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CBD

Submitted by Amy Sercel MS RD CD

Edited by Marcia Bristow MS RDN CSSD CD

Marijuana has recently been legalized for either medical or recreational use in many states.  Many people are now exploring cannabis-derived products to treat a wide variety of conditions, including (but not limited to) anxiety, arthritis, chronic pain, inflammation, muscle spasms, seizures, and insomnia.1,2 People looking for something to help manage one of these conditions without the intoxicating effect of marijuana often turn to CBD.

CBD, or cannabidiol, is the second-most prevalent compound in the marijuana plant behind THC (tetra-hydrocannabidiol, the psychoactive compound).  CBD is also present in hemp plants, which do not contain THC.  Hemp-based CBD oil is legal in every state, and is often added to tinctures, pills, salves, and even baked goods or energy bars.1,2 The World Health Organization recently reported that CBD has not been associated with addiction or dependence because it does not create the “high” that occurs with the use of THC.2

Both CBD and THC act by stimulating the endocannabinoid system.  This system is made up of neurotransmitters and endocannabinoid receptors in the brain, spinal cord, and peripheral neurons throughout the body.  The activation of endocannabinoid receptors can influence mood, cognition, appetite, pain, blood pressure, digestion, and inflammation, among many other essential processes.3

Although people use CBD to manage a wide variety of ailments, so far there is only strong evidence that CBD can effectively treat seizures.4 A medication called Epidiolex, which contains CBD, was recently approved by the FDA and can now be prescribed to treat two different types of epilepsy.5 Other than that, small-scale studies and case reports indicate that CBD is also a successful treatment for insomnia and anxiety, and has been shown to reduce pain in animals when used topically.2,6 However, more long-term, large-scale studies in humans are needed to determine whether CBD truly does alleviate all of the conditions it has been associated with.

One of the most significant problems with CBD is the lack of dosing recommendations.  Studies suggest that humans can safely tolerate up to 1500 mg of CBD each day, but a daily dose of 100 mg CBD has been shown to reduce seizure frequency in children and adolescents.  In one patient, a 5-month course of just 25 mg of CBD per day helped improve sleep quality and reduce anxiety. There are also no high-quality scientific studies that can provide guidance on how long someone should continue using CBD after their symptoms improve.4,6,7

In addition, CBD is currently treated as a supplement, not a medication, and as such there is little to no regulation of a product’s quality or CBD content.  Although CBD itself is not associated with any negative health impacts, there is a risk that products containing CBD may be contaminated with harmful substances, including pesticides or molds.  A study in the Netherlands recently found that many CBD products also contained THC, and some did not actually contain any CBD at all.7

Given the widespread popularity of CBD products, all of this suggests that there is an urgent need for more studies on the effectiveness of CBD so people can be sure they are using it in the correct dosages.  Additionally, there is a need for more specific testing to guarantee the purity and CBD content of all CBD products available for purchase.  If possible, look for CBD products that have been tested by a third party organization to determine the amount of CBD they contain. In Vermont, the store Ceres Natural Remedies can perform a lab analysis of hemp and marijuana products to determine their CBD and THC content.  Hemp producers who have paid for this analysis should be able to provide the results to their customers.  The Ceres Natural Remedies store is affiliated with the state’s medical marijuana dispensary and certifies products sold there, in addition to other hemp products sold throughout the state.8,9 Although there does not appear to be a risk of dependence and there is no risk of intoxication from CBD alone, it can interact with certain medications (such as Coumadin), so be sure to inform your doctor if you use CBD.

References:

  1.  Ask the Expert: Spotlight on Cannabidiol – Today’s Dietitian Magazine. https://www.todaysdietitian.com/newarchives/0618p8.shtml. Accessed April 8, 2019.
  2.  Cannabidiol (CBD) — what we know and what we don’t – Harvard Health Blog – Harvard Health Publishing. https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476. Accessed April 8, 2019.
  3.  Endocannabinoids: Overview, History, Chemical Structure. https://emedicine.medscape.com/article/1361971-overview. Accessed April 15, 2019.
  4.  Halford J, Marsh E, Mazurkiewicz-Beldzinska M, et al. Long-term Safety and Efficacy of Cannabidiol (CBD) in Patients with Lennox-Gastaut Syndrome (LGS): Results from Open-label Extension Trial (GWPCARE5) (P1.264). Neurology. 2018;90(15 Supplement):P1.264.
  5.  Epilepsy Foundation Statement on DEA’s Scheduling of Epidiolex® Philip M. Gattone, President and Chief Executive Officer, Epilepsy Foundation. Epilepsy Foundation. https://www.epilepsy.com/release/2018/9/epilepsy-foundation-statement-dea%E2%80%99s-scheduling-epidiolex%C2%AE-philip-m-gattone-president. Accessed April 22, 2019.
  6.  Shannon S, Opila-Lehman J. Effectiveness of Cannabidiol Oil for Pediatric Anxiety and Insomnia as Part of Posttraumatic Stress Disorder: A Case Report. Perm J. 2016;20(4). doi:10.7812/TPP/16-005
  7.  Hazekamp A. The Trouble with CBD Oil. Med Cannabis Cannabinoids. 2018;1(1):65-72. doi:10.1159/000489287
  8.  Baird JB. Test the potency of your homegrown VT weed. Burlington Free Press. https://www.burlingtonfreepress.com/story/news/2018/06/12/vermonters-can-legally-test-cannabis-potency/659507002/. Published June 12, 2018. Accessed April 22, 2019.
  9.  Lab Analysis of CBD Content – Green Mountain Hemp Company. Vermont CBD Hemp Products: Green Mountain Hemp Company. https://www.greenmountainhempcompany.com/lab-analysis/. Accessed April 22, 2019.

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