University of Otago (New Zealand), February 15, 2021

Some women desperate for relief from the chronic pain of endometriosis have found using cannabis provides more effective relief from their symptoms than other over-the-counter or prescribed medication, a new study reveals.

Of the 213 women surveyed who had ever used cannabis—either prescribed or illicit—for their endometriosis symptoms, 170 (almost 80 percent) were current users.

The majority of those who had stopped using cannabis did so because of its illegal status or because they weren’t able to find a regular supplier. None of the women stopped because it was not effective in controlling or easing their symptoms.

The paper was authored by the researchers from the University of Otago, in collaboration with those from the University of Western Sydney and Endometriosis New Zealand. While the researchers stressed the paper was not undertaken to advocate the use of illicit cannabis, they say it has highlighted a potential lack of effective available medication, access to health services and how desperate women can get when living with chronic pain.

Study co-author Dr. Geoff Noller, an Assistant Research Fellow in Otago’s Department of General Practice and Rural Health, says the study clearly showed cannabis provides patients with some relief or benefit with 98 percent reporting no negative side effects.

A cross-sectional online survey of those taking cannabis for health-related conditions ran between May and July 2019. This paper then took the sub-group of those where endometriosis was self-identified as a that was being treated with cannabis.

“It also suggests that for these patients at least, the current medical treatment or management of their conditions were not meeting their needs.

“Having noted that, we’re not for one second saying all women who have endometriosis should take cannabis—that would be irresponsible and inaccurate. Cannabis might be an option, but it is important that option comes with solid information about the pros and cons so clinicians and patients can make informed choices.”

Of the 213 women in the study, the majority used cannabis for pain relief (96 percent) and to improve sleep (96 percent). Respondents reported that their symptoms were “much better” for pain (81 percent), sleep (79 percent) and nausea or vomiting (61 percent).

Some 81 percent of women indicated cannabis had reduced their normal medication usage and 50 percent had completely stopped taking their medication—most commonly analgesics, such as paracetamol, and opioids.

“Again, this potentially suggests that patients’ current treatments and medications may not be meeting their needs. This could be for a variety of reasons including both that cannabis may be more effective in managing some of the patients’ symptoms and also possibly that it has less negative side effects than some prescribed medications, for example opioids, which are recognised as having negative effects including constipation, as well as a significant potential for physical dependence.”

Dr. Noller says a “key strength” to the study is that the respondents were “fairly representative” of New Zealand demographics.

“One of the common assumptions is that people who identify as using cannabis for therapeutic reasons are simply looking for an excuse to explain their use; this perspective tends to go with a stereotypical view of a type of person who might use cannabis, commonly thought of as young, male and unemployed.

“The varied demographics from our sample, including the median age of 31 years … median income $35k to $40k, 52 percent working, suggests this is not simply a sample of recreational cannabis users.”

The study provides evidence that cannabis-based medicines “should at least be considered as an option for treatments,” he says.

“Appreciating that patients with specific conditions appear to find relief from symptoms by using cannabis suggests that researchers should consider more specific inquiries regarding the use of cannabis for specific conditions. Additionally, research could be directed at health professionals concerning their knowledge and views about medicinal cannabis.”

Sativex, a sublingual spray, is the only formally approved cannabis-based medicine available in New Zealand. At more than $1000 for a month’s prescription it is an expensive option, which may also contribute to patients exploring other cannabis preparations, including illicit cannabis, he says.

“However, there is further legislation pending for 1 April 2021, that will facilitate access to a greater variety of cannabis-based medications, including those containing a greater variety of cannabinoids. It is hoped that this may increase options for patients, particularly if their health professionals are aware of these increased options.

“Health practitioners will need to develop a greater understanding of medicinal cannabis options, to be able to advise patients about both the pros and cons of these medications,” Dr. Noller says.

Co-author Professor Neil Johnson, of Auckland Gynaecology Group, says some endometriosis-sufferers are desperate for symptom-relief, but caution is necessary.

