Can CBD Help With Ulcerative Colitis, and if So, How?
- Ulcerative colitis (UC) is a chronic inflammatory disease in a category known as Inflammatory Bowel Disease (IBD) and is known to affect the large intestine and cause sores, or ulcers, in the digestive tract(1).
- Aminosalicylates have been the primary means of treating colitis for many years, with doctors aiming to reduce inflammation in IBD patients and improve their quality of life. Physicians may also prescribe medications, such as corticosteroids and antibiotics, to treat the symptoms of UC(2).
- Studies have shown that CBD’s anti-inflammatory properties may help treat colitis(3). Several studies report that CBD may prevent colon injury(4), inhibit disturbances in the large intestine(5), and reduce intestinal damage overall(6).
- However, most of these studies were conducted on animal subjects. There is no substantial evidence that CBD can alleviate ulcerative colitis symptoms in humans.
- Seeking advice from a medical professional, particularly someone experienced in cannabis use, is best for individuals who want to take CBD for UC.
Why Some People Are Turning to CBD for Ulcerative Colitis
Ulcerative colitis (UC) is a chronic inflammatory disease that affects the colon and causes long-lasting ulcers, or sores, in the digestive tract.
UC affects the inner lining of the large intestine (microscopic colitis), causing a person to experience bowel movements frequently.
UC commonly affects adults aged thirty to forty years old and is said to account for about $8 to $15 billion in total economic burden in the United States(7).
The cause of this type of inflammatory bowel disease (IBD) is not clear. However, researchers believe colitis develops in genetically susceptible individuals as a response to environmental triggers.
Although there is no known cure for ulcerative colitis, doctors may prescribe treatment to reduce the inflammation that causes its symptoms.
Aminosalicylates have been the main form of treatment for the disease for many years. A physician could also prescribe corticosteroids or antibiotics(8).
A new approach that could potentially alleviate the symptoms of ulcerative colitis is the use of CBD (cannabidiol). Studies have shown that CBD’s anti-inflammatory properties may help treat UC(9).
Cannabidiol is one of the many chemical compounds present in the Cannabis sativa plant, which could be hemp or marijuana.
Compared to delta-9-tetrahydrocannabinol (THC), which is predominantly found in marijuana, CBD from hemp is non-intoxicating and does not cause a high when consumed(10). Meanwhile, the use of cannabis (marijuana) induces psychoactive effects.
A study published in 2009 in the Journal of Molecular Medicine found that cannabidiol may have protective effects in rats with colitis(11).
The researchers examined the large intestines of the subjects and found that CBD was able to reduce injury in the general area.
Another study on rats with ulcerative colitis was carried out the following year to learn about CBD’s effects on this type of IBD.
Results revealed that THC and CBD inhibited inflammation and functional disturbances in the large intestines of the rodents(12).
The results of these two small studies led another team to continue examining CBD and how it affects colitis in animal models.
In a 2011 study published by the scientific journal PLOS One, scientists once again found that CBD reduced intestinal damage in mice with colitis(13).
Meanwhile, a clinical trial found that applying CBD as a topical can improve colonic inflammation in mice with UC(14).
Despite these positive results, most of the studies on CBD’s effects on colitis were carried out on rodents. However, at least one clinical trial attempted to translate the supposed health benefits of CBD on human subjects with UC.
The study compared the effectiveness of CBD oil capsules on individuals with UC to another group that was given placebo pills.
The CBD group participants were given 50 mg of CBD capsules twice each day, increasing up to 250 mg twice daily, if tolerated(15).
After ten weeks, twenty-four percent of the subjects that took CBD claimed to have improved remission rates, stating that they no longer experience colitis symptoms.
Meanwhile, several participants also reported improved quality of life scores compared to the placebo group(16).
Although appearing to have potential, CBD’s effects on human subjects with ulcerative colitis are unclear. The lack of human studies is why researchers today could not conclude the efficacy of cannabidiol in adults with active UC.
