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.