“While the women who took part in this survey obviously found relief from their symptoms, cannabis won’t be a magic bullet, it won’t work for everyone. And, just like any potential medication, we need to be aware of the side-effects and consequences of use, particularly in young reproductive-age women.”

Clinical trials are needed to demonstrate which formulations provide the most benefits, with the least downsides, he says.

“What I think this study highlights are the difficulties those with endometriosis face dealing with their symptoms on a day-to-day basis. We still have a long way to go to adequately provide for those who have to deal with this disease.”

The paper, co-authored by Otago’s Dr. Noller, Dr. Jane Girling, Maria Larcombe, Western Sydney University’s Dr. Mike Armour, Justin Sinclair and Mahmoud Al-Dabbas, Endometriosis New Zealand CEO Deborah Bush, and doctors Neil Johnson and Erika Hollow was published in the Journal of Women’s Health.

Sweet discovery in leafy greens holds key to gut health

University of Melbourne and University of York, February 15, 2021

 

A critical discovery about how bacteria feed on an unusual sugar molecule found in leafy green vegetables could hold the key to explaining how ‘good’ bacteria protect our gut and promote health.

The finding suggests that leafy greens are essential for feeding good gut bacteria, limiting the ability of bad bacteria to colonise the gut by shutting them out of the prime ‘real estate’.

Researchers from Melbourne and the UK identified a previously unknown enzyme used by bacteria, fungi and other organisms to feed on the unusual but abundant sugar sulfoquinovose – SQ for short – found in green vegetables.

Each year, leafy green vegetables – such as spinach – produce the sugar on an enormous scale globally, comparable to the world’s total annual iron ore production.

The research, published in the journal Nature Chemical Biology, was led by Dr Ethan Goddard-Borger from the Walter and Eliza Hall Institute, Professor Spencer Williams from the Bio21 Institute and University of Melbourne, and Professor Gideon Davies from the University of York, UK.

Dr Goddard-Borger said the discovery could be exploited to cultivate the growth of ‘good’ gut bacteria. “Every time we eat leafy green vegetables we consume significant amounts of SQ sugars, which are used as an energy source by good gut bacteria,” he said.

“Bacteria in the gut, such as crucial protective strains of E. coli, use SQ as a source of energy. E. coli provides a protective barrier that prevents growth and colonisation by bad bacteria, because the good bugs are taking up all the habitable real estate,” Dr Goddard-Borger said.

“E. coli is a key bacterial coloniser needed by our gut. We speculate that consumption of this specific molecule within leafy greens will prove to be an important factor in improving and maintaining healthy gut bacteria and good digestive health.”

Professor Williams said the team had revealed how bacteria extract the sugar from plants in order to fuel their growth. “We discovered the enzyme YihQ, which is used by bacteria to absorb and metabolise these sulfur-containing sugars as food,” he said.

“Sulfur is critical for building proteins, the essential components of all living organisms. SQ is the only sugar molecule which contains sulfur, and ‘digestion’ of the molecule by bacteria releases sulfur into the environment, where it re-enters the global ‘sulfur cycle’ to be reused by other organisms.”

Professor Williams said that the pathway was unusual, but abundant in biological organisms.

“This work answers a 50-year mystery that has surrounded how sulfur – an element essential for life on Earth – was used and recycled by living organisms,” he said. “What is remarkable is that the YihQ enzyme was hiding in plain sight and is produced by the humble bacterium E. coli, present in nearly every biologist’s laboratory.”

The discovery also provides crucial insights that may one day be exploited to develop an entirely new class of antibiotics, Dr Goddard-Borger said. “New antimicrobial strategies are desperately needed as more and more bacteria acquire resistance to existing classes of antibiotics.”

“We think it will be possible to use these widespread enzymes to enable highly specific delivery of antibiotics to harmful forms of E. coli and other pathogens, such as Salmonella, responsible for food poisoning, while leaving the good gut bacteria untouched.”