cbd oil for inflammatory bowel disease

Can CBD Oil Help My Dog’s Inflammatory Bowel Disease?

Inflammatory bowel disease (IBD) in dogs is a condition that results in chronic intestinal inflammation. It can be serious, painful, and even dangerous, and needs to be treated by your veterinarian to avoid other serious health conditions.

If your dog is suffering from recurrent or chronic vomiting and/or diarrhea resulting in weight loss and poor appetite, consult with your veterinarian to rule out IBD.

Inflammatory bowel disease can affect any dog breed, with German Shepherds, Yorkshire Terriers, and Cocker Spaniels being the most prone to gastrointestinal disorders. IBD is a group of digestive system diseases that are diagnosed by specific symptoms, and also by inflammation without an exact cause.

IBD can affect dogs of all ages, breeds, and sexes. The most common age for the onset of this disease is six years in dogs, though it may affect dogs younger than two years of age.

If you have a furry best friend suffering from IBD, your vet may have recommended a CBD pet tincture. In this article, we’ll discuss why CBD may be beneficial for inflammatory bowel disease in dogs. Keep in mind that IBD is a serious illness that is painful and dangerous to pets.

Fortunately, IBD in dogs can be prevented and treated after a cause has been detected. That said, CBD pet products may be beneficial for decreasing intestinal inflammation, and promoting weight gain.

Glucocorticosteroids are also used as an anti-inflammatory but suppress the immune system, whereas cannabidiol can strengthen the immune system keeping your dog healthy and free of disease and infection.

What is Inflammatory Bowel Disease?

Inflammatory bowel disease, or IBD may be difficult to diagnose because of the many symptoms that are similar to other diseases. Severity of this condition depends on the type of immune cells involved which include lymphocytes and plasmacytes, eosinophils or neutrophils (bacterial infection).

There are two most common types that exist in pets. Let’s discuss these, and see how CBD may be beneficial.

Lymphocytic-Plasmacytic Gastroenteritis in Dogs

Lymphocytic-plasmacytic gastroenteritis is the most common form in dogs, and occurs when lymphocytes and plasma cells enter the stomach lining and intestines. This is a result of an abnormal immune response to environmental stimuli.

No exact cause is known, but intestinal bacteria may be the cause with the body reacting to the intestinal bacteria. The most common signs are diarrhea, but vomiting also occurs if the stomach has been affected.

Eosinophilic IBD

This is an inflammatory condition affecting the stomach and intestine, and is the second most common type of IBD affecting dogs. Eosinophilic IBD occurs when the lining of the stomach is affected by a specific white blood cell called the eosinophil.

Gastritis caused by the eosinophil (EGE) may be severe and causes intermittent vomiting. Eosinophilic IBD tends to be more serious than lymphocytic IBD.

How is IBD Diagnosed?

IBD may be difficult to diagnose. That said, intestinal changes caused by IBD can be seen when your vet uses an endoscope. Goals of treatment will be to reduce vomiting and diarrhea, to encourage weight gain, and to decrease intestinal inflammation. Modifying dog food diets may also be recommended, and may be effective.

Changes in your dog’s diet may also help enhance medications. This may allow for reduced drug dosages or for a discontinuation of meds once symptoms have improved.

Dog Food Diets for IBD

Dogs may benefit from a hypoallergenic or elimination diet. Your dog will need to have a new source of protein, and/ or diet changes. Sometimes homemade diets are recommended such as lamb and rice or venison and rice. Commercial diets for IBD are available from your veterinarian. The new diet needs to be fed for a period of up to six weeks, with no dog treats, unless approved by your vet. Dogs that have large intestinal diarrhea generally do well with diets that are high in fiber.

Tests for GI illness in Dogs

GI illness that includes vomiting and diarrhea in dogs also include fecal testing. Your veterinarian may do several tests to diagnose GI. These tests may include:

  • Microscopic fecal examination
  • Fecal Gram’s stain (to check for abnormal bacteria overgrowth)
  • Elisa Test to check for protozoa parasite Giardia
  • Fecal PCR test to check for the DNA of numerous parasites, bacterial toxins, and bacteria.

Symptoms of IBD

Symptoms will include vomiting, diarrhea with mucus, sometimes blood, and weight loss, and it may take your vet a while to get to the cause. Dogs affected with irritable bowel syndrome may also suffer from discomfort after eating, causing them to eat less and lose weight. You may also notice frequent, and smaller bowel movements.

Since IBD can result in nutritional deficiencies, the goal of treatment is to reduce diarrhea, encourage weight gain, and decrease intestinal inflammation.

With commercial pet food not specifically meeting all the nutritional needs of our pets, it’s important to include nutritional supplementation like probiotics and CBD to help with digestive issues. That said, supplementation taken as an individual supplement will ensure the right dosage and efficacy more so than supplements that are added into commercial dog food formulas.

Can IBD Be Cured?

Fortunately, IBD in dogs can be prevented and treated after a cause has been detected. Your vet may try out a series of meds, and/or try out new dog food diets to see which one your dog responds to. Because IBD is a complicated condition that may be confused with other common canine bowel problems, your vet will have to rule out other common bowel problems.

Parasites or dietary issues like food allergies need to be taken into consideration. Food allergies are most times an unlikely cause, but may contribute to the development of irritable bowel syndrome in dogs.

Intestinal Inflammation

  • Can result from excessive allergic reactions to food, bacteria, or parasites inside the intestine.
  • Intestinal inflammation damages the mucosal barrier that protects the intestinal lining, and results in the intestine becoming more sensitive to antigens.
  • If the intestine has persistent inflammation, it will result in it thickening, and cause other changes in the lining of the intestine.

That said, CBD oil may be beneficial for decreasing intestinal inflammation, and promoting weight gain. Glucocorticosteroids are also used as an anti-inflammatory, but suppress the immune system, whereas cannabidiol can strengthen the immune system keeping your dog healthy and free of disease and infection.

Gastroenteritis

Gastroenteritis refers to inflammation of the gastrointestinal tract. It normally occurs in the stomach and intestines resulting from a bacterial infection, parasites, or viruses. They can also come about from a reaction to a medication or a change in diet.

