Tag: ulcerative colitis

IBD and Cannabis | NutritionFacts.org

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Smoking cannabis may help with symptoms of inflammatory bowel disease (IBD) in the short term, but it may make the long-term prognosis worse.

As this study asks, “Medical Marijuana: A Panacea or Scourge?” For 5,000 years, cannabis “has been used throughout the world medically, recreationally, and spiritually.” It was even prescribed by American physicians “for a plethora of indications” from the mid-19th century to the 1930s, a fact that’s often used by medical marijuana proponents as evidence justifying the modern medical applications.” But the field of old-timey medicine is “fraught with potions and herbal remedies,” not to mention bloodletting and other questionable and harmful remedies.

Skeptics criticize the medical marijuana movement as the “‘medical excuse marijuana’ movement,” insinuating that children with epilepsy and the terminally ill are being “used as a ‘Trojan horse’ for the legalization of recreational cannabis use” or to peddle “outlandish claims” about “miracle cancer cures,” frustrating researchers in the field who just want to get at the science.

For example, what about the therapeutic use of cannabis for inflammatory bowel diseases like Crohn’s disease and ulcerative colitis? Conventional therapies work mainly by suppressing the immune system to try to tamp down inflammation. “Given the limited therapy options and known adverse side effects with chronic use” from these drugs, people suffering from these diseases often need to have inflamed sections of their bowels removed surgically, so it’s clear why there’s so much interest in alternative approaches.

About one in six IBD patients who use marijuana say it helps with their symptoms, so researchers decided to put it to the test. Thirteen patients with IBD were given a third of a pound of marijuana to smoke at their leisure over a period of three months, and they reported feeling significantly better with “reported improvement in general health perception, social functioning, ability to work, physical pain, and depression.” There wasn’t a control group, so it’s unknown if they would have improved anyway or what role the placebo effect may have played. It’s like some of the studies of cannabis used for pediatric epilepsy that had response rates exceeding 30 percent and a frequency cut in half in a third of the kids. Amazing results until you realize you can sometimes get similarly amazing responses from giving kids nothing but a sugar pill placebo, as seen below and at 2:21 in my video Friday Favorites: Cannabis for Inflammatory Bowel Disease (IBD). That’s why it’s critical to do randomized, double-blind, placebo-controlled trials, but there weren’t any on cannabis and IBD until 2013.

For 21 patients with Crohn’s disease, nothing seemed to help. So researchers randomized them to either smoke two joints a day of marijuana or a look-alike placebo. The results? Ninety percent of those in the cannabis group got better, compared to only 40 percent in the placebo group. Shown below and at 3:11 in my video is a graph of their symptom scores. As you can see, there was no big change in the placebo group over the two-month study, but the cannabis group cut their symptoms by about half.

The researchers acknowledge that long-term cannabis use is not without risks, but it may be a cakewalk compared to the potential adverse—and even life-threatening—side effects of some of the more powerful conventional therapies, so the study was heralded in a paper entitled “High Hope for Medical Marijuana in Digestive Disorders.”

The study was funded by a medical marijuana advocacy organization, the main supplier in the country, in fact. So, expectations may have been placed on the participants about how much better they would feel—in other words, they may have been primed for the placebo effect. But the researchers controlled for that, right? Those getting the real cannabis did significantly better than those randomized to get the placebo. But the point of a placebo is that it is indistinguishable from the real thing, so the participants don’t know which group they’re in—the control group or the treatment group. How can that be accomplished with a psychoactive drug? It can’t, which is the problem. The researchers tried to hide which group participants were in by only recruiting patients who had never tried cannabis before in the hopes that they wouldn’t notice placebo pot, but, unsurprisingly, most of them did. So, we’re basically left with another unblinded study. The researchers asked a bunch of subjective questions, like “How are you feeling?” and those who pretty much knew they were taking the drug said they were feeling better.

There were no significant changes in objective lab values, like CRP, a sign of inflammation, so perhaps the “cannabis may simply be masking symptoms without affecting intestinal inflammation.” Another indicator that it may not be affecting the course of the disease itself is how quickly the symptoms rebound. Two weeks after the study ended, those in the cannabis group were right back to where they started, as shown here (see week 10) and at 5:05 in my video.