How CBD Oil Works to Help with Ulcerative Colitis
The endocannabinoid system (ECS) is a system present in most mammals and is responsible for regulating several critical bodily functions. Its discovery in the 90s has led many researchers to believe that it could be manipulated to bring about therapeutic effects in parts of the body it controls(17).
Knowing how the ECS works is essential in understanding how CBD may help alleviate ulcerative colitis and IBD symptoms.
Cannabinoids, like CBD, express their therapeutic effects in the body through receptors in the ECS(18). The two primary endocannabinoid receptors are the CB1 and CB2 receptors.
CB1 receptors are primarily distributed on neural tissue and the central nervous system. CB2 receptors mediate the functions concerning the immune system.
A study in 2001 mentioned that CB1 receptors are said to play a role in controlling gastrointestinal motility and gastric intestinal secretion(19). This statement is supported by at least two studies on mice, which demonstrated that CB1 and CB2 receptors are crucial in modulating colonic inflammation(20).
Although both CB1 and CB2 receptors are considered mediators of inflammation in the ECS, the CB2 receptor seems to be the primary regulator of inflammation and immune functions(21).
When CB2 receptors are activated, they trigger a response which fights inflammation in the body. This anti-inflammatory reaction is said to help treat chronic inflammatory diseases, one of which is colitis(22).
CBD supposedly provides its anti-inflammatory benefits by interacting with the cannabinoid receptors in the ECS. Doing so could help treat inflammation of the colon, which is common in ulcerative colitis.
The Pros and Cons of CBD Oil for Ulcerative Colitis
- CBD is said to have anti-inflammatory properties(23) that could potentially alleviate ulcerative colitis and Crohn’s disease symptoms.
- Several studies on cannabis and inflammatory bowel conditions support the concept that compounds, like CBD, can be used to treat inflammatory bowel diseases(24).
- CBD intake does not result in a euphoric high, unlike THC, which is the psychoactive component prevalent in medical marijuana.
- People can purchase CBD oil products even without a prescription so long as they do so in locations where they are legal.
- According to a study in 2018, cannabidiol is non-addictive and may even help with substance abuse and drug addiction(25).
- Most of the findings from the studies mentioned earlier were obtained from clinical trials on rodents. At the time of writing, there is no direct evidence proving that CBD can effectively treat ulcerative colitis.
- Research on CBD’s efficacy on human subjects with colitis has shown limited clinical response, with the results of these studies being generally inconclusive.
- People who take CBD may experience adverse effects, such as dizziness, nausea, fatigue, and headache(26).
- At this time, Epidiolex is the only CBD product approved and evaluated by the United States Food and Drug Administration (FDA)(27).
- The FDA also warns the public that using CBD and other medications together may affect how these drugs work, potentially causing severe side effects(28).
How CBD Oil Compares to Alternative Treatments for Ulcerative Colitis
Herbal medicines have been used in treating IBDs, like ulcerative colitis and Crohn’s disease. They are said to be effective in alleviating inflammatory bowel disease symptoms in the gastrointestinal tract.
In Italy, complementary medicines, particularly herbal therapies, are frequently used by patients with inflammatory bowel diseases(29).
Likewise, Chinese literature recognizes the IBD treatment of ulcerative colitis with herbal remedies.
Herbs, such as aloe vera, Boswellia serrata, and turmeric, are often used in the hopes of alleviating the symptoms of colitis(30).
This belief is based on the alleged anti-inflammatory effects that these herbs provide upon consumption.
Aloe vera is said to have therapeutic potential in treating IBD, based on the positive results of a clinical trial on patients with the disease(31). Meanwhile, Boswellia serrata(32) and curcumin from turmeric(33) are also reported to have anti-inflammatory activities.
CBD has been shown to possess characteristics that could combat inflammation and help with IBDs, like colitis. There are CBD products available in the form of tinctures and capsules that are infused with herbal medicines.
Users can find CBD oil mixed with herbs, such as aloe vera, Boswellia serrata, and turmeric. There are also CBD supplements in the form of soft gels that contain Boswellia and curcumin.