Diarrhea in Dogs

This is a sign of a digestive disorder, and can be attributed to numerous causes. Watery diarrhea that has large volume is usually linked to hypersecretion. This is a condition when there is excess fluid that is secreted into the intestines, and may be the result of a bacterial infection. It can also be caused by malabsorption where the body is unable to properly absorb nutrients.

Malabsorption

Malabsorption comes about when there’s a defect in the intestinal cells that are responsible for absorption. This can be due to viruses like parvovirus, coronavirus, and rotavirus. It can also be caused by defects that would limit the ability of the intestines to absorb liquids. Defects in the pancreatic secretions that are needed for effective digestion also cause malabsorption.

Diarrhea can result in dehydration and electrolyte imbalance in dogs, which may result in shock. That said, it’s best to consult with your veterinarian to check for specific disorders or diseases affecting the digestive system.

Treatment

Drugs may not be beneficial in every case involving diarrhea or constipation. Dogs will sometimes be prone to diarrhea when they need to get rid of harmful organisms and their toxins. Additionally, some of these drugs may not be beneficial in treating the condition. Your veterinarian may also recommend fluid and electrolyte replacement to prevent dehydration if your dog has severe vomiting or diarrhea.

Bloat

If your dog is suffering from one of the most dangerous conditions, bloat, immediate emergency veterinary care is critical in which a stomach tube or surgery may be recommended, if the digestive tract is distended with gas, food, or fluid.

Non-Infectious Diseases

The causes of non-infectious diseases that affect the digestive system will include the following:

  • Overeating
  • Consuming a low-quality diet
  • Chemicals
  • Consuming a foreign object that results with injury to the digestive system
  • Enzyme deficiencies
  • Gastric ulcers

Digestive system diseases include symptoms like vomiting and diarrhea due to kidney, adrenal gland, or liver failure. The causes of bloat or gastric torsion are still unknown.

What is CBD Oil?

CBD is a non-psychotropic phytocannabinoid that yields therapeutic and medicinal benefits for all dogs. To help you understand more about the benefits of CBD oil for dogs that have lost their appetite, CBD studies have shown that CBD may be beneficial in improving appetite, easing chronic pain, helping with digestive and skin issues and more!

CBD oil for pets contains 113 plus phytocannabinoids which work together as a therapeutic supplement. THC is the one phytocannabinoid that is not included in CBD pet products. Because hemp plants have low levels of THC to begin with, it makes it easier for hemp farmers to further eliminate THC levels even further so ensure 100% safety for all cats, dogs and horses.

Hemp CBD has a higher cannabidiol concentration, and lower THC level compared to marijuana. Hemp is a natural supplement that cannot be overdosed on. It’s safe and non-toxic, and excess cannabidiol is excreted. That said, it’s much healthier than giving your dog Benadryl or pain meds that may have long-term side effects, and harm the kidneys and liver, although with serious illnesses your dog will need to have pain meds and drugs.

2018 Study Demonstrating CBD Oil for Nausea & Loss of Appetite

A 2018 study shows how cannabidiol (CBD) may be effective in preventing nausea. The study adds that the researchers “ observed a surge in levels of the neurotransmitter serotonin in the rat interoceptive insular cortex (IIC) — a brain region responsible for nausea in humans — following injection with the nauseating chemical compound lithium chloride.

The increase in serotonin and subsequent gaping behavior (a behavior displayed by rodents to flavors paired with a nauseating treatments) was prevented by treatment with cannabidiol — a form of cannabis that does not contain the component found in recreational marijuana responsible for the drug’s psychotropic effects,” via EurekAlert.

The study goes on to add that “Treatment with a drug that elevates the endogenous cannabinoid, 2-AG, also prevented the elevation of serotonin in the IIC by activating the cannabinoid type 1 receptor. These findings implicate the endocannabinoid system and IIC serotonin release in the sensation of nausea, opening up new therapeutic opportunities to explore in future research.”

CBD interacts with the endocannabinoid system which controls endocrine processes. When it activates the receptors in the brain and body, CBD also influences the endocrine system. This system consists of a group of tissues that release hormones into the bloodstream, which in turn travel to other parts of the dog’s body.

CBD Interacts with the Endocannabinoid System (ECS)

Some hormones will only act on a single tissue, while other hormones affect the whole body. When cannabidiol is used in dogs with reduced appetite, it triggers a “jump start” on the endocannabinoid system, and stimulates appetite.

Cannabidiol acts on the endocannabinoid receptors and affects the receptors by regulating neural transmissions. CBD oil for dogs is helpful in the treatment of numerous conditions without taking on the intoxicating effect of marijuana.

Hemp CBD for pets contain phyto-cannabinoids, terpenes and fatty acids which support a huge range of ailments like phobias, anxiousness, joint pain, inflammation, digestive issues, mobility, seizures and anxiety. Today, there are numerous studies that indicate that CBD for pets may have many uses, some of which traditional meds fail to match.

Cannabidiol May Be Beneficial for Digestive Health in Dogs

First and foremost, if your dog is showing signs of illness, consult with your veterinarian for treatment. Some signs of digestive issues in dogs can be serious like poisoning, bloat, pancreatitis, liver or kidney failure or an obstruction in the gut or stomach. CBD does not replace veterinary care or treatment.

Gut Health & The Endocannabinoid System (ECS)

The ECS includes a series of receptors, specialized proteins, and neurotransmitters that all work together to regulate your dog’s body functions. With gastrointestinal motility issues, the ECS is important in regulating GI motility in dogs.

In addition, research has found that cannabidiol is effective in improving gastrointestinal motility. It does so by reducing inflammation and allowing for proper functioning of the digestive tract.

CBD as an Antibiotic

Another 2019, CBD study from the University of Queensland’s Institute for Molecular Bioscience with Dr. Blaskovich and his team of researchers together with Botanix Pharmaceuticals LTD, published in the American Society of Microbiology, found that cannabidiol is beneficial in fighting gram-positive bacteria like staphylococcus aureus and Streptococcus pneumoniae, with potencies similar to that of established antibiotics such as vancomycin or daptomycin. It’s now being researched for its potential as an antibiotic.

