The medicinal use of cannabis for digestive issues has gained widespread popularity. This isn’t surprising. Australia’s rates of inflammatory bowel disease (IBD) are among the highest in the world.¹
Still, digestive disorders remain difficult to diagnose and effectively treat. Symptoms often overlap, and causes are seldom known. Conventional treatment protocols don’t adequately address long-term management, either.
These challenges necessitate the need for more alternative therapeutic approaches in gastroenterology. Evidence-based cannabis solutions might just be the answer.
But what works and what doesn’t? This article answers that question and more.
Read on to discover the therapeutic potential of cannabis and its science-backed uses in treating digestive disorders.
The impact of common digestive disorders
Common gastrointestinal (GI) conditions like IBD, irritable bowel syndrome (IBS) and Crohn’s disease (CD) present significant challenges for patients. While symptoms vary in type and severity, they can greatly reduce quality of life.
These conditions also pose difficulties for practitioners seeking effective, lasting treatments.
The overview of digestive disorders below offers some quick insights into the four most common conditions.
Inflammatory bowel disease (IBD)
IBD refers to a group of digestive disorders characterised by chronic inflammation of the digestive tract.
Inflammatory bowel disease is said to be an autoimmune disorder. However, research suggests that IBD is the result of an inappropriate immune response, particularly to gut microflora.²
Still, the precise cause of IBD remains unknown. Many immune response triggers have been implicated. But a universally present causal agent hasn’t been identified.
Two primary types of IBD exist, namely Crohn’s disease and ulcerative colitis. They’re each classified by severity and location. Both disorders remain incurable.
Indeterminate colitis IBD is a third type of inflammatory bowel disease. It presents with characteristics of both Crohn’s disease and ulcerative colitis.
Crohn’s disease (CD)
Crohn’s disease is a type of IBD characterised by chronic inflammation and irritation of the gastrointestinal tract. It can affect any segment of the GI tract, from the mouth to the anus. It also extends through all layers of the bowel.
Five primary types of Crohn’s disease exist, each characterised by location.
Commonly limited to the small intestine, CD can also occur in the large intestine and even the upper GI tract. One in every two patients has Crohn’s disease, affecting both the colon and small intestine.³
Individuals with CD typically experience periods of symptomatic relapse (flare-ups) and remission. As a lifelong disease, it can progress from mild to moderate and, finally, to severe phenotypes.
There’s no single cause of Crohn’s. An unusual immune response to infections, intestinal microbes, drugs, or toxins is what causes the disease. Genetic susceptibility is also a factor.
Common symptoms of Crohn’s disease include:
- Nausea
- Diarrhoea
- Weight loss
- Abdominal pain
- Fever
- Fatigue
- Bloating and flatulence
- Mucus or bloody stools
Severe Crohn’s disease can also present with symptoms outside of the GI tract. These include kidney stones, inflammation of the joints, skin, and eyes, and iron deficiency.
Ulcerative colitis (UC)
Ulcerative colitis is another type of inflammatory bowel disease. It’s characterised by the presence of ulcers and inflammation in the colon and rectum (large intestine).
UC occurs on the surface layers of the bowel’s innermost lining. It causes small open sores to form, as well as inflammation.
The common symptoms of ulcerative colitis are similar to those of Crohn’s disease. They include:
- Fatigue
- Diminished appetite
- Weight loss
- Diarrhoea
- Mucus or bloody stools
- Abdominal cramping
The cause of this condition isn’t well understood. Unusual immune responses, genetics and the gut’s microbiome are all contributing factors.⁴
Irritable bowel syndrome (IBS)
IBS is also known as a functional gut disorder (FGD) or a functional gastrointestinal disorder (FGID). It’s clinically described as a collection of medically unexplained gastrointestinal symptoms.⁵
Irritable bowel syndrome typically affects the digestive tract, including the stomach and intestines. Like IBD, it’s a chronic condition with no known cure.
IBS symptoms include:
- Constipation
- Diarrhoea
- Cramping
- Bloating
- Flatulence
IBS has no definitive cause, yet it’s a common affliction.
One in every five Australians experiences IBS symptoms.⁶ They manifest differently in each individual, depending on various factors. These include diet, infection, gut motility, emotional stress and psychological distress.
IBS is a disorder of brain-gut interaction. Studies show that functional changes of the large bowel in IBS patients are linked to microbiome diversity, gut barrier integrity, immunology and gut-brain signalling.⁷
Although symptoms can be severe, IBS doesn’t increase the risk of colorectal cancer. Nor does it cause long-term bowel damage.⁸
Other gastrointestinal conditions
Digestive disorders encompass various mild-to-severe conditions. Below are three other common gastrointestinal types.
- Gastroenteritis (gastro), caused by a gut infection.
