Weeding Out Gut Inflammation

About 10 to 15 percent of patients with IBD use cannabis for relief of nausea, abdominal pain, and diarrhea. But marijuana can come with some undesirable side effects, like confusion, dizziness, nausea, vomiting, lack of motivation, and memory problems.

Could CBD provide relief without the drawbacks? While many theorize about its anti-inflammatory properties, only a few small studies have been done.

Here’s what’s the research says so far:

• Several studies have shown CBD may alleviate intestinal inflammation (in mice, anyway). This could be because CBD is an antagonist for a receptor responsible for inflammation.
• In a 2016 study of mice, a high-CBD cannabis extract decreased intestinal damage from colitis and reduced hypermotility (overactive intestines). The extract was more effective than pure CBD, supporting the inclusion of other chemicals from the cannabis plant.
• CBD may also help maintain a healthy intestinal barrier.
• On the other hand, in a small 2017 study, 19 participants with Crohn’s disease who took 10 milligrams of oral CBD twice daily for 8 weeks saw no improvements. But the CBD was found to be safe and well tolerated.
• In a 2018 study of 60 people with IBD, taking 50 milligrams of high-CBD botanical extract twice daily didn’t lead to remission but did improve quality of life.

CBD comes in many forms, strengths, and combinations, so it helps to know what you’re looking for.

CBD products fall into three categories:

• Full spectrum: contains CBD, varying levels of THC, other cannabinoids, terpenes, and flavanoids — all the natural components extracted from the cannabis plant
• Broad spectrum: contains CBD, other cannabinoids, terpenes, and flavanoids, but THC has been removed
• CBD isolate: contains only CBD with none of the other cannabis chemicals

Once you decide which type of CBD to use, it’s time to consider all the different ways you can consume or apply it:

• Oils, tinctures, and sprays are absorbed quickly either under the tongue or through mucous membranes of the nose.
• Capsules and soft gels contain CBD oil but take effect more slowly, because they’re absorbed through the digestive system.
• Edibles are usually candy or baked goods containing CBD.
• Vaping oils are inhaled through vaporizing pens and enter the bloodstream fastest, through the lungs.
• Suppositories are applied internally to the rectum or vagina.

• Topical products (lotions, creams, and ointments) are most often used for localized pain or skin conditions.
• Transdermal patches deliver CBD through the skin for another localized option.
• One CBD-based prescription drug, Epidiolex, was approved by the FDA in 2018 for the treatment of severe epilepsy.

A 2019 review of CBD research analyzed dosing used in studies and found a broad range of 1 to 50 milligrams per kilogram of body weight per day. IBD studies from that same review used 20 and 50 milligrams of CBD per day.

Generally, studies with higher doses had more positive outcomes. But more research is needed to establish effective CBD doses for different conditions.

To determine dosage, you should know your weight in kilograms and the concentration of CBD in your chosen product. Start with a low dose and increase it slowly to find the lowest amount that gives you the effect you’re looking for.

The FDA cautions consumers about these risks associated with CBD use:

• CBD can harm your liver.
• CBD may interact negatively with other drugs, especially drugs that are processed by the liver.
• Using CBD at the same time as alcohol or sedatives can cause drowsiness and lead to injury.
• Using CBD may increase the blood-thinning effects of the drug warfarin (aka Coumadin).
• Reproductive toxicity and reduced fertility of offspring have been observed in animal studies.

Because CBD products aren’t regulated by the FDA, labels may not show accurate amounts of CBD, THC, other chemicals, and pesticides. So proceed with caution if you decide to give CBD a try.

Taking CBD won’t produce a high feeling unless the product also contains substantial levels of THC. Any legal CBD product should be clearly labeled with the content of both CBD and THC, if it’s present.

In the 2018 study mentioned above, 90 percent of participants experienced adverse effects from taking a high-CBD botanical extract. The most common side effect reported was dizziness.

The FDA also lists these side effects for CBD:

• drowsiness
• gastrointestinal issues such as diarrhea or decreased appetite
• mood changes like irritability or agitation

In 2018, researchers summarized relevant studies on the use of complementary and alternative therapies to ease symptoms of inflammatory bowel disease. They found that up to 60 percent of IBD patients use complementary and alternative therapies.

Here are the research highlights:

• Probiotics can help patients achieve and maintain remission of ulcerative colitis (UC).
• Curcumin (a component of the spice turmeric) may also help people with UC due to its anti-inflammatory properties.
• Acupuncture and moxibustion may improve UC and Crohn’s disease when combined with conventional treatment.
• Cognitive behavioral therapy improves quality of life and reduces depression and anxiety in people with IBD.
• Mindfulness practice also improves quality of life and reduces depression and anxiety.
• Hypnotherapy may extend remission of UC.
• Yoga improves quality of life and reduces abdominal pain and anxiety.
• Exercise improves quality of life, bone mineral density, and relapse rates.

If you’ve been diagnosed with IBD, you should be under the regular care of a doctor who can help you manage symptoms and monitor changes in your condition. Talk to your doctor before trying CBD or other alternative remedies for IBD.

If you’re experiencing symptoms of IBD, see a doctor about diagnosis. IBD is diagnosed through a combination of scoping procedures to examine the GI tract and imaging like X-ray, MRI, or CT scans. Stool and blood tests may also be necessary.

It looks like the United States is on track to eventually set weed free. With looser regulations on cannabis-derived CBD products, researchers are keen to identify how the chemical can be used to address a broad range of conditions.

CBD is traditionally thought to be anti-inflammatory, so its use is particularly interesting to people who live with inflammatory bowel disease. While CBD is generally considered safe for adults, research on its use for IBD has had mixed results.

Talk with your doctor and check for the latest research (which is rolling out rapidly) on how CBD may make life with IBD easier.