Using CBD for Ulcerative Colitis
Lindsay Curtis is a health writer with over 20 years of experience in writing health, science & wellness-focused articles.
Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.
Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York, where he is also a professor. He was the founding editor and co-editor in chief of Inflammatory Bowel Diseases.
Ulcerative colitis (UC) is a chronic disease that affects the large intestine (colon), causing inflammation and small sores (or ulcers). UC symptoms include diarrhea, abdominal cramps and pain, bloody stool, and the need to pass stool frequently.
There is no cure for ulcerative colitis, so treatment prioritizes symptom relief and reducing flare-ups. Many people with ulcerative colitis turn to alternative treatments, such as cannabidiol (CBD), to take control of the disease and improve their quality of life.
Read on to learn more about how CBD may be a useful supplemental therapy in the management of UC symptoms.
Tinnakorn Jorruang / Getty Images
Inflammation, CBD, and Ulcerative Colitis
Cannabis plants contain chemicals called cannabinoids, which are compounds unique to the plant. The two primary cannabinoids are:
- Tetrahydrocannabinol (THC), which has psychoactive effects that make a person feel “high”
- Cannabidiol (CBD), which has no psychoactive effects but can provide a number of therapeutic benefits
Both CBD and THC interact with the endocannabinoid system (ECS) in the body. The ECS is a complex biological system that regulates cardiovascular, nervous, and immune system functions.
CBD binds to and activates receptors in the brain that create a therapeutic effect in the body, helping users find relief from painful symptoms without feeling impaired.
CBD has many therapeutic properties and is a known anti-inflammatory, antimicrobial, and antioxidant. Thanks to its anti-inflammatory properties, CBD may be a potential therapeutic treatment for ulcerative colitis.
CBD for Ulcerative Colitis Symptoms
CBD has been explored in several studies as a potential treatment for ulcerative colitis. Research shows that CBD may potentially help reduce inflammation in the gastrointestinal system caused by inflammatory bowel diseases (IBD), such as ulcerative colitis.
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. However, more research and follow-up studies are needed.
Another study analyzed the efficacy of CBD use in adults with ulcerative colitis. The study concluded that CBD extracts may help alleviate symptoms of IBD and UC.
Although more research is needed, current study results show promise that CBD may be beneficial for treating symptoms of ulcerative colitis.
Are There Any Side Effects?
Though CBD is generally well tolerated, you may experience some side effects. Common side effects include:
- Changes in mood (e.g., irritability)
- Decreased appetite
- Dry mouth
CBD and Your Liver
CBD is metabolized by the liver, and large doses may lead to liver toxicity. Talk with your healthcare provider before using CBD. If you are on any prescription medications, they may recommend regularly monitoring your liver through bloodwork to ensure CBD is safe for you.
How to Use CBD for Ulcerative Colitis
While CBD won’t cure ulcerative colitis, it may help make your symptoms more manageable and help reduce flares.
There are many different forms of CBD, and you may need to try different delivery methods before finding the one that is right for you.
CBD is available in:
- Edibles (e.g., gummies, CBD-infused beverages)
- Plants (to be inhaled/smoked)
- Capsules and pills
- Tinctures and oils
- Topicals (e.g., lotions, creams)
To date, CBD has only been approved by the Food and Drug Administration to treat epilepsy. As a result, there is no standard recommended dosage of CBD for treating ulcerative colitis.
Shopping for CBD
When shopping for CBD, you will notice different types available. These include:
- Full-spectrum CBD: Contains all the natural components found in the cannabis plant, including terpenes, flavonoids, fatty acids, and cannabinoids. Full-spectrum CBD products contain trace amounts of THC. These compounds work in synergy in the body to obtain the desired therapeutic effects.
- Broad-spectrum CBD: Similar to full-spectrum CBD, broad-spectrum CBD contains compounds in the cannabis plant, but with all traces of THC removed, so you will not experience any mind-altering effects.
- CBD isolates: All other cannabinoids, terpenes, and flavonoids are removed to create a 99% pure CBD product.
For the best results, look for broad-spectrum or full-spectrum CBD products. These may combine the effects of multiple cannabis compounds that work together in synergy, creating an “entourage effect” to offer the most health benefits.
Because CBD is still a relatively new therapeutic option for managing different health conditions, including inflammatory bowel diseases, there is currently no recommended standard dosage.
In one study, patients with ulcerative colitis were given 50 mg of CBD oil twice a day. Some participants were able to increase to as much as 250 mg twice a day for a period of 10 weeks.
Another study also recorded dose ranges of 50 mg to 250 mg CBD capsules twice daily. Many participants were able to tolerate the higher dosage and saw improvements, though the study authors suggested that more research is needed.