So, “there was no difference in objective inflammatory markers to indicate disease modification. Given the rapid rebound…to pretreatment levels after the 2-week washout period, it seems more plausible that cannabis ameliorated the symptoms of Crohn’s disease, rather than actually modulating the disease.” That may be, but the symptoms are terrible. A reduction in pain is a reduction in pain. Indeed, “from the point of view of the patients, a marked symptomatic improvement and ability to resume normal life is not trivial, even if inflammation persists.” Of course, what if cannabis somehow makes the disease worse in the long run?

A survey study published the following year found that cannabis provided the same immediate symptomatic relief but was associated with a worse disease prognosis over time. Patients with IBD reported that cannabis improved their pain, cramping, and diarrhea, but use for more than six months by Crohn’s patients appeared to be a strong predictor of them ending up in surgery; they had five times the odds of going under the knife. There are two possible explanations for this: It’s quite possible that the increased disease severity led to the cannabis use and not the other way around. The alternative explanation: “Cannabis use may worsen the prognosis of IBD, leading to greater surgeries and hospitalizations.”

This is why we need prospective clinical trials where people are followed over time to see which came first. Until then, perhaps we should consider cannabis use for IBD as “potentially harmful.” Not just to err on the side of caution, but because there was a study on hepatitis C patients that found that daily cannabis use was associated with nearly seven times the odds of worse liver fibrosis, which is like scar tissue. If cannabis really does make fibrosis worse, that may explain why cannabis users with IBD may be more likely to require surgery.

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Michael Greger M.D. FACLM

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July 17, 2025
Eating to Treat Crohn’s Disease | NutritionFacts.org

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Switching to a plant-based diet has been shown to achieve far better outcomes than those reported on conventional treatments for both active and quiescent stages of Crohn’s disease (CD) and ulcerative colitis.

Important to our understanding and the prevention of the global increase of inﬂammatory bowel disease (IBD), we know that “dietary ﬁber reduces risk, whereas dietary fat, animal protein, and sugar increase it.” “Despite the recognition of westernization of lifestyle as a major driver of the growing incidence of IBD, no countermeasures against such lifestyle changes have been recommended, except that patients with Crohn’s disease should not smoke.”

We know that “consuming whole, plant-based foods is synonymous with an anti-inflammatory diet.” Lists of foods with inflammatory effects and anti-inflammatory effects are shown here and at 0:50 in my video, The Best Diet for Crohn’s Disease.

How about putting a plant-based diet to the test?

Cutting down on red and processed meats didn’t work, but what about cutting down on all meat? A 25-year-old man “with newly diagnosed CD…failed to enter clinical remission despite standard medical therapy. After switching to a diet based exclusively on grains, legumes [beans, split peas, chickpeas, and lentils], vegetables, and fruits, he entered clinical remission without need for medication and showed no signs of CD on follow-up colonoscopy.”

It’s worth delving into some of the details. The conventional treatment he was started on is inﬂiximab, sold as REMICADE®, which can cause a stroke and may increase our chances of getting lymphoma or other cancers. (It also costs $35,000 a year.) It may not even work in 35 to 40 percent of patients, and that seemed to be the case with the 25-year-old man. So, his dose was increased after 37 weeks, but he was still suffering after two years on the drug. Then he completely eliminated animal products and processed foods from his diet and finally experienced a complete resolution of his symptoms.

“Prior to this, his diet had been the typical American diet, consisting of meat, dairy products, refined grains, processed foods, and modest amounts of vegetables and fruits. Having experienced complete clinical remission for the first time since his Crohn’s disease diagnosis, the patient decided to switch to a whole food, plant-based diet permanently, severely reducing his intake of processed foods and limiting animal products to one serving, or less, per week.” Whenever his diet slipped, his symptoms started coming back, but he could always eliminate them by eating healthier again. After six months adhering to these diet and lifestyle changes, including stress relief and exercise, a follow-up “demonstrated complete mucosal healing [of the gut lining] with no visible evidence of Crohn’s disease.”

We know that “a diet consisting of whole grains, legumes, fruits, and vegetables has been shown to be helpful in the prevention and treatment of heart disease, obesity, diabetes, hypertension, gallbladder disease, rheumatoid arthritis, and many cancers. Although further research is required, this case report suggests that Crohn’s disease might be added to this list of conditions.” That further research has already been done! About 20 patients with Crohn’s disease were placed on a semi-vegetarian diet—no more than half a serving of fish once a week and half a serving of meat once every two weeks—and they achieved a 100 percent remission rate at one year and 90 percent at two years.

Some strayed from the diet, though. What happened to them? As you can see below and at 3:32 in my video, after one year, half had relapsed, and, at year two, only 20 percent had remained in remission. But those who stuck with the semi-veg diet had remarkable success. It was a small study with no formal control group, but it represents the best-reported result in Crohn’s relapse prevention published in the medical literature to date.

Nowadays, Crohn’s patients are often treated with so-called biologic drugs, expensive injected antibodies that suppress the immune system. They have effectively induced and maintained remission in Crohn’s disease, but not in everybody. The current remission rate in Crohn’s with early use of REMICADE® is 64 percent. So, 30 to 40 percent of patients “are likely to experience a disabling disease course even after their first treatment.” What about adding a plant-based diet? Remission rates jumped up to 100 percent for those who didn’t have to drop out due to drug side effects. Even after excluding milder cases, researchers found that 100 percent of those with serious, even “severe/fulminant disease, achieved remission.”

If we look at gold standard systematic reviews, they conclude that the effects of dietary interventions on inflammatory bowel diseases—Crohn’s disease and ulcerative colitis—are uncertain. However, this is because only randomized controlled trials were considered. That’s totally understandable, as that is the most rigorous study design. “Nevertheless, people with IBD deserve advice based on the ‘best available evidence’ rather than no advice at all…” And switching to a plant-based diet has been shown to achieve “far better outcomes” than those reported on conventional treatments in both active and quiescent stages in Crohn’s disease and ulcerative colitis. For example, below and at 5:37 in my video, you can see one-year remission rates in Crohn’s disease (100 percent) compared to budesonide, an immunosuppressant corticosteroid drug (30 to 40 percent), a half elemental diet, such as at-home tube feedings (64 percent), the $35,000-a-year drug REMICADE® (46 percent), or the $75,000-a-year drug Humira (57 percent).

Safer, cheaper, and more effective. That’s why some researchers have made the “recommendation of plant-based diets for inflammatory bowel disease.”

It would seem clear that treatment based on addressing the cause of the disease is optimal. Spreading the word about healthier diets could help halt the scourge of inflammatory bowel disease, but how will people hear about this amazing research without some kind of public education campaign? That’s what NutritionFacts.org is all about.

Doctor’s Note:

This is the third in a series on inflammatory bowel disease. If you missed the first two, see Preventing Inflammatory Bowel Disease with Diet and The Best Diet for Ulcerative Colitis Treatment.

My previous Crohn’s videos include Preventing Crohn’s Disease with Diet and Does Nutritional Yeast Trigger Crohn’s Disease?.

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Michael Greger M.D. FACLM

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May 20, 2025
Eating to Keep Ulcerative Colitis in Remission | NutritionFacts.org

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Plant-based diets can be 98 percent effective in keeping ulcerative colitis patients in remission, far exceeding the efficacy of other treatments.

“One of the most common questions physicians treating patients with IBD [inflammatory bowel disease] are asked is whether changing diet could positively affect the course of their disease.” Traditionally, we had to respond that we didn’t know. That may now be changing, given the “evidence in the literature that hydrogen sulfide may play a role in UC,” ulcerative colitis. And, since the sulfur-containing amino acids concentrated in meat cause an increase in colonic levels of this rotten egg gas, perhaps we should “take off the meat.” Indeed, animal protein isn’t associated only with an increased risk of getting inﬂammatory bowel disease in the first place, but also IBD relapses once you have the disease.

This is a recent development. “Because the concept of IBD as a lifestyle disease mediated mainly by a westernized diet is not widely appreciated, an analysis of diet in the follow-up period [after diagnosis] in relation to a relapse of IBD has been ignored”—but no longer. Ulcerative colitis patients in remission and their diets were followed for a year to see which foods were linked to the return of their bloody diarrhea. Researchers found that the “strongest relationship between a dietary factor and an increased risk of relapse observed in this study was for a high intake of meat,” as I discuss in my video The Best Diet for Ulcerative Colitis Treatment.

