CBD is everywhere these days—in products from supplements to sparkling water to shampoo. What’s the best way to benefit? A doctor and a pharmacist explain.
“Hemp-derived CBD has a very large therapeutic potential to help in a multiplicity of ways,” says Joseph Maroon, MD, a neurological surgeon at the University of Pittsburgh, a pioneer in nutritional healing, and coauthor of a recent scientific review of CBD published in Surgical Neurology International. “It is a significant anti-inflammatory; it’s an analgesic—a pain reliever; and it’s an antianxiety agent.”
And it does these things safely. In using CBD with hundreds of patients, Maroon has found no side effects other than some gastrointestinal upset in one or two cases. He recommends it for neck pain, back pain, degenerative disk disease, osteoarthritis, trauma, sleep problems, anxiety, and peripheral neuropathy, such as burning, painful feet that are a common complication of diabetes.
For any type of pain, CBD is a safer alternative to over-the-counter remedies such as acetaminophen or ibuprofen. “Ibuprofen kills 16,000 to 17,000 people a year from gastric hemorrhage, and it hospitalizes over another 100,000 for gastrointestinal bleeds,” says Maroon. And acetaminophen, when used long-term, is a common cause of liver failure and the need for a liver transplant.
However, says Maroon, “CBD is not a cure-all.” Rather, it works best when used much like aspirin or the other over-the-counter pharmaceutical remedies, as a safer, plant-derived alternative.
CBD, short for cannabidiol, brings about benefits by influencing the endocannabinoid system—a signaling system that helps to regulate inflammation, the brain and central nervous system, and the immune system. Although its effects aren’t fully understood, CBD has a balancing effect.
“It’s an adaptogen,” says Earl Mindell, a pharmacist, pioneer in nutritional healing, and author of Healing With Hemp CBD Oil. “It adapts to your needs.” As an example, someone taking CBD for pain might also experience reduction in anxiety or improvement in sleep, even though these weren’t the symptoms that prompted the use of CBD.
The short answer is, “No.” CBD can be extracted from hemp or marijuana. Unlike hemp-derived products, CBD from marijuana may be combined with THC, the component in the marijuana plant that does produce a high.
The hemp plant contains traces of THC, but by law hemp may not contain more than 0.3 percent THC—too little to produce a psychoactive effect.
The popularity of CBD has been driven by user experience, and the legalization of hemp cultivation in the United States in 2018 has opened the door to a proliferation of research. Mindell estimates that there are more than 40 human trials of CBD currently underway.
CBD formulated as an FDA-approved drug, Epidiolex, is used to treat certain forms of childhood epilepsy, and there is anecdotal evidence that over-the-counter CBD products can also reduce epileptic seizures. Other study highlights:
One study tested a hemp CBD extract among people who had been taking opioids for chronic pain for at least a year. The study, published in Postgraduate Medicine, tracked 94 patients of a pain clinic based in New Albany, Ind., who took an extract containing approximately 15 mg of CBD, twice daily in most cases. After 8 weeks, 53 percent of patients had significantly reduced or eliminated use of opioids, and 94 percent reported better quality of life.
In Poland, researchers tested a topical hemp CBD oil against a placebo for jaw pain in 60 people. In the study, published in the Journal of Clinical Medicine, applying hemp CBD oil topically to jaw muscles, twice daily for 14 days, significantly reduced pain intensity—by 70 percent in those using hemp CBD oil, compared to about 10 percent in those using a placebo oil.
At a mental health clinic in Fort Collins, Colo., the effects of CBD were tracked in 72 patients suffering from anxiety or poor sleep. Nearly all patients took 25 mg of CBD daily in capsules (a handful took larger doses) as an adjunct to their usual drug treatment. After a month, there was mild improvement in sleep and greater improvement in anxiety.
Among those who continued to take CBD for another month—56 percent—sleep varied but improvements in anxiety were sustained. Results of the research were published in The Permanente Journal.
A review of studies that used CBD doses ranging from 75 to 400 mg daily, taken in addition to medications, found that patients experienced improved mental and emotional health and less disruptive involuntary movement while sleeping. The review was published in the European Archives of Psychiatry and Clinical Neuroscience.
The quality of CBD products varies a great deal. Look for a company whose website describes its agricultural, extraction, and testing methods and provides a Certificate of Analysis (COA)—results of testing by a competent lab. Tests should be done to ensure that products do not contain any microbial contaminants, pesticides, or other toxins that could be harmful. In addition, products should be tested to make sure that the label accurately states quantities of CBD and other ingredients.
In capsules and tinctures, hemp CBD should be extracted from the aerial parts of the plant and should be “broad spectrum,” or “full spectrum,” meaning that in addition to CBD, it contains other beneficial components found naturally in the hemp plant. On labels, take note of the serving size and look for the quantity of CBD per serving.
When choosing topical CBD balms or lotions, check other ingredients on labels for possible skin irritants or allergens.
CBD is best absorbed with fat, and some tinctures and soft gels contain fat. Otherwise, take CBD with a fatty food.
The overriding recommendation is “Start low and go slow.” Maroon recommends starting with 15 mg daily for three days and if needed, increase to 30 mg for another three days. If needed, keep increasing the dose by 15 mg every three days, up to 100 mg.
To enhance sleep, take CBD in the evening. To relieve anxiety, pain, or other symptoms, take it during the day. In some cases, it makes sense to split the daily amount into two or more doses—if you experience anxiety relief for only a few hours, for example.
For localized pain, such as a painful joint, start with a CBD balm or cream, rubbed on as needed. If, after a few days, you need more relief, try adding a tincture or pill.
Conditions for which CBD may be beneficial include:
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