Cannabis Use and the Risk of Cholera
The International Association for Medical Aid to Travelers (IAMAT) states on its website that cannabis users are “more prone to cholera infections.” However, cannabis has been used for both the treatment and prevention of cholera throughout history. Does IAMAT have false facts or is there a deeper relationship at work?
Cholera is a bacterial disease that primarily affects the small intestine, causing watery diarrhea and vomiting. If left untreated, it can lead to extreme dehydration and be fatal. Cholera is caused by the bacterium Vibrio cholerae and is transmitted through ingestion of contaminated water or food.
Diarrhea and vomiting occur due to the effects of a toxic protein (known as cholera toxin or CT) that is secreted by the bacteria. It stimulates the cells of the small intestine, causing them to release a clear, watery liquid in large quantities.
How is cholera transmitted?
An infected person can produce 10 to 20 liters of diarrhea per day, causing severe dehydration. The diarrhea acts as a reproductive vehicle. It contains new generations of the bacterium that can enter the water supply in areas with poor sanitation, where they can infect a new host.
Although cholera has been all but eradicated in developed countries, cases still occasionally occur. In developing countries, where sewage and safe drinking water are inaccessible to large parts of the population, cholera remains a deadly threat.
According to the World Health Organization, cholera has an estimated incidence of 1.3 to 4 million people worldwide. Worldwide between 21,000 and 143,000 people die from the consequences of cholera.
Cannabis and susceptibility to cholera
The basis of IAMAT’s claim is that smoking cannabis “decreases gastric acid secretion,” which in turn decreases the body’s defense against V. cholerae bacteria. Existing research supports cannabis’ ability to inhibit gastric acid secretion, although there are few studies that specifically assess the relationship between cannabis use and susceptibility to cholera itself.
A link between low levels of gastric acid (hypoacid) and susceptibility to cholera has also been demonstrated. If the stomach acid is too low, the bacteria can enter the small intestine more easily and in greater numbers. In fact, stomach acid is seen as the first line of defense against cholera.
Cannabis, hypochlorhydria and cholera
This study, published in the Lancet in 1978, attempts to describe a link between cannabis, gastric secretions and cholera. The study subjected 92 volunteers to E. coli and V. cholerae bacteria. During preliminary tests, the researchers found that the heavy cannabis users in the group had lower stomach acid levels and that the heavy beer drinkers had the highest levels.
The Vibrio cholerae bacterium, which is responsible for causing cholera
The study also found that people with low stomach acid levels had more severe diarrhea after being infected with V. cholerae. The study concluded that heavy cannabis use was associated with increased volume of diarrhea and that cannabis use “may be an important factor in predisposing to severe diarrhea”.
Cannabis as a cure for cholera
Throughout history, cases have been documented of doctors and traditional doctors prescribing cannabis to relieve symptoms of cholera. There is compelling evidence, given historical and modern sources, that the endocannabinoid system can be used for pharmacological intervention in cholera.
In India, doctor William B. O’Shaughnessy reported in 1839 that cholera could be treated with cannabis. In 1893, the India Hemp Commission reported that cannabis was used to treat cholera by traditional folk healers, as well as to protect against infection from the bacterium.
The 1868 edition of the US Dispensatory, an influential pharmacopoeia of the time, strongly recommended cannabis for the treatment of cholera.
Dr. Willemin’s cannabis tincture regimen
A paper presented to the Académie de Médecine in Paris describes the use of cannabis by a doctor to treat cholera. The man in question was Dr. Willemin, a German doctor who lived and practiced in Cairo around 1848. During a bout of cholera, he treated himself and others who were extremely ill with the disease with cannabis.
Willemin’s theory was that cannabis “stimulated” the nervous system and reversed the “debilitating” effects of cholera – characterized by a weakened pulse, cold, numb limbs and bluish skin from extreme dehydration. He also suggested that the effect might be dose-dependent, as previous patients had been given a lower dose and they had died even though their symptoms were less severe.
Although he could not fully describe the mechanism, modern research has confirmed the idea that cannabis “stimulates” the cannabinoid receptors of the enteric nervous system. This can, in fact, help reverse the extreme signs of dehydration by reducing the amount of excess fluid in the small intestine.
