CBD or Cannabidiol has been gaining a lot of traction recently. Everywhere you look there seems to be someone offering it in a new form, accompanied by a new claim as to how it will benefit your well-being. Some of these claims are supported by solid evidence, but some are often exaggerated, and many even tend towards the dubious.

I have personally benefited significantly from using CBD products. However, I have been increasingly concerned by the number of false or misleading claims circulating about it online, and feel that there is a need for an accessible overview of what we currently do and do not know about CBD in plain language.

Today we are going to take a look at what exactly CBD is, how it works, and what current research says about its efficacy in different forms. We are also going to look at some of the problems within the growing CBD industry, and the reasons why so many patients continue to turn to it anyway.

(This is a long article, you can jump straight to a summary of the key points here.)

Disclaimer: This is not medical advice. CBD is a medicinal compound like any other. As such, it carries risks and has the capacity to interact with other medications and cause side effects. Always speak to your doctor before trying CBD and check the legal standing of CBD products in your state/country.

A note for my Belgian friends: CBD is currently in a legal “grey area” in Belgium. Please read the FAMHP guidelines about this carefully and speak to your doctor about the products that you can legally and safely access in your specific situation. They may still be able to write you a prescription as doctors in Belgium enjoy “therapeutic freedom.”

What is CBD?

CBD or Cannabidiol is one of the active compounds found in the Cannabis Sativa plant. Unlike medical Marijuana, it does not contain THC; the substance which causes people to experience a “high.” There is currently no evidence that CBD leads to physical dependency or has a psychoactive effect on humans. Because of this, it has recently gained popularity as a treatment for pain, anxiety, insomnia and a number of chronic health conditions.

Research suggests that when CBD enters the bloodstream it binds to the CB1 and CB2 receptors in the endocannabinoid system in the same way as THC. The endocannabinoid system is a complex cell signalling system linked with the regulation of several important bodily functions. These include pain and inflammation responses, muscle formation and mood.

There is also growing evidence that CBD combined with THC may be more useful in the treatment of certain types of Epilepsy and for the spasticity associated with Multiple Sclerosis. While this will not be the focus of this article, further information about the use of CBD/THC formulations in the treatment of Epilepsy can be found on the Healthline and Epilepsy Action websites. Information about the use CBD/THC formulations for Multiple Sclerosis can be found on the Healthline and MS Society websites. There is also a short overview of the existing research in the US National Library of Medicine.

Overall, research is still largely in its infancy and is often overstated by manufacturers. In reality, there is yet to be a clear consensus on the type, dosage and administration method of CBD that is best for different health concerns.

What is the difference between isolate, broad spectrum and full spectrum CBD?

CBD isolate is the most “conservative” type of CBD and is generally found in topical treatments or CBD-based cosmetics. It may also be found as an oil intended for sub-lingual administration. CBD crystals are formed from a sample of the Hemp plant (containing very low THC levels) which has been refined to remove all it’s other cannabinoids after the extraction process. It is also common for these crystals to be sold on to a secondary company before they are combined with other ingredients to create consumer products.

Broad Spectrum CBD is created from a similar extraction process but is not refined to the same extent. It is still completely free from THC, but contains other cannabinoids such as CBG and Terpenes. Broad spectrum CBD is generally found in the form sub-lingual oils or edibles.

Finally, full spectrum CBD contains all of the Hemp plant’s cannabinoids, including a trace amount of THC. The legal amount of THC varies from country to country and could be anywhere from 0.02 – 0.3%.

There is emerging evidence that the different cannabinoids in both broad spectrum and full spectrum CBD work together to create a more potent effect due to something called the “entourage effect.” However, more research is needed to confirm this. (More information on this is linked at the bottom of this page.)

How does topical CBD work?

Topical CBD usually comes in the form of a cream or balm and is used to target a specific area of pain. For example, you may rub CBD cream into a painful joint after exercise.