How to Choose the Best CBD Oil for Ulcerative Colitis
Choosing the right type of CBD oil is imperative to experiencing CBD to the fullest. Three variants of CBD oil are being manufactured by companies today.
The first is full-spectrum CBD, which has all of the chemical compounds that are naturally found in cannabis. This type also has other chemical compounds, like terpenes that provide the distinctive aroma in cannabis plants and flavonoids, which give their unique colors.
Full-spectrum CBD also contains trace amounts of THC, which cannot cause a psychoactive reaction.
Combining all of these compounds and consuming them provides the user with the entourage effect. This effect means that the cannabis constituents are more effective when consumed together compared to taking them individually.
Cannabidiol is not the only compound of cannabis that is said to have therapeutic effects. When choosing a CBD product, users often decide to select one containing the full range of cannabinoids to maximize their health benefits.
The second type of CBD oil is called broad-spectrum, which is similar to full-spectrum. It also contains all of the phytocannabinoids that are derived from cannabis except THC.
This variety of CBD is ideal for individuals who do not want to consume THC.
The third type of oil is known as isolate, which contains pure cannabidiol. Users that are allergic to specific cannabinoids of the hemp plant, or those who want to take pure CBD, can opt for CBD isolates.
This type of CBD is often available in powdered form but can sometimes be found as crystals.
Regardless of whether a person chooses full-spectrum, broad-spectrum, or isolate, careful consideration is necessary to obtain the best CBD oil suitable for one’s preferences.
Here are several tips to ensure that high-quality, safe, and reliable cannabis products are bought today:
- Look for the certificate of analysis (COA) or the laboratory report of the CBD product selected. This document is especially important since it indicates that the item has undergone thorough testing and contains precisely the specifications listed on its label.
- Read up on product and shop reviews when buying from an online store. If purchasing from a physical dispensary, check if it has proper authorization to sell CBD.
- Only buy organic CBD derived from hemp. The hemp plant is the most reliable source of quality cannabidiol.
- Ensure that the legalities involving CBD are followed in the state where it is planned to be bought and used.
- Consult a medical professional, preferably someone experienced in medical cannabis, before deciding to use CBD for the symptoms of ulcerative colitis.
Additional Tips to Get the Best CBD Oil Products
- Keep an eye out for CBD brands claiming that their CBD is acquired from the stalk and seeds of hemp plants. Cannabidiol is not found in hemp seeds, and there are minimal traces of CBD in the stalks of hemp.
- Do not purchase CBD vape cartridges containing thinning agents, such as propylene glycol and polyethylene glycol, as these can be toxic and harmful to one’s health.
- Avoid purchasing low-quality CBD edibles and gummies that are made of artificial colors and sub-standard ingredients.
- Contact CBD brands directly for any questions or concerns. Try another CBD company if they do not respond.
CBD Dosage for Ulcerative Colitis
There are no official guidelines concerning the consumption of CBD for ulcerative colitis. However, it might help to review the dosage of past human clinical trials to have an idea concerning the safe amount for intake.
From the study mentioned earlier, patients with UC were given 50 mg of CBD oil capsules twice a day. The participants who tolerated it well took increasing amounts, reaching as much as 250 mg twice per day for ten weeks.
The study showed that the subjects who took CBD felt better and claimed to no longer experience colitis symptoms. A few individuals also reported mild reactions, such as dizziness and nausea.
A systematic review of CBD dosing found that patients who took doses between 1 and 50 mg/kg per day reported significant improvements in their conditions(34). This review took into account the results of twenty-three studies and found that CBD was well-tolerated in all subjects.
Perhaps the best rule to apply with regards to CBD dosage is to start with a small amount and then observe its effects. If there are no severe reactions, users can gradually increase their dosing until they experience the desired outcome.
How to Take CBD Oil for Ulcerative Colitis
When seeking the anti-inflammatory effects of CBD for colitis, users can choose to take CBD sublingually via tinctures and droppers. This approach involves placing drops of CBD oil under the tongue and keeping it there for several seconds before swallowing.
