Marijuana, Alcohol, and ED: Correlations with LUTS/BPH Benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) is a disease complex with enormous societal burden and yet the Many patients are turning to CBD oil for help with issues related to enlarged prostate and prostate cancer. Learn how and why cannabidiol may help.
Marijuana, Alcohol, and ED: Correlations with LUTS/BPH
Benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) is a disease complex with enormous societal burden and yet the pathogenesis of LUTS/BPH is poorly understood. We set out to review the literature on the relationship between depression, marijuana usage, and erectile dysfunction (ED) to LUTS/BPH.
LUTS/BPH has independent associations with depression as well as with ED. In each case, the causality and mechanistic relationship is unknown. The impact of marijuana, as it increasingly pervades the general population, on the disease complex of LUTS/BPH is not well studied but recent results support short-term benefit and long-term caution.
Depression, a form of central nervous dysfunction, and ED, which is likely mediated via endothelial dysfunction, are independently associated with LUTS/BPH. The presence of cannabinoid receptors in urologic organs, coupled with recent population studies, supports a modulatory effect of marijuana on voiding although an enormous knowledge gap remains.
Benign prostatic hyperplasia (BPH) and BPH-associated lower urinary tract symptoms (LUTS) have a significant impact on men’s health. Globally, BPH carries the highest health burden of any urologic disorder, malignant or benign, and is poised to rise even more rapidly . As the population ages and the societal burden of LUTS/BPH increases, better understanding of its underlying causes and associated disease processes becomes more critical. LUTS/BPH has multiple causative factors and many epidemiologic correlates, but an effective and unifying understanding of this heterogeneous disease has proven elusive.
Specific associations have been investigated in hopes of better understanding how to treat and avoid progression of BPH and LUTS. Metabolic syndrome (MetS) has been linked with the disease process of LUTS/BPH, but evidence has been variable and inconclusive [2•]. Hypertension (HTN), type 2 diabetes (DM), obesity, physical inactivity [3, 4], autonomic nervous system overactivity , prostate growth rates, and failure of senescence [6, 7] have all been found to contribute to or correlate with LUTS/BPH. Other community surveys of erectile dysfunction (ED) found that prostatitis and incontinence are strongly associated with LUTS/BPH , and a subsequent meta-analysis verified deep interrelationship between these two diseases of the aging male. Implicating central nervous system involvement in the process, depression has been linked with both LUTS and BPH although causality is unknown [9–12]. Furthermore, recent studies have shown a relationship between marijuana usage and LUTS/BPH that suggest short-term improvement in voiding but raise concerns about long-term usage [13–17]. However, we are unaware of any data showing impact on urinary function related to alcohol usage. We set out to review the latest literature on the relationship between LUTS/BPH, and these comorbid conditions and coexisting habits.
Marijuana Use and LUTS
Marijuana is a product derived from the cannabis plant, a flowering member of the family Cannabaceae. The genus is thought to be indigenous to central Asia. Medicinal uses for marijuana date back 5000 years across many cultures for a variety of medical problems. The active ingredients of marijuana include tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is a psychoactive compound which can induce euphoria, relaxation, altered perception of time, increased appetite, and heightened sensory perception . CBD is a non-psychoactive substance that is hypothesized to have an effect on anxiety, cognition, movement disorders, and pain . Suggestive of pharmacologic effect, usage for myriad processes has been reported in the modern medical literature for hundreds of years .
THC, the primary identified active agent in marijuana, mediates effect on target tissue via two primary receptors: CB-1 and CB-2. This identification of a direct effect of cannabinoids on the bladder, and the identification of the widespread cannabinoid receptor (CB-1) as a mechanism for the mediation of that effect, has led to studies, primarily in murine models. The second receptor, CB-2, shares 44% homology with CB-1 and is more limited in distribution, being mostly found in brain and testes .
Translational Studies of Cannabinoid Effects on Bladder and Voiding
Cannabinoids have been observed to modulate bladder function in animal models including an increase in voided volume, voiding pressure, and prolonged intermicturition intervals [22••]. Direct arterial injection of CB agonist also decreased bladder voiding threshold, both at baseline and in response to irritants . This effect was ameliorated by competitive antagonists of the receptor. Intravesical instillation of synthetic cannabinoids also had an effect on bladder response pointing towards the involvement of CB-1 receptors when compared to the CB-2, with CB-1 appearing to be the primary mediator of voiding effects . In a separate murine model of acrolein-induced cystitis, cannabinoids were found to significantly counteract the irritative effects of the chemical, suggesting a potential role for bladder pain management in humans [25, 26]. Overall, THC and synthetic cannabinoid agonists of the CB-1 and to a lesser extent CB-2 receptor appear to have generally beneficial short-term effects on voiding in animal models. Long-term effects and chronic adaptation are still mostly unknown.