CBD for Inflammation Reduction in Dogs

A 2017 study concludes that “”Given cannabidiol’s documented anti-inflammatory effects, existing safety data in humans, and potential for varied delivery routes, it is a promising new antibiotic worth further investigation. The combination of inherent antimicrobial activity and potential to reduce damage caused by the inflammatory response to infections is particularly attractive,” via Science Daily.”

Importantly, the drug retained its activity against bacteria that have become highly resistant to other common antibiotics. Under extended exposure conditions that lead to resistance against vancomycin or daptomycin, Cannabidiol did not lose effectiveness. Cannabidiol was also effective at disrupting biofilms, a physical form of bacteria growth that leads to difficult-to-treat infections.”

Leading research published in Frontiers of Pharmacology adds that cannabidiol treatment improves endothelium dependent vasorelaxation in mesenteric arteries of Zucker diabetic fatty rats. It concludes that “ this study has shown that a short in vivo treatment protocol with CBD was associated with improvements in endothelium-dependent vasorelaxation in mesenteric arteries, and an improvement in the profile of cardiovascular and metabolic parameters,” via Frontiers Media SA.

Today, we understand how closely gut health is related to other body systems like the central nervous system and the immune system. With the endocannabinoid system playing a major role in the gut/brain axis of dogs, it seems that CBD hemp pet products may be beneficial for your dog’s stomach problems.

ECS helps regulate digestive signals and transmissions in the body. Receptors (CB1 and CB2) work better with support when the dog’s stomach is upset

It can also be used as a preventative care supplement to boost optimal health in pets.

A new 2020 study about how cannabinoids can help treat IBD in people adds that “ Endogenous cannabinoids (endocannabinoids) have shown a regulatory role in inflammation and mucosal permeability of the gastrointestinal tract where they likely interact with the gut microbiome. Anecdotal reports suggest that in humans, Cannabis exerts antinociceptive, anti-inflammatory, and antidiarrheal properties,” via PubMed.

CBD Oil for Dogs

Cannabidiol oil works together with the ECS to support gut health. If you’re opting to purchase a CBD tincture for your furry best friend as a digestive aid, be sure to look out for the following:

  • Organic CBD oil
  • Specifically formulated for pets
  • Offers accurate and informative dosing information
  • Offers a certificate of analysis (COA)

CBD can help pets with irritable bowel disease, gastritis, food allergies, and other stomach issues. Additionally, it may be beneficial for both parasites and infections. Studies are still ongoing. Cannabidiol pet products that are of a high-quality CBD oil can also help to reduce the effects of traditional veterinary medications to help dogs feel more comfortable while they’re being treated.

CBD may also help by increasing your dog’s appetite, and also by boosting your dog’s weakened immune system. Cannabidiol tinctures or treats are also beneficial for reducing stress and pain in dog’s that are suffering from an upset stomach.

Minimizing your dog’s digestive issues while boosting immune health involves more than just a high-quality dog food formula. Why some dogs are prone to IBD is unknown. What we do understand is that the extensive infiltration of cells from the immune system into the intestinal tissues causes painful inflammation. Dogs suffering from IBD may display numerous symptoms that may mimic other diseases.

Adding probiotics and/or CBD may be beneficial to guard against intestinal distress, bloat, and to inhibit the growth and activity of harmful bacteria via live microbials. A dog’s immunity also resides in his gut, meaning that looking after your furry best friend’s gut health may just ensure optimal health, vitality, and focus!

Cbd oil for inflammatory bowel disease

Cannabis in inflammatory bowel disease: a narrative summary

Camilo Castañeda Cardona , MD 1

Pieralessandro Lasalvia , MD 2

Alexandra Ferreiros , MD 3

Camila Pantoja Ruiz , MD 4

Paula Restrepo Jiménez , MD 5

Diego Rosselli , MD 6 *

1 Médico cirujano y neurólogo. Gerente de proyectos en Neuroeconomix, Bogotá, Colombia

2 Médico cirujano. Departamento de Epidemiología Clínica y Bioestadística de la Pontificia Universidad Javeriana. Bogotá, Colombia

3 Médico y cirujano, residente de neurología. Hospital Universitario San Ignacio, Bogotá, Colombia

4 Médico y cirujano, residente de neurología. Hospital Universitario San Ignacio, Bogotá, Colombia

5 Médico cirujano, residente de oftalmología. Hospital Universitario San Ignacio, Bogotá, Colombia

6 Médico cirujano, neurólogo, MSc, MEd. Profesor del departamento de Epidemiología Clínica y Bioestadística en la Pontificia Universidad Javeriana. Bogotá, Colombia

Although cannabinoids have been used for several years, only recently have their mechanisms of action and therapeutic targets been described. Alterations in the endocannabinoid system have been observed in various diseases and conditions such as pain, inflammation, autoimmune diseases and various specific disorders. Inflammatory bowel disease groups two chronic idiopathic conditions with uncertain pathogeneses in which deregulation of the immune system plays an important role. Alternative treatments need to be developed for these patients since only a minority of patients achieve disease remission. Our goal is to review recent evidence related to the use of cannabis to treat ulcerative colitis and Crohn’s disease.

This is a focused narrative review based on searches of Pubmed and Embase. Relevant articles have been reviewed and summarized in narrative form.

The two main components of cannabis, CBD and THC, have been extensively studied, and their anti-inflammatory and antinociceptive effects have been tested. The effects of these components for control of the symptoms of ulcerative colitis and Crohn’s disease have been widely described. However, high quality studies are needed to continue evaluating the efficacy and safety of cannabis use in patients with inflammatory bowel disease.

