What is ulcerative colitis?
Ulcerative colitis is a chronic, long-term illness that causes inflammation of the colon and rectum. Symptoms may include diarrhea, rectal bleeding, passage of mucus, and abdominal pain. It is characterized by periods of acute flares when people experience symptoms as well as periods of remission when symptoms stop.
What are cannabis and cannabinoids?
Cannabis is a widely used recreational drug that has multiple effects on the body via the endocannabinoid system. Cannabis contains multiple sub-ingredients called cannabinoids. Cannabis and cannabis oil containing specific cannabinoids can cause cognitive changes such as feelings of euphoria and altered sensory perception. However, some cannabinoids, such as cannabidiol, do not have a psychoactive effect. Cannabis and some cannabinoids have been shown to decrease inflammation in animal and laboratory models which suggests it may help people with ulcerative colitis. For example, cannabidiol is one such cannabinoid that has shown anti-inflammatory activity in mice.
What did the researchers investigate?
The researchers evaluated whether cannabis or cannabis oil (cannabidiol) was better than placebo (e.g. fake drug) for treating adults with active ulcerative colitis or ulcerative colitis that is in remission. The researchers searched the medical literature extensively up to 2 January 2018.
What did the researchers find?
Two studies including 92 adult participants with ulcerative colitis were included. Both studies assessed cannabis therapy in participants who had active ulcerative colitis. No studies that assessed cannabis therapy in participants with ulcerative colitis in remission were identified. One study (60 participants) compared 10 weeks of treatment with capsules containing cannabis oil with up to 4.7% D9-tetrahydrocannabinol (THC) to placebo in participants with mild to moderately active ulcerative colitis. The starting dose of cannabidiol was 50 mg twice daily which was increased, if tolerated, to a target of 250 mg twice daily. The other study (32 participants) compared 8 weeks of treatment with two cannabis cigarettes per day containing 0.5 g of cannabis, corresponding to 11.5 mg THC to placebo cigarettes in participants with ulcerative colitis who did not respond to conventional medical treatment.
The study comparing cannabis oil capsules to placebo found no difference in remission rates at 10 weeks. Twenty four (7/29) percent of cannabidiol participants achieved clinical remission compared to 26% (8/31) of placebo participants. The study also showed higher self reported quality of life scores in cannabis oil participants compared to placebo participants. More side-effects were observed in the cannabis oil participants compared to the placebo participants. These side effects were considered to be mild or moderate in severity. Common reported side effects include dizziness, disturbance in attention, headache, nausea and fatigue. No patients in the cannabis oil group had any serious side effects. Ten per cent (3/31) of the placebo group had a serious side effect. Serious side effects in the placebo group included worsening ulcerative colitis and one complicated pregnancy.
The second study comparing two cannabis cigarettes (23 mg THC/day) to placebo cigarettes showed lower disease activity index scores in the cannabis group compared to the placebo group. C-reactive protein and fecal calprotectin levels (both measures of inflammation in the body) were similar in both groups. No serious side effects were reported. This study did not report on remission rates.
The effects of cannabis and cannabis oil on ulcerative colitis are uncertain, thus no firm conclusions regarding the effectiveness and safety of cannabis or cannabis oil in adults with active ulcerative colitis can be drawn. There is no evidence for cannabis or cannabis oil use for maintenance of remission in ulcerative colitis. Further studies with a larger number of participants are required to assess the effects of cannabis in people with active and inactive ulcerative colitis. Different doses of cannabis and routes of administration should be investigated. Lastly, follow-up is needed to assess the long term safety outcomes of frequent cannabis use.
The effects of cannabis and cannabidiol on UC are uncertain, thus no firm conclusions regarding the efficacy and safety of cannabis or cannabidiol in adults with active UC can be drawn.There is no evidence for cannabis or cannabinoid use for maintenance of remission in UC. Further studies with a larger number of patients are required to assess the effects of cannabis in UC patients with active and quiescent disease. Different doses of cannabis and routes of administration should be investigated. Lastly, follow-up is needed to assess the long term safety outcomes of frequent cannabis use.
Cannabis and cannabinoids are often promoted as treatment for many illnesses and are widely used among patients with ulcerative colitis (UC). Few studies have evaluated the use of these agents in UC. Further, cannabis has potential for adverse events and the long-term consequences of cannabis and cannabinoid use in UC are unknown.
To assess the efficacy and safety of cannabis and cannabinoids for the treatment of patients with UC.
We searched MEDLINE, Embase, WHO ICTRP, AMED, PsychINFO, the Cochrane IBD Group Specialized Register, CENTRAL, ClinicalTrials.Gov and the European Clinical Trials Register from inception to 2 January 2018. Conference abstracts and references were searched to identify additional studies.
