CBD has become all the rage lately, which has caused all manner of creams, oils, and pills to pop up for sale pretty much everywhere you go. Much of this is due to the fact that the system in the body that uses CBD and molecules like it is a fairly new discovery. In addition, it is only recently that states have begun to allow CBD to be sold at all. My intent is to clear up how CBD works, what conditions it works best for, and how to make sure you are getting a quality product that has been proven to be effective.
The Endocannabinoid System
Pretty much everyone knows the word “cannabis” so no need to define that. “Endo” is short for “endogenous” which basically means the body produces it and it doesn’t come from external sources. So the endocannabinoid system (which we will call the ECS for the rest of this post) is referring to the internal system that responds to and produces molecules that are similar in structure to the molecules in hemp. The fact that the body can produce these molecules is a relatively new discovery, around the early 1990’s. Since then it has been revealed that the ECS regulates sleep, mood, appetite, memory, reproduction/fertility, and the immune system. The reason for such a wide range of effects is due to the fact that the main role of the ECS is to help maintain something called homeostasis. Homeostasis is the process by which the body tries to maintain balance, and a stable environment. It is constantly in action in all systems of the body, helping to regulate blood pressure, heart rate, blood sugar, and thousands of other processes and reactions. The main function of the ECS is to fine tune neurotransmitter release, which in turn fine tunes homeostasis. Neurotransmitters, the most famous being things like serotonin and dopamine, are the primary way that the nervous system communicates with itself and the rest of the body. The fine tune control of the ECS helps to balance out the response that the nervous system is trying to illicit.
There are two types of receptors in the system and they are cleverly named CB1 and CB2 receptors. The CB1 receptors are primarily located in the central nervous system (the brain and spinal cord) and the CB2 receptors dominate the peripheral nervous system and immune cells. THC, which is the psychoactive component, has a stronger affinity for the CB1 receptors in the central nervous system which is why it causes the high associated with marijuana. More in depth review of the health benefits of THC are beyond the scope of this article. If it becomes legalized in more areas of the country it may be worth another look, but we will leave that for another day. Cannabidiol, or CBD, is the non-psychoactive portion of the plant. It has a low affinity for both receptors, but it exerts its actions in a different way. It does still bind to receptors in small amounts, but CBD oil mainly works by modulating the breakdown and signalling of the body’s natural endocannabinoids which allows them to work more efficiently and last longer in the system. This is actually a better mechanism because it allows the body to help control it’s own response versus forcing a response on it. When a molecule act directly on a receptor, the body can develop a sort of resistance to that molecule and so more is usually needed over time to get the same reaction. This happens with hormone therapy. Hormones are usually produced as needed and are controlled via homeostasis to be reduced when the receptors are saturated. If the receptors are always saturated, the hormone response of the body is changed, or the body will actually stop making receptors to help control the response. So with CBD oil, it is less likely that the dose will need to be increased over time to have the same effect.
CBD and THC work together to balance each other in the plant. The more CBD that is present, the less effect THC will have. In medicinal uses, it is helpful to have a high CBD content because you can get the benefit of both the THC and the CBD with much less of the psychoactive effects. However, since THC is not legal in most states or federally, we must get the most benefit we can out of CBD only. It is only legal to sell CBD if it contains 0.03% THC or less. There is a slight risk, and we have seen it before, that someone will test positive on a marijuana screen for work if they take high levels of CBD, even it if contains the legal amount of THC. The CBD that we work with is tested to have zero THC so that we aren’t risking a positive test.
The Entourage Effect
CBD works fairly well by itself, but it works even better when combined with other substances. This is called the Entourage Effect. One of the best examples of this is CBD and cinnamon essential oil. Essential oils contain active chemicals called terpenes. When you combine CBD with certain terpenes in enhances the effect of both chemicals. The main terpene in cinnamon oils is called betacaryophyllene and it helps CBD interact with the body’s own endocannabinoids, it helps it work with the CB2 receptors, and it can actually do both of those things itself. Cinnamon oil itself has so many benefits on it’s own that I am working on another post dedicated to it. The main takeaway is that, while CBD can be extremely effective on it’s own, it works better when enhanced with other natural compounds that have similar actions.
CBD Dosing and Uses
CBD oil is used for a wide variety of complaints especially anxiety, chronic pain, and sleep issues. As mentioned earlier, it also has effects on the immune system, the reproductive system, weight control, and general mood. We have seen very strong effects on children with ADHD and other behavioral issues. It also has been shown to reduce the symptoms of irritable bowel syndrome and other gut symptoms. There are also CBD creams that can be rubbed on painful muscles and joints. The benefit to these over other pain relief creams is that the CBD that is absorbed is anti-inflammatory so it actually works to reduce the swelling and pain in the area, rather than just masking it. Dosing can be different for each individual case. Products range from a few milligrams to a gram or more. For daily use to help with mild anxiety or pain, a smaller dose could be enough, for more severe chronic pain or extreme difficulty sleeping, a higher dose may be needed. It is usually best to start out at a dose around 20 to 30 mg and then increase from there. However, it is best to talk with your healthcare provider to determine the proper dosing for your condition. The good news is that it is an extremely safe supplement, as we will discuss below, with doses as high as 1200 to 1500 mg being shown to be safely tolerated for long periods of time. That dosing would require an entire bottle or more of most CBD products.
Safety and Side Effects
As we just mentioned, CBD products are extremely safe and have very few side effects. However, as with anything, side effects are always possible. Side effects are very rare but can include fatigue, diarrhea, weight changes, and appetite changes. Every human being is different and they have different health challenges and different internal environments so it is always best to start slow and build up with any supplement to make sure it is well tolerated. It is also very important to check with your healthcare provider before starting any supplement, especially if you are on medication. CBD can effect some liver detox enzymes in the same way that grapefruit can, so if you are on a medication that limits or restricts grapefruit you will want to avoid CBD oil. Otherwise it is tolerated well even at doses that would be cost prohibitive anyway.
It is also extremely important to pay attention to the source of your product. You will see CBD being sold at healthcare offices, golf courses, supplement shops, pet stores, and we have even seen it being sold at the side of the road or in flea markets. CBD is not well regulated, so it is important to find products that are third party tested and meet their label statements. It is always better to spend a little more to get a higher quality product than to buy something that may have harmful additives or may not have the level of active ingredient that it states. The CBD that we use in our office are from companies that we have extensively researched. Due to federal regulations, it is difficult to recommend them in an article like this, but we would be happy to help if you contact us or ask us in the office. In general we use products that we have known to be successful with our patients. We are particularly excited about products that contain other oils, like cinnamon, because we have seen that our patients do notice an increase in effectiveness.
We will definitely have more information on CBD and conditions it can be used for as more research continues to be done. Stay tuned for another article regarding the chemistry of CBD and the science of the absorption which will help you distinguish between marketing language and actual science. We are also working on an online and in person CBD class, along with classes on a variety of other subjects so stay tuned for that as well!
If you have any questions, please feel free to comment and we can address it there or in another post.