Keywords: Cannabis; medical marijuana; ulcerative colitis; Crohn’s disease; inflammatory bowel disease

si bien los cannabinoides se han utilizado durante varios años, apenas recientemente se han descrito los descubrimientos sobre sus mecanismos de acción y blancos terapéuticos, así como las alteraciones en el sistema endocannabinoide, observadas en diversas enfermedades y condiciones que se manifiestan con dolor, inflamación, patologías autoinmunes y distintos desórdenes específicos de los órganos. La enfermedad inflamatoria intestinal (EII) agrupa dos condiciones idiopáticas crónicas con patogénesis incierta, en las que se ha identificado que una desregulación del sistema inmune desempeña un papel importante. Así, pues se necesita desarrollar tratamientos alternativos para estos pacientes, ya que solo una minoría de ellos alcanza una remisión de la enfermedad. Nuestro objetivo es revisar las evidencias recientes relacionadas con el uso de cánnabis en la colitis ulcerativa (CU) y en la enfermedad de Crohn (EC).

se realizó una revisión narrativa focalizada, a partir de las bases de datos de búsqueda de Pubmed y Embase. Los artículos pertinentes fueron revisados y resumidos en forma narrativa.

los dos componentes principales del cannabis, el cannabidiol (CBD) y el tetrahidrocannabinol (THC), han sido estudiados extensivamente y han probado causar efectos antiinflamatorios y antinociceptivos. Se han descrito ampliamente las propiedades de estos componentes en el control sintomático de la CU y de la EC. No obstante, se sugieren estudios de alta calidad para seguir evaluando la eficacia y la seguridad del uso del cannabis en pacientes con la EII.

Palabras clave: Cannabis; marihuana medicinal; colitis ulcerativa; enfermedad de Crohn; enfermedad inflamatoria intestinal

Cannabis has been used for decades for both its medicinal and psychotropic properties. The discovery of cannabinoids, key active components of Cannabis sativa, and research into their mechanisms of action and molecular targets are relatively recent. 1 , 2

The two main components of marijuana are tetrahydrocannabinol (THC), known for its psychoactive effects, and cannabidiol (CBD), a non-psychotropic substance found in high concentrations in the plant. 3 The molecular targets for cannabinoids have been described as G protein-coupled cannabinoid receptors. CB1 and CB2 have been identified as the two key receptors of their endogenous ligands, endocannabinoids. 1 , 3

Alterations in the endocannabinoid system have been observed in various diseases and conditions. They manifest with pain, inflammation, autoimmune diseases, allergic conditions, neurological and neuropsychiatric disorders, obesity, cancer, and cardiovascular and gastrointestinal diseases. 1

Inflammatory bowel disease (IBD) includes two types of idiopathic conditions: ulcerative colitis (UC) and Crohn’s disease (CD). 4 Neither condition’s pathogenesis is yet certain, but dysregulation of the immune system in response to gut microbiota appears to be complicated and leads to inflammation of the gastrointestinal tract. 4 , 5 The two diseases have peak incidences between the second and fourth decades of life without significant differences between genders. 4 Slight differences related to race or ethnicity have been identified. Western populations tend to have higher prevalences of UC and CD, 4 , 5 but the prevalence of IBD has increased markedly in developing countries. Indeed, recent evidence suggests that incidence is increasing in South America, Asia, Africa and Europe. 5 , 6

Identification of several inflammatory pathways in IBD has led to the use of immunomodulatory and anti-inflammatory agents. 7 Since IBD is considered to be an incurable chronic disease, treatment goals aim to minimize symptoms, improve quality of life and reduce the progression of the disease and associated complications. 4

The main agents used to manage IBD include anti-inflammatories, immunomodulators, immunosuppressants, and biological compounds such as tumor necrosis factor inhibitors (Tumor Necrosis Factor, anti-TNF). In addition, new therapeutic options include biosimilars of the most widely used anti-TNF agents and Janus kinase inhibitors. 8

Because about 40% of patients do not achieve remission surgery is often required. 5 Consequently, there is a need to develop alternative treatments which has led us to review recent evidence regarding the use of cannabis to manage UC and CD.

The Endocannabinoid System and Cannabis

The endocannabinoid system consists of endogenous cannabinoids, cannabinoid receptors, and enzymes responsible for synthesis or degradation of cannabinoids. 9 In contrast to classical neurotransmitters which are produced and stored in synaptic vesicles, endocannabinoids are produced and released immediately on demand. 1 , 9 , 10

Several receptors have been described in the endocannabinoid system, but the effects of endocannabinoids are mainly mediated by CB1 and CB2 receptors which are coupled to the G protein. 1 , 3 , 9 CB1 receptors are present at high density in the central nervous system (CNS) especially in the cortex, basal ganglia, hippocampus, and cerebellum. 9 , 10 Apparently, low concentrations of these receptors are found in the brain stem which explains the low toxicity of cannabinoids. 11

In contrast, CB2 receptors are highly expressed on peripheral and immune cells, including mast cells, lymphocytes, macrophages, natural killer (NK) cells, mononuclear cells, and microglia. 9 – 11

Lesions and tissue inflammation induce high levels of CB2 expression. Activation of the CB1 and CB2 receptors has consequences for synaptic functioning gene transcription and cell motility. 9 Other receptors described in the endocannabinoid system include the G protein-coupled receptor 55 (GPR55) and Transient receptor potential vanilloid subtype 1 (TRPV1).

Distribution of GPR55 varies since it occurs in the CNS and other organs, while TRVP1 is found predominantly in the nociceptive terminals of the peripheral nervous system (SNP) and, to some degree, in the CNS. 11 Acharya et al. have reviewed the role that endogenous cannabinoids play in maintaining immune homeostasis in the gut and found that anandamide, an endogenous cannabinoid, is an important promoter of regulatory T cell and macrophage differentiation since they promote expression of CB2 and TRVP1 receptors. 12

Various studies have evaluated the function of the endocannabinoid system in gastrointestinal diseases such as IBD. A review by Hasenoehrl et al. described alterations in 5-hydroxytryptamine (5-HT) signaling that led to symptoms such as abdominal pain, altered intestinal peristalsis, and abdominal discomfort. 13 Similarly, a link between 5-HT and endocannabinoid levels has been identified suggesting a possible positive role for administration of cannabinoids or cannabinoid receptor agonists for management of these conditions.

IBD is characterized by dysregulation of the gut microbiota which can alter gut permeability. 14 The epithelial cells of the intestine express CB receptors which can regulate the permeability of the intestine. This occurs because 2-arachidonylglycerol and N-palmitoylethanolamide (PEA) appear to increase the intestinal barrier while anandamide apparently decreases it. 13 This suggests the existence of an important role for the endocannabinoid system in the regulation of the permeability of the intestine and in exposure of microbes to the immune system.

In addition, Pertwee’s review of the pharmacology of the CB1 and CB2 receptors mediated by the two main components of Cannabis sativa, THC and CBD, showed that THC is capable of activating both receptors. 2 It suppresses locomotor activity, hypothermia and CB1 receptor mediated antinociception in vivo in healthy mice. Furthermore, it has been reported to help relieve symptomatic pain relief in patients with multiple sclerosis, cancer, chronic pain, and other conditions.

Given the presence of CB1 receptors in neurons, THC has been shown to inhibit the release of certain neurotransmitters and promote the release of others in specific regions of the brain suggesting that this is the mechanism that causes psychoactive effects. 2

CBD also has the ability to activate both CB1 and CB2 receptors, although it shows a lower affinity for them than THC does. Lower concentrations of CBD are required for their interaction, and CBD has been reported to inhibit migration of immune cells and reduce clinical signs of inflammation. It appears to be an agonist for CB1 receptor agonists and an inverse agonist for CB2 receptors. This characteristic may explain its anti-inflammatory properties. 2 , 3

Capasso et al. wrote that CBD has been observed to have antioxidant, neuroprotective and antiproliferative, anxiolytic, hypnotic, anticonvulsant, anti-nausea and anti-inflammatory effects. 15

Mechoulam et al. focus on CBD’s powerful antioxidant effects which appear to inhibit the release of reactive oxygen species and production of nitric oxide by neutrophils. An increase in interleukin-12 (IL-12) and a decrease in interleukin-10 (IL-10) have also been documented after use of CBD. They also reported an immunosuppressive effect caused by inhibition of IL2 production. 3

Endocannabinoid overexpression has been shown to have a protective role in intestinal inflammation in experimental models of colitis. These effects are thought to be mediated by CB1 and CB2 receptors, involved in visceral perception, intestinal motility, inflammation, and endothelial damage. 1 Activation of CB1 receptors inhibits the release of acetylcholine thereby decreasing intestinal smooth muscle contractility. Although CB2 receptors have been reported to be present in the enteric nervous system (ENS), their role in controlling peristalsis is believed to be minor. 13

The Pathophysiology of IBD

The development of UC and CD involves the interaction of environmental factors, genetic factors, gut microbiota, and immune response. 14 Various environmental factors such as smoking, diet, lifestyle, and medications appear to alter the gut microbiota in genetically susceptible individuals. In the presence of a weakened intestinal barrier, these changes in the microbiota favor activation of the immune system and chronic intestinal inflammation. 5

The role of environmental factors in various autoimmune diseases has been extensively studied within this context. In IBD, individuals who have been exposed to smoke, early use of antibiotics, consumption of food additives, and low levels of vitamin D appear to be at increased risk of developing these conditions. Similarly, improvements in such diverse issues as access to purified water and home health services, higher vaccination rates, and use of antimicrobials have clear correlations with lowering rates of IBD and other autoimmune diseases. 14 , 16 , 17

Regarding genetic susceptibility, a number of studies have identified various genes with immune regulatory functions and others that mediate bacterial recognition associated with the development of CD and UC. 5 , 14 , 16

Several enriched loci have been identified for genes involved in immunodeficiency, in proper functioning of T cells, and in modulation of cytokine production that are all related to IBD. 14 A recent study has found a significant association of the CB2-R63 variant with CD in children. 18 In addition, other genetic variants of components of the endocannabinoid system may be related to IBD 13 .

Therefore, aggregation of the IBD family suggests genetic susceptibility. Many genes have been found to be associated with IBD, but this relationship only explains 25% of total IBD cases and only 7% of UC cases. 5 , 16

The immune system is mostly shaped by early contact with microbes and therefore depends on the environmental exposure of an individual through diet and hygiene practices. 5 , 14 In this sense, the intestinal immune system is generally tolerant to high loads of microbes. Although the loss of immune tolerance has been described as an important step in the pathogenesis of IBD, the evidence is more consistent regarding the role of this loss of tolerance in the appearance of CD and UC. 6

Decreased richness and alterations in the composition of the microbiota have been observed in patients with IBD. This generates defects in mucosal immunity and can also lead to development of illness. 6 , 8 , 16 , 17

Thus, in IBD, infiltration of the intestinal mucosa by neutrophils which occurs early in the process of inflammation is responsible for disruption of the intestinal barrier, destruction of tissue and perpetuating inflammation. 14 Macrophages play an important role in the pathogenesis of CD, as they appear to produce large amounts of interleukin-6 (IL-6), interleukin-23 (IL-23), and TNF while also promoting production of interferons (IFN) by mononuclear cells.

In UC, neutrophils appear to accumulate in the blood and colonic tissue of patients. 16 Dendritic cells are responsible for mediating interference with B and T cells and for maintaining homeostasis. In IBD these cells appear to be conditioned to promote inflammation by expressing increased levels of TLR2 (Toll-like Receptor 2) and TLR4 (Toll-like Receptor 4) as well as producing more IL- 12 and IL-6. Apparently, they also express molecules that mediate their attraction and retention in the inflamed mucosa. 14 , 16

Increases in the production of interleukin-1 (IL-1), IL-6, TNF and other cytokines have been described without distinction between UC and CD. 6 So far, there is no clear evidence of dysregulation of innate immunity in UC while the opposite occurs in CD in which abnormalities in innate immunity are related to genetic variations. 6

Although the role of antibodies in UC and CD has yet to be determined given that no antibodies have been found in either disease, they have been shown to have a pathogenic role and their presence supports altered humoral activity towards bacterial antigens. 6 , 14 Nevertheless, there is very little evidence that these conditions are antibody mediated diseases. 16

Innate lymphoid cells play a central role in the pathogenesis of IBD, whereas cells isolated from UC patients have shown increased expression of interleukin-17A (IL-17A), interleukin-22 (IL-22), transcription factors and various cytosine receptors. 16 Similarly, alterations in adaptive immunity have been described in UC since disproportionate increases in immunoglobulin levels have been detected during development of this disease. 6

In addition to the role of innate and adaptive immunity in the pathogenesis of IBD, alterations in the mucosal barrier of the intestine have also been observed in patients with UC and CD. 14 , 16 These alterations result in increased permeability of the mucosal barrier which allows bacteria to reach the epithelium and trigger an immune response. 14 .

