CBD for IBD: Cure all or con?

What is CBD?

Perhaps you’ve seen it in advertised on TV, online, or maybe you’ve even stumbled upon it in your health food store, despite where you may have seen it, chances are that you’ve at least heard of CBD. Not only does it appear to be everywhere these days, it seems like it can cure anything! Supporters of CBD tout its many benefits and encourage everyone to get their hands on it. A big topic of conversation that has arisen is the use of CBD for IBD (Inflammatory Bowel Disease). But what does the research say? Is CBD the cure-all it claims to be? Or is it merely a con?

Before diving into what the research is telling us about CBD and IBD, let’s take a step back and understand what CBD is. CBD is shorthand for cannabidiol. Cannabidiol is just one of more than a hundred cannabinoids found in Cannabis, commonly known as marijuana or hemp. Marijuana and hemp are from the same plant, the difference lies in that hemp plants contain no more than 0.3 percent of tetrahydrocannabinol (THC), the psychoactive substance found in marijuana, that gets users “high.” Marijuana typically contains five to twenty percent THC. Thus, hemp is not psychoactive, it does not get you “high.” CBD can be derived from both marijuana and hemp. CBD is available in a variety of forms, including oral capsules, tinctures, and topical salves. CBD is legal to sell as long as it is derived from hemp and contains less than 0.3 percent THC.

There are many purported benefits of CBD. People use CBD for anti-anxiety, anti-inflammatory, anti-addiction, anti-depressant, anti-epileptic, and anti-insomnia benefits. Recently, there has been a lot of interest in utilizing CBD for gastrointestinal disorders and diseases, namely IBD. CBD acts on the endocannabinoid system, a system that controls many homeostatic processes within the body. The endocannabinoid system plays a role in gastrointestinal motility, hunger, perception of pain, and immunity. Considering there are receptors for the endocannabinoid system throughout the GI tract, is believed that activation of the endocannabinoid system, through CBD, could be beneficial to individuals suffering from IBD.

What is IBD?

Inflammatory Bowel Disease is a term used to describe two autoimmune diseases that are marked by chronic inflammation of the gastrointestinal (GI) tract, ulcerative colitis and Crohn’s disease. Crohn’s disease can affect any part of the GI tract, from the mouth to the anus. The inflammation and damage in Crohn’s disease appears in patches; the inflammation can travel through multiple layers of the wall of the GI tract. Ulcerative colitis occurs exclusively in the large intestine and rectum. Inflammation in ulcerative colitis is continuous, typically starting in the rectum, and spreading further into the colon. The inflammation in ulcerative colitis is present only in the innermost layer of the lining of the colon. Some common symptoms of IBD include persistent diarrhea, abdominal pain, rectal bleeding/bloody stools (seen more frequently in ulcerative colitis), weight loss, and fatigue. The exact cause of IBD remains unknown. It is believed to be a combination of genetic and environmental factors. An individual with a family history of IBD is more likely to have IBD themselves. A diagnosis of IBD is usually confirmed by an endoscopy and/or a colonoscopy. A doctor may collect blood and/or stool samples as well. There are several types of medications that are used to help manage IBD, while these medications have been shown to induce remission, there are associated with side effects. There is no cure for IBD and many patients do not fully respond to the current therapies, leading many individuals to seek alternative therapies. One of the popular alternative therapies that has been sought out is CBD.

What does the research say?

Considering using CBD for IBD is a relatively new phenomenon; there isn’t a lot of high quality research that has been conducted yet. The current research is varied, some studies show significant improvements in inflammation with CBD, while others do not. Be sure to check out the helpful resources and reference list at the end of this post for links to these studies. One study demonstrated that treatment with CBD reduced signs of inflammation in rats with Crohn’s disease. One study on patients with ulcerative colitis showed that compared to a placebo group, a greater percentage of patients who were treated with CBD-rich botanical extract achieved remission. Additionally, even in studies that don’t show statistically significant improvements in disease, many patients report their quality of life improved while taking CBD.

