Mounting evidence suggests that medical cannabis can relieve symptoms of inflammatory bowel disease (IBD) – but what role does it have to play in treatment? Sarah Sinclair reports.
“For seven or eight years cannabis was a lifeline for me. I really don’t know if I’d be here without it,” says Alex Fraser.
“It’s not that the disease would have killed me, but that it was so awful that I might have taken my own life if I hadn’t had the relief from cannabis.”
He adds: “I don’t say that lightly. It’s such a horrific disease that people do, especially when diagnosed young, sadly take their own life.
“It’s that severe and there’s that much pain.”
Alex, 29, was diagnosed with Crohn’s Disease 10 years ago. He was already using cannabis recreationally when he started to see an improvement in his symptoms.
Without it he could find himself rushing to the toilet up to 12 times a day. But the cannabis reduced this drastically, as well as easing his pain and nausea, boosting his appetite and helping him to sleep. All of which had a knock on effect on his overall quality of life.
“Cannabis allowed me to have a good quality of life despite having difficulties with the disease, it certainly didn’t eliminate my symptoms but it did help me cope,” he says.
“I think people underplay that aspect of cannabis, joking about the munchies, but without any appetite I would have lost a lot more weight and become much more unwell as a result.
“It’s so important to have a good sleep and three meals a day, especially when you’ve got such a serious illness.”
In 2014 Alex’s disease was manageable enough for him to form the United Patient Alliance, advocating for better access to medical cannabis, and went on to become involved with the End Our Pain movement, supporting the campaigns of Billy and Charlotte Caldwell and Hannah Deacon and Alfie Dingley.
He would later find cannabis to be a relief for his mental health, after having surgery and a colostomy bag fitted as a result of his Crohn’s in 2017.
“It was certainly something I struggled to come to terms with and cannabis was a lifeline for me afterwards in helping with my mental health and anxiety,” he admits.
Since the surgery Alex’s Crohn’s Disease has been in remission and he now has a full-time role as patient access lead with Grow Pharma, a UK supplier of unlicensed cannabis medicines.
Through his work he speaks to medical cannabis patients every day and believes there is a wealth of anecdotal evidence to support the use of cannabis in IBD patients.
“I speak to hundreds of patients now, at various different points with their cannabis use and I do talk to a lot of people with Crohn’s Disease as well,” he says.
“Some use cannabis and some don’t, but nearly everyone I have spoken to who has tried it says they have had some benefit from it.
“It seems to be fairly consistent that it helps with symptoms of pain, nausea, sleep, appetite and mental health.”
While he believes there are a small number of gastroenterologists prescribing medical cannabis in the private sector, many patients will receive a prescription for the pain-related symptoms.
He adds: “I would love to see more research into it and more IBD specialists being aware of and understanding the endocannabinoid system and how these medicines work.”
Dr. Timna Naftali, a gastroenterologist at the University of Tel Aviv, was the first person to explore the effect of medicinal cannabis on inflammatory bowel disease (IBD) and has studied its impact on both Crohn’s and Ulcerative Colitis patients.
Writing in the ‘Overview of cannabis based treatment in Crohn’s disease’ published earlier this year, Dr Naftali noted that the plant has ‘therapeutic potential’ that ‘must not be neglected’ suggesting that it can have a ‘significant’ improvement on symptoms.
Her most recent study of 50 patients with Crohn’s Disease, reported that those who received medical cannabis – of a ratio of four to one CBD/THC – saw their symptoms improve over a period of eight weeks.
Patients reported less diarrhea, reduced abdominal pain, an increase in their appetite and an overall better quality of life, she says.
“Patients taking cannabis say they have less abdominal pain, less diarrhea and can reduce the amount of steroids they are taking.
“They all say sleep much better, have a better appetite and generally feel better,” Dr Naftali explains.
However, there was no change in the actual inflammation caused by the disease.
“The study not only looked at clinical data, but patients underwent a colonoscopy before and after,” she continues.
“What we observed is that while patients felt better there was no endoscopic change – the inflammation inside remained as it was before.”
To date there have only been three small placebo controlled studies on cannabis in IBD patients, two of which showed ‘significant clinical improvement’ but no change in markers of inflammation.
Despite being initially sceptical about the role of cannabis in medicine, it was a patient who unknowingly convinced Dr Naftali to carry out her own research.
One day out of the blue a particularly symptomatic patient stopped turning up to her clinic. When she returned a year later she revealed she had been using cannabis and her symptoms had stopped.
“This was just one case, so I wasn’t terribly convinced,” she says.