Topical products do not absorb into the bloodstream, but are able to interact with the endocannabinoid receptors located in the skin to provide a localised anti-inflammatory effect. A such, there is currently no evidence that topical CBD provides benefits for health concerns such as anxiety, insomnia or seizures. However, several scientific studies support the idea that topical CBD is an effective method of pain relief for chronic conditions such as Peripheral Neuropathy and Arthritis. Unfortunately, human trials have not yet been conducted on a large enough scale to confirm the dose (or frequency of application) at which topical CBD becomes effective.

There is also some very limited evidence that topical CBD may help with inflammatory skin conditions such as eczema. More promising studies are emerging that show it could also be beneficial for face and body acne.

I have personally benefited from the using topical CBD to relieve minor muscle and joint pain. However, I found that the frequency at which I had to keep re-applying it made it too expensive to be practical (at least with the products that are currently licensed for the Belgian market).

How do CBD edibles work?

Edibles are products which contain small amounts of CBD and are designed to be swallowed directly (for example, in the form of a capsule or gummy). Despite the popularity of these products, their bio-availability is extremely low. When swallowed, the majority of Cannabidiol is broken down during digestion and these products rarely contain a high enough dose to provide any therapeutic benefits.

Some manufacturers claim that directly swallowing water soluble CBD is an exception to this, as it has significantly higher bio-availability. I have not been able to find any reliable studies which confirm this. Some people have also cited concerns about the lack of transparency surrounding the types of emulsifiers which can be added to CBD to make it water-soluble.

How does CBD oil work?

The most effective way to consume CBD oil is sub-lingually. This involves placing one or more drops of oil under the tongue and holding it in the mouth while it absorbs directly into the bloodstream.

There is a growing body of evidence to suggest that sub-lingual CBD oil can be used to treat psychological and psychiatric illnesses, and reduce the frequency and severity of certain types of seizures. There is also evidence that CBD oil helps to relieve symptoms of chronic neuropathic pain, inflammation, and insomnia. Once again, larger scale human trials are needed to confirm the prevalence of these benefits.

Many companies that sell CBD oil also tout it both as a preventative and rescue treatment for migraine. There is currently no clinical evidence for this. When making these claims, the majority of CBD companies are either extrapolating the evidence for CBD or Cannabis (with THC) as a general neuropathic pain-reliever. Migraine is still a poorly understood condition with several different causes and symptoms. While many migraine sufferers have reported that CBD does help them, we desperately need formal research into this phenomenon.

Anecdotally, other consumer experiences with CBD oil are extremely variable. I have heard some fellow chronic pain sufferers say that it’s a more effective pain-reliever than opiates (!) while others have said that is has improved their mood (and therefore their ability to cope with pain) but not the actual pain itself. Others have said that it has done absolutely nothing at all for them.

I have personally found sub-lingual CBD oil to be an excellent tool for controlling the pain associated with muscle and joint trauma, as well as for reducing muscle spasms and nausea. I have also found that CBD reduces the frequency of some of my neurological symptoms, such as migraines, partial paralysis and involuntary movements. This has honestly been quite life-changing for me, but it has also not been a complete replacement for some of my other medications.

How does vaping CBD work?

Vaping is another method by which CBD can be directly absorbed into the bloodstream. When vaporised CBD is inhaled, it is quickly absorbed by the alveoli in the lungs. As such, it can have many of the same benefits as sublingual CBD. However, the long term risks of vaping are still unknown, and in some cases there is a risk of exposure to dangerous by-products when vaping.

What are some the problems with the CBD industry? (And what are the potential risks of using CBD?)

One of the primary claims of CBD manufacturers is that is a safe, effective treatment for chronic pain. However, science’s understanding of the potential benefits of Cannabidiol is still limited. There are many different types and causes of pain, and not all of their responses to CBD have been adequately evaluated by quality research. There is also no consensus on the appropriate dosage of CBD to treat different types of medical problems.

This issue becomes even more complicated when you take into account that many clinical studies into CBD use much higher doses than what is currently available in consumer products.

The regulations surrounding the sale of CBD also vary wildly depending on location. In some countries the sale of CBD is still not legal. In others, it can be sold so long as specific claims are not made about its medicinal properties. In others, manufacