Can CBD Oil Help Inflammatory Bowel Disease (IBD)?
If you have inflammatory bowel disease, there’s a good chance you’ve considered using cannabis products or CBD oil to help manage your IBD – surveys from the last few years show that between 10-20% of people with Crohn’s Disease and Ulcerative Colitis use cannabis products to help manage their IBD symptoms . And now that both medical marijuana and legal, non-intoxicating cannabidiol (CBD) are becoming more widely accepted across the United States, those numbers are probably rising.
But if you suffer from IBD, every inflammatory flare-up could bring you one step closer to surgery – meaning it’s a good idea to do your research before making any changes to your routines. There are many studies underway on cannabis and hemp extracts for Crohn’s and ulcerative colitis, but what have scientists learned? Should you be using cannabidiol (CBD) alone or in combination with THC? Is it actually effective? And are there any risks involved?
If you’re already using cannabinoids (like THC and CBD) to manage inflammatory bowel disease – or if you’re merely flirting with the idea – there’s a bewildering amount of information to keep straight. We’ll explain the current research along with what it means for:
- Symptoms Management and Quality of Life
- Inflammation and Endoscopic Remission
- Future Outlook and Flare-Ups
Some Background First
If you suffer from IBD, it can feel extremely isolating… but you actually belong to an enormous and growing community of people who share your pain. The rise of inflammatory bowel disease over the last few decades is shocking — the diagnosis is rising on every continent while skyrocketing in developing countries. And for more than 1 in 100 American adults , this IBD diagnosis comes with high medical bills, a high likelihood of serious surgery, and an increased risk of mortality.
The hallmark trait of IBD — inflammation within the digestive tract — causes pain and suffering that is mostly invisible to the people around you. And one of the most frustrating things about IBD is that there’s no clear reason why you have it — or why it keeps flaring back up. Everything from your DNA to your diet, and from your daily habits to how you were raised, could have contributed to your current prognosis.
Whatever combination of genetics and environmental factors combined to trigger Crohn’s or ulcerative colitis, the end result is chronic gut inflammation that damages and weakens your digestive tract over time. Unfortunately, that damage comes with worsening symptoms, increased pain, and even increased risk of other diseases like colon cancer.
Hidden Roots = Difficult to Weed Out
Scientists struggle to develop safe and effective treatments for illnesses that can’t be traced to a clear root cause. If you’ve been diagnosed with Crohn’s or ulcerative colitis, you’re probably already aware that IBD is a chronic illness with no cure. The treatments offered by doctors — including aminosalicylates, corticosteroids, and risky surgical procedures — will at best merely hold the IBD in check. And they often come with a long list of serious side effects.
This is why so many people are seeking holistic approaches to deal with their recurrent illness – through diet and other lifestyle changes – and incorporating cannabinoids (like CBD and THC) into their treatment routine.
Many Levels of IBD Treatment
Although IBD symptoms are usually the first sign you’re experiencing a flare-up, they are just the end result of a long chain of events occurring within your body. And for the best possible outcome, you — along with the help of a medical professional — will want to treat IBD as far back along this chain as possible.
To begin with, if you are currently suffering, it’s important to relieve any symptoms that interfere with your life. Meanwhile, you should use every resource available to combat inflammation and achieve remission. And finally, even when your IBD is in remission, you need to stay vigilant by continuing an anti-inflammatory routine while tracking and avoiding triggers.
So where do cannabinoids fit in?
Cannabinoids to Treat IBD Symptoms — Some evidence
The prestigious National Academies of Sciences, Engineering and Medicine recently rated pain management as one of the most scientifically supported uses of cannabis. Many IBD patients agree with this conclusion: A large majority of surveyed IBD patients who use cannabis report that it helps relieve abdominal pain and cramps , while others find it helpful for combating nausea and diarrhea .
Cannabis study results (combo of THC, CBD and other cannabinoids): Surveys can be biased — in this case, we only learn about the experience of IBD patients who are already using cannabis for their symptoms. However, a number of studies have followed IBD patients who are newly prescribed cannabis as part of their treatment routine. A small study that compared inhaled cannabis to a placebo for 8 weeks found that 90% of cannabis users’ symptoms improved while only 40% of the controls saw an improvement.
One thing to keep in mind, though, is that although there’s good evidence that cannabis can help improve IBD symptoms, it might not help with the underlying inflammation. Here’s why.
CBD study results: To date, most of this research has been on cannabis products containing a combination of THC, CBD, and a full spectrum of other cannabinoids. However, THC is not legal in all states, and also comes with a notorious side effect – getting high – that not everyone enjoys. For these reasons, hemp-extract CBD products are being explored as an alternative to cannabis for treating IBD symptoms.
Pre-clinical evidence suggests that CBD provides pain relief by desensitizing TRPV1 channels on pain-perceiving nerves . And in addition to pain relief, CBD can improve “intestinal hypermotility” — aka diarrhea — when tested in rodents with inflamed guts. However, there have been few human clinical trials to date. One, which used a low oral dose (10mg daily) of purified CBD on Crohn’s Disease, reported that a low dose of CBD isolate was safe but ineffective at relieving Crohn’s symptoms. On the other hand, when scientists tested a higher dose (100-500mg daily) of full-spectrum CBD for Ulcerative Colitis, they reported a higher quality of life — although it did not impact remission.
An important distinction: Isolate vs full-spectrum : Why would these two CBD studies have different results? The most obvious answer is that 10mg may have been too low of a dose. However, another important distinction between these two studies is that the first study used CBD isolate — a single, purified molecule — which may be less effective than broad-spectrum extracts.
Indeed, full-spectrum hemp extracts contain a wide variety of beneficial molecules other than CBD, called the “ entourage ,” and studies typically have better results when the whole entourage is used together instead of CBD isolate. And for individuals struggling with colitis, the entourage molecule cannabigerol (CBG) might be even more effective than either THC or CBD. When purchasing CBD products, choose full-spectrum or broad-spectrum hemp extracts for full entourage benefits.
Cannabinoids for IBD Remission — Some preclinical but no clinical evidence
If you have IBD, always be aware that your physical symptoms might improve despite high levels of gut inflammation. To date, most human studies suggest that cannabinoids relieve IBD symptoms, but not intestinal inflammation . However, scientists are still actively investigating this topic.
A clue that cannabinoids could one day be used to fight intestinal inflammation comes from the current usefulness of medications (anti-TNFα drugs) that fight a notorious inflammatory molecule, Tumor Necrosis Factor. In preclinical studies using rodents and human biopsies, CBD combated gut inflammation by decreasing TNFα levels, as well as by turning on and off genes controlled by PPARγ .
Recently, a review of over 50 rodent studies concluded that two out of three studies found a positive effect of cannabinoids on colitis . In these experiments, scientists reported better results the earlier the cannabinoids were taken during an inflammatory episode.
However, until there’s clinical evidence that cannabinoids can improve intestinal inflammation, it’s safest to continue taking your prescription drugs to prevent progression of the disease. If you suffer from IBD and find major relief from cannabis or CBD oil, do not stop your meds without proper testing and approval from a medical professional.
Cannabinoids and IBD Flare-up Prevention — Unknown
Even in remission, low baseline levels of inflammation could escalate at the slightest trigger. In addition to prescription medications, the Mayo Clinic suggests stress-management and dietary changes as good practices to manage flare-ups, and even lists anti-inflammatory supplements like fish oil and turmeric as suitable complementary approaches.
CBD and THC are widely considered anti-inflammatory supplements, and CBD may have a role in managing some forms of anxiety . However, there is no current evidence that CBD or THC helps maintain remission for IBD.
Downsides and risks of cannabinoids for IBD:
THC’s cognitive effects – Most of the research to date has been with cannabis and cannabis extracts — which contain psychoactive THC in addition to a wide variety of other molecules. But for many people, being stoned all day is not a good option. If this describes you, choose high quality CBD products from reliable companies that use full-spectrum hemp extracts — that way you can stay sober while benefiting from the “ entourage effect. ”
Assuming you’re better because you feel better – Although research suggests that cannabis and CBD oil could help relieve IBD symptoms, there is no clinical evidence yet that they also stop intestinal inflammation. Nonetheless, many people use cannabis to decrease their dependence on prescription drugs. If you’re taking cannabinoids and feel great, do not take that as evidence that you can stop taking prescription medications without first consulting a medical professional.
Prescription drug interactions – Similar to grapefruits, CBD interferes with enzymes (cytochrome p450) that your body uses to metabolize certain pharmaceutical drugs. If you currently take prescription drugs — particularly any that come with a warning not to consume with grapefruits (ie warfarin, anti-epileptics, HIV antivirals, and chemotherapy) — we suggest speaking with a medical professional before incorporating CBD into your wellness routine.
Uncertainty if it should be considered an NSAID – CBD likely fights inflammation in multiple ways — and one of those ways is through inhibiting COX-2, an enzyme that produces inflammatory prostaglandins. Unfortunately, long-term NSAIDs (which also inhibit prostaglandins) are generally contraindicated for IBD because they can contribute to gastric ulcers.
Fortunately, s tudies indicate that cannabinoids are more likely to protect against aspirin-induced ulcers (through the endocannabinoid system ) than they are to create them, and data suggests that COX-2-selective drugs like CBD are safer compared to traditional NSAIDs because they don’t affect COX-1 digestive enzymes.
Consider different routes of application
There are many ways to take cannabis and CBD oil; orally, inhaled, rectally… and each route can affect how much enters your body and where the molecules go. If you’re unfamiliar with the many types of products available, see our quick guide on routes and dosage .
For most of the studies we’ve discussed, patients either inhaled or ingested the cannabinoids. However, rodent studies have also tested the effects of injections and rectal suppositories.
One study which compared these different routes found that an oral treatment of CBD was ineffective, while an equivalent or lower rectal or injected dose actually improved colitis. There are no current human studies which suggest one route over another for IBD, but if you’re considering self-experimentation, you should be familiar with your options, and be open to trying suppositories.
Should you use CBD oil to supplement your IBD treatment?
As you know, achieving and maintaining remission is vital to your health and happiness. Ultimately, we don’t have enough evidence to say for sure whether or not cannabis or CBD oil will work for you. The standard recommendation is that cannabinoids might be a good choice for improving your symptoms and wellbeing when standard therapies fall short.
When taking cannabidiol or medical cannabis for IBD, consider it a supplement, not a replacement for your current treatment. Always discuss your decision with a trusted medical professional. And when choosing a product, be wary of bold claims and brands without a solid reputation – unfortunately, since it’s still largely unregulated, this industry is rife with fraudulent products and misinformation.
If you use or have previously used cannabinoids to treat your IBD symptoms, we’d love to hear about your experience. Email [email protected] to share your story.
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Cbd oil for inflammatory bowel disease
Australians are illegally sourcing cannabis to manage their conditions. Photo: Pixabay
New research conducted by the Lambert Initiative for Cannabinoid Therapeutics at the University of Sydney reveals a quarter of Australians with inflammatory bowel disease (IBD) have used cannabis, predominantly from illicit sources, to manage their condition. They reported improvements in symptoms and reduced use of prescription medication.
The first Australian nationwide survey – and largest ever survey on medicinal cannabis use in IBD patients – has revealed that 25.3 percent of the 838 respondents were using or had previously used medicinal cannabis to manage their symptoms.
Inflammatory Bowel Disease
In Australia, IBD is becoming more prevalent, more complex, and more severe, according to a PricewaterhouseCoopers report. It affects approximately 1 in 250 people aged 5-40. Almost 75,000 Australians have Crohn’s disease or ulcerative colitis, with this number projected to increase to 100,000 by 2022.
IBD, which includes the conditions Crohn’s disease and ulcerative colitis, is caused by inflammation of the gastrointestinal tract and can be debilitating. It causes symptoms including weight loss, diarrhoea and bleeding, along with chronic pain, anxiety and stress that significantly impact a patient’s day to day quality of life.
The condition can be difficult to manage with conventional treatment options, which is why some patients are turning to cannabis for symptom relief.
Inflammation of the gastrointestinal tract can be debilitating. Photo: Pixabay
Medicinal cannabis “alleviated suffering”
Results from the anonymous online survey, published in the journal Crohn’s & Colitis, examined IBD severity, medication adherence, quality of life, as well as medicinal cannabis use and its perceived impact on these measures. The survey expanded on previous surveys by accessing a larger patient population. It also allowed separation of and insights into different IBD subgroups – Crohn’s disease, ulcerative colitis or “IBD unclassified”; and different cannabis use populations – non-user, previous user and current self-prescribed medicinal cannabis users.
Principal investigator and academic director of the Lambert Initiative Professor Iain McGregor said: “The survey was inspired by the experiences of the Taylor family from the Blue Mountains: father Steven Taylor was arrested for growing cannabis to alleviate the suffering of his daughters Morgan and Taylor who suffered from severe IBD and found great relief from non-intoxicating cannabis leaf juice preparations.”
A statement from the Taylor family said: “Medicinal cannabis alleviated our daughters’ suffering after all conventional treatments failed. The survey reflects the lived experience in the community where vulnerable families resort to accessing unreliable products with no certainty of future supply. When doctors are so cautious about prescribing cannabis medicines and when current official products are unaffordable for patients, then either the law needs to change, or we need to have an amnesty for genuine medicinal users and their carers.”
Professor McGregor said: “This case reflects the reality that many IBD patients do not have their condition adequately managed by existing drugs and so turn to alternative options, such as cannabis, to manage their condition.”
The survey revealed:
- Cannabis was predominantly obtained from illicit sources with only three respondents (1.4 percent) using legal pathways provided by the Australian government.
- More than 90 percent of patients reported that medicinal cannabis use improved their symptom management – with greatest benefits reported for abdominal pain, stress, sleep, cramping and anxiety symptoms.
- There were, however, fewer benefits to symptoms associated with disease pathology, such as rectal bleeding, obstructive symptoms and stool frequency/consistency/urgency.
- Patients with ulcerative colitis who use medicinal cannabis scored higher on measures of “quality of life” than non-users.
- Medicinal cannabis users reported less adherence to prescribed medications and were less likely to be engaged in specialist care for their IBD, which suggests low levels of clinical engagement in many of the cannabis-using patients.
- Medicinal cannabis use was associated with some minor side-effects, mostly drowsiness/sedation and memory impairment.
- About half of the respondents who were actively using medicinal cannabis at the time of completing the survey also consumed cannabis recreationally, although less frequently than for medicinal purposes.
- Both cannabis-using and non-using patients expressed high levels of support for the use of medicinal cannabis in IBD and interest in participating in future clinical trials of medicinal cannabis products.
Lead author Dr Melissa Benson from the Lambert Initiative said: “This survey is informative to future research in this field and to continuing the discussion around medicinal cannabis for IBD management – particularly so that clinicians may better understand what their patients’ may already be doing to self-manage their symptoms.”
This work was supported by the Lambert Initiative for Cannabinoid Therapeutics, University of Sydney.