High-THC varieties are helpful but maybe high-CBD or high-CBG varieties, as many users report anecdotally, are really better.

How Is Marijuana Used In Treating Crohn’s Disease?

The most helpful approach to using marijuana for Crohn’s disease probably would be to start with a high-CBG (cannabigerol) variety. High-CBG strains are hard to find. The buds have to harvested about three-fourths of the way through harvesting, and if a growers are going to go to the trouble, probably they are also growing a Dutch strain of high-CBG weed known as Bediol. This is hard to get outside of Holland, although the situation may change. In the United States, the highest-CBG variety that is regularly available is Pincher Creek.

If Pincher Creek is not available, then OG Kush, which has a citrusy aroma provided by its chemical constituent limonene, is a second choice. The limonene helps with acid stomach and gastroesophageal reflux. Any strain of marijuana that has a peppery flavor is likely to be high in beta-caryophyllene, which protects cells in the membranes lining the intestines (actually the authors refer to “caryophyllene,” rather than specifically beta-caryophyllene, which suggests that any strain with a cloves-like or pepper-like taste may be protective).

High-THCV varieties such as Malawi Gold and Willie Nelson can stem “munchies” and give the digestive tract a needed rest that may reduce symptoms.

Most people with Crohn’s disease smoke marijuana rather than taking oral preparations. It isn’t necessary to be a heavy hitter to benefit. It takes about four times as much THC to quell digestive disturbance caused by chemotherapy as it takes to relieve symptoms of Crohn’s disease. Enough marijuana to deliver 5 to 7 mg of THC per dose is adequate. 

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