Effects of Marijuana on Human Voiding
Human voiding response to cannabinoids has not been much studied, although an identifiable effect appears to exist. Cannabis usage induced intriguing responses in bladder and urine proteomics: increases in immune response pathways, and carbohydrate-related mechanisms, among others . Two cross-sectional population studies have found a statistically significant association between marijuana usage and the presence of LUTS. First, 3037 men aged 20–59 and completing the National Health and Nutrition Examination Survey from 2005 to 2008 found that self-reported marijuana users experienced less LUTS [28•]. More recently, it was observed that in a sample of 173,469 men (aged 45 or over), those who were identified as using cannabis were significantly more likely to receive treatment for LUTS/BPH than men who were not . This “substance use-symptom” relationship between marijuana and LUTS/BPH was not present in the same group when assessed for the effects of alcohol consumption.
These two findings address separate end points: self-reported voiding dysfunction is different than the receipt of treatment for LUTS/BPH. Additionally, the age groups were somewhat different in these two groups, and it was not possible to control the NHANES data for age-related correlation of usage. This is important because the use of marijuana decreases substantially with age: 30% of adults in the 18–25 age group reported marijuana usage in the past year, but this rate drops to 3.4% of those who are 50–64 years old and 0.6% in adults over 65 . It seems likely that adult marijuana users represent a somewhat distinct population subset, behaviorally, socially, or biologically. Perhaps, men who use marijuana, especially those that use into adult life and past the age of 45, find it therapeutic in the same fashion that leads general and younger users to report lower baseline urinary symptoms. Alternatively, continued consumption in later life may be a marker for long-term exposure and a high cumulative dose of cannabinoid, which in turn may represent a damaging effect. It is not possible to draw conclusions regarding effects of chronic exposure to marijuana from these data. Other substances of abuse and toxins can result in severe and direct urinary morbidity, such as ketamine , although this pharmacological agent is unrelated to THC and marijuana.
In multiple sclerosis (MS) patients, cannabinoids showed some beneficial effects on muscular spasticity and on urinary function in men and women, although results have varied between the studies and formulation of cannabinoid administration . A survey of MS patients using marijuana found that over half of patients reported subjective improvement in urinary symptoms, and others confirmed improvement in urge and incontinence, thereby, supporting self-selection for a perceived benefit of cannabinoids [14–17]. A controlled trial of cannabinoids and placebo in 24 patients with a variety of neurological symptoms, primarily from MS, showed a notable improvement in pain and other symptoms, including LUTS improvement in cannabinoid users.
Depression and LUTS
Depressive disorder is a common medical problem among older adult males. It has significant health-related quality of life implications including decreased functional status and increased mortality, and is a risk factor for the development of other chronic diseases . Depression as a diagnosis is characterized by depressed mood and loss of interest in enjoyable facets of life and/or pleasure. The condition can manifest itself in a variety of ways both mentally and physically . The prevalence of depression in adults is 7.7% in those age 20–39, 8.4% in those age 40–59, and 8.0% in those age 60 and over, according to the National Health and Nutrition Examination Survey (2013–2016). Clinical studies revealed a correlation between depression and the diagnosis of LUTS. A review of 547 men identified that the 22% who scored poorly on a geriatric depression scale were three times more likely to also have severe LUTS, as was defined by an IPSS score of > 20. 9 Similar observations have been made in patients from Australia and Korea [35–37], and a systematic review of nocturia also found strong correlation with depression . Our group was able to identify the same association in an American sample of 173,649 men, with the diagnosis of depression carrying an odds ratio of 2.05 (95% CI 1.95, 2.16) for requiring LUTS/BPH therapy after multivariable controls . The range of depression prevalence in patients with LUTS lies within 11.5–12.3% [39, 40]. The severity of LUTS directly correlates with increasing severity of depressive symptoms, as well as with higher odds of suicidal ideation in cross-sectional studies [41, 42]. Whether this is a centrally mediated effect or whether the depressive state is a consequence of other symptoms and organ dysfunction is still unknown.
Whether the depressive state is a CNS-mediated effect, a consequence of other symptoms and organ pathology, or broad CNS dysfunction occurs in parallel to LUTS in the aging male is still unknown. Likely, a decline in organ function, for example, of the urinary bladder, might be paralleled or enhanced by a decrease in the function of the central or peripheral nervous system.
Adding to the myriad of interrelated factors is the apparent interaction between depression and cannabis usage. A study of 14,000 twins from Australia as well as other groups has suggested a correlation between heavy marijuana usage and depression [46–49]. The exact relationship between the two entities is not completely established, but studies suggest that regular marijuana use in adolescents results in a decrease in size in certain regions of the brain (hippocampus, amygdala, prefrontal cortex) that are dense in endocannabinoid receptors . Furthermore, early cannabis use was also associated with anhedonia and decreased serotonin levels in adults . The underlying deficiency in the intrinsic endocannabinoid system may be involved in heightened risk of post-traumatic stress development and may be the cause of increased cannabis use . The use of cannabinoids may also play a role in other behavioral diseases where the intrinsic endocannabinoid system appears to mediate neurochemical changes underlying the placebo effect . Could a subset of individuals similarly discover that the addition of exogenous cannabinoid to their own internal milieu corrects other forms of bother? There is a complex interaction between cannabinoid use, depression, and LUTS and further studies will be needed to understand their effects on each other ( Fig. 1 ).
Can You Take CBD Oil for Enlarged Prostate & Other Prostate Issues?
