Tailoring Cannabinoid Therapy to Crohn’s Disease
“It’s no fun looking at food and wondering what it’s going to do to me,” said the 44-year-old Crohn’s patient to me during our interview.
“Can I eat it? Am I going to be in deep pain?’ Fears of what you can and cannot eat…they get to you. Marijuana helped me want to eat,” he said gratefully.
Those were the words of Al Graham, a Crohn’s patient in Ontario, Canada, who has successfully managed his disease for more than a decade with the aid of cannabis.
As a legal cultivator under federal law in the Great White North, Graham is able to focus on particular strains in an effort to target his condition with specific cannabinoids.
In other words, Graham has been able to treat his condition with cannabinoid therapy.
What is cannabinoid therapy?
FACT: Cannabinoids are the special therapeutic molecules found within the resinous trichome glands of the cannabis plant’s mature flowers.
As of 2016, researchers have uncovered more than 110 cannabinoids possible in this plant.
That is a lot of cannabinoids. And we are discovering more about them and their therapeutic value every week.
As you began to learn about the nature of customized cannabinoid consumption, you will come to better understand how this unique and powerfully medicinal plant interacts with the human body by way of the endocannabinoid system.
If you’re not yet familiar with the endocannabinoid system, prepare to have your mind blown.
“The discovery of the endocannabinoid system in the last decade of the 20th century has provided the rational basis for understanding the therapeutic value of cannabis and its various components.” – Dr. Sunil Aggarwal, M.D., Ph.D.
How to tailor cannabinoid therapy for a specific illness
Cannabis is a very complex medicine. With so many cannabinoid combinations, it can be confusing to the newcomer.
But tailoring cannabinoid therapy for any illness can be simple once you understand the medical properties of cannabis and how to consume it.
In fact, your biggest challenge may likely be safe access to this medicine (why we must keep pushing to end federal prohibition).
In the following case study on Crohn’s disease, we look at the two major cannabinoids, tetrahydrocannabinol (THC) and cannabidiol (CBD) – and an important acidic precursor, THC-A.
More specifically, we will examine:
- What is Crohn’s disease and how does it affect patients?
- Does cannabis have efficacy in the treatment of Crohn’s?
- If a patient were to adopt cannabis to treat their Crohn’s, how would they do so?
- What major cannabinoids should be used to target Crohn’s and its specific symptoms?
- What are the best sources of these cannabinoids?
- What are the specific benefits of tetrahydrocannabinol, or THC?
- What are the specific benefits of cannabidiol, or CBD?
- What are the specific benefits of THC’s acidic precursor, THC-A?
- What options are available to patients in terms of the consumption of these cannabinoids?
- How to consider cannabis therapy within the overall holistic context of mind, body, and spirit.
Diagnosis: Crohn’s Disease
Imagine the following scenario: Your friend Susan, who you met in college, is a 44-year-old software development project manager in Houston, Texas. She has recently been diagnosed with the most common form of inflammatory bowel disease (IBD), Crohn’s disease.
Crohn’s is a potentially fatal condition of the gastrointestinal tract involving inflammation, pain, nausea, and often extreme weight loss (the type experienced by sufferers of wasting syndromes like HIV/AIDS).
Scientists believe that Crohn’s is caused by a combination of factors, including malfunction of the immune system, one’s environment, and inherited genetics. It may also be triggered by extreme anxiety.
About half a million people in North America suffer from this painful condition, which can also result in chronic diarrhea, bloody stool, fatigue, malnourishment, and even arthritis.
In terms of real-world ramifications, severe manifestations of Crohn’s can result in disability, loss of employment, financial hardship, deterioration of family relationships, substance addiction, and depression.
Susan wishes to treat herself with cannabis and minimize her use of pharmaceutical drugs, but doesn’t know where to begin.
Unfortunately, Susan’s primary care physician is opposed to her use of cannabis, citing prohibitionist rhetoric like addiction and lung cancer–both of which have been disproven by multiple research studies and a wealth of anecdotal evidence.
