CBD is a popular topic amongst individuals aspiring to live a healthier lifestyle. The touted benefits of CBD range from relieving day-to-day anxiety, all the way to being an effective treatment for epilepsy. However, the age old rule of “If it sounds too good to be true, it most likely is” probably still applies in this circumstance. In this review we will dive into some of the proclaimed, and backed, benefits of CBD usage and whether or not it’s worth its high price tag.
What is CBD –
CBD stands for Cannabidiol. CBD is the second most abundant cannabinoid found in cannabis, after THC (tetrahydrocannabinol) 1. Although the compound is stemmed from cannabis, there is believed to be no psychoactive effect when taking CBD. This is due to the compounds extremely low concentration of THC1. CBD is commonly found isolated and intended to commonly treat pain, anxiety, sleep disorders, and depression2.
Benefits of CBD –
The main benefit of CBD that has been studied in human clinical trials is the usage of CBD for treating two rare forms of epilepsy (Lennox-Gastaut and Dravet syndrome) 3. Unfortunately, the other proposed benefits of CBD have not yet been extensively studied, and human randomized trials are scarce in these respects. There have been some positive rodent studies, but these do not translate well to humans and usually wouldn’t elicit the same effects.
Is CBD Legal –
The answer is, it’s complicated. CBD oils are derived from hemp and are supposed to have a low THC level (below 0.3%).
In 2018 the Agriculture Improvement Act of 2018 (the 2018 Farm Bill) was passed. Along with many other things, this bill defined a new category of cannabis known as “hemp” defined as cannabis and cannabis derivatives with extremely low (no more than 0.3 percent on a dry weight basis)4. The act removed hemp from the controlled substance list which means it is no longer a controlled substance under federal law. At the same time, Congress explicitly preserved the FDA’s current authority to regulate products containing cannabis or cannabis-derived compounds under the Federal Food, Drug, and Cosmetic Act (FD&C Act) and section 351 of the Public Health Service Act4.
In the FDA’s statement on CBD, it was also mentioned that many companies are already beginning to use absurd claims such as,
•“CBD successfully stopped cancer cells in multiple different cervical cancer varieties.”
•“CBD also decreased human glioma cell growth and invasion, thus suggesting a possible role of CBD as an antitumor agent.”
•“For Alzheimer’s patients, CBD is one treatment option that is slowing the progression of that disease.”
•“Fibromyalgia is conceived as a central sensitization state with secondary hyperalgesia. CBD has demonstrated the ability to block spinal, peripheral and gastrointestinal mechanisms responsible for the pain associated with migraines, fibromyalgia, IBS and other related disorders.”
•“Cannabidiol May be Effective for Treating Substance Use Disorders.”
•“CBD reduced the rewarding effects of morphine and reduced drug seeking of heroin.”
•“CBD may be used to avoid or reduce withdrawal symptoms.”
The FDA states that there is currently no substantial scientific backing to these claims, and they will not tolerate claims of the sort4.
Is CBD Dangerous –
In small amounts, most likely not. In larger doses over time, possibly.
Side effects of CBD are relatively benign with reduced appetite, diarrhea, and fatigue5. Along with the limited research on the benefits of CBD, there is also limited research on the deleterious effects of it. Majority of the CBD studies on humans are short term and do not get a chance to explore the potential effects of chronic CBD consumption5.
Despite this lack of research, CBD does seem to be relatively safer than other recreational drugs used for alleviating symptoms of pain and anxiety6.
How does CBD Work -
How CBD works is not yet fully understood, but a rational explanation is through the newly discovered endocannabinoid system, first described in 19927. THC actually works by acting with the CB1 and CB2 receptors which are believed to be important for our homeostasis. However, THC usage comes along with cognition impairment, slight memory loss, and the psychoactive “high”8. CBD actually works to counteract these effects on the CB1 and CB2 receptors.
CBD also works on other various receptors that impact our pain management, anxiety, and even potentially cancer9,10. A caveat to all of this is that CBD typically works much better in conjunction with THC. This is often referred to as the "entourage effect" – that a single ingredient might, maybe do a little something, but you need the whole crew of compounds in the plant to have full efficacy11. Unfortunately, that method will make you “high” and that may not be desired for most people.
How to Take CBD –
CBD is unregulated, what that means is some products may contain less CBD than is claimed on the bottle, and some may contain much more. The same is to be said about THC content. Ideally, there should be no more than 0.3% THC, but this might not always be the case. As far as dosing, recommendations are all over the place. As mentioned before, CBD has not been studied enough to give a solid recommendation when it comes to dosing. Studies and there doses have ranged from less than 5 mg/d to well over 100 mg/d. As with any new medication, it is imperative that you speak to your physician before trying CBD. When taking CBD start with a low dose and assess tolerance. Also, try your best to purchase from reputable brands that hopefully have the most accuracy when it comes to label claims.
Take Home Message –
CBD is a new area of interest when it comes to treatment of various conditions. Anecdotally speaking, I work at a supplement shop part-time. Once a new trend hits the market (keto, CBD, etc.), our store jumps on the craze and stocks up. We now currently sell CBD oils of all kinds, some with added compounds, and even some in the form of aromatherapy and beauty products. With all of these new products coming to the market, it is important not to fall prey to the flashy words of “CBD” on new products.
Will a high dosed CBD oil work? Maybe.
Will a CBD aromatherapy/facemask do anything? Probably not.
Another important consideration is the price tag. I have seen CBD oils range anywhere from $30 - $200. To spend two-hundred dollars on something that may or may not work is a hard sell for me. Coming from a personal training facility my assumption is a lot of you may be interested in the possibly pain alleviation you can get from CBD. My first recommendations if you wanted to go to the drug/supplement route would be to implement Omega-3 fish oils or try something like turmeric capsules. These two products are great at reducing inflammation and have been shown to do so in various research. These products are also much more cost effective that CBD. As always, before starting any supplements regiment consult your health care provider, and don’t forget you can get those two compounds from food alone if you so choose.
1. Andre CM, Hausman JF, Guerriero G. Cannabis sativa: The Plant of the Thousand and One Molecules. Front Plant Sci. (2016)
2. Corroon J, Phillips JA. A Cross-Sectional Study of Cannabidiol Users. Cannabis Cannabinoid Res. (2018)
3. Chen JW, Borgelt LM, Blackmer AB. Epidiolex (Cannabidiol): A New Hope for Patients With Dravet or Lennox-Gastaut Syndromes. Ann Pharmacother. (2019)
4. New steps to advance agency’s continued evaluation of potential regulatory pathways for cannabis-containing and cannabis-derived products. FDA. https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-new-steps-advance-agencys-continued-evaluation. Accessed 9/3/19.
5. Fischer B, et al. Lower-Risk Cannabis Use Guidelines: A Comprehensive Update of Evidence and Recommendations. Am J Public Health. (2017)
6. WHO - CANNABIDIOL Critical Review Report,.
7. Devane WA, et al. Isolation and structure of a brain constituent that binds to the cannabinoid receptor. Science. (1992)
8. Aso E, et al. Adenosine A2A-Cannabinoid CB1 Receptor Heteromers in the Hippocampus: Cannabidiol Blunts Δ9-Tetrahydrocannabinol-Induced Cognitive Impairment. Mol Neurobiol. (2019)
9. Basavarajappa BS, Nixon RA, Arancio O. Endocannabinoid system: emerging role from neurodevelopment to neurodegeneration. Mini Rev Med Chem. (2009)
10. Pacher P, Bátkai S, Kunos G. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol Rev. (2006)
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