A new study found that cannabis oil significantly improves Crohn’s disease symptoms. Surprisingly, the effect doesn’t seem to be due to cannabis’ anti-inflammatory properties.

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Anecdotal reports suggested to Dr. Timna Naftali, a gastroenterologist and a professor at Tel Aviv University,  that cannabis seems to help people with Crohn’s disease. Naftali thought that the effect may be related to cannabinoid action that reduces inflammation in the gut, so she and colleagues set out to investigate this connection.

What is Crohn's disease?

Crohn’s disease is a chronic inflammatory bowel disease (IBD) characterized by inflammation of the digestive, or gastrointestinal (GI) tract. In fact, Crohn’s can affect any part of the GI tract, from the mouth to the anus, but it is more commonly found at the end of the small intestine (the ileum) where it joins the beginning of the large intestine (or colon).

It’s important to note that one shouldn’t confuse an IBD disease, such as Crohn’s, with irritable bowel syndrome (IBS), which is a different type of disorder that affects the muscle contractions of the bowel. IBS is not characterized by intestinal inflammation, nor is it a chronic disease. 

The Israeli researchers performed a randomized, placebo-controlled study involving 50 participants with severe forms of the disease. Each participant was given a dose of cannabis oil containing a 4:1 CBD to THC ratio.

Cannabidiol (CBD) is one of the dozens of cannabinoid compounds found in the cannabis plant. CBD interacts with the receptors of the endocannabinoid system, predominantly the CB1 and CB2 receptors that are found mainly in the brain and immune cells. Delta9-Tetrahydrocannabinol (THC) is the active substance found in marijuana, which is responsible for its psychoactive effect. Unlike THC, CBD is not only non-psychoactive, but it actually blocks the high one typically experiences when ingesting cannabis.

The researchers found that 65% of the participants who were given the cannabis oil entered clinical remission. This group also reported significant improvements in their quality of life. Only 35% of the placebo group met remission criteria at the end of the study.

In 2011, Naftali performed a small observational study involving 30 Crohn’s disease patients in Israel, which found that those who smoked 1-3 joints daily reported a positive effect on their disease severity. Patients don’t actually have to smoke to get the benefits, however. As the new study shows, ingesting oil can be just as effective and today there are a lot of options on the market, although choosing the best CBD oil can be challenging.

But despite the symptomatic improvements, the researchers found that the CBD oil didn’t have any effect on the gut inflammation that is responsible for the disease — surprising, as cannabis is known to have anti-inflammatory properties. Perhaps cannabinoids interact with a person’s biology in such a way that it treats Crohn’s disease symptoms without actually interfering with inflammation.

“We have previously demonstrated that cannabis can produce measurable improvements in Crohn’s disease symptoms but, to our surprise, we saw no statistically significant improvements in endoscopic scores or in the inflammatory markers we measured in the cannabis oil group compared with the placebo group,” Naftali said in a statement.

“We know that cannabinoids can have profound anti-inflammatory effects but this study indicates that the improvement in symptoms may not be related to these anti-inflammatory properties,” the researcher added.

In the future, Naftali and colleagues plan to investigate cannabis’ anti-inflammatory properties on other IBDs.

“There are very good grounds to believe that the endocannabinoid system is a potential therapeutic target in Crohn’s disease and other gastrointestinal diseases,” Dr. Naftali said. “For now, however, we can only consider medicinal cannabis as an alternative or additional intervention that provides temporary symptom relief for some people with Crohn’s disease.”

The findings have not yet been peer-reviewed or published in a journal. Researchers presented their conclusions recently at the UEG Week Vienna, 2018.

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