Applying CBD by way of tinctures is probably the fastest way to deliver cannabidiol to the body as the compound can enter the bloodstream immediately.
CBD in capsule form is also another way to take cannabidiol, allowing individuals to take them daily, similar to supplements.
Meanwhile, users can find CBD edibles in the form of cookies and gummies that can be consumed as snacks.
This kind of product is usually available in various flavors and can be a delightful introduction to CBD. However, edibles can take effect longer than other forms of CBD, as it has to travel through the gastrointestinal tract first.
Ulcerative colitis is an inflammation of the colon that primarily affects the lining of the large intestine, causing people to experience frequent bowel movement or flare-ups.
UC commonly occurs in adults between the ages of thirty to forty years old and is reported to be a significant economic burden in the United States.
There is no clear indication of what causes colitis and, as of this time, scientists have not yet found a cure for the disease.
Aminosalicylates are the most prescribed treatment for UC, with doctors aiming to reduce inflammation and improve the quality of life of IBD patients.
Several studies have shown that CBD is a possible medical treatment option for ulcerative colitis and other inflammatory bowel conditions. Researchers discovered that CBD could prevent injury and inflammation to the colon, potentially providing relief for colitis disease activity.
Experts believe that CBD may reduce inflammation by interacting with the CB1 and CB2 receptors of the ECS.
However, most randomized controlled trials were carried out on animals, with no direct evidence showing that CBD is an effective treatment for UC symptoms in humans.
When deciding to purchase CBD for intestinal inflammation, interested cannabis users should consult a doctor to get the right medical advice.
People can benefit from visiting a healthcare provider experienced with cannabis oil and CBD.
- Cohen RD, Yu AP, Wu EQ, Xie J, Mulani PM, Chao J. Systematic review: the costs of ulcerative colitis in Western countries. Aliment Pharmacol Ther. 2010;31(7):693-707. doi:10.1111/j.1365-2036.2010.04234.x
- Collins P, Rhodes J. Ulcerative colitis: diagnosis and management. BMJ. 2006;333(7563):340-343. doi:10.1136/bmj.333.7563.340
- Atalay S, Jarocka-Karpowicz I, Skrzydlewska E. Antioxidative and Anti-Inflammatory Properties of Cannabidiol. Antioxidants (Basel). 2019;9(1):21. Published 2019 Dec 25. doi:10.3390/antiox9010021
- Borrelli F, Aviello G, Romano B, et al. Cannabidiol, a safe and non-psychotropic ingredient of the marijuana plant Cannabis sativa, is protective in a murine model of colitis. J Mol Med (Berl). 2009;87(11):1111-1121. doi:10.1007/s00109-009-0512-x
- Jamontt JM, Molleman A, Pertwee RG, Parsons ME. The effects of Delta-tetrahydrocannabinol and cannabidiol alone and in combination on damage, inflammation and in vitro motility disturbances in rat colitis. Br J Pharmacol. 2010;160(3):712-723. doi:10.1111/j.1476-5381.2010.00791.x
- De Filippis D, Esposito G, Cirillo C, et al. Cannabidiol reduces intestinal inflammation through the control of neuroimmune axis. PLoS One. 2011;6(12):e28159. doi:10.1371/journal.pone.0028159
- Cohen RD. et al. op. cit.
- Collins P, Rhodes J. op. cit.
- Atalay S. et al. op. cit.
- Meissner H, Cascella M. Cannabidiol (CBD) [Updated 2020 Mar 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556048/
- Borrelli F. et al. op. cit.
- Jamontt JM. et al. op. cit.
- De Filippis D. et al. op. cit.
