Over the past decade, interest in the potential of the 500-plus compounds in the cannabis plant to treat inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s disease, has led to the expansion of medical research in that area. While current IBD treatments have made huge inroads in controlling the impact of the disease, many sufferers continue to experience symptoms related to their condition. Here enters the potential of cannabis to improve the quality of life of those suffering from Ulcerative Colitis.
The potential for cannabis as a safe and effective treatment for patients with ulcerative colitis is promising. A number of small, randomized, blind, and double-blind studies are bringing more awareness to cannabis as an alternative medication in place of or to supplement medical procedures and or other prescriptions. More substantial and long-term clinical studies are necessary for wide-scale approval of medical cannabis treatment for colitis.
The Endocannabinoid System
The endocannabinoid system (ECS) is a complex system found in all vertebrates that helps maintain homeostasis (balance) throughout the body. Research identifying and studying the major neuromodulatory system has been ongoing for over 25 years. The ECS consists of cannabinoid receptors, endocannabinoids, and the enzymes that break down the endocannabinoids.
The endocannabinoids, molecules also known as endogenous cannabinoids because they are produced inside the body, are primarily anandamide (AEA) and 2-arachidonoylglycerol (2-AG). These are produced by the body when a system has a deficit. The ECS maintains levels through the signaling process between the cannabinoid receptors and endocannabinoids.
The two most abundant cannabinoid receptors are CB1 and CB2. Though found throughout the body, CB1 receptors are concentrated along the central nervous system, and CB2 receptors are mainly in the immune system. Endocannabinoids bind to these receptors to send signals to the ECS. After the CB1 and CB2 connect with the ECS, the enzymes break down the endogenous cannabinoids. The two main enzymes are fatty acid amide hydrolase (FAAH) and monoacylglycerol acid lipase (MAGL).
The ECS also interact with phytocannabinoids, plant-based cannabinoids similar to those found in the body, including the ones found in cannabis. Scientists have isolated at least 144 cannabis plant-based cannabinoids. Researchers have the most data about the cannabinoids delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), and many of the studies involving ulcerative colitis and cannabis are specific to these compounds.
Many cannabinoid receptors are located in areas significant to ulcerative colitis, such as the gastrointestinal tract, brain, immune cells, and the enteric nervous system. A 2009 study of mice with colitis found that inflammation, which leads to the symptoms of ulcerative colitis, decreased when the CB1 and or CB2 receptors signal the ECS in the colon or rectum.
Dozens of peer-reviewed research papers and anecdotal reports show that THC and CBD reduce inflammation in patients with a variety of conditions, including many gastrointestinal diseases. Survey-based results also concur that cannabis can reduce the symptoms, such as stomach pain, nausea, and diarrhea. In addition to THC and CBD, many of the plant’s lesser-known cannabinoids and terpenes have anti-inflammatory properties.
Cannabis & Ulcerative Colitis
Ulcerative colitis can cause painful inflammation in the colon and/or rectum. Several clinical studies conducted over the past several years provide evidence that whole-plant cannabis treatments and CBD isolates may reduce associated symptoms and improve patients’ quality of life.
A 2018 journal review of studies and clinical trials in 51 publications took a look at the findings about the role of cannabinoids on murine colitis (colitis induced in mice). Most of the studies involved CBD rather than THC or other cannabinoids, likely because CBD is easier to access legally due to its non-psychoactive nature. The authors concluded that the amount of quality reviews provided enough information to warrant more large-scale clinical studies.
- In 2017, the Inflammatory Bowel Disease Journal published a review of the CB1 and CB2, endocannabinoids, and murine colitis. It found the manipulation of the ECS had the potential to reduce inflammation in the colon and rectum. This study looked at the method of delivery, too—rectal administration of CBD (suppositories) showed the most significant results, and oral methods did not reduce inflammation. This anatomically correlates with disease activity of UC, where inflammation is most often found in the rectum.
- A 2018 report in the Inflammatory Bowel Disease Journal published the results of a randomized, double-blind, placebo-controlled, parallel-group, pilot study of cannabidiol-rich treatment of patients over 18 with left-sided or extensive ulcerative colitis. The CBD-rich extract, GWP42003, contained 4% THC. Patients in the study receiving the CBD achieved positive results by the end of the 10 weeks. The results found that 59% of the participants had remission rates of 28%.
- In 2018, researchers reviewed two studies involving 92 adult patients with active ulcerative colitis. The first study included 60 participants using cannabis oil capsules containing up to 4.7% THC. Of 60 participants, 24% went into clinical remission. The second study took place over 8 weeks, and patients smoked two cannabis cigarettes with a half gram of flowers in each. These participants had lower disease activity index scores. The second study didn’t include remission rates.
In addition to these studies, there are patient surveys providing anecdotal results. These aren’t science-based. Instead, they recorded the responses of current cannabis users with ulcerative colitis. A survey of patients in the US found less abdominal pain, an increase in appetite, and reductions in nausea and diarrhea.
Potential side effects of cannabis use
Cannabis as medication used in conjunction with a physician’s care is considered safe. The most common side effects that patients experience are mild compared to other medications. They include drowsiness, fatigue, dizziness, feelings of euphoria, dry mouth, paranoia, anxiety, increased appetite, reduced attention, headaches, and nausea.
Side effects can vary depending on dosage, and differ depending on the cannabinoid. For instance, a CBD-isolate, a single-compound oil extract, doesn’t produce extreme feelings of euphoria or paranoia because CBD is a non-psychoactive compound.
To this day, there are no recorded fatalities secondary to direct intake of cannabis.
Drug interactions may occur with cannabinoid treatments. Studies show that the phytocannabinoids THC and CBD may interfere with patients taking warfarin, a medication that helps prevent blood clots. The compounds might interfere with specific cancer breast cancer chemotherapies and antiepileptic drugs. Like any other medicine, always discuss taking medical cannabis with your doctor prior to starting.
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