“Later I had a patient who was very symptomatic, she was limited in what she could eat and couldn’t go out of the house for longer than an hour, because he would have to rush to the toilet.
“I suggested she try cannabis and she came back next time and had eaten an apple – this is someone who didn’t eat anything but boiled chicken and soup for 10 years.”
Dr Naftali now believes that cannabis does have the potential to treat inflammation, but research is still in its infancy and more studies are needed to investigate the effects of the various cannabis compounds.
“We need a lot more research. If you look at the animal and lab studies, it seems that cannabis does have the potential to cure inflammation, but these studies have not yet been translated to human trials,” she says.
“Cannabis has so many different compounds. I’m sure if we managed to isolate the right active ingredients and found the right way of taking it, it could turn out to be a useful treatment.”
In Israel, the Ministry of Health permits the use of medical cannabis for patients with Crohn’s Disease who meet certain criteria, including not responding to any alternative biologic treatments.
But until more research is conducted, Dr Naftali is hesitant to prescribe, seeing its role as largely a last resort.
“The main role that cannabis can have at the moment is either as a bridge for a period until more effective medicines work, or for those who have such severe disease that they don’t respond to any other medicine,” she adds.
“30 years ago we knew we had no better treatments, I would have said this is wonderful. But now we have six different types of biologic treatments that will reduce the inflammation in the first place so patients will not need the symptomatic treatment.”
“Currently we know that cannabis is very useful for symptomatic improvement, but it cannot replace the real anti-inflammatory treatments.”
Considerable developments have been made in biologic and autoimmune treatments for IBD since Alex was diagnosed.
He decided not to try biologics when they were first offered to him in 2014, but feels that maybe he may have felt differently if he had had a better, more open relationship with his doctor.
“At the time I was resistant to using biologics and immunosuppressant drugs and you could say that was the wrong decision as I ended up having surgery at the end, but had I been able to receive cannabis through a doctor, I would have trusted them with other potential treatments as well, he says.
“My doctors knew nothing about cannabis and so my trust in the healthcare system waned, because I was treating myself better than they were treating me.”
“Now we have more research into those drugs I can see that actually they are having some very positive effects, but I do think there’s a role for cannabis there, at least for symptom control.”
Another 45-year-old Crohn’s Disease patient, who asked not to be named, has found using just CBD products has helped him manage his symptoms.
“I suffer from extreme tiredness, severe pain and having to use the bathroom at least 20 times a day, he says.
“To manage the pain I always used Tramadol, which was the only painkiller that helped.”
He has been using CBD for three months and has been able to come off painkillers for the first time. It has also helped him manage the anxiety that comes with IBD.
“Crohn’s makes you live an anxious life, nervous about where you’re going and what you are doing,” he continues.
“It has a big impact on work as a business owner and employer, It makes you nervous and I worry all of the time about falling ill.
“Within 48 hours of taking my first drops, I felt less anxious, had a nights sleep for the first time in months and was at a point where I didn’t need my tramadol as my pain settled.”
Dr Naftali is currently investigating where CBD on its own can relieve symptoms in patients, but expects it may not be enough to have a noticeable impact.
“If this is effective, it would be perfect, because it’s a really safe substance and there’s no central effect, but I have a feeling that you need more than just CBD.
“If you look at my previous experience with patients it seems that the plant extract with some THC works better than the pure CBD.”
Alex also found that while using CBD on its own had some positive effects in relieving his anxiety and stress it wasn’t as effective as full extract cannabis.
He adds: “I’ve tried cannabis products of all kinds and while CBD definitely has a role to play, as an anti-inflammatory I don’t think it’s powerful enough to control Crohn’s Disease alone.”
Do we really need CBD hand sanitiser?
A new antibacterial CBD and CBG infused hand sanitiser has launched on the US market – but can cannabinoids really help protect you from infection?
Since the start of the coronavirus pandemic hand sanitiser has become everyone’s must-have accessory.
During one week in February 2020, sales of hand gel in US pharmacies increased by more than 80 percent on the same period the previous year and the global hand sanitiser market is projected to grow significantly to reach $17.2 Billion by 2026.
Now US skin and personal care company Naturaholic has announced it is expanding into CBD – it’s first product? Hand sanitiser infused with CBD and CBG.
Nahid LaCiura, the founder and lead product director of Naturaholic announced earlier this year that the company would put focus on adding different cannabinoids into their already successful natural product line.
“Early 2020, as our research into a new CBD skincare line began, Covid-19 struck which turned the company’s attention into a totally different direction in order to fill in the void in the marketplace and keep our community safe,” said Nahid.