As inflammation occurs in the vicinity of the epithelium in UC, colonocytes become very involved in the pathogenesis of this disease. 6 Intestinal fibrosis is a common complication of IBD although it develops in different places on the intestinal in UC than it does in CD. Both lymphangiogenesis and angiogenesis occur in IBD and help perpetuate inflammation. These three processes are believed to occur in response to chronic inflammation and secretion of proliferation factors coupled with poor control mechanisms. 14

Numerous alterations of the morphology and immunohistochemical composition of the ENS have been described in IBD. Neuropeptides such as substance P, corticotropin-releasing hormone, neurotensin, vasoactive intestinal peptide, opioid receptors, and galanin appear to be involved in the pathogenesis of IBD.

This focused narrative literature review is based on searches of the Pubmed and Embase databases. For interventions with cannabis, the following medical subject headings (MeSH) and associated free terms were used through the Boolean operator “OR”: “Marijuana”, “Ganja”, “Hashish”, “ Hemp “,” Bhang “,” Cannabis sativa “,” Cannabinoids “,” Cannabinol “,” Dronabinol “,” Tetrahydrocannabinol “,” CBD “and” THC “.

For health conditions, the MeSH and free terms were “inflammatory bowel disease”, “Crohn’s disease” and “Ulcerative colitis”. These terms were associated with the Boolean operator “OR”. The intervention and the health condition of interest were associated with the Boolean operator “AND”.

A total of 526 articles were obtained without language or date restrictions. One author (Paula Restrepo Jiménez) reviewed and selected those with the most recent or pertinent information.

Cannabis in IBD

Complementary and Alternative Medicine (CAM) is considered to be separate from conventional medical practice. 19 About 30 to 50% of IBD patients use CAM, and predictors of its use have been identified as side effects of conventional therapies, female gender, long progression of disease, and long-term use of steroids. 20

Among the most common CAM treatments are herbs. Marijuana use is more common among patients with IBD than in the general population: about 15% of IBD patients use it to relieve symptoms such as nausea, abdominal pain, diarrhea, and increased appetite. 18 , 20 , 21

A review of the current literature on the use of cannabis for managing experimental and human IBD by Ambrose and Simmons has described the presence of CB1 receptors in the colonic epithelium, in the plasma cells of the lamina propria, in the smooth muscle and in the submucosal myenteric plexus. 18 CB2 receptors have been identified in goblet cells of the epithelium, in Paneth cells, in macrophages, and in plasma cells of IBD patients.

Thus, changes in expression of CB1 and CB2 receptors have been observed in relation to the inflammatory process of the intestine. Endocannabinoid levels have also been found to be altered in IBD patients. An observational cross-sectional study conducted in Chile evaluated the use of CAM in 200 patients with IBD and found around 25% of those patients were then using CAM, close to 30% had previously used CAM, and 45% had never used CAM. 22

A descriptive cross-sectional study of 99 adolescent and young adult patients in Colorado with UC, CD, or undetermined IBD found that 68% of reported not using cannabinoids, but 32% reported using cannabis on one or more occasions. Among those who had used cannabinoids, 52% reported weekly use, and 31% reported daily use. 23

A recent study evaluated the profiles of patients who use marijuana to control IBD through a survey of 1,666 adults who self-identified as IBD patients. 24 Of those who used marijuana (114/1666), about 80.7% perceived benefits from its use. The principal symptoms that improved were pain, appetite, anxiety, fatigue, stool frequency, weight gain, bloody stool and nausea.

Another survey of 302 CD patients in Boston found that the rate of marijuana use has increased since 2012. 25 However, no significant increases in the medical use of cannabis were observed. Similarly, predictors of marijuana use were identified since a significant number of patients with previous hospitalizations and current biological therapy used marijuana.

The most common symptom for which marijuana was used was abdominal pain, and 35 out of 39 patients reported complete or moderate relief after treatment. Nausea, poor appetite, and diarrhea were also common symptoms treated by the participants and were mostly alleviated.

Phatak et al. 26 used a prospective questionnaire with 53 patients in a pediatric IBD clinic and found that 24 used marijuana for medicinal reasons. The 24 patients justified the use of this substance was and little appetite, 21 consumed it to control nausea, and 20 used it to control diarrhea. Complete relief was reported for abdominal pain in 29%, for poor appetite in 37%, for nausea in 14%, and for diarrhea in 10% of cases.

Meanwhile, a summary of the results of several studies published by Cheifetz et al.) described the positive effects of cannabis use for IBD. Patients seemed to show reductions of disease activity although most controlled studies did not reach their primary end points. 18 , 20

A systematic review by Katchan et al. of the role of cannabinoids in autoimmune diseases has summarized many effects mediated by CB1 and CB2 receptors as well as various alterations described earlier in this article. 27 They highlighted the need for additional studies and clinical trials to clarify its action, safety and its efficacy for these patients even though there is evidence that treatment with cannabinoids can have a positive effect for IBD patients.

A systematic review and metaanalysis by Couch et al. that was updated in March 2017 found 105 experiments comparing cannabinoids with placebos or excipients. 28 Of these experiments, 63.8% favored cannabinoids, 32.3% showed no differences, and 3.8% were favorable to the excipient. Mice were used in 89 experiments of which 68.5% favored cannabinoids.

Cannabinoids were administered therapeutically in 37/104 experiments, prophylactically in 19/104 experiments, and prophylactically and therapeutically in 48/104 experiments. The results favored the cannabinoids in all of the last group.

Two other clinical trials have evaluated the effects of CBD and THC on CD.

In the first study, eleven patients were treated with 115 mg of inhaled THC and 10 patients received placebos. After 8 weeks, the group treated with THC had a non-significantly lower rate of remission than did the group that received placebos when evaluated by the Clinical Disease Activity Index (CDAI) (p = 0.43). 29

However, a significant increase in the treatment group’s quality of life found with the SF-36 questionnaire (p = 0.04). No significant differences were found between the groups’ blood counts, C-reactive protein, liver and kidney function tests, or side effects.