However, considering that almost no medical schools in the United States include cannabinoids or the endocannabinoid system in their programs, it’s no wonder that the majority of doctors are clueless when it comes to even the most basic aspects of the nuanced and synergistic interplay of cannabinoids and the human body.
Assume that you are familiar with much of the research regarding cannabis as a holistic wellness therapy. More important, Susan trusts you. She has decided that, despite the misinformation and irrational fear mongering of her Houston doctor, she also trusts cannabis as a therapeutic framework for dealing with her disease.
Susan turns to you for help and direction. What do you tell her?
Case Study: Severe Crohn’s
Unfortunately, your friend’s case of Crohn’s is one of the more severe that her doctor has diagnosed. Because she had always perceived herself to be slightly overweight, she ironically welcomed the weight loss that accompanied the onset of her condition and pushed off taking action to learn the cause of her symptoms.
Despite the painful digestion she was experiencing in her abdominal region and the loss of appetite – which led to a lack of energy from poor nutrition – Susan didn’t initially perceive the true danger of her rapid weight loss.
She also didn’t schedule an exam with her doctor until she visited the Medical Jane website and realized that she was experiencing most of the possible symptoms of Crohn’s.
When Susan scheduled an appointment with her doctor and the nurse inquired as to her symptoms, she replied that she was suffering from the following:
- Intestinal pain and discomfort
- Loss of appetite
- Weight loss (although she downplayed this fact)
- Insomnia and poor sleep (from pain and anxiety)
- Generalized anxiety (from the unknown nature of the changes occurring in her body)
- Mild to moderate depression (from the fear of the potential severity of her condition and diagnosis)
Because her Crohn’s is severe and diagnosis should have occurred six to 12 months earlier, Susan must undergo chemotherapy. While traditionally associated with cancer patients, Crohn’s sufferers are one of the largest recipient groups for this conventional and controversial medical treatment.
Susan has elected to undergo minimal chemotherapy and to consume as few pharmaceutical drugs as possible during her treatment. Unfortunately, she cannot simply forego these conventional therapies due to the significant progress of the disease and the severity of her symptoms.
But her goal is to gradually discontinue both and depend solely on cannabis, diet, exercise, and meditation to keep her disease in remission.
How Cannabis Combats Crohn’s
Cannabis will serve your friend in many ways.
You should first sit down with Susan in a comfortable environment that’s void of the distraction and din of daily life.
Explain to her that cannabis is not a cure-all or panacea. Rather, it is part of a holistic approach adopted by millions of Americans, a health strategy that also involves a nutritious diet, low or no alcohol intake, regular exercise, and may incorporate activities like yoga or meditation.
Put simply, cannabis is part of a bigger picture for wellness.
Consumption of cannabis will provide relief in three major categories for patients like Susan who are suffering from moderate to severe Crohn’s and the litany of negative symptoms that accompany the condition.
#1) Cannabis will deal with the negative side effects of the pharmaceutical treatments Susan must undergo, such as the nausea resulting from chemotherapy and the anti-inflammatory drugs prescribed by her doctor.
#2) Cannabis will relieve the symptoms of her Crohn’s, most notably pain, inflammation, and nausea. This is accomplished by THC, CBD, and THC-A (more on these cannabinoids in a moment). In fact, the greatest benefits derived from cannabis, aside from nausea relief, are as an analgesic (pain reliever) and anti-inflammatory agent.
#3) Cannabis will relieve Susan’s core disease. A milestone study conducted in Israel in 2013 and published in the journal Clinical Gastroenterology and Hepatology revealed that 45% of human study subjects experienced “complete remission” of their Crohn’s after eight weeks of 115 mg of smoked THC per day.
It should be noted that this Israeli study revealed no negative side effects of smoked “marijuana.” This is good, because Susan is concerned with potential side effects of all of her medication, including cannabis. She would like to learn her options for consuming the herb so she can choose the best method.
If she doesn’t want to smoke cannabis, she can explore other consumption avenues such as edibles or vaporization (more about these options below).
The one thing that really stands out in Susan’s mind is this: all participants in Israel’s human study on Crohn’s had been unresponsive to conventional treatments – cannabis was a last resort for these desperate people.