As with many medications, it’s best to start with a lower dose and gradually increase the amount of CBD to determine the appropriate dosage.
Talk to Your Healthcare Provider
It’s important to talk with your healthcare provider before adding any supplemental therapy, such as CBD, to your ulcerative colitis treatment. They will be able to determine if CBD will be beneficial for your individual case and can recommend the right dosage.
How to Buy CBD
With so many different options available, it can be daunting to shop for CBD. CBD is generally safe and well tolerated, but the industry is poorly regulated, and consumers should be aware of what to look for before purchasing CBD.
You’ll want to carefully read the label of any products you are considering and look for:
- Amount of CBD per serving
- Suggested use/dosage
- Type (full-spectrum, broad-spectrum, or isolate)
- List of ingredients
- Manufacturer and distributor name
You’ll also want to consider:
- Cannabis source: Ensure the product you are purchasing is sourced from a company that ensures the quality and safe cultivation of their plants. Look for products that come from organic cannabis/hemp plants when possible.
- Certificate of Analysis (CoA): CoAs are conducted by independent, accredited labels that verify third-party testing of the products.
- Customer reviews: Testimonials from other users can tell you a lot about a product’s efficacy.
Avoid products and vendors that make broad, definitive statements or promises of a “cure” for something. If you are currently taking any other medications or supplements for your UC, speak with your healthcare provider before using CBD, as it may interact with other medications you are taking.
A Word From Verywell
People with ulcerative colitis may want to consider alternative treatments such as CBD to help manage their symptoms. It’s important to remember that while CBD may help improve your symptoms, it will not treat or cure the condition.
CBD is best used as a supplemental therapy alongside conventional treatments recommended by your healthcare provider, as well as dietary modifications. As with any supplement or medication, talk with your healthcare provider before trying CBD.
Frequently Asked Questions
Cannabinoids have anti-inflammatory properties that may make them helpful in managing symptoms of gastrointestinal diseases like ulcerative colitis. Research suggests CBD is a promising therapeutic for inflammatory bowel diseases, helping reduce mucosal lesions, ulceration, and inflammation associated with IBD. CBD may also help manage gastrointestinal pain, as well as secondary symptoms that come with IBD, such as anxiety, nausea, and sleep disturbances.
The cannabis plant (to be smoked/vaped) comes in different strains, with varying CBD and THC levels. CBD-dominant cannabis strains may provide the best relief for inflammation. These strains tend to be high in the terpene called myrcene, which helps reduce inflammation.
There are many delivery methods for CBD, including edibles (e.g., gummies), flowers, oils, tinctures, topicals, and suppositories. Finding the right one for you may require a little trial and error. The best method for you depends on personal preference and how quickly you may need relief. For example, you may get relief from painful symptoms sooner by vaping oil vs. consuming an edible. Start off with smaller doses and gradually increase the amount you use until you find the amount that offers you relief from your symptoms. Make sure to talk with your healthcare provider before you begin use.
Can CBD Oil Help Inflammatory Bowel Disease (IBD)?
If you have inflammatory bowel disease, there’s a good chance you’ve considered using cannabis products or CBD oil to help manage your IBD – surveys from the last few years show that between 10-20% of people with Crohn’s Disease and Ulcerative Colitis use cannabis products to help manage their IBD symptoms . And now that both medical marijuana and legal, non-intoxicating cannabidiol (CBD) are becoming more widely accepted across the United States, those numbers are probably rising.
But if you suffer from IBD, every inflammatory flare-up could bring you one step closer to surgery – meaning it’s a good idea to do your research before making any changes to your routines. There are many studies underway on cannabis and hemp extracts for Crohn’s and ulcerative colitis, but what have scientists learned? Should you be using cannabidiol (CBD) alone or in combination with THC? Is it actually effective? And are there any risks involved?
If you’re already using cannabinoids (like THC and CBD) to manage inflammatory bowel disease – or if you’re merely flirting with the idea – there’s a bewildering amount of information to keep straight. We’ll explain the current research along with what it means for:
- Symptoms Management and Quality of Life
- Inflammation and Endoscopic Remission
- Future Outlook and Flare-Ups
Some Background First
If you suffer from IBD, it can feel extremely isolating… but you actually belong to an enormous and growing community of people who share your pain. The rise of inflammatory bowel disease over the last few decades is shocking — the diagnosis is rising on every continent while skyrocketing in developing countries. And for more than 1 in 100 American adults , this IBD diagnosis comes with high medical bills, a high likelihood of serious surgery, and an increased risk of mortality.