The second study randomized patients to either receive 10 mg of CBD or placebos orally twice daily. There were 10 patients in the study group and 9 in the placebo group. A non-significant difference in CDAI was observed between groups after 8 weeks of treatment. Similarly, no significant differences were found between the groups in blood tests or in side effects. 30

The metaanalysis of these studies showed that the two phytocannabinoids, CBD and THC, decreased severity scores below those of patients given placebos. Similarly, metaanalysis of 34 rat and mouse model studies found that cannabinoid drugs reduced CDAI with the excipient. However, a significant difference was observed among subtypes of the groups. 28

Lahat et al. 31 analyzed the impact of cannabinoids on quality of life, weight, and disease activity in patients with IBD through a prospective pilot study that included 13 patients. After 3 months of inhaled cannabinoid treatment, patients showed a significant reduction in pain intensity and depression as well as in the Harvey-Bradshaw index. Similarly, these patients’ perceptions of their own health, social functioning and ability to work improved.

A case-control pilot study that compared botanical extracts rich in cannabidiol to placebos for symptomatic treatment of UC randomized 60 patients into a treatment group of 29 patients and a control group of 31 patients. 32 It found that remission rates observed in the treatment group were higher than those of the placebo group (Odds ratio [OR] = 1.30; 90% confidence interval [CI]: 0.42 to 4.04). However, the difference was not statistically significant.

Similarly, the treatment group’s disease severity lessened and quality of life scores improved, but differences were not significant. Adverse events were reported in 90% of the treatment group, compared to 48% of the placebo group. As expected, the most common adverse events, dizziness and drowsiness, were related to the nervous system.

In contrast, adverse events associated with possible disease progression were reported in 42% of the placebo group compared to only 10% of the treatment group.

The safety profile of cannabis has not been well established as few controlled studies have been conducted. Swaminath et al. reported results of a retrospective study in which the use of cannabis was associated with increased risk of surgery, but causality cannot be attributed given the nature of the study design. 21 , 33

In addition to the administration of cannabinoids, another potential therapeutic strategy may be to inhibit catabolism of endocannabinoids by blocking degradation enzymes. Anandamide degrades to arachidonic acid and fatty acid amide hydrolase while 2-acylglycerol,another cannabinoid, degrades to monoacylglycerol lipase. Pesce et al. suggest that inhibition of the enzymes responsible for these processes could increase the levels of endocannabinoids which act as indirect agonists and could reduce pain and inflammation. 34

Various studies have evaluated the effect of cannabis on experimental models of colitis. Borrelli et al. 35 investigated the effects of CBD on colitis induced by colonic administration of 2,4,6-trinitrobenzenesulfonic acid in mice. Administration of CBD in doses containing 1 to 10 mg/kg significantly reduced the macroscopic damage associated with colitis. The maximum protective effect was achieved with the 5 mg/kg dose.

In addition to macroscopic findings, microscopic evaluation of mice treated with 5 mg/kg CBD found glandular regeneration and edema of the lower mucosa and submucosa. Thus, administration of 5 mg/kg to mice attenuated the expression of inducible Nitric-Oxide Synthase (iNOS) and the production of nitrites. An imbalance in the production of proinflammatory and anti-inflammatory interleukins has been shown to be a major event in intestinal inflammation. The authors described a CBD-counteracting effect on altered interleukin production. All the characteristics described above reaffirm the anti-inflammatory effects of CBD.

THC, the main component of marijuana, has been shown to produce various biological effects in humans and animals. In the gastrointestinal tract, stimulation of CB1 cannabinoid receptors appears to mediate inhibition of excitatory transmission in animals which reduces peristalsis. Several studies have evaluated the effect of CBD on hypermotility of inflamed intestines caused by administration of croton oil to mice.

Thus, Izzo et al. wrote that both natural and synthetic cannabinoid receptor agonists (cannabinol) reduced upper gastrointestinal motility in control mice and those treated with croton oil, with more noticeable effects when intestinal inflammation was present. 36

It is important to mention effects were mediated by CB1 receptors became notorious, since the use of CB1 antagonists counteracted the effect, but this was not observed when CB2 antagonists were used.

Capasso et al. described similar results with the non-psychotropic component of marijuana, CBD. As in the study by Izzo et al., they found no changes in gastrointestinal motility in control mice. 15 , 36

For their part, Pagano et al. reported that oral or CBD provided orally or peritoneal administration reduced intestinal inflammation and damage in an experimental model of colitis. 37 Furthermore, it improved intestinal hypermotility in animals treated with croton oil. This suggests that these may components act on the basis of overreaction of receptors only under conditions of inflammation.

Some authors suggest that the effects observed may be mediated by stimulation of immune cells CB2 receptors. In an experimental model of colitis described by Leinwald et al., CB2 receptor upregulation occurred in response to inflammation and stimulation of these receptors induced pro-regulatory and anti-inflammatory effects. 38

Similarly, Singh et al. 39 reported that the use of a selective CB2 agonist reduced experimental colitis and induced apoptosis of inactive T cells. This inhibited T cell production of inflammatory cytokines and inhibited migration and filtration of inflammatory cells in the colon.

However, Storr et al. 40 showed that drugs that target both CB1 and CB2 receptors could be more effective for protecting against colitis than selective drugs. Mice knocked out by CB1 receptors appeared to show an exacerbation of colitis, while those knocked out by CB2 did not. Nevertheless, targeting CB2 receptors has been shown to be effective for limiting colitis. 41

Jamontt et al. evaluated the effects of CBD and THC alone or in combination in an experimental mouse model of colitis. 42 Treatment with these two components in doses of 10 mg/kg led to reductions in damage, neutrophil infiltration, and motility disturbances similar to those obtained with sulfasalazine, a standard treatment for IBD. In any case, the authors suggest that reduction of myeloperoxidase (MPO) activity could be an indirect effect of THC since it reduces the levels of cytokines involved in the recruitment of neutrophils.

Meanwhile, Schicho et al. evaluated the effect of an atypical cannabinoid (O-1602) in two experimental models of colitis. 43 This cannabinoid may act through the GPR55 receptor and inhibit neutrophil migration. The authors described that these atypical cannabinoids protected against experimental colitis by inhibiting recruitment of neutrophils, independent of CB1, CB2 and GPR55 which suggests the existence of other receptors that regulate this effect.