What if people lower their intake of sulfur-containing amino acids by decreasing their consumption of animal products? Researchers tried this on four ulcerative colitis patients, and without any change in their medications, the patients experienced about a fourfold improvement in their loose stools. In fact, they felt so much better that the researchers didn’t think it was ethical to try switching the patients back to their typical diets. “Sulfur-containing amino acids are the primary source of dietary sulfur,” so a “low-sulfur” diet essentially means “a shift from a more traditional western diet (high in animal protein and fat, and low in ﬁber) to more of a plant-based diet (high in fiber, lower in animal protein and fat).” “Altogether, westernized diets are pro-inflammatory, and PBD [plant-based diets] are anti-inflammatory.”

What can treatment with a plant-based diet do after the onset of ulcerative colitis during a low-carbohydrate weight-loss diet? A 36-year-old man lost 13 pounds on a low-carb diet, but he also lost his health; he was diagnosed with ulcerative colitis. When he was put on a diet centered around whole plant foods, his symptoms resolved without medication. He achieved remission. That was just one case, though. Case reports are akin to glorified anecdotes. The value of case reports lies in their ability to inspire researchers to put them to the test, and that’s exactly what they did.

Until then, there had never been a study published that focused on using plant-based diets for treating ulcerative colitis. Wrote the researchers, a group of Japanese gastroenterologists, “We consider that the lack of a suitable diet is the biggest issue faced in the current treatment of IBD. We regard IBD as a lifestyle disease caused mainly by our omnivorous (Western) diet. We have been providing a plant-based diet (PBD) to all patients with IBD” for more than a decade and have published extraordinary results, far better than have been reported elsewhere in the medical literature to date. (I profiled some of their early work in one of the first videos that went up on NutritionFacts.org.) The researchers found a plant-based diet to be “effective in the maintenance of remission” in Crohn’s disease by 100 percent at one year and 90 percent at two years. What about a plant-based diet for relapse prevention in ulcerative colitis?

“Educational hospitalization” involved bringing patients into the hospital to control their diet and educate them about the benefits of plant-based eating (so they’d be more motivated to continue it at home). “Most patients (77%) experienced some improvement, such as disappearance or decrease of bloody stool during hospitalization.” Fantastic!

Here’s the really exciting part. The researchers then followed the patients for five years, and 81 percent of them remained in remission for the entire five years, and 98 percent kept the disease at bay for at least one year. That blows away other treatments. Those relapse rates are far lower than those reported with medication. Under conventional treatment, other studies found that about half of the individuals relapse, compared to only 2 percent of those taught to eat healthier.

“A PBD was previously shown to be effective in both the active and quiescent stages of Crohn’s disease. The current study showed that a PBD is effective in both the active and quiescent stages of UC as well.” So, the researchers did another study on even more severely affected cases with active disease and found the same results, with plant-based eating beating conventional drug therapy by far. People felt so much better that they were still eating more plant-based food even six years later. The researchers conclude that a plant-based diet is effective for treating ulcerative colitis to prevent a relapse.

Why? Well, plant-based diets are rich in fiber, which feeds our good gut bugs. “This observation might partly explain why a PBD prevents a variety of chronic diseases. Indeed, the same explanation applies to IBD, indicating that replacing an omnivorous diet with a PBD in IBD is the right approach.”

It’s like using plant-based diets to treat the cause of heart disease, our number one killer. Plant-based eating isn’t only safer and cheaper, but it also works better with no noted adverse side effects. Let’s compare that to the laundry list of side effects of immunosuppressants used for ulcerative colitis, like cyclosporine, which you can see below and at 5:40 in my video.

We now have even fancier drugs costing about $60,000 a year, about $5,000 a month, and they don’t even work very well; clinical remission at one year is only about 17 to 34 percent. And, instead of no adverse side effects, the drugs can give us a stroke, give us heart failure, and can even give us cancer, including a rare type of cancer that often results in death. Also, a serious brain disease known as progressive multifocal leukoencephalopathy, which can kill us, and for which there is no known treatment or cure. One drug lists an “increased risk of death” but touts that it’s just “a small pill” in an “easy-to-open bottle.” I’d skip the pills (and their potential side effects) and stick with plant-based eating.

Doctor’s Note:

If you missed the previous video, see Preventing Inflammatory Bowel Disease with Diet and stay tuned for The Best Diet for Crohn’s Disease Treatment, coming up next.

Check the related posts below for some older videos on IBD that may be of interest to you.

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Michael Greger M.D. FACLM

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May 15, 2025
Foods That Disrupt Our Microbiome | NutritionFacts.org

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Eating a diet filled with animal products can disrupt our microbiome faster than taking an antibiotic.

