Updated January 2025
What is Crohn's Disease
Crohn's disease is a subcategory of inflammatory bowel disease and is characterized by chronic inflammation of the gastrointestinal tract. Doctors have identified five types of Crohn's disease:
- Ileocolitis - The most common type affecting the small intestine (ileum) and the colon. Common symptoms include diarrhea, cramping, and considerable weight loss.
- Ileitis - This subtype affects only the small intestine. Common symptoms include diarrhea, cramping, inflammatory abscesses in the lower right side of the abdomen, and considerable weight loss.
- Gastroduodenal Crohn's disease - This subtype affects the stomach and duodenum, which is the first part of the small intestine. Common symptoms include nausea, vomiting, loss of appetite, and weight loss.
- Jejunoileitis - This subtype causes areas of inflammation in the jejunum, which is the middle part of the small intestine. Common symptoms include abdominal pain, cramps after meals, and diarrhea.
- Crohn's colitis - This subtype affects only the colon. Common symptoms include rectal bleeding, diarrhea, skin lesions, and joint pain.
Symptoms of Crohn's Disease
The symptoms of Crohn's range from mild to severe, differing among patients. They include:
- Abdominal pain
- Abdominal cramping
- Frequent diarrhea
- Chronic constipation
- Rectal bleeding
- Extreme fatigue
- Fever
- Reduced appetite
- Unexplained weight loss
- Anal fissures
Current Treatment Approaches
To date, doctors don't know what causes Crohn's and there is currently no known cure. Treatment focuses mainly on symptom management through a combination of lifestyle and dietary changes as well as drug interventions.
Pharmaceutical Interventions
The first step in the treatment of inflammatory bowel diseases such as Crohn's Disease is for a doctor to prescribe a series of anti-inflammatory drugs. In acute cases, or cases where anti-inflammatories alone do not provide relief, antibiotics are prescribed. In severe cases where all other interventions have been unsuccessful, surgery is recommended. Nearly half of all Crohn's disease patients require at least one surgery, during which a surgeon removes the damaged portion of the digestive tract and reconnects the healthy sections. The benefits of surgery are usually only temporary.
Non-Pharmaceutical Interventions
For less severe cases, or as an adjunct to medications, dietary and lifestyle changes are advised for those suffering from Crohn's disease. It is recommended that sufferers experiencing a "flare up" avoid foods high in insoluble fiber, sugary foods, high-fat foods, alcohol, caffeine, spicy foods and lactose. In addition, it is also helpful to get adequate exercise, stop smoking, and supplement their diet with vitamins and minerals to avoid malnutrition.
CBD & Crohn's Disease: Latest Research Evidence
Updated Research Findings (2021-2024)
Recent systematic reviews and meta-analyses have provided new insights into the effectiveness of cannabinoids for inflammatory bowel diseases, with important implications for Crohn's disease treatment.
Key 2022 Meta-Analysis Findings
A comprehensive systematic review and meta-analysis published in 2022 examined randomized controlled trials of cannabinoids in IBD patients. This analysis of 208 patients across six studies found:
- Clinical improvement: Cannabinoids may increase the chances of success for standard therapy of Crohn's Disease when used as adjuvant therapy
- CDAI reduction: In Crohn's disease patients specifically, cannabinoid supplementation led to a mean CDAI (Crohn's Disease Activity Index) reduction of 36.63 points
- Dosage considerations: Better responses were observed with relatively low cannabinoid dosages
2021 Landmark Clinical Trial
A significant randomized controlled trial published in 2021 provided crucial evidence about CBD-rich cannabis in Crohn's disease:
- Study design: Double-blind, randomized, placebo-controlled trial with 56 participants
- Treatment: Cannabis oil containing 160mg CBD and 40mg THC per ml for 8 weeks
- Results: Significant clinical improvement in quality of life and reduced Crohn's disease symptoms, though endoscopic measures remained unchanged
Recent Systematic Reviews (2020-2023)
Multiple systematic reviews have concluded that while cannabinoids do not induce clinical remission or directly affect inflammation markers in IBD patients, they significantly improve patient-reported symptoms and quality of life.
Mechanism of Action
Several studies regarding cannabidiol (CBD) for treating and managing the symptoms of Crohn's disease have left scientists feeling optimistic about the efficacy as a potential treatment option. Researchers now believe that CBD may interact at extra-cannabinoid system receptor sites as well as on the gastrointestinal system itself to help reduce inflammation and other gut disturbances.
Anti-inflammatory Properties
A 2013 review study published in Phytotherapy Research highlights the importance of CBD as a non-psychotropic cannabinoid intervention for inflammatory bowel diseases (IBDs) such as Crohn's disease. The reviewers concluded that CBD appears to possess anti-inflammatory, anti-oxidant and anti-apoptotic effects. CBD displays potent anti-inflammatory and immune-modulatory properties, making it a promising therapeutic candidate for inflammatory and pain-associated disorders such as Crohn's disease.