Despite this, nearly half of the patients experienced a full remission of their disease. And yet, the American Medical Association continues to essentially ignore the efficacy of cannabinoids and terpenes within the human body.
Targeting Crohn’s with Specific Cannabinoids
Of the more than 110 cannabinoids that have been discovered in the cannabis plant, each plays a distinct role in achieving and maintaining homeostasis within the human body. This is all accomplished via the endocannabinoid system in an effort to return a diseased body or organ to balance and health.
In the case of Susan, these diseased organs are her mind and her large intestine.
Physically, Susan is plagued with chronic inflammation. Overt sensitivity and discomfort emanate from her lower abdomen almost 24 hours per day.
Mentally, this professional middle aged woman is haunted not only by the stress of constant pain, but also the fear that it may permanently and very negatively impact her life – and, along with it, the lives of her children.
Her mind is stricken with the anxiety of daily life and being a single mother of two teens; she is overwhelmed by thoughts regarding her health and mortality. Susan cannot leave behind the fear that her Crohn’s may produce a premature death, something that is wreaking havoc on her sleep, resulting in insomnia and mild nightmares.
Of the dozens of cannabinoids commonly found in the plant, two major examples, THC and CBD, and the acidic precursor to THC, known as THC-A, provide some of the greatest efficacy for Crohn’s sufferers.
- THC is the infamous cannabinoid that delivers psychoactive effect and euphoria, along with a long list of medical benefits. Strains rich in this cannabinoid include Trainwreck, Gorilla Glue #4, and Juicy Fruit, among many others. In the Israeli study cited above, the cannabis employed was 23% THC and 0.5% CBD.
- CBD is a non-psychoactive cannabinoid that is known for helping cancer patients shrink tumors and dramatically reducing or even eliminating seizures in those with epilepsy. Most strains of cannabis are very low in CBD; one exception is AC/DC.
- THC-A is the non-psychoactive precursor to THC. “Raw” buds of cannabis contain very little THC, but plenty of THC-A, the source from which it is derived. When cannabis flowers are exposed to sufficient heat, excessive oxygen or light, or even just physical jostling, THC-A (a delicate, volatile molecule) breaks down into THC (this is the heart of the decarboxylation process, which occurs instantaneously during smoking or vaporization)
- CBN: For insomnia, strains high in cannabinol (CBN) are very effective. CBN is basically “stale” THC, and is an excellent cannabinoid for encouraging sleep. Although the topic of terpenes – which are the aromatic molecular cousins of cannabinoids – exceeds the scope of this article, myrcene is an example that, in volumes over 0.5%, is an excellent sleep aid and common to strong indica strains.
During a lecture in Costa Rica in 2015, Mara Gordon, a specialist in the development of cannabis extract treatment protocols for seriously ill patients, described how the cannabinoids THC, CBD, and THC-A are especially beneficial for patients with Crohn’s and other forms of IBD and Irritable Bowel Syndrome (IBS).
“Crohn’s disease, irritable bowel syndrome, the THC…activates the CB1 and CB2 receptor sites in the gut and it relieves the motility and inhibits the secretions causing inflammation. It makes everything in your stomach just work better,” said Gordon during her lecture.
Gordon is familiar with this mechanism from her work with 600+ patients and a number of physicians since 2011.
Benefits of Cannabidiol (CBD)
Strains of cannabis that are high in CBD help reduce the sometimes severe inflammation and discomfort suffered by Crohn’s patients.
Project CBD defines CBD-rich strains as those containing 4% or more (by volume) of this medicinal cannabinoid.
CBD also delivers an anti-bacterial effect that is important because “opportunistic” infections are often present in people who have chronic gastrointestinal conditions.
According to Gordon, a therapy targeted at Crohn’s and incorporating the primary cannabinoids THC and CBD might involve 30 mg per day of THC and 15 mg of CBD (note the 2:1 ratio), as was the case with one of her more than 650 patients.
When searching for cannabis containing CBD, it should be noted that CBD-rich strains can be somewhat elusive on both the black market and in legal dispensaries. Finding strains that are a good source of CBD will require some research on Susan’s part – if the strains are even available.