Interestingly, the Crohn’s and Colitis foundation’s position statement on cannabis and CBD is as follows:

“The Crohn’s and Colitis Foundation supports policy changes that facilitate the conduct of clinical research and the potential development of cannabinoid-based medications, including further consideration for revising marijuana’s status as a federal Schedule I controlled substance.”

Unfortunately, there hasn’t been enough research done to say with certainty that CBD will improve IBD symptoms and inflammation. Though, the current research appears promising. For a more in-depth look at some of the current literature, take a look at the reference/reading list provided at the end.

Some things to consider:

Before going out and buying some CBD oil, there are a few things to consider.

- This is a new field of study, with the exact mechanisms of action still unknown. Also, CBD is not regulated as a medication, meaning that CBD may vary from manufacturer to manufacturer.

- Some CBD products may contain THC, the psychoactive component of marijuana. While THC has shown efficacy for treating IBD symptoms, it could potentially be dangerous if used in the children and adolescent population.

- The exact dosage to elicit an effect is unknown, it is probably best to start with a smaller dose and work your way up.

- Look for a product that has been verified by a third party to ensure that you are getting what the label says you are getting.

- CBD appears to inhibit the cytochrome P450 enzyme, which is involved in the metabolism of many drugs. Compounds in grapefruit inhibit the same enzyme group, which is why many doctors urge people to not consume grapefruit with certain medications. Thus, CBD can reduce or increase the effects of various drugs when taken at the same time. Talk to your registered dietitian and/or physician to see if CBD would interact with any of the medications you are currently taking.

If you are interested in learning more about CBD, in general, for IBD, or perhaps another condition, check out the resources below and speak with your registered dietitian.

Helpful Resources

- Project CBD

o https://www.projectcbd.org/

- FDA Regulation of Cannabis and Cannabis Derived Products

o https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd#farmbill

- WHO CBD Critical Review Report

o https://www.who.int/medicines/access/controlled-substances/CannabidiolCriticalReview.pdf

- Crohn’s and Colitis Foundation

o https://www.crohnscolitisfoundation.org/

References/Reading List:

1. CDC -What is inflammatory bowel disease (IBD)? - Inflammatory Bowel Disease - Division of Population Health. What is IBD? https://www.cdc.gov/ibd/what-is-ibd.htm. Published March 22, 2018. Accessed November 11, 2019.

2. Couch DG, Maudslay H, Doleman B, Lund JN, O’Sullivan SE. The Use of Cannabinoids in Colitis: A Systematic Review and Meta-Analysis. Inflammatory Bowel Diseases. 2018;24(4):680-697. doi:10.1093/ibd/izy014.

3. Jamontt J, Molleman A, Pertwee R, Parsons M. The effects of Δ9-tetrahydrocannabinol and cannabidiol alone and in combination on damage, inflammation andin vitromotility disturbances in rat colitis. British Journal of Pharmacology. 2010;160(3):712-723. doi:10.1111/j.1476-5381.2010.00791.x.

4. Couch DG, Cook H, Ortori C, Barrett D, Lund JN, O’Sullivan SE. Palmitoylethanolamide and Cannabidiol Prevent Inflammation-induced Hyperpermeability of the Human Gut In Vitro and In Vivo—A Randomized, Placebo-controlled, Double-blind Controlled Trial. Inflammatory Bowel Diseases. 2019;25(6):1006-1018. doi:10.1093/ibd/izz017.

5. Irving PM, Iqbal T, Nwokolo C, et al. A Randomized, Double-blind, Placebo-controlled, Parallel-group, Pilot Study of Cannabidiol-rich Botanical Extract in the Symptomatic Treatment of Ulcerative Colitis. Inflammatory Bowel Diseases. 2018;24(4):714-724. doi:10.1093/ibd/izy002.

6. Foundation Position Statement: Medical cannabis. Crohn's and Colitis Foundation. https://www.crohnscolitisfoundation.org/sites/default/files/legacy/resources/MedicalCannabis-PositionStatement-November2018.pdf. Published March 2019. Accessed November 11, 2019.

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