Randomized controlled trials (RCTs) comparing any form or dose of cannabis or its cannabinoid derivatives (natural or synthetic) to placebo or an active therapy for adults (> 18 years) with UC were included.
Two authors independently screened search results, extracted data and assessed bias using the Cochrane risk of bias tool. The primary outcomes were clinical remission and relapse (as defined by the primary studies). Secondary outcomes included clinical response, endoscopic remission, endoscopic response, histological response, quality of life, C-reactive protein (CRP) and fecal calprotectin measurements, symptom improvement, adverse events, serious adverse events, withdrawal due to adverse events, psychotropic adverse events, and cannabis dependence and withdrawal effects. We calculated the risk ratio (RR) and corresponding 95% confidence interval for dichotomous outcomes. For continuous outcomes, we calculated the mean difference (MD) and corresponding 95% CI. Data were pooled for analysis when the interventions, patient groups and outcomes were sufficiently similar (determined by consensus). Data were analyzed on an intention-to-treat basis. GRADE was used to evaluate the overall certainty of evidence.
Two RCTs (92 participants) met the inclusion criteria. One study (N = 60) compared 10 weeks of cannabidiol capsules with up to 4.7% D9-tetrahydrocannabinol (THC) with placebo capsules in participants with mild to moderate UC. The starting dose of cannabidiol was 50 mg twice daily increasing to 250 mg twice daily if tolerated. Another study (N = 32) compared 8 weeks of therapy with two cannabis cigarettes per day containing 0.5 g of cannabis, corresponding to 23 mg THC/day to placebo cigarettes in participants with UC who did not respond to conventional medical treatment. No studies were identified that assessed cannabis therapy in quiescent UC. The first study was rated as low risk of bias and the second study (published as an abstract) was rated as high risk of bias for blinding of participants and personnel. The studies were not pooled due to differences in the interventional drug.
The effect of cannabidiol capsules (100 mg to 500 mg daily) compared to placebo on clinical remission and response is uncertain. Clinical remission at 10 weeks was achieved by 24% (7/29) of the cannabidiol group compared to 26% (8/31) in the placebo group (RR 0.94, 95% CI 0.39 to 2.25; low certainty evidence). Clinical response at 10 weeks was achieved in 31% (9/29) of cannabidiol participants compared to 22% (7/31) of placebo patients (RR 1.37, 95% CI 0.59 to 3.21; low certainty evidence). Serum CRP levels were similar in both groups after 10 weeks of therapy. The mean CRP in the cannabidiol group was 9.428 mg/L compared to 7.638 mg/L in the placebo group (MD 1.79, 95% CI -5.67 to 9.25; moderate certainty evidence). There may be a clinically meaningful improvement in quality of life at 10 weeks, measured with the IBDQ scale (MD 17.4, 95% CI -3.45 to 38.25; moderate certainty evidence). Adverse events were more frequent in cannabidiol participants compared to placebo. One hundred per cent (29/29) of cannabidiol participants had an adverse event, compared to 77% (24/31) of placebo participants (RR 1.28, 95% CI 1.05 to1.56; moderate certainty evidence). However, these adverse events were considered to be mild or moderate in severity. Common adverse events included dizziness, disturbance in attention, headache, nausea and fatigue. None (0/29) of the cannabidiol participants had a serious adverse event compared to 10% (3/31) of placebo participants (RR 0.15, 95% CI 0.01 to 2.83; low certainty evidence). Serious adverse events in the placebo group included worsening of UC and one complicated pregnancy. These serious adverse events were thought to be unrelated to the study drug. More participants in the cannabidiol group withdrew due to an adverse event than placebo participants. Thirty-four per cent (10/29) of cannabidiol participants withdrew due to an adverse event compared to 16% (5/31) of placebo participants (RR 2.14, 95% CI 0.83 to 5.51; low certainty evidence). Withdrawls in the cannabidiol group were mostly due to dizziness. Withdrawals in the placebo group were due to worsening UC.
The effect of cannabis cigarettes (23 mg THC/day) compared to placebo on mean disease activity, CRP levels and mean fecal calprotectin levels is uncertain. After 8 weeks, the mean disease activity index score in cannabis participants was 4 compared with 8 in placebo participants (MD -4.00, 95% CI -5.98 to -2.02). After 8 weeks, the mean change in CRP levels was similar in both groups (MD -0.30, 95% CI -1.35 to 0.75; low certainty evidence). The mean fecal calprotectin level in cannabis participants was 115 mg/dl compared to 229 mg/dl in placebo participants (MD -114.00, 95% CI -246.01 to 18.01). No serious adverse events were observed. This study did not report on clinical remission, clinical response, quality of life, adverse events or withdrawal due to adverse events.