Cannabidiol (CBD) has developed a dedicated following thanks to its perceived effectiveness against anxiety, epilepsy, localized pain, and other conditions. Using CBD oil for issues such as an enlarged prostate is fairly common place, and although research is still limited (and much of the evidence for its efficacy is anecdotal) the popularity of this compound continues to grow. Like THC, CBD is a cannabinoid, an active compound found in cannabis. But unlike THC, CBD is non-psychoactive, so it doesn’t get the user high.
Some researchers are examining cannabidiol and other cannabinoids as part of a larger treatment for common prostate issues, including prostate cancer and prostate enlargement. Little is known for certain at this point, but researchers have uncovered some intriguing findings.
Before we delve into the specifics of CBD for enlarged prostate (and other prostate issues), we need to define the conditions. For the purposes of this article, we’re going to address the three most common prostate issues that men face:
- Benign prostatic hyperplasia (BPH, commonly known as enlarged prostate)
- Prostatitis (bacterial and non-bacterial)
- Prostate cancer
Each of these conditions has its own causes, treatments, and implications when it comes to using cannabidiol.
CBD for Enlarged Prostate (Benign Prostatic Hyperplasia)
The term “enlarged prostate” most commonly refers to benign prostatic hyperplasia (BPH). This is a condition where the prostate is enlarged but not affected by cancer. It commonly affects older men and may cause unpleasant symptoms like painful urination, pain in the hips and pelvic area, blood in the urine or semen, painful ejaculation, and frequent urination.
Though prostate enlargement can have numerous causes including inflammation, UTI, and kidney stones, it’s important to understand the role that testosterone plays. Testosterone causes the prostate to grow, so it may be possible to reduce the likelihood of hyperplasia by slowing testosterone production.
Some research indicates that cannabinoids like cannabidiol may inhibit testosterone production. This may prove beneficial for people who struggle with recurrent BPH. Though researchers point to THC as being the cannabinoid most closely associated with this effect, there may still be value in CBD and other cannabinoids as well.
For BPH sufferers, there’s another possible benefit of taking CBD: pain relief. In a comprehensive review of cannabis studies, the National Academies of Sciences, Engineering, and Medicine found that “there is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment for chronic pain in adults.” A University of South Carolina School of Medicine study found cannabidiol to be among the most effective cannabinoids for inflammation.
CBD for Prostatitis
Not to be confused with an enlarged prostate, prostatitis is a condition commonly caused by a type of bacteria that enters the prostate from the urinary tract; it can also be caused by a sexually transmitted disease like HIV or chlamydia. The condition may be chronic or acute, and it affects people of all ages.
As with enlarged prostate, cannabidiol may be able to relieve some of the pain, discomfort, and inflammation associated with this condition. What’s more intriguing, cannabidiol may have antibacterial properties that can address the problem at its source. Researchers at the Institute for Molecular Bioscience at the University of Queensland tested the antibacterial properties of CBD and found that it “had a very similar potency to that of common antibiotics.” This is an intriguing development, as antibiotics are the most common treatment solution for prostatitis.
CBD and Prostate Cancer
Prostate cancer is the second-most common cancer that men face (the first being skin cancer), impacting about 175 thousand American men each year. Over the past few years, researchers have been looking at cannabinoids as a potential treatment option for people with prostate cancer. A 2013 study found that cannabidiol is particularly effective among cannabinoids as a killer of prostate cancer cells. A growing body of research reinforces this potential. While cannabidiol may not cure prostate cancer, the compound may be effective for helping prevent and treat the disease.
In addition, CBD may help with the vomiting and nausea associated with chemotherapy. Research shows a link between the body’s endocannabinoid system (the internal receptors that respond to cannabinoids) and the areas of the brain responsible for nausea and vomiting. For those struggling with nausea as part of a cancer treatment, CBD may help to provide some relief.
Should You Take Cannabis or CBD for Prostate Issues?
Granted much of the research has focused on the whole cannabis plant and the full spectrum of cannabinoids, raising the question as to whether CBD on its own has as much value. While cannabidiol should provide at least some of the desired benefit, here are the factors to consider:
- CBD is non-psychoactive while whole-plant cannabis is psychoactive. If you don’t want the high or you’re concerned that you may be subject to drug-testing, stick with cannabidiol.
- Cannabis may be more potent overall due to the entourage effect (the interaction of cannabinoids, terpenes, and other compounds to maximize the drug’s effect). However, a Full Spectrum CBD product may also offer the entourage effect to a lesser extent. That’s because it contains all the compounds, including THC—the THC content is limited to just .3% in hemp-derived products.
- Recreational cannabis is legal in 11 states, and medical marijuana is legal in 33 states with the proper doctor’s recommendation. Hemp-derived CBD products are legal nationwide. If you want to remain in compliance with the law, you may need to consider this as a deciding factor.
If you’re considering CBD for prostate issues, first speak with your licensed cannabis doctor. Then consider if cannabidiol or other cannabinoids might be a viable part of your treatment. CBD has only minor side effects and is well-tolerated in most people, so it’s worth trying out even if the benefits prove to be minor.