The hallmark trait of IBD — inflammation within the digestive tract — causes pain and suffering that is mostly invisible to the people around you. And one of the most frustrating things about IBD is that there’s no clear reason why you have it — or why it keeps flaring back up. Everything from your DNA to your diet, and from your daily habits to how you were raised, could have contributed to your current prognosis.
Whatever combination of genetics and environmental factors combined to trigger Crohn’s or ulcerative colitis, the end result is chronic gut inflammation that damages and weakens your digestive tract over time. Unfortunately, that damage comes with worsening symptoms, increased pain, and even increased risk of other diseases like colon cancer.
Hidden Roots = Difficult to Weed Out
Scientists struggle to develop safe and effective treatments for illnesses that can’t be traced to a clear root cause. If you’ve been diagnosed with Crohn’s or ulcerative colitis, you’re probably already aware that IBD is a chronic illness with no cure. The treatments offered by doctors — including aminosalicylates, corticosteroids, and risky surgical procedures — will at best merely hold the IBD in check. And they often come with a long list of serious side effects.
This is why so many people are seeking holistic approaches to deal with their recurrent illness – through diet and other lifestyle changes – and incorporating cannabinoids (like CBD and THC) into their treatment routine.
Many Levels of IBD Treatment
Although IBD symptoms are usually the first sign you’re experiencing a flare-up, they are just the end result of a long chain of events occurring within your body. And for the best possible outcome, you — along with the help of a medical professional — will want to treat IBD as far back along this chain as possible.
To begin with, if you are currently suffering, it’s important to relieve any symptoms that interfere with your life. Meanwhile, you should use every resource available to combat inflammation and achieve remission. And finally, even when your IBD is in remission, you need to stay vigilant by continuing an anti-inflammatory routine while tracking and avoiding triggers.
So where do cannabinoids fit in?
Cannabinoids to Treat IBD Symptoms — Some evidence
The prestigious National Academies of Sciences, Engineering and Medicine recently rated pain management as one of the most scientifically supported uses of cannabis. Many IBD patients agree with this conclusion: A large majority of surveyed IBD patients who use cannabis report that it helps relieve abdominal pain and cramps , while others find it helpful for combating nausea and diarrhea .
Cannabis study results (combo of THC, CBD and other cannabinoids): Surveys can be biased — in this case, we only learn about the experience of IBD patients who are already using cannabis for their symptoms. However, a number of studies have followed IBD patients who are newly prescribed cannabis as part of their treatment routine. A small study that compared inhaled cannabis to a placebo for 8 weeks found that 90% of cannabis users’ symptoms improved while only 40% of the controls saw an improvement.
One thing to keep in mind, though, is that although there’s good evidence that cannabis can help improve IBD symptoms, it might not help with the underlying inflammation. Here’s why.
CBD study results: To date, most of this research has been on cannabis products containing a combination of THC, CBD, and a full spectrum of other cannabinoids. However, THC is not legal in all states, and also comes with a notorious side effect – getting high – that not everyone enjoys. For these reasons, hemp-extract CBD products are being explored as an alternative to cannabis for treating IBD symptoms.
Pre-clinical evidence suggests that CBD provides pain relief by desensitizing TRPV1 channels on pain-perceiving nerves . And in addition to pain relief, CBD can improve “intestinal hypermotility” — aka diarrhea — when tested in rodents with inflamed guts. However, there have been few human clinical trials to date. One, which used a low oral dose (10mg daily) of purified CBD on Crohn’s Disease, reported that a low dose of CBD isolate was safe but ineffective at relieving Crohn’s symptoms. On the other hand, when scientists tested a higher dose (100-500mg daily) of full-spectrum CBD for Ulcerative Colitis, they reported a higher quality of life — although it did not impact remission.
An important distinction: Isolate vs full-spectrum : Why would these two CBD studies have different results? The most obvious answer is that 10mg may have been too low of a dose. However, another important distinction between these two studies is that the first study used CBD isolate — a single, purified molecule — which may be less effective than broad-spectrum extracts.
Indeed, full-spectrum hemp extracts contain a wide variety of beneficial molecules other than CBD, called the “ entourage ,” and studies typically have better results when the whole entourage is used together instead of CBD isolate. And for individuals struggling with colitis, the entourage molecule cannabigerol (CBG) might be even more effective than either THC or CBD. When purchasing CBD products, choose full-spectrum or broad-spectrum hemp extracts for full entourage benefits.
Cannabinoids for IBD Remission — Some preclinical but no clinical evidence
If you have IBD, always be aware that your physical symptoms might improve despite high levels of gut inflammation. To date, most human studies suggest that cannabinoids relieve IBD symptoms, but not intestinal inflammation . However, scientists are still actively investigating this topic.
