Colitis is inflammation of the lining of the colon. There are many causes of colitis, including infection, inflammatory bowel disease, ischemic and microscopic. Symptoms can include abdominal pain, diarrhea with or without blood and sometimes fever. Conventional treatment includes anti-inflammatory drugs, including steroids, immunomodulators, which work by decreasing the overall immune response, and more recently available biologicals, which work by targeting a specific component of the immune system. These treatments can be quite effective but are often associated with significant adverse side effects and expense.
Evidence is building that suggests that the endocannabinoid system is involved in many processes in the gastrointestinal system, including inflammation, growth of cells that line the gut, motor function and pain perception.1 Remember that the role of the endocannabinoid system is to maintain homeostasis of cellular function. The gastrointestinal system contains many cannabinoid receptors. Studies show that endocannabinoid dysfunction/deficiency may be the mechanism by which gut disease, especially inflammation, occurs.2 Although much research is still needed, initial studies reveal lowered endocannabinoid levels in inflammatory bowel disease.3
Cannabinoids decrease intestinal motility (the movement of the bowel musculature that affects the transit of gut contents) in the normal gut.4,5 Studies show that when the bowel is inflamed, as occurs in inflammatory bowel disease, activation of both CB1 and CB2 cannabinoid receptors helps to balance gut motility. What this means is that the diarrhea often associated with inflammatory bowel disease is reduced when these receptors are activated by cannabinoids. Quite interestingly, a lower dose of cannabinoids was effective in inflamed bowel when compared to healthy bowel, which is thought to be due to increased receptors being present in the disease state.6,7 Researchers have also found that increasing the “healthy bacteria” in the gut increases the expression of Type 2 cannabinoid receptors, which modulate pain perception in the gut.8
I have evaluated thousands of patients with gastrointestinal disease who have had successful results with cannabis treatment. These patients report that many symptoms, including nausea, poor appetite, abdominal pain, diarrhea and bloating, respond to treatment with cannabis. Often patients with nausea and vomiting prefer to inhale as the onset of relief is immediate. Other patients have found success with sublingual tinctures and oils and especially with CBD-rich medicine due to its potent anti-inflammatory effects. Some patients with gastrointestinal illness have reported an inability to use edible cannabis products as they can cause further gastrointestinal upset. As with other disease states, patients may find that THC-rich, CBD-rich or combination CBD+THC cannabis to be helpful depending on trial and error. I encourage patients with significant colitis symptoms to include CBD in their medicine regimen even if they find THC to be helpful. Terpenoids that have been found to specifically help the gut include terpinolene, beta-caryophyllene, limonene, and pinene.
Izzo, Angelo A., et al. “Endocannabinoids and the Digestive Tract and Bladder in Health and Disease.” Endocannabinoids. Springer International Publishing, 2015. 423-447.
Di Sabatino, A., et al. “The endogenous cannabinoid system in the gut of patients with inflammatory bowel disease.” Mucosal immunology 4.5 (2011): 574-583.
Marquéz, Lucia, et al. “Ulcerative colitis induces changes on the expression of the endocannabinoid system in the human colonic tissue.” PLoS One 4.9 (2009): e6893.
Aviello, G., B. Romano, and A. A. Izzo. “Cannabinoids and gastrointestinal motility: animal and human studies.” Eur Rev Med Pharmacol Sci 12.Suppl 1 (2008): 81-93.
Izzo, Angelo A., et al. “Cannabinoid CB1‐receptor mediated regulation of gastrointestinal motility in mice in a model of intestinal inflammation.” British journal of pharmacology 134.3 (2001): 563-570.
Ibid.
Izzo, Angelo A., et al. “Central and peripheral cannabinoid modulation of gastrointestinal transit in physiological states or during the diarrhoea induced by croton oil.” British journal of pharmacology 129.8 (2000): 1627-1632.
Rousseaux, Christel, et al. “Lactobacillus acidophilus modulates intestinal pain and induces opioid and cannabinoid receptors.” Nature medicine 13.1 (2007): 35-37.