Gut-Specific Benefits
CBD shows beneficial effects in gut disorders themselves, possessing many protective and anti-oxidant functions, relieving oxidative stress, increasing intestinal motility and selectively inhibiting intestinal hypermotility. According to the literature, CBD possesses an "extraordinary range of beneficial effects that may slow the course of the disease, ameliorate symptoms and potentially increase the efficacy of the drugs actually available for the therapy of invalidating gut disorders such as ulcerative colitis or Crohn's disease."
Clinical Trial Evidence
Ex-vivo Human Tissue Studies
Publishing their results in 2017 in the journal Clinical Science, researchers attempted to quantify the anti-inflammatory effects of CBD using ex vivo human tissue obtained from colonic samples of patients with IBD. They found that CBD shows a significant anti-inflammatory action in experimentally as well as clinically inflamed colon cells while also down-regulating pro-inflammatory intracellular pathways. From the data, they concluded that CBD is well tolerated in humans, has few side effects, and is clinically effective for treating inflammatory bowel disease.
Mixed Results from Early Trials
In a randomized control trial published in 2017 in Digestive Diseases and Sciences, researchers found that low-dose CBD (10 mg twice daily) was safe but not effective for treating moderately active Crohn's disease in 20 patients over 8 weeks. However, the researchers noted that the results could be due to the low dose of CBD, the small number of patients, and/or a lack of the necessary synergism with other cannabinoids found in full- and broad-spectrum CBD extracts.
Current Understanding and Limitations
Based on the most recent evidence, the scientific consensus indicates that:
- Symptom Relief: Cannabinoids significantly improve patient-reported symptoms and quality of life in IBD patients
- Inflammation: Current studies show cannabinoids do not directly reduce inflammatory markers or induce clinical remission
- Adjuvant Therapy: CBD appears most promising as a complementary treatment alongside standard therapy rather than a standalone treatment
- Dosage Matters: Recent meta-analyses suggest that lower doses may be more effective than higher doses
CBD as Complementary Treatment
In addition to its potential anti-inflammatory properties, CBD can provide benefits as a complementary treatment for Crohn's disease symptoms:
Pain Management
CBD has repeatedly been shown as having the ability to inhibit and control pain while also suppressing pain processing and reducing chronic pain. This can help reduce the abdominal pain and cramping Crohn's patients often experience.
Mental Health Support
Many patients also tend to suffer from anxiety and depression as a side effect of having to deal with the disease. CBD boosts the production of "happy" endocannabinoids such as anandamide while also binding to 5-HT1A serotonin receptors implicated in anxiety disorders.
Safety Profile and Considerations
Recent research confirms that CBD has a favorable safety profile for IBD patients:
- Side Effects: Studies report mild side effects including fatigue, sleepiness, and occasional diarrhea
- Drug Interactions: CBD can interact with other medications, particularly those metabolized by the liver
- Long-term Use: Limited data exists on long-term effects of regular CBD use in IBD patients
Current Limitations and Future Directions
While the evidence for CBD in Crohn's disease has expanded significantly since 2020, several limitations remain:
- Small Sample Sizes: Most studies involve relatively small numbers of patients
- Heterogeneous Studies: Different formulations, dosages, and outcome measures make direct comparisons difficult
- Lack of Standardization: No standardized dosing protocols exist for CBD in IBD
- Mixed Results: Some studies show clinical improvement while others do not
Emerging Research Areas
Recent studies are exploring:
- Optimal dosing strategies for CBD in IBD
- Combination therapies with conventional treatments
- The role of the endocannabinoid system in gut health
- Personalized medicine approaches based on individual patient genetics
Bottom Line
Crohn's disease can be painful and, if untreated, debilitating. The latest research from 2021-2024 provides a more nuanced understanding of CBD's role in Crohn's disease treatment:
- Symptom Management: Strong evidence supports CBD's effectiveness in improving quality of life and reducing patient-reported symptoms
- Adjuvant Therapy: CBD appears most promising when used alongside conventional treatments rather than as a replacement
- Inflammation: Current evidence does not support CBD's ability to directly reduce inflammation or induce clinical remission
- Safety: CBD maintains a favorable safety profile with mild side effects
Important Note: Before using CBD to help treat the symptoms of Crohn's disease, always consult a medical practitioner first. Not only can CBD interact negatively with other medications, but your physician can monitor dosage, symptom severity and other clinical parameters to ensure that the CBD treatment protocol is both safe and effective. The evidence suggests CBD may be a valuable addition to comprehensive Crohn's disease management when properly supervised by healthcare professionals.
Key Recommendations for Patients
- Discuss CBD use with your gastroenterologist before starting
- Consider CBD as part of a comprehensive treatment plan, not a replacement for conventional therapy
- Start with lower doses as suggested by recent meta-analyses
- Monitor symptoms and quality of life improvements rather than expecting inflammation reduction
- Be aware of potential drug interactions with your current medications
- Source CBD products from trusted source like Eir Health
