Have you been suffering from a chronic health problem, but have found little relief from prescription medications or multiple natural remedies? If so, you may want to explore CBD (Cannabidiol) as a potential legal, safe remedy. While conferring with a practitioner experienced in its administration is recommended when using CBD, this basic primer is meant to provide sufficient information to help you determine whether trying this remedy may be right for you.
What Is CBD? – Legality & Safety
The endocannabinoid system (ECS) of the human body, discovered in the 1990s, is the biological basis for mind-body medicine. It regulates well-being, energy and pleasure, and maintains physiological equilibrium (homeostasis) when the body is confronted with injury or disease. Phytocannabinoids are chemical messengers that work like the body’s own endocannabinoids, neurotransmitters found throughout the nervous system that regulate the body’s major systems.
CBD is one of over 100 phytocannabinoids found in hemp, a plant genetically distinct from, but related to, marijuana. Both CBD (more correctly referred to as hemp oil) and marijuana are from different varieties of the same plant species, Cannabis. While marijuana generally refers to the cultivated plant used as a psychotropic drug, hemp is cultivated from the subspecies Cannabis sativa for use in the production of various products, including nutritional supplements, foods and beverages, personal care products, and fabrics and textiles.
~ CBD: A Patient’s Guide to Medicinal Cannabis, Leonard Leinow and Juliana Birnbaum (2017)
Federal law defines hemp and marijuana differently. If a plant contains 0.3% or less of Δ-9-tetrahydrocannabinol (Δ-9-THC, known as THC, the mind-altering component of Cannabis), the federal government considers it “industrial hemp” that can be legally formulated and sold as tinctures, gummies, capsules, and topical remedies. (Interestingly, CBD actually lowers THC’s psychotropic effect.) If, however, a plant contains more than .3% THC, it is considered marijuana, and even states that have legalized it sharply limit where and how it may be sold. CBD research has been relatively limited due to political bias against Cannabis, and researchers generally agree that more randomized controlled trials are warranted. In this article, CBD refers solely to industrial hemp or hemp oil.
While CBD has very few known adverse effects (can include fatigue, diarrhea, and changes in appetite and weight), the right dose depends on multiple factors, including the condition being addressed and its stage or intensity, the individual’s biology, metabolism, and sensitivity to Cannabis, and how their ECS acclimates to the use of CBD over time. CBD should be used in low amounts initially and adjusted slowly until the desired effect is reached. In addition, there are certain contraindications and precautions that should be considered when ingesting CBD in any form. CBD temporarily alters the activity of cytochrome P450, a family of liver enzymes that metabolize both CBD and many widely-used pharmaceuticals, including steroids, proton pump inhibitors (PPIs), antibiotics, benzodiazepines, blood pressure medications, antidepressants, antihistamines, and anti-epileptics. CBD can either increase or decrease the breakdown of these and other drugs.
Other precautions include: (1) CBD should not be mixed with alcohol; (2) due to its “bidirectional effect,” with excess dosing or due to individual body chemistry, CBD can over-stimulate the ECS, causing or exacerbating the adverse effects it normally relieves; and (3) since Cannabis readily absorbs heavy metals, pesticides, and other potentially harmful chemicals that may be in soil or water, it is important to buy only reputable CBD brands that regularly test their products for THC and contaminants, and/or use organic hemp.
CBD Effectiveness: Delivery Methods
The effectiveness of CBD varies widely among individuals, in part based on delivery method, dose, the time of day it is administered, the treated condition and degree of advancement, and how much food has been consumed relative to the time of administration (because CBD is fat-soluble, its absorption increases greatly when taken with fatty food). Phytocannabinoids work better in whole plant extracts than in isolated, refined, or synthetic products. CO2 extraction, the most widely used method for removing CBD from hemp, produces a safe, pure product.