One example of a CBD-rich strain is AC/DC, a phenotype of the strain Cannatonic that, according to Medical Jane, sometimes exhibits a 22:1 CBD-to-THC ratio. “Its high concentration of cannabidiol (CBD) makes the AC/DC strain ideal for coping with anxiety and pain,” wrote the medical cannabis site in a 2013 article.
It just so happens that anxiety and pain are two of the primary symptoms of Crohn’s disease – especially in severe cases like that of your friend Susan.
But because she lives in Texas, a relatively strict prohibitionist state, her black market dealer is probably completely unaware of cannabinoids other than THC.
So Susan has made the difficult decision to move to a legal state (she is seeking employment in California) and will eventually be able to look for such strains at her local dispensary. This will include discussing the varieties offering the best efficacy for Crohn’s with both her primary care physician and a knowledgeable budtender.
Juicing for THC-A
Mara Gordon stresses how THC and CBD alone are not enough. “I also would say that you should include THC-A in any protocol that’s for Crohn’s or irritable bowel,” she said during her Costa Rica lecture.
You have shown Gordon’s findings to Susan, who now knows that the non-psychoactive cannabinoid THC-A is the acidic precursor to THC and that it provides significant medical efficacy involving no psychotropic effect – including relief from her inflammation and pain. So where can she get it?
One of the best sources of THC-A is the fresh, raw leaves of the cannabis plant. The importance of the freshness of the leaves is paramount and cannot be stressed enough. Dry, brittle leaves are of little value to those seeking the health benefits of THC-A.
When juiced, cannabis leaves are a ready source of this valuable and medicinal cannabinoid. Juicing the plant makes sense as it is not only an herb, but also categorized as a vegetable because of its green, leafy matter.
According to the Colorado Pot Guide, juiced cannabis is “a nutritionally dense, very potent medicine.”
The problem with juicing is the fact that it requires a relatively large number of leaves. Unfortunately, home cultivation is illegal in most areas of the United States, including in some legal adult use states, such as Washington.
If Susan can’t grow her own cannabis (illegal and dangerous in Houston) and there are no local farms, cultivation facilities, or cannabis-friendly farmer’s markets at which she can purchase leaf and trim, juicing will simply be impractical and out of her reach.
This is one of the greatest reasons Susan has decided to relocate to a legal medical state on the West Coast. Because her career keeps her busy and she lacks sufficient space to cultivate the number of plants necessary for daily juicing, she plans to purchase fresh trim leaves from a local cultivation facility and visit the weekend farmer’s market as frequently as possible.
One thing that is important for you to emphasize to Susan is that, while raw cannabis flowers, or “buds,” can be ingested or juiced along with the leaves, this part of the plant is best vaporized, smoked, or used to create cannabutter for baking edibles.
However, many experts recommend supplementing fan leaves and trim with some small buds, which offer relatively concentrated THC-A. The need for this would be driven by Susan’s cannabinoid daily dosing targets, something she should carefully determine with a clinician or doctor.
One strong advocate for cannabis juicing is Dr. William Courtney, a psychiatrist and holistic physician in Mendocino County, California. Courtney is a proponent of juicing THC-A for the treatment of a variety of diseases, including lupus, migraine, fibromyalgia, IBS, and IBD.
Courtney claims that THC-A has efficacy that extends beyond that of psychotropic THC due to the fact that much more can be consumed in a single dose.
For example, he teaches his patients how they can consume 600 mg of THC-A via raw cannabis leaves, while such a level of THC would be highly undesired and potentially produce negative side effects such as fatigue, anxiety, and paranoia.
Because the fan leaves of cannabis can be very bitter when juiced, you should recommend to Susan that she add carrots or another vegetable or herb that will counter this flavor. This will make daily consumption a more pleasant experience, encouraging it as a habit.
She will also need to purchase a nice consumer or prosumer juicing machine that will stand up to daily use and deliver results commensurate with an effort to defeat a life-altering disease.