“It only made sense for us to turn our focus to offering a hand sanitizer that would be strong and efficient enough yet gentle and moisturising.
“Also since we are an online company we could reach many people around the country in need of this high-demand product.”
Why use a CBD and CBG hand sanitiser?
A Journal of Natural Products research article published in 2008 by the American Chemical Society reported that cannabidiol (CBD) and cannabigerol (CBG), two of the most abundant cannabinoids found in hemp, “showed potent activity against a variety of MRSA strains in mice.”
Nahid added: “For those that don’t know, MRSA is the antibiotic resistant “superbug” that haunts the halls of many hospitals and healthcare facilities.
“The infection caused by MRSA is very difficult to treat because of its resistance to most antibiotics.”
This issue has enormous clinical implications since MRSA is spreading throughout the world. In the United States MRSA accounts for killing nearly 19,000 Americans every year — more than the nation’s annual number of AIDS deaths (which is around 13,000).
“Although the use of cannabinoids as systemic antibacterial agents are still lacking rigorous clinical trials, they are well-suited antibiotic and sanitizing agents when applied topically, particularly against gram-positive pathogens including MRSA,” continued Nahid.
“For a hand sanitizer to have such a property, this could help many people through this hard time. The science behind this is CGB’s ability to stop the growth of biofilms by destroying the cell membrane of the microorganisms architecture, while also halting the growth of any new biofilms as well. The Paper published by McMaster University in Canada is a very interesting read if you’re into the science behind it.
“As it stands now, though it’s only been a few months, the CBD+CBG hand sanitizer is outselling most of our other products.
“Of course, the Hyaluronic Acid and Skin Tightening Oil are still on top, but we can’t discount the amazing performance the hand sanitizer is having.”
The CBD+CBG hand sanitizer is available in 4 oz at a 1:1 ratio of CBD to CBG with 200mg potency.
The formula uses ethanol alcohol at over a 60 percent potency in a gel formula with added Vitamin E and cannabinoids. This product is FDA registered and comes complete with 3rd party lab testing and COA (Certificate of Analysis) to guarantee potency.
Naturaholic is an artisanal line of skin and personal care products handcrafted in small batches using high quality organic ingredients.
“I’ve been given so many labels, but CBD made me feel normal again”
Founder of the cannabidiol brand, Euphoria CBD, talks to Cannabis Health about how CBD has helped him turn his life around and move on from the trauma of his childhood.
23-year-old Matthew Cobb says he has seen “way too much” for someone his age.
At the age of 12, Matthew was taken into the care system, suffering from serious mental health issues stemming from traumatic events in his early youth.
Throughout the course of his childhood, he was diagnosed with PTSD, autism spectrum disorder, multiple personality disorder and bipolar and was given medication in an effort to treat his mental health.
“I took medication from a very young age,” Matthew says over the phone.
“I suppose a lot of it at the time was my mum trying to find a reason as to why my behaviour was the way it was.”
His doctors prescribed him medications such as Ritalin, Concerta XL, sertraline and olanzapine to cope but none of them worked for him and the side effects were, at times, crippling.
“Prescribed medication was very prominent in my childhood. They didn’t really do anything for me but I was forced to take them every day,” he says.
“There was not one [medication] that I could take and feel myself. Some of them made me angry, some of them absolutely tore me apart and made me borderline suicidal.”
Eventually, the side effects became too much, and Matthew decided to stop taking prescription medication at 15-years-old.
Having first encountered cannabis at the age of 13, he began to solely rely on “medicating” through the drug. In his late teenage years, Matthew says he would often consume upwards of £70 worth of cannabis in one day.
“It was the only thing that gave me some sense of normality at the time. The fact that ‘stoned’ was the closest to normality that I could get at 17-years-old was a problem,” he says.
At the age of 18, Matthew stumbled across CBD for the first time in a local convenience store where he saw a pack of CBD flower for sale.
“I saw this thing that ultimately looked like cannabis. I’d never heard of CBD before,” he recalls.
He bought the 0.5 g pack and went to the local park to roll a ‘CBD joint’ and was astounded by the effects.
“It was just a feeling of constant relaxation. I didn’t feel paranoid. I didn’t feel like anyone was judging me,” he says.
Later, Matthew began to experience more profound benefits as his consumption of CBD began to positively impact his mental health.
“I started to notice that my depression was easing off and I was starting to feel better in myself,” he continues.
“It was completely different to smoking cannabis. I wasn’t getting high anymore, but I was sleeping again and I was eating properly. My head didn’t feel so up in the air, I didn’t feel manic.”