As previously noted, CBD is available in multiple forms. Selection should take into account how quickly the CBD will take effect (onset), how long it will last in the system (duration), and bioavailability (how much will be absorbed). These guidelines generally apply for the most readily available, and thus most widely used, delivery methods: (1) Topical (salves/creams): Onset – 15 minutes, Duration – 2-4 hours, Bioavailability – N/A (local relief only; does not enter the bloodstream); (2) Ingestion (capsules/chewed and swallowed gummies): Onset – 30 to 90 minutes, Duration – 6-8 hours, Bioavailability – 8-15% (slow, erratic absorption through the intestines; maximum plasma concentrations usually in 1-2 hours; can take 2-3 times/day); (3) Oral Mucous Membranes (oil based tinctures, gummies/lozenges dissolved in the mouth): Onset – 40-75 minutes (sublingual use – 30 seconds to 2 minutes), Duration – 6-8 hours, Bioavailability – 6-20% (can take up to 6 times/day).
Science-Based Uses of CBD
Drawn from relatively limited, preliminary scientific evidence, below is a short, alphabetized list of some of the more promising CBD applications when used responsibly according to the above guidelines. CBD also has widespread application in the treatment of veterinary health challenges.
- Acne: CBD may help treat acne by combating inflammation and controlling sebaceous gland secretions.
- Anxiety & Stress: Though calling for more clinical studies of the chronic effect of CBD, researchers reported in their 2015 review of multiple studies that preclinical evidence strongly supports it as an acute treatment for various anxiety disorders, including GAD, panic disorder, OCD, and PTSD.
- Inflammation: Cannabinoids are well-established anti-inflammatory agents. In one 2009 scientific review, the researchers maintain that they can reduce multiple disease symptoms, including those that arise in autoimmune disorders (multiple sclerosis, rheumatoid arthritis, ulcerative colitis), and certain cancers with inflammatory components. Other reviews maintain that future clinical studies are warranted before the exact role of CBD in treating inflammatory diseases can be determined.
- Migraine Headaches: Studies to date have examined only the combined effect of CBD and THC on migraines. In a 2018 study review, the researchers concluded that the anticonvulsive, analgesic, antiemetic, and anti-inflammatory properties of cannabinoids make CBD and THC promising remedies for both acute and prophylactic treatment of migraine pain.
- Neurological Disorders: CBD has been proven to have anti-seizure, antipsychotic, neuroprotective, and antidepressant value. Initial research has demonstrated that CBD may reduce seizure frequency and be safe for children and young adults with highly treatment-resistant epilepsy. (However, some epilepsy study subjects have experienced adverse reactions, including convulsions and sleepiness/fatigue.) One very small 2014 study established that CBD controlled sleep difficulties in Parkinson’s patients. In a mini-review of the effect of CBD on Alzheimer’s disease in animal and test tube studies, researchers concluded that it reverses and prevents the development of cognitive deficits and is a valid candidate for novel Alzheimer’s therapies.
- Pain: Studies on over one thousand patients have established that CBD may help reduce chronic pain by impacting endocannabinoid receptor activity, reducing inflammation, and interacting with neurotransmitters. One animal study found that oral CBD treatment significantly reduced sciatic nerve pain and inflammation. While determining the right dosage is critical, studies have demonstrated that, when used with opioid medication, CBD can reduce opioid dosing, tolerance buildup, and withdrawal severity.
- Sleep Disorders: While the ECS helps regulate sleep and the body’s circadian rhythms, little is known of exactly how CBD combats sleeplessness. It is thought that CBD may promote healthy sleep patterns by addressing the causes of sleeplessness, including anxiety, pain, PTSD, and depression.
The world of CBD research is a relatively new and exciting frontier. In addition to the above applications, initial evidence supports the value of further study of the use of CBD to address various other health conditions, including Type 2 diabetes, obesity, IBS, immunity modulation, high blood pressure and cardiovascular disease, addiction, and cancer-related symptoms and treatment side effects. Given that CBD is considered safe and legal, personal exploration of CBD for these purposes may prove beneficial.
The statements in this article have not been evaluated by the Food and Drug Administration, are for educational purposes only and are not intended to take the place of a physician’s advice.
Submitted by Erika Dworkin, Board Certified in Holistic Nutrition®, Owner of the Manchester Parkade Health Shoppe (860.646.8178), 378 Middle Turnpike West, Manchester, CT, www.cthealthshop.com, nutrition specialists trusted since 1956. Erika is available to speak to groups including on Zoom.
All statements in this article are practice or scientific evidence-based and references are available upon request.