If you search online for “Crohn’s disease and diet” or “ulcerative colitis and diet,” the top results are a hodgepodge of conflicting advice, as you can see below and at 0:15 in my video Preventing Inflammatory Bowel Disease with Diet.

What does science say? A systematic review of the medical literature on dietary intake and the risk of developing inflammatory bowel disease finds that Crohn’s disease is associated with the intake of fat and meat, whereas dietary fiber and fruits appear protective. The same associations are seen with ulcerative colitis, the other major inflammatory bowel disease—namely, increased risk with fat and meat, and a protective association with vegetable intake.

Why, according to this meta-analysis of nine separate studies, do meat consumers have about a 50 percent greater risk for inflammatory bowel disease? One possibility is that meat may be a vehicle for bacteria that play a role in the development of such diseases. For instance, meat contains “huge amounts of Yersinia.” It’s possible that antibiotic residues in the meat itself could be theoretically mucking with our microbiome, but Yersinia are so-called psychotropic bacteria, meaning they’re able to grow at refrigerator temperatures, and they’ve been found to be significantly associated with inflammatory bowel disease (IBD). This supports the concept that Yersinia infection may be a trigger of chronic IBD.

Animal protein is associated with triple the risk of inflammatory bowel disease, but plant protein is not, as you can see below and at 1:39 in my video. Why? One reason is that animal protein can lead to the formation of toxic bacterial end products, such as hydrogen sulfide, the rotten egg gas. Hydrogen sulfide is not just “one of the main malodorous compounds in human flatus”; it is a “poison that has been implicated in ulcerative colitis.” So, if you go on a meat-heavy, low-carb diet, we aren’t talking just about some “malodorous rectal ﬂatus,” but increased risk of irritable bowel syndrome, inflammatory bowel syndrome (ulcerative colitis), and eventually, colorectal cancer.

Hydrogen sulfide in the colon comes from sulfur-containing amino acids, like methionine, that are concentrated in animal proteins. There are also sulfites added as preservatives to some nonorganic wine and nonorganic dried fruit, but the sulfur-containing amino acids may be the more important of the two. When researchers gave people increasing quantities of meat, there was an exponential rise in fecal sulfides, as seen here and at 2:37 in my video.

Specific bacteria, like Biophilia wadsworthia, can take this sulfur that ends up in our colon and produce hydrogen sulfide. Eating a diet based on animal products, packed with meat, eggs, and dairy, can specifically increase the growth of this bacteria. People underestimate the dramatic effect diet can have on our gut bacteria. As shown below and at 3:12 in my video, when people are given a fecal transplant, it can take three days for their microbiome to shift. Take a powerful antibiotic like Cipro, and it can take a week. But if we start eating a diet heavy in meat and eggs, within a single day, our microbiome can change—and not for the better. The bad bacterial machinery that churns out hydrogen sulfide can more than double, and this is consistent with the thinking that “diet-induced changes to the gut microbiota [flora] may contribute to the development of inflammatory bowel disease.” In other words, the increase in sulfur compounds in the colon when we eat meat “is not only of interest in the field of flatology”—the study of human farts—“but may also be of importance in the pathogenesis of ulcerative colitis…”

Doctor’s Note:

This is the first in a three-part video series. Stay tuned for The Best Diet for Ulcerative Colitis Treatment and The Best Diet for Crohn’s Disease Treatment.

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Michael Greger M.D. FACLM

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May 13, 2025
Build Your Ulcerative Colitis Support System

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Ulcerative Colitis: Securing Support When You Need It Most

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January 2, 2024
Hypnosis Could Work Wonders on IBS

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The change in Zack Rogers was sudden. In the middle of his 12th birthday party, his stomach started hurting. He went to bed early that night, missing much of his own slumber party, and then stayed home from school the whole next week. The stomach pain was excruciating, and he couldn’t keep any food down. He lost 40 pounds in just a few weeks.

Zack spent the next three years in and out of hospitals and trying medicines that didn’t seem to work. His doctors eventually told the family that they had only one option: surgery to remove large parts of his damaged colon. But Zack’s mom, Angela Rogers, wasn’t on board. She had lost faith in his medical team and feared such an invasive step, so she asked another gastroenterologist for a second opinion. The new doctor suggested that Zack try one last treatment before surgery: hypnotherapy, in which a clinical professional helps a patient become deeply focused and relaxed in order to change their patterns of thinking.