Other Avenues of Consumption
Susan should understand that cannabis is not a cure, but instead a wellness herb and medicine that can be used to treat literally hundreds of diseases. The plant offers great flexibility in how its cannabinoids, such as THC, CBD, and THC-A, can be consumed.
NOTE: It should be emphasized that many patients who are well enough to be employed, but sick enough to require cannabis medicine, may prefer or need to avoid THC before and during their work. This is especially true for pilots, drivers, day care assistants, and folks who travel a great deal.
There are a few potential delivery systems that should be taught to Susan, who has traditionally smoked cannabis flowers a few times a month from a joint or glass pipe.
Because she is familiar with it, smoking is a valid option for Susan. If she is consuming potent, high-quality flowers, she will require much less smoke to achieve the desired effect and combat her symptoms.
Another option, especially if she is in severe pain or discomfort, is concentrates. These are the very potent result of processes by which the resin produced by the flowers of the mature cannabis plant are separated from the green plant matter. Concentrates are also known as extracts and include butane hash oil (BHO), also known as “honey oil” throughout the United States and Canada.
Let’s look a little more closely at some of the different cannabis delivery systems:
- Smoke: Even within the category of smoking, many options are available. Both flowers and concentrates can be smoked. Avenues of smoking include joints, pipes, bongs, and a variety of exotic devices designed to allow the consumption of combusted cannabis.
Pros include fast onset (about 2.5 minutes) and inexpensive smoking devices.
- Vapor: Both flowers and concentrates can be vaporized. Vaporization offers the benefit of harm reduction by completely eliminating the carcinogens and toxins produced when the flowers of the herb are burned. Onset is fast, identical to that of smoking.
- Edibles: Many patients prefer edibles to all other forms of consumption. Today, legal states offer edibles in the form of not only baked goods, but also energy drinks, chocolate bars, and even chewing gum.
New types of edible products are being introduced to market in legal states on nearly a weekly basis. Cons include a slow onset of 45 minutes to two hours and difficulty in determining dose.
- Tinctures: These are the oldest and lowest tech form of cannabis concentrate. Tinctures are typically available in the form of a liquid that is administered sublingually via an eyedropper. This is also how most of America treated itself for minor aches and pains during the 100 years leading up to prohibition in August 1937. Sublingual onset is about 10 to 20 minutes, somewhere between smoking and edibles.
- Topicals: Topicals are useful for a variety of conditions, including the arthritis that accompanies some severe examples of Crohn’s. Potent topicals in the form of sprays, creams, balms, and lotions can also be applied to the abdominal region of some Crohn’s patients in an effort to decrease pain and intestinal motility.
Little known fact: Topicals containing THC do not result in a psychoactive effect, so they are safe for children, seniors, and anyone who doesn’t desire to get “high.”
Beyond the Disease: Treating Mind & Spirit
An important observation that should be shared with Susan is that restoring homeostasis and balance to her body – in other words, eliminating her disease and pain – involves more than simply cannabinoids and specialized endocannabinoid receptors.
Holistic health and physiological balance also involve mindfulness. This mindfulness must embrace the concept of using cannabis with intent.
Susan’s intent should be to heal, nourish, and repair. If her motive is simply to escape reality and avoid the responsibility of managing her health (and life), she’ll never enjoy the full benefits of cannabis therapy and may prolong or sustain her suffering.
Mindfulness also involves and requires relief from anxiety. Susan cannot reasonably, sincerely, and intelligently approach her disease and how best to treat it under the weight of excessive stress and the anxiety that it produces.
Because those like Susan, with a life-threatening disease, necessarily experience a great deal of anxiety, cannabis plays the role of a soothing psychological and physical tonic to ease frazzled nerves and adrenal fatigue.
Skeptics will note that the highest concentrations of one major cannabinoid receptor type within the endocannabinoid system, CB1, are in the brain and central nervous system. Cannabinoids and the human body are literally and quite dramatically designed to work together to maintain health and well being.
This special herb is so effective at stress relief, in fact, as to allow patients like Susan to rationally reflect on their disease and properly strategize a revised lifestyle to best combat it – in addition to gaining the confidence to execute on and maintain their plan.
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