Cannabigerol (CBG), another non-psychotropic cannabinoid, has been shown to reduce generation of inflammatory cytokines, reduce production of reactive oxygen species, reduce the number of macrophages and reduce the number of mast cells in experimental models of IBD. 44

Harvey et al. have studied the effect of anandamide and CBD on human colonic explant tissue treated with IL-17A, an interleukin known to be expressed in large numbers in UC, as well as being present in colonic mucosal tissue and serum from CD patients. 45

Treatment with CBD significantly reduced both luminal and crypt epithelial damage, whereas anandamide treatment did not reduce crypt damage but reduced luminal epithelial damage. Thus, the protective effect of anandamide is thought to be caused by stimulation of CB2 receptors which reduces the production of IL-17A by T lymphocytes.

Consequently, the effect of CBD is not completely clear. It appears to activate PPAR-y receptors which mediates the anti-inflammatory response more than it activates CB1 or CB2. Couch et al. found that CBD represses phosphorylation of various intracellular proteins and represses production of proinflammatory cytokines in explant colonic tissue simulated with IFN and TNF. 47

The authors also showed that CBD has anti-inflammatory effects on explant tissue of IBD patients and attributed this characteristic to the presence of immune cells in the tissue. Enteric cells are known to mediate acute and chronic inflammation through production of pro-inflammatory cytokines which amplify immune responses.

De Filippis et al. evaluated the effect of CBD on the brain-gut axis. Their findings suggest that CBD treatment results in protection from intestinal damage secondary to modulation of the glial-immune axis in cultured biopsies of UC patients. 46

In addition to THC and CBD, other phytocannabinoids such as CBG, cannabinol (CBN), tetrahydrocannabivarin (THCV) and tetrahydrocannabinolic acid (THCA) have been shown to have beneficial effects although further studies are needed to establish their actions and dosages. 47

Various preparations of cannabis sativa have been used for a number of years for treatment of different medical conditions. The two main components of cannabis, CBD and THC, have been extensively studied and proven to exert anti-inflammatory and antinociceptive effects, suggesting a possible role in symptomatic control of IBD.

Although symptom relief and quality of life improvements have been obtained in clinical studies, more high-quality research is required to assess the immediate and long-term efficacy and safety of cannabis use for treatment of UC and CD.

Swissx CBD Products Can Help Improve Symptoms of Ulcerative Colitis

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that affects the colon, and can cause inflammation and ulcers in those suffering from the illness. UC symptoms include diarrhea, abdominal cramps and pain, bloody stool, and the need to pass stool frequently. But research shows that people suffering from UC can now treat their pain and inflammatory bowel symptoms through the use of CBD products, including Swissx’s unique blend of CBD plants.

Swissx’s CBD offers many beneficial effects to the physical health of people living with UC. While there isn’t a cure for the disease, treatment prioritizes symptom relief and reducing flare-ups. So many sufferers are turning to alternative treatments, such as CBD, to control the illness and improve their quality of life. Swissx’s CBD products are useful supplemental therapy in the management of UC symptoms.

CBD interacts with the endocannabinoid system (ECS) in the body, which regulates cardiovascular, nervous and immune system functions. CBD also binds to and activates receptors in the brain that create a therapeutic effect in the body, which helps users find relief from painful symptoms without feeling impaired.

There are also many therapeutic properties in CBD, which is a known anti-inflammatory, antimicrobial and antioxidant. Due to its anti-inflammatory properties, CBD is a perfect therapeutic treatment for UC.

Several studies have been conducted on CBD to see if it’s a potential treatment for UC. The results show that CBD may potentially help reduce inflammation in the gastrointestinal system caused by IBDs, such as UC.

One study found that participants with UC who took 50 milligrams (mg) of CBD oil twice a day, increasing to 250 mg per dose if needed and tolerated, experienced significant improvements in their quality of life. Another study analyzed the efficacy of CBD use in adults with UC. The study concluded that CBD extracts may help alleviate symptoms of IBDs, including UC.

Although more research is needed, current study results show that CBD is beneficial for treating symptoms of UC. While CBD won’t cure the disease, it may also help reduce flare-ups.

Using Swissx CBD to treat UC doesn’t lead to adverse health effects. In an assessment on CBD, the World Health Organization (WHO) noted that CBD is generally well tolerated, and doesn’t show any indicators of potential for abuse or dependence.

One of the most highly effective forms of CBD to use in order to help treat symptoms of UC is hemp oil, of which Swissx sells several forms. One such product is the OG Skywalker Blend CBD Gold Label oil, which is sold in one gram syringes. Swissx’s Gold Label is considered to be a part of the upper elite of the available CBD oils, as it contains a CBD share of 50% and 3% THC. Swissx Gold Label CBD Oil, which is made in accordance to legal measures, is being sold in glass syringes for $50. (Note that due to its highly potency, consumers shouldn’t use more than the suggested amount.)

One of Swissx’s most highly effective forms of CBD to use in order to help treat physical pain and stress is its finest 0.7 gram Delta-8 joints, which are richly-flavored with premium terpenes, and contain less than 0.3% THC 18%. The pre-rolled CBD joints also contain over five grams of Swissx’s Raspberry OG KUSH, WaterMelon Skittles, Headband Og and Wedding Cake. Swissx’s Delta-8 joint six-pack, which retails for $60, is now available on the company’s official website.

Swissx also sells CBD crumbles, a concentrated cannabis extract that’s very potent, which helps provide its users with quick relief. The company’s highly rated pure OG Kush Crumble is a legal dab that’s made from premium Hemp flowers in Switzerland, and doesn’t include any THC. The crumble, which can also be added into food and drinks, is being sold for $20.

Swissx is one of the leading companies in the world that supports affordable and healthy cannabis use. Its CBD products improve the quality of life of people who have genetic predisposition to such ailments as anxiety, depression and insomnia, as well as general physical pain. For more information on Swissx, which was founded and run by Greek billionaire-CEO, Alki David, visit the company’s official website.

In addition to its CBD products, Swissx has also become known for its popular streaming service, Swissx TV. The streaming service enables viewers to watch live and recorded UK and international television shows, movies and music videos in a variety of genres, including news, sports, drama, comedy, horror, lifestyle, shopping, pop, EDM and blues. For more information on Swissx TV, visit the service’s official website.