This time, the change was gradual, but no less dramatic. In the evening after his first hypnotherapy session, Zack felt nauseated but kept his dinner down. Over the next few weeks, he stopped throwing up in school and regained the stamina to play basketball and go for bike rides. Today, Zack is a freshman in college, living away from home—something he wouldn’t have thought was possible before he was hypnotized. “If I never did hypnosis,” he told me, “I would be a complete mess. I genuinely don’t know where I would be.”

As far-fetched as it may seem, science supports the idea that digestive disorders can be treated with psychological interventions, including hypnosis. Research dating back to the 1980s suggests that, at least in the short term, hypnotherapy can be an effective treatment for irritable bowel syndrome, a gut disorder characterized by painful gastrointestinal symptoms but no visible damage to the gut. Now scientists are investigating whether it might also bring relief to patients with inflammatory bowel disease, who, like Zack, have observable damage to their digestive tract.

Although hypnosis is a powerful relaxation tool on its own, in clinical settings, it’s most often combined with other, better-studied psychotherapy techniques, such as cognitive behavioral therapy. Research suggests that CBT, which is commonly used to treat conditions such as depression and anxiety, can also be helpful in the treatment of gastrointestinal disorders.

Read: I got hypnotized over Skype and it actually worked

Unlike CBT, hypnosis retains a reputation for quackery, and is regularly portrayed in pop culture and stage shows as a tool for exercising control over participants—willing or otherwise. And some practitioners do use it for debunked treatments, including recovered memory therapy. But whether hypnotherapy is legitimized as a medical tool has real stakes. Hypnosis practitioners believe—and there’s some research to back this up—that the technique may amplify the effectiveness of more well-established psychological interventions and therefore has the potential to provide rare benefit to patients

Hypnosis has a long history as a pain reliever. In the first half of the 19th century, before anesthetics were widely available, some surgeons hypnotized their patients. Even today, hypnosis proponents claim that it may be an effective alternative treatment for chronic back pain and the stress of childbirth; a growing body of research suggests that hypnosis can be a cost-effective and side-effect free analgesic for some people with chronic pain, though good clinical data are hard to come by.

The first randomized controlled trial of hypnotherapy for IBS was published in 1984. Among the participants—a small group of mostly female patients with severe, treatment-resistant disease— those who received hypnotherapy showed greater improvements in abdominal pain, bloating, and bowel function than those who received psychotherapy plus a placebo medication. A 2014 meta-analysis found that about half of IBS patients who try hypnotherapy see at least short-term improvements in their symptoms.

Read: The rogue theory that gravity causes IBS

The evidence for hypnotherapy isn’t as robust in the treatment of IBD, which is really an umbrella term for ulcerative colitis (Zack’s diagnosis) and Crohn’s disease. But there’s reason to believe that hypnosis could yield similar success in addressing symptoms of those conditions. The line between IBD and IBS can be murky; more than a quarter of IBD patients in remission have IBS as well. And although the evidence is still mixed—a study published in 2021, for example, found no difference in treatment outcomes between standard medical treatments and hypnotherapy—some early evidence suggests that hypnotherapy can also reduce inflammation in patients with ulcerative colitis. One small study found that just one session of hypnotherapy reduced ulcerative-colitis patients’ blood levels of several inflammatory markers.

Perhaps most important, a large body of research shows a strong link between cognition and digestion. Millions of neurons, collectively known as the enteric nervous system, regulate our digestion and are in constant communication with the central nervous system. This connection, called the “brain-gut axis,” may be why we feel so many emotions in our gut, whether the butterflies of anxiety or the clench of anger. It might also explain why both anxiety and depression are more common among patients with IBD compared with the general population. “Unequivocally, stress plays a major role in any digestive disease,” Gary Lichtenstein, a gastroenterology professor and the director of the Inflammatory Bowel Disease Center at the Hospital of the University of Pennsylvania, told me.