A clue that cannabinoids could one day be used to fight intestinal inflammation comes from the current usefulness of medications (anti-TNFα drugs) that fight a notorious inflammatory molecule, Tumor Necrosis Factor. In preclinical studies using rodents and human biopsies, CBD combated gut inflammation by decreasing TNFα levels, as well as by turning on and off genes controlled by PPARγ .
Recently, a review of over 50 rodent studies concluded that two out of three studies found a positive effect of cannabinoids on colitis . In these experiments, scientists reported better results the earlier the cannabinoids were taken during an inflammatory episode.
However, until there’s clinical evidence that cannabinoids can improve intestinal inflammation, it’s safest to continue taking your prescription drugs to prevent progression of the disease. If you suffer from IBD and find major relief from cannabis or CBD oil, do not stop your meds without proper testing and approval from a medical professional.
Cannabinoids and IBD Flare-up Prevention — Unknown
Even in remission, low baseline levels of inflammation could escalate at the slightest trigger. In addition to prescription medications, the Mayo Clinic suggests stress-management and dietary changes as good practices to manage flare-ups, and even lists anti-inflammatory supplements like fish oil and turmeric as suitable complementary approaches.
CBD and THC are widely considered anti-inflammatory supplements, and CBD may have a role in managing some forms of anxiety . However, there is no current evidence that CBD or THC helps maintain remission for IBD.
Downsides and risks of cannabinoids for IBD:
THC’s cognitive effects – Most of the research to date has been with cannabis and cannabis extracts — which contain psychoactive THC in addition to a wide variety of other molecules. But for many people, being stoned all day is not a good option. If this describes you, choose high quality CBD products from reliable companies that use full-spectrum hemp extracts — that way you can stay sober while benefiting from the “ entourage effect. ”
Assuming you’re better because you feel better – Although research suggests that cannabis and CBD oil could help relieve IBD symptoms, there is no clinical evidence yet that they also stop intestinal inflammation. Nonetheless, many people use cannabis to decrease their dependence on prescription drugs. If you’re taking cannabinoids and feel great, do not take that as evidence that you can stop taking prescription medications without first consulting a medical professional.
Prescription drug interactions – Similar to grapefruits, CBD interferes with enzymes (cytochrome p450) that your body uses to metabolize certain pharmaceutical drugs. If you currently take prescription drugs — particularly any that come with a warning not to consume with grapefruits (ie warfarin, anti-epileptics, HIV antivirals, and chemotherapy) — we suggest speaking with a medical professional before incorporating CBD into your wellness routine.
Uncertainty if it should be considered an NSAID – CBD likely fights inflammation in multiple ways — and one of those ways is through inhibiting COX-2, an enzyme that produces inflammatory prostaglandins. Unfortunately, long-term NSAIDs (which also inhibit prostaglandins) are generally contraindicated for IBD because they can contribute to gastric ulcers.
Fortunately, s tudies indicate that cannabinoids are more likely to protect against aspirin-induced ulcers (through the endocannabinoid system ) than they are to create them, and data suggests that COX-2-selective drugs like CBD are safer compared to traditional NSAIDs because they don’t affect COX-1 digestive enzymes.
Consider different routes of application
There are many ways to take cannabis and CBD oil; orally, inhaled, rectally… and each route can affect how much enters your body and where the molecules go. If you’re unfamiliar with the many types of products available, see our quick guide on routes and dosage .
For most of the studies we’ve discussed, patients either inhaled or ingested the cannabinoids. However, rodent studies have also tested the effects of injections and rectal suppositories.
One study which compared these different routes found that an oral treatment of CBD was ineffective, while an equivalent or lower rectal or injected dose actually improved colitis. There are no current human studies which suggest one route over another for IBD, but if you’re considering self-experimentation, you should be familiar with your options, and be open to trying suppositories.
Should you use CBD oil to supplement your IBD treatment?
As you know, achieving and maintaining remission is vital to your health and happiness. Ultimately, we don’t have enough evidence to say for sure whether or not cannabis or CBD oil will work for you. The standard recommendation is that cannabinoids might be a good choice for improving your symptoms and wellbeing when standard therapies fall short.
When taking cannabidiol or medical cannabis for IBD, consider it a supplement, not a replacement for your current treatment. Always discuss your decision with a trusted medical professional. And when choosing a product, be wary of bold claims and brands without a solid reputation – unfortunately, since it’s still largely unregulated, this industry is rife with fraudulent products and misinformation.
If you use or have previously used cannabinoids to treat your IBD symptoms, we’d love to hear about your experience. Email [email protected] to share your story.
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