- Gastritis refers to an inflamed stomach lining. It’s typically caused by infection, alcohol consumption or certain medications.
- Gastro-oesophageal reflux disease (GORD) occurs when stomach acid frequently rises up into the food pipe (oesophagus).
Common symptoms of these digestive disorders are similar to those of IBD, IBS and Crohn’s disease.
Prevalence and challenges in traditional treatment methods
In Australia, digestive disorders are extremely prevalent. According to Crohn’s and Colitis Australia (CCA), IBD isn’t just becoming more common. It’s getting more severe and complex, too.
According to the available statistics:
- Inflammatory bowel disease affects one in 250 people.⁹
- An estimated 100,000 Australians have Crohn’s disease or ulcerative colitis.⁹
- IBS affects about 30% of the Australian population.¹⁰
- FGIDs comprise up to 50% of all specialist gastrointestinal referrals.¹¹
Globally, IBD patients have a high degree of unmet medical needs. The condition isn’t limited to the GI tract and can affect other organs. With multiple contributing factors and symptoms, IBD has no gold treatment standard.¹²
Moreover, FGIDs are often poorly characterised.¹³
That’s why effective and lasting symptom relief can be pervasive. This significantly impacts patients’ quality of life and mental health.
These challenges in traditional treatment necessitate therapeutic or complementary approaches that are effective and holistic.
Cannabinoids and their therapeutic potential
The cannabis plant has over 100 identified cannabinoids, including CBG, THC and CBD. The human body also produces cannabinoids, called endocannabinoids.
These chemical compounds play a unique role in physiological functions via the endocannabinoid system (ECS). The ECS helps regulate various body processes, including sleep, mood and appetite.
Here’s where the therapeutic potential of cannabinoids becomes apparent. They bind to cannabinoid receptors (CB1 and CB2) throughout the body, which play a role in ECS function.
Cannabinoids like CBD, THC and cannabigerol (CBG) have demonstrated anti-inflammatory, antispasmodic, antiemetic and analgesic properties.¹⁴
Scientific research on cannabis for digestive issues
Studies indicate that cannabis may benefit patients with digestive disorders in more ways than one.
The scientific evidence for cannabis in gastroenterology suggests that cannabinoids:
- May have protective qualities. They mitigate and reduce gastrointestinal damage and inflammation. They also minimise gastric mucosal lesions.¹⁵
- May reduce gastric acid and hypermotility, which causes diarrhoea and digestive problems. They also regulate gut-barrier function.¹⁵
- Are well-established gut motility modulators. They assist in the optimal movement of food through the gastrointestinal system.¹⁵, ¹⁶
- Modulate visceral hypersensitivity and pain. This aids in the alleviation of chronic abdominal pain.¹⁵, ¹⁶
Research has also established a bidirectional link between the body’s gut microbiota and the ECS. This crosstalk may have wide-ranging implications for overall gut health.¹⁷
While cannabis may help restore gastrointestinal homeostasis, much is unknown. More research is needed.
Cannabis-based therapeutic approaches for digestive disorders
Cannabis-based therapeutic approaches have great potential for treating digestive disorders. Let’s take a closer look.
CBD for inflammation and pain management
CBD is a non-psychoactive cannabinoid that influences ECS activity in the GI tract. This affects inflammation and responses related to immune function, pain and stress.
Cannabidiol, or CBD, has demonstrated anti-inflammatory, antispasmodic, antidepressant and analgesic properties.¹⁴,¹⁵ But research indicates that it may be a particularly powerful therapeutic agent for digestive disorders.
The gastrointestinal tract has relative predominance of CB2 cannabinoid receptor expression. CBD binds to these receptors without any psychotropic effects (unlike THC).
Although not well characterised, the function and presence of CB2 receptors along the entire gut have been found to play important roles in:
- Modulating or reducing intestinal inflammation which is synonymous with conditions like IBD or IBS.
- Decreasing pain and sensitivity felt in the abdominal or intestinal areas, which is a typical symptom of digestive disorders.
- Helping to control abnormal or painful intestinal contractions like cramping (dysfunctional motility).
Essentially, CB2 receptors act as a braking system helping to resolve GI tract inflammation and its accompanying symptoms.
Therefore, CBD is uniquely positioned as a promising therapeutic agent for effective pain management and inflammation associated with digestive disorders.¹⁸,¹⁹
THC’s impact on appetite, nausea and pain
THC is the primary psychoactive cannabinoid in cannabis. It Interacts with cannabinoid receptors CB1 and, to a lesser extent, CB2 via the ECS.
With antiemetic properties,THC can help manage nausea and vomiting associated with chronic digestive diseases.²⁰ Research has also shown THC’s ability to increase appetite and promote eating.²¹
These effects, along with its well-documented pain-relieving properties, are primarily attributed to THC binding to CB1 receptors in the central nervous system.