When this brain-gut axis gets out of whack, it’s known to worsen some digestive disorders. In patients with gastrointestinal issues, the tissues in the gut can become hypersensitive over time. The brain learns to interpret signals from the gut, including normal functioning, as discomfort. This faulty communication results in what experts now call disorders of gut-brain interaction (DGBIs), which include IBS, functional dyspepsia, and other digestive disorders (but not IBD). Hypnosis, proponents say, can help patients rewire the cognitive-digestive connection. In many IBS and IBD cases, “we know there’s a mind-gut connection that can only be helped by a mental-health expert,” says Mark Mattar, a gastroenterologist and director of the IBD center at MedStar Georgetown University Hospital.

Read: When gut bacteria change brain function

Mattar works closely with Ali Navidi, the clinical psychologist to whom Zack was referred in 2020. Navidi told me that at his practice, GI Psychology, 83 percent of patients with DGBIs who complete at least 10 hypnotherapy sessions achieve their treatment goals, which usually amount to reducing pain, bloating, and other uncomfortable symptoms enough to go about their day-to-day life. His data are unpublished but in line with other studies on IBS showing that more than 80 percent of patients who get gut-directed hypnotherapy as part of their treatment plan experience improvements in pain and other GI symptoms. Those numbers are even higher among children and adolescents.

Such findings persuaded the American College of Gastroenterology to recommend gut-directed psychotherapies—including hypnosis and CBT—for the treatment of IBS symptoms in its 2021 guidelines. Still, even among IBS patients, they’re not commonly used. No one appears to have studied the popularity of hypnosis specifically among IBS patients, but a 2017 study found that only 15 percent of people diagnosed with IBS had ever pursued “psychological therapies” of any kind.

For many patients who follow through with hypnotherapy, the experience is not what they expect. Patients may conflate clinical hypnosis with entertainment hypnosis, where subjects quack like a duck or forget their own name. But at practices like Navidi’s, the therapist instead focuses on helping the patient enter a trance state—the same type of consciousness we all experience when we lose track of time working, scrolling Instagram, or driving and suddenly arriving at our destination. “When we’re in a trance, we have this intense, focused concentration, and that can be used in powerful ways,” Navidi said.

Once the patient is in a trance state, therapists use guided imagery and suggestion to target specific gastrointestinal symptoms. “People get into a very relaxed state, and in that state I start to make suggestions about how the brain and the gut can work together better,” Jessica Gerson, a psychologist at NYU Langone’s Inflammatory Bowel Disease Center, told me. Gerson instructs her IBD patients to imagine the lining of their intestines healing. During his trance states, Zack was able to envision a control room for his pain in which he could dial knobs up and down. “I could turn the stomach pain down to a one or a zero, and it would go away,” Zack recalled recently, a note of surprise still in his voice.

Read: Can you quit smoking through hypnosis?

Many patients initially fear that during hypnosis they are ceding control of their mind and body to the hypnotherapist, Gerson told me. But patients are always “totally conscious, totally in control.” Indeed, Navidi and Gerson use this trance state to show patients exactly how much control they have over their own body. “Having a sense of agency is therapeutic,” Gerson said.

These days, many gastroenterologists see psychotherapies like hypnosis as an important part of a holistic treatment plan—even for IBD. (IBD patients who do respond to hypnotherapy are likely to continue to need medical monitoring and interventions, Lichtenstein said.) While gut-directed hypnotherapy still hasn’t been proved to help IBD patients without co-occurring IBS symptoms, there’s not much of a downside to trying. The experts I spoke with agreed that hypnosis is relatively risk-free as long as it is administered by a clinician, patients continue to be monitored by their medical doctors, and therapists screen potential patients for severe mental illness and untreated trauma. Patients, too, need to consider whether they can afford hypnotherapy. Like many mental-health services, it’s not always covered by insurance. Zack’s sessions were $265 each out of pocket, but according to Angela, “it was worth every cent and then some.”

Zack remembers getting stressed out a lot as a kid—over grades, making friends, basketball games, or nothing in particular. He credits Navidi with alleviating not only his stomach pain but also the relentless anxiety; he still uses the relaxation techniques he learned from Navidi when he gets worried about school or a basketball game.

Read: Reiki can’t possibly work. So why does it?

Zack is still on medication for his ulcerative colitis; every eight weeks he has an injection of Stelara, a medication that works by blocking inflammatory proteins. But after two years of appointments with Navidi, for the first time since his 12th birthday, his symptoms are reliably under control—and stress doesn’t make them come roaring back. He hasn’t had a flare up in about a year and a half. Most days, he doesn’t think about his diagnosis at all.

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Kate Wheeling

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November 29, 2023