Doctors and healers across many cultures have used cannabis for centuries to treat a long list of ailments from nausea to expelling tapeworms. But It looks like it might be time to add a few more ailments to the list.

Recent studies show cannabis may aid in the treatment and symptom management for certain inflammatory bowel diseases (IBD) such as Irritable Bowel Syndrome (IBS), Crohn’s disease and ulcerative colitis.

Gastrointestinal ailments plague people of all ages, races, creeds and genders. Experts estimate that IBS affects anywhere from 25 to 45 million Americans. The CDC estimates another three million suffer from a form of IBD — either Crohn’s disease or ulcerative colitis.

Some research points to cannabis as a therapeutic remedy for a wide range of IBDs.

More specifically, researchers suggest the key to understanding the therapeutic link between cannabis and IBDs lies within the endocannabinoid system (ECS).

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The Endocannabinoid System

Scientists first discovered the ECS back in the 1990s while studying cannabis’ most renowned cannabinoid — THC, according to Healthline.

The ECS is a cell-signalling system which plays an important role in regulating sleep, immune responses and more. It’s primary function is to maintain homeostasis within the body, a.k.a “the Goldilocks zone” — because everything feels just right.

It is composed of three core components: endocannabinoids, receptors and enzymes. Endocannabinoids are molecules similar to cannabinoids, except human and animal bodies create them. “Endo” comes from the Greek word “endon” meaning “within.”

In a 2016 interview with Project CBD, Dr. Greg Gerdeman, a neuroscientist who has researched the ECS for over 20 years, described endocannabinoids as cannabis from the body.

“People say [endocannabinoids are] like the body’s own marijuana. A structural chemist, they might take some objection to that because the [molecular] structures don’t look that much alike. But functionally, which is what a physiologist thinks about, the physiology of how anandamide binds to and changes cellular activity binding a cannabinoid receptor is actually quite similar to THC,” he told Project CBD.

Receptors are located throughout the body. Endocannabinoids bind to the two main receptors — CB1 and CB2 — signaling the ECS that it’s time to work.

CB1 receptors are most abundant in the body’s nervous systems (central, peripheral and enteric). CB2 receptors are most prevalent in the immune system. Although, both are found throughout the body, according to Leafly.

Which receptors endocannabinoids bind to depends on the function the ECS is carrying out. For example, endocannabinoids might bind to CB1 receptors in the spinal nerve to relieve pain. Or they might bind to CB2 receptors in immune cells to alert the body to inflammation.

Lastly, enzymes break down endocannabinoids once they’ve completed their desired task.

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Cannabis and Gut Health

When cannabinoids like THC enter the body, they bind to receptors just like endocannabinoids. However, cannabinoids can bind to CB1 and CB2 receptors all over the body. That’s why sometimes cannabis is used to relieve pain, stimulate appetite and/or induce drowsiness, according to Healthline.

Though CB1 receptors are mainly located in the nervous systems and CB2 receptors in the immune system; researchers found both types of receptors in the gastrointestinal system as well, including all layers of intestinal sections.

Because scientists discovered the ECS less than 30 years ago, they know little about it compared to other bodily systems. And with cannabis still a Schedule I Controlled Substance, scientists have conducted even less research on the connection between the two.

However, in recent years some researchers have concluded that there is a rather promising relationship between cannabis, the ECS, and gut health.

In 2015, a team of researchers in Canada discovered that a daily regimen of THC improved the gut microbiome health in mice on a high-fat diet after three to four weeks. The resulting gut microbiome health resembled that of mice fed a healthy, balanced diet.

Researchers in 2017 studied cannabis and the human gut microbiome, comparing 19 lifetime cannabis users and 20 non-users. They discovered that the cannabis users’ gut microbiome contained bacteria populations associated with higher caloric intake but lower BMI. Although researchers thought diet may have played a role, according to Project CBD.

Though there is a lack of viable studies on the topic, the evidence thus far suggests that the ECS does interact with gut bacteria, and that cannabinoids like THC or CBD may modify or even improve gut microbiome health.

Some attribute the potential viability of cannabis as a treatment for IBDs to the plant’s anti-inflammatory properties.

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Cannabis for IBS and IBDs

Sara Rotman, who suffers from Crohn’s disease, and is founder of Wellfounded Botanicals, a cannabis wellness brand, says cannabis was a lifeline for her after modern treatments failed to control her symptoms.

“I tried [cannabis] and low and behold it really helped alleviate my symptoms. It really brought my inflammation down and absolutely curbed my pain. And we started to discover that with regular use it could really help me control my symptoms,” she told Emerald.

From @wellfoundedbotanicals

She’s not the only one who’s found success in treating IBDs with cannabis.

In 2012 a group of researchers instructed 13 patients with long-standing IBD to inhale cannabis flower whenever they felt pain for three months. After three months, patients reported overall improved health. More specifically, they experienced less abdominal pain, depression, and diarrheal symptoms. Additionally, they reported increased social functioning and ability to work.

A study from 2011 highlighted the potential for cannabis as a therapy for Crohn’s disease. Thirty patients suffering from Crohn’s disease reported improved symptoms after cannabis use. These improvements were reflected by a reduction in disease activity index and the need for other drugs and surgeries.

In another study, published in 2019 in the European Journal of Gastroenterology and Hepatology, researchers observed 127 patients with IBS. They concluded that a dose of 30 g/month of cannabis —  or 21 mg of THC and 170 mg of CBD per day — improved IBS symptoms. Patients also reduced use of medication and gained weight.

Another 2019 study, this one on the viability of using cannabis to treat ulcerative colitis, found that cannabis consumption was associated with shorter hospital stays. Cannabis users also had less bowel obstructions.

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Some Still Skeptical

Though, even with a growing pool of data, studies and anecdotal evidence, some researchers, including Dr. Adie Rae, a neuroscientist who specializes in cannabis research, are still hesitant to definitively say cannabis is a viable cure for IBDs.

“Some clinical studies show strong promise for cannabis treating IBS, but it’s complicated. Cannabis and its constituents appear to improve the quality of life for these patients, although the severity of their disease may not measurably improve,” she told Weedmaps in 2020. “IBS patients who use cannabis may be able to reduce their other medications and go back to work. They might have fewer complications and shorter hospital stays. However, in randomized clinical trials, the disease itself doesn’t appear to improve much. Lots more research is needed.”

While Rotman, owner of Wellfounded Botanicals, is empathetic to the concerns posed by skeptical researchers, she says the anecdotal evidence is too much to ignore.
“I understand why it’s challenging for someone to definitively recommend something that they only have anecdotal evidence for,” she explained to Emerald. “I think what I would really like is for the federal government to allow some of our medical establishments to actually run real, legitimate clinical trials to see if they could help people.”