Sustainable practices for medical marijuana patients

Celiac Disease and Medical Marijuana

People with celiac disease have inherited an ancient type of immune system that attacks one or more of their major body systems when they eat foods containing gluten, a constituent of wheat, barley and rye  (1,2). More than 1.5 million Americans (one in 133) suffer from celiac disease, making it twice as common as Crohn’s disease, ulcerative colitis and cystic fibrosis combined, but most are unaware they have the disease.

In classical celiac disease, immune system cells inflame the small intestines and destroy its lining. This causes digestion problems when partially digested food moves to the large intestine where it is consumed by bacteria, producing cramping, diarrhea, gas, bloatiing and abdominal pain. Celiac disease is often misstaken for irritable bowel syndrome or Crohn’s disease.  A simple blood test, followed by sampling and veiwing of the lining of the small intestines, is used to diagnose classical celiac disease.

A wide variety of medical conditions are associated with celiac disease.  In some forms of celiac disease, autoimmune damage to other body systems occur. In some people, kidney processing capacity is reduced and waste products can build up in the blood. In some, blood platelet count is reduced reducing the blood’s ability to coagulate. In some, brain damage occurs when brain cells are lost in the cerrebellum, the “autopilot” part of the brain that controls balance and coordination. Migraine headaches, joint pain, muscle cramps and esophageal spasms (5) are often associated with celica disease.

The autoimmune attack on body systems subsides when the person with celiac disease adopts a strict gluten-free diet and avoids eating wheat, barley, rye and, sometimes, oats. Unfortunately, celiac disease is often misdiagnosed for 10 years or more and irreversiable damage to some body systems can occur. Moreover, accidential consumption of wheat, barley or rye can occur when eating at a friend’s house or at a restaurant, no matter how careful the celiac tries to be, once again triggering the autoimmune response.  Non-compliance with a gluten-free diet increases the risk of specific types of cancer.

Marijuana can be used to treat many of the symptoms of celiac disease that are qualifying medical conditions under state medical marijuana laws. Marijuana “cools the gut.” It slows down the muscle contractions that move food through the stomach and intestines and reduces the secretion of liquid into the intestines associated with diarrhea (3). Marijuana also controls the muscle spasms associated with diarrhea. It also increases appetite and can offset the inefficiency in the celiac’s ability to absorb nutrients from the food he/she eats.

Constituents in marijuana called cannabinoids interact with receptors (called CB1 receptors) in the enteric nervous system (the part of the nervous system that directly controls the gastrointestinal system) and with CB1 receptors in the brain.  The cannabinoids in marijuana that contribute to its ability to treat the symptoms of celiac disease include tetrahydrocannabinol (THC) and cannabidiol (CBD). People with celiac disease should use marijuana strains that contain relatively high concentrations of both of these constituents.  Active celiac disease causes the number of CB1 receptors in the small intestines to increase (6) as the body seeks to counteract the consequences of gluten-dependent inflamation.  THC binds to CB1 receptors on cells in the gut and brain and acts as an agonist to inhibit emptying of the stomach and transit of food through the intestines (7,8).  CBD acts on CB2 receptors on immune cells to reduce inflammation of the gastrointestinal tract (4).  CBD has little effect on intestinal motility on its own, but it synergizes the effect of THC (5).

1.  The American College of Gastroenterology, Celiac disease.

2.  Mayo Clinic, Celiac disease.

3. Pertwee, Cannabinoids and the gastrointestinal tract, Gut (2001) 48:859-867.

4. Sanger, Endocannabinoids and the gastrointestinal tract:  what are the key questions?, British Journal of Pharmacology (2007) 152:663-670.

5. Usai et al., Autonomic dysfunction and upper digestive functional disorders in untreated adult coeliac disease, European Journal of Clinical Investigatiom (1997) 27:1009-1015.

6. D’Argenio et al., Overactivity of the intestinal endocannabnoid system in celiac disease and in methotrexate-treated rats, Journal of Molecular Medicine (2007) 85:523-530.

7. Luft, Endocannabinoids, just a gut feeling, Journal of Molecular Medicine (2007) 85:423-425.

8. Hornby et al., Involvement of cannabinoid receptors in gut motility and visceral perception, (2004) 141:1335-1345.

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