Meanwhile, CB2 and other receptors mediate THC’s antispasmodic (smooth muscle relaxation) and anti-inflammatory effects.²² Moreover, studies indicate that CB2 agonists may effectively suppress acute, inflammatory and neuropathic pain.²³
This highlights THC’s powerful therapeutic potential to provide symptomatic relief from the chronic pain and cramping associated with inflammatory bowel disease.
CBG and its potential anti-inflammatory properties
CBG is a chemical precursor of THC and CBD. Besides its antioxidant, anti-tumoral and analgesic properties, CBG has shown promise in treating GI disorders.²⁴
Early research suggests CBG prevents colitis-associated damage, reduces intestinal inflammation and promotes colon tissue recovery.²⁵ These potential therapeutic agents may aid in symptomatic relief.
Dosage considerations for different cannabinoids
Proper cannabis dosing and administration are vital for patient safety and efficacy outcomes. Cannabinoid dosages for digestive disorders vary according to the patient’s medical history, cannabis use and current medications.
Excessively high doses of cannabis may cause unwanted side effects like intoxication, paranoia, anxiety and nausea.
The “start low, go slow” approach can prevent these issues. Bhaskar et al.’s dosing method includes standard, conservative and rapid protocols. They focus on safety, effectiveness, and tolerability.²⁶
The Therapeutic Goods Administration (TGA) also offers guidance on medical cannabis use.²⁷
Personalising cannabis prescriptions for digestive health care
Integrating cannabis-based medicines into gastroenterological care takes a patient-tailored approach. It necessitates personalised cannabis prescriptions and treatment, requiring:
- A comprehensive patient assessment and medical history.
- Identification of any contraindications and potential interactions.
- Collaborating with healthcare teams to determine accurate dosing and treatment protocols.
- Monitoring cannabis treatment for adverse reactions and efficacy.
- Adjusting dosage for digestive disorders based on patient response.
The above guidelines consider the complex nature of both cannabis and digestive disorders.
Educating patients on cannabis usage
Using cannabis for digestive issues has become popular among Australians. Still, specialist care engagement remains low.²⁸ That’s why patient education on cannabis is essential.
Gastroenterologists and health practitioners can ensure optimal care by:
- Providing comprehensive information on cannabis, including key differences between cannabinoids.
- Addressing misconceptions and common patient concerns.
- Encouraging open, judgement-free discussions to explain vital aspects like overuse risks, effects and dosing schedules.
- Stressing the importance of consistent follow-ups for tolerability and continued efficacy.
Guiding patients to trustworthy educational resources can further empower those with digestive disorders.
Legal and ethical considerations
Legal considerations for prescribing cannabis revolve around compliance. Federal prescriber requirements apply nationwide. States and territories may have additional requirements.
Ethical cannabis prescribing follows well-established principles of evidence-based care and transparency.²⁹ Health practitioners have an ethical responsibility to stay abreast of the latest legal and scientific developments to better inform treatment protocols.
Below are three prominent resources for legal cannabis updates and guidelines:
Cannabis solutions for digestive wellbeing
Digestive disorders significantly affect the Australian population and pose severe treatment challenges. Overlapping symptoms, unknown causes, and lacklustre traditional treatments make effective symptom management challenging.
Fortunately, cannabis-based therapeutic approaches in gastroenterology show promising potential. Cannabinoids like CBG, CBD and THC have pain-relieving, anti-nausea, anti-inflammatory, antispasmodic and appetite-stimulating qualities.
Cannabinoid activity has also demonstrated protective actions in the GI tract. However, much remains unknown, necessitating ongoing research.
That’s why evidence-based practice is an ethical responsibility, along with continuing education for medical practitioners.
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References
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- Zheng L, Wen X-L. Gut microbiota and inflammatory bowel disease: The current status and perspectives. World Journal of Clinical Cases. 2021 Jan 16;9(2):321–33. https://doi.org/10.12998/wjcc.v9.i2.321
- Ranasinghe IR, Hsu R. Crohn Disease [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK436021/
- Australia H. Ulcerative colitis [Internet]. www.healthdirect.gov.au. 2019. https://www.healthdirect.gov.au/ulcerative-colitis
- Hillestad EMR, van der Meeren A, Nagaraja BH, Bjørsvik BR, Haleem N, Benitez-Paez A, et al. Gut bless you: The microbiota-gut-brain axis in irritable bowel syndrome. World Journal of Gastroenterology. 2022 Jan 28;28(4):412–31. https://doi.org/10.3748/wjg.v28.i4.412
- Better Health Channel. Irritable bowel syndrome (IBS) [Internet]. Vic.gov.au. 2012. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/irritable-bowel-syndrome-ibs
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