Modern research on cannabis and cholera
Few studies specifically analyzed the effects of cannabinoids on symptoms of cholera. However, a 2003 study of cholera-related fluid secretions in mice shows the complexity of the relationship. The researchers found that mice given orally administered cholera toxin (CT) showed increased CB1 receptor activity and increased levels of the endocannabinoid anandamide.
Two synthetic CB receptor agonists have also been shown to decrease CT-induced fluid secretion in the small intestine: the THC analogue CP55,940 (a non-selective agonist) and arachidonoyl chloroethanolamide or ACEA (a selective CB1 receptor agonist).
A selective CB2 receptor agonist, JWH-015, was found to have no inhibitory effect on fluid secretions. In addition, mice that were treated exclusively with the antagonist SR141716A showed increased fluid secretions.
CB1 receptor agonists decrease fluid secretion
The researchers also discovered that the effects of CP55.940 and ACEA were counteracted by a CB1 receptor antagonist, but not a CB2 receptor antagonist. From this, the researchers were able to conclude that the inhibitory effect on cholera-related fluid secretions is exclusively mediated by the CB1 receptor.
The researchers concluded that in cases of cholera infection, which also involved excessive fluid retention, the CB1 receptor is overstimulated, causing levels of the endogenous agonist anandamide to rise. The result is an inhibitory effect on fluid secretion, which reduces diarrhea.
While this seems to contradict the notion that cannabis use predisposes a person to more severe diarrhea, these results have not yet been repeated in humans, so no firm conclusion can be drawn.
Cannabis extracts can kill cholera bacteria
Raw sewage flows past a school in Zimbabwe
Another study published in 2012 showed that acetone and aqueous extracts of cannabis were effective in killing V. cholerae bacteria in vitro. Sterile agar jelly petri dishes were infected with the bacteria and paper disks soaked in cannabis extract were then inserted into the petri dish.
After prolonged storage at human body temperature, the zone of inhibition (the area in which bacteria had been killed) around the discs soaked with the extract was measured. The researchers found that the acetone extract showed the strongest antibacterial effect and that the zone of inhibition surrounding both extracts increased with increasing concentration (from 5 µg / ml to 10 µg / ml).
Health care implications
Recent research showing that hemp textiles are effective at killing Klebsiella pneumonia and Staphylococcus aureus bacteria support the research presented in this article. Together, they could prove critical to the future development of approaches to addressing these highly contagious and potentially devastating diseases.
In addition, this property is possibly the basis for the traditional use of cannabis as a prophylaxis against cholera infections. If a tea or tincture contains cannabinoids in sufficient concentration, regular consumption may play a role in fighting the ingested bacteria of V. cholerae.
However, our knowledge of the antibacterial effects of cannabinoids is still in its infancy. Further research must be carried out before this question can be answered.
Is cannabis a treatment or a risk factor?
In the 1978 study mentioned in this article in 1978, cannabis and alcohol were banned from the study station. This means that the potential curative effects of cannabis on people already infected with V. cholerae have not been measured. It may even turn out to be the case that suddenly stopping cannabis use exacerbates the symptoms of diarrhea experienced by normal heavy smokers.
There may also be a dose-related explanation for the seemingly contradicting results of the various existing studies. Cannabis has been shown to have very different effects when administered in high and low doses. This seems to be particularly true of gastrointestinal function.
In small doses, some of Dr. Willemin, but at higher doses, even those in more advanced stages of the disease survived. Research into the antibacterial effects of cannabinoids shows again that cannabis extracts are more effective at higher doses.
Specially modified cholera beds with holes and buckets for diarrhea
Cannabis certainly has a complex effect on the gastrointestinal system. Our understanding of the separate and synergistic effects of the various cannabinoids is still in its infancy, and until we get deeper insights, many questions remain incompletely answered or entirely unanswered.
Since many of those still at risk of cholera live in countries that also have an established culture of cannabis use, it would be extremely beneficial to gain a full understanding of the complex relationship at work here. In this way, we can potentially benefit from the potentially protective and healing effects.
This article is not a substitute for professional medical advice, diagnosis, or treatment. Always contact your doctor or other licensed health care practitioner. Do not hesitate to seek medical advice or to ignore medical advice because you have read something on this website.