- Schicho R, Storr M. Topical and systemic cannabidiol improves trinitrobenzene sulfonic acid colitis in mice. Pharmacology. 2012;89(3-4):149-155. doi:10.1159/000336871
- Kafil TS, Nguyen TM, MacDonald JK, Chande N. Cannabis for the treatment of ulcerative colitis. Cochrane Database of Systematic Reviews 2018, Issue 11. Art. No.: CD012954. DOI: 10.1002/14651858.CD012954.pub2
- Pacher P, Bátkai S, Kunos G. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol Rev. 2006;58(3):389-462. doi:10.1124/pr.58.3.2
- Picardo S, Kaplan GG, Sharkey KA, Seow CH. Insights into the role of cannabis in the management of inflammatory bowel disease. Therap Adv Gastroenterol. 2019;12:1756284819870977. Published 2019 Sep 3. doi:10.1177/1756284819870977
- Pertwee RG. Cannabinoids and the gastrointestinal tract. Gut. 2001;48(6):859-867. doi:10.1136/gut.48.6.859
- Kimball ES, Schneider CR, Wallace NH, Hornby PJ. Agonists of cannabinoid receptor 1 and 2 inhibit experimental colitis induced by oil of mustard and by dextran sulfate sodium. Am J Physiol Gastrointest Liver Physiol. 2006;291(2):G364-G371. doi:10.1152/ajpgi.00407.2005; Massa F, Marsicano G, Hermann H, et al. The endogenous cannabinoid system protects against colonic inflammation. J Clin Invest. 2004;113(8):1202-1209. doi:10.1172/JCI19465
- Ashton JC, Glass M. The cannabinoid CB2 receptor as a target for inflammation-dependent neurodegeneration. Curr Neuropharmacol. 2007;5(2):73-80. doi:10.2174/157015907780866884
- Turcotte C, Blanchet MR, Laviolette M, Flamand N. The CB2 receptor and its role as a regulator of inflammation. Cell Mol Life Sci. 2016;73(23):4449-4470. doi:10.1007/s00018-016-2300-4
- Atalay S. et al. op. cit.
- Picardo S. et al. op. cit.; Ahmed W, Katz S. Therapeutic Use of Cannabis in Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2016;12(11):668-679.; Hasenoehrl C, Storr M, Schicho R. Cannabinoids for treating inflammatory bowel diseases: where are we and where do we go?. Expert Rev Gastroenterol Hepatol. 2017;11(4):329-337. doi:10.1080/17474124.2017.1292851
- Gonzalez-Cuevas G, Martin-Fardon R, Kerr TM, et al. Unique treatment potential of cannabidiol for the prevention of relapse to drug use: preclinical proof of principle. Neuropsychopharmacology. 2018;43(10):2036-2045. doi:10.1038/s41386-018-0050-8
- Kafil TS. et al. op. cit.
- U.S. Food and Drug Administration (2020, March 5). What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD. Retrieved from: https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis.
- D’Inca R, Garribba AT, Vettorato MG, et al. Use of alternative and complementary therapies by inflammatory bowel disease patients in an Italian tertiary referral centre. Dig Liver Dis. 2007;39(6):524-529. doi:10.1016/j.dld.2007.03.001
- Ke F, Yadav PK, Ju LZ. Herbal medicine in the treatment of ulcerative colitis. Saudi J Gastroenterol. 2012;18(1):3-10. doi:10.4103/1319-3767.91726
- Langmead L, Makins RJ, Rampton DS. Anti-inflammatory effects of aloe vera gel in human colorectal mucosa in vitro. Aliment Pharmacol Ther. 2004;19(5):521-527. doi:10.1111/j.1365-2036.2004.01874.x
- Krieglstein CF, Anthoni C, Rijcken EJ, et al. Acetyl-11-keto-beta-boswellic acid, a constituent of a herbal medicine from Boswellia serrata resin, attenuates experimental ileitis. Int J Colorectal Dis. 2001;16(2):88-95. doi:10.1007/s003840100292
- Holt PR, Katz S, Kirshoff R. Curcumin therapy in inflammatory bowel disease: a pilot study. Dig Dis Sci. 2005;50(11):2191-2193. doi:10.1007/s10620-005-3032-8
- Millar SA, Stone NL, Bellman ZD, Yates AS, England TJ, O’Sullivan SE. A systematic review of cannabidiol dosing in clinical populations. Br J Clin Pharmacol. 2019;85(9):1888-1900. doi:10.1111/bcp.14038