For Matthew, smoking cannabis was never about getting high. He just wanted to feel “normal”, and cannabis was the only substance he could find that got him close to that feeling.
“I had a lot of issues that I didn’t understand, a lot of issues that didn’t make sense,” he says.
“I was heading in a massive downward spiral and [cannabis] was the only thing that took the edge off.
“It was about making me feel some sense of normality. I got that with CBD, so it almost made cannabis null and void.”
With a renewed clarity of mind, Matthew realised that he had to make a change in his life.
“In two years, you’re going to be in prison or you’re going to be dead,” he thought.
Matthew says he hasn’t picked up a cannabis joint since the first time he tried CBD and from that moment, he was himself for the first time in his life. He no longer recognises in himself the mental health issues that he was diagnosed with as a child.
“My view is I don’t have any mental health issues,” he says.
“I was given many different labels, but they would change week to week; ADHD, bipolar disorder, personality disorder this, personality disorder that, depression.
“I had had a label for everything, but my life now is pretty normal.
“CBD has taken those labels away. It has given me something that no medication could; it’s given me – me.”
Having experienced first-hand the benefits of CBD, Matthew launched his own brand, Euphoria CBD, in July 2020.
It is set to launch a range of new products throughout 2021, including e-liquids, soap bars, bath bombs, moisturiser creams.
Frustrated with the lofty costs of CBD products, he set out to make high-quality cannabidiol affordable. Recalling a time in his life where he was struggling to make ends meet and pay for the supplement that had such a huge impact on his life, Matthew aims to make CBD accessible to everyone, regardless of their income.
“CBD is something that comes with benefits for so many different people, but the problem is that people don’t realise how much poverty there actually is in this country,” he adds.
“People can’t afford this kind of product, it’s just not possible. My goal is to provide an affordable product that genuinely helps people.”
Five tips for coping with life after lockdown
As much as many of us can’t wait for life to return to normal, after over year of living with some form of restrictions, it’s normal to be feeling a little bit anxious about life after lockdown.
From March 8 onwards, the UK will start to slowly emerge from lockdown, with schools opening first, followed by non-essential shops and leisure facilities over the coming months.
And while there are things about the return to ‘normal’ that we will all be looking forward to, it’s not unusual to be feeling a little apprehensive, or even anxious, about re-entering society.
Luckily, there are a number of ways you can manage your anxiety – and the sooner you start, the more effective it will be.
Take it slowly
If you’re feeling worried, it’s probably best not to book tickets for a festival or a round-the-world cruise. Instead, aim to maybe meet up with one person at a time, or have a coffee at an outside café. Whatever you choose, it’s best to do something, as the longer you leave it, the worse your anxiety will be.
Keep in touch
While Zoom and text fatigue have definitely set in after 12 months of lockdowns and distancing, now is the time to rekindle some of those connections.
Even if you don’t meet up in person just yet, it can be good to chat through your anxiety with a friend – chances are, they’ll know exactly how you’re feeling.
Try something new
Try to vary your routine so you see different people and situations until you find what you’re comfortable with. Maybe your usual walking route is very busy in the mornings; now the nights are getting lighter, try going out in the early evening.
Trying something different can also break any negative connections you may associate with lockdown; if your local streets were as far as you travelled during lockdown, a walk around a different neighbourhood gives your brain a clear signal that something has changed.
Have a plan
While you can’t control everything, you do have power over some aspects of returning to a more normal life. If you’re feeling worried or anxious about going out, make yourself an action plan of how you’re going to handle it – and how you’ll respond to anything unexpected.
A little extra help
CBD is well known for its calming effects, and many people use it to relieve symptoms of anxiety. Although more research is needed to understand the science behind using CBD as a treatment for anxiety, plenty of people anecdotally report a positive impact on their symptoms. A 2019 Gallup Poll discovered that 37 percent of CBD users take the supplement for anxiety.
CBD is thought to work by changing serotonin signals in the body through the interaction with CB1, a receptor found in the central nervous system.
Low serotonin levels are generally linked with depression, however there is also evidence that it could be a cause of anxiety.
In another study from 2019, researchers gave 300mg of CBD (or a placebo) to 37 Japanese teenagers suffering from social anxiety.
The results found that the group who received CBD experienced a significant reduction in their symptoms and concluded that “the results indicate that CBD could be a useful option to treat social anxiety.”
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- “I’ve been given so many labels, but CBD made me feel normal again”
- Five tips for coping with life after lockdown
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- Safe, certified and high-power CBD vaping formula’s hit the shelves
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