Cochrane What is ulcerative colitis? Ulcerative colitis is a chronic, long-term illness that causes inflammation of the colon and rectum. Symptoms may include diarrhea, rectal bleeding,
CBD Oil for Ulcerative Colitis [How It Works]
Ulcerative colitis is a type of inflammatory bowel disease, the other type being Crohn’s disease. However, while the two diseases may share similar symptoms, what is actually going on in the body is different.
While Crohn’s disease may affect any region of the digestive gut, ulcerative colitis (UC) is strictly confined to inflammation of the colon – aka the large intestine. Also, while Crohn’s disease involves inflammation of all layers of the digestive gut, UC is limited to inflammation of the inner lining only.
UC must also not be mistaken with irritable bowel syndrome (IBS), which is a disorder characterized by episodes of constipation, episodes of diarrhea, and relief after going to the bathroom.
In this article, we talk about the possible use of CBD oil for ulcerative colitis. We also ask whether or not the natural cannabis compound may present itself as a viable treatment option based on recent studies and research publications.
Current sufferers of UC will know that conventional pharmaceutical medications for the disorder are both costly and may have dangerous side effects. As such, many have been actively seeking alternative forms of treatment, with CBD appearing as one possible option.
First Things First: What Is CBD… And Is It Legal?
For those UC patients who are still entirely in the dark as to what CBD is, it is essentially a natural component of the cannabis plant. However, it deserves little affiliation with the stereotypical perception of cannabis, as it produces no high whatsoever.
Rather, in the limited amount of years that scientists have studied it, CBD appears to be strictly therapeutic in nature. In other words, it seems to possess many of the health and healing properties of cannabis, without causing any of the mind-altering effects.
CBD oil, which has become the most popular form of CBD as a therapy, is essentially a natural extract from raw cannabis plant material. It can come from actual strains of marijuana (which contain THC), or from industrial hemp, which is similar to marijuana but contains less than .3% THC.
On a federal level, CBD products that are extracted from industrial hemp are legal to possess and use in all 50 U.S. states. On the state level, however, there are still a few regions where use and possession of the compound is not so widely accepted. In North Carolina, for example, police recently arrested a vape store owner for selling bottles of CBD oil, even though the oil came from perfectly legal industrial hemp.
Regardless, it’s important to point out that the majority of top U.S. CBD oil manufacturers are shipping to all 50 states. No matter what part of the country you live in, it is easy to order online and have the product shipped to your home.
What Is Ulcerative Colitis – And How Is It Typically Treated?
As we’ve mentioned, ulcerative colitis is defined as persistent inflammation of the colon, aka the large intestine. This chronic inflammation may range from mild to severe, and in the latter instances, it is common for the colon’s inner lining to develop painful lesions, sores, and other forms of irritation.
UC symptoms are relatively uniform in nature, and can include:
- Loose and urgent bowel movements
- Persistent diarrhea
- Abdominal pain
- Bloody stool
- Abdominal pain/cramping
- Loss of appetite
- Weight loss
- Low energy and fatigue
- Inhibited growth and development (in children)
It’s important to note, however, that symptoms of ulcerative colitis are non-persistent in nature; a victim may go several weeks or even months with no symptoms at all, only to experience a severe flare-up seemingly out of nowhere.
How Is Ulcerative Colitis Currently Treated?
There is currently a wide range of treatment options available for patients with ulcerative colitis. These may range from strong prescription pharmaceuticals in the most severe cases, to generic OTC drugs in milder instances.
Prescription medications commonly include:
- Antibiotics such as metronidazole and ciprofloxacin
- Aminosalicylates (5-ASAs) that function by reducing inflammation in the intestinal lining
- Corticosteroids that may reduce inflammation by suppressing the immune system
- Immunomodulators that suppress the body’s immune response
- Biologics that target a specific pathway to reduce inflammation
Non-prescription medications for UC may include generic over-the-counter (OTC) drugs such as antidiarrheals, anti-inflammatory analgesics (pain relievers), and even nutritional supplements that work to lower instances of chronic intestinal inflammation.
In more severe instances that are not responsive to conventional treatment, surgery may be necessary to remove portions of the large intestine that are most affected. In some instances, it is possible to cure ulcerative colitis with surgical removal of the colon (via a process known as a colectomy). However, invasive surgery always presents its own risks – particularly among elderly patients.
What Causes Ulcerative Colitis?
In terms of factors that may influence the onset or development of ulcerative colitis, doctors and researchers still have not been able to pinpoint an exact cause of the disease. It’s thought that initial onset may stem from an immune response to a bacterial or viral infection of the colon; in most instances, this inflammatory response will subside after the infection has cleared, but for whatever reason, inflammation seems to persist long-term in those that develop symptoms of the disease.
Genetics also seems to play a significant role in the onset of UC, since it can run in families. Ulcerative colitis also has what is called a ‘bimodal distribution,’ which means there’s a risk of it occurring at a younger age (in the 20s and 30s) and then again at an older age (60s and 70s). According to the Centers for Disease Control and Prevention, 3 million people in the country suffer from inflammatory bowel disease, the majority of which have ulcerative colitis.
CBD for Ulcerative Colitis – How Might It Work?
Simply put, it is hypothesized that CBD may be effective for ulcerative colitis because of its ability to function as an anti-inflammatory. The National Institute of Health’s PubChem database, for example, lists cannabidiol (the scientific name for CBD) as being “devoid of psychoactivity,” and as having both analgesic (pain-relieving) and anti-inflammatory properties.
Moreover, few people know that the U.S. government currently holds a patent on CBD for (among other things) its role as an anti-inflammatory agent, which states: “Cannabinoids have been found to have antioxidant properties … [making them] useful in the treatment of a wide variety of oxidation-associated diseases, [including] inflammatory and autoimmune diseases.”
What’s equally as intriguing, however, is the fact that the endocannabinoid system, or ECS, is known to have an abundance of receptors located throughout the digestive system – including the lining of the colon.
Unfortunately, there have not yet been multi-stage clinical trials on the use of CBD oil for ulcerative colitis. The FDA has recently approved a CBD-based drug called Epidiolex for the treatment of intractable forms of epilepsy, but as of now, physicians are unable to prescribe the cannabis-based medication for any ulcerative colitis patients.
Current Research on CBD for Ulcerative Colitis
Even though the requisite clinical trials are still lacking, there have been a surprising number of specific scientific investigations carried out on the effects of CBD for ulcerative colitis. Here is a list of several of the most relevant ones:
CBD for Ulcerative Colitis: The Studies
- One study took place in Israel from 2011 to 2016. Researchers wanted to find if there was any correlation between cannabis consumption and IBD (inflammatory bowel disease). They observed 127 patients, all who had been successful in their application to use cannabis. By using a variety of biomarkers, including mode of consumption and rate of consumption, they collected data from each participant using the Harvey-Bradshaw Index. Not only did the patients themselves report significant improvements in pain, but the index, where a lower score is considered better, decreased from 0 to 5.0. Despite the positive response, there were minor side effects, including dry mouth and memory decline.
- A 2011 report in PLOS One claims that CBD presents a “new therapeutic strategy” in treating inflammatory bowel disease. The goal of the study was to monitor the effects of CBD on intestinal biopsies from actual patients with ulcerative colitis, as well as intestinal segments of mice with induced intestinal inflammation. Results showed that CBD was able to “counteract the inflammatory environment” in both instances. This led researchers to claim that the natural compound presents a “new therapeutic strategy” in treating various forms of IBD, including ulcerative colitis. However, this study was only done on ex vivo samples and does not necessarily represent what would happen in the body.
- A 2018 study looked into the efficacy of CBD extract in patients 18 and older with ulcerative colitis. While it did not find a difference in the remission rates between those using CBD and those using a placebo, the study did suggest that CBD extract may be beneficial for symptomatic treatment.
- Another 2018 study was unable to draw any conclusions about the safety or efficacy of CBD oil in those with ulcerative colitis, suggesting more research needs to be done.
Final Thoughts on CBD Oil for Ulcerative Colitis
A lot of research still needs to be done to determine the efficacy of CBD oil for those with ulcerative colitis. As things currently stand, there is some evidence that CBD oil can have a beneficial effect, but there is no good information about dosing or route of administration.
Additionally, CBD may provide extra symptomatic relief for those suffering from the disease. What is important to keep in mind is that if you are suffering from ulcerative colitis, you should still take all medications prescribed by your doctor. If you are considering going off of your medications or beginning alternative treatments (including CBD), talk with your doctor first to see if it is a good idea for you.
If you do end up trying CBD, there are several high-quality CBD oil manufacturers currently selling legal products to all 50 U.S. states, but as always, we recommend that everyone do their own research (or better yet speak with their physician) in order to find a product that will work for them.
Lastly, it’s important to recognize that none of the information in this article should be taken as medical advice, and should not be used to diagnose, treat, cure, or prevent any disease.
Ulcerative colitis is one of a few different forms of Inflammatory Bowel Disease, otherwise known as IBD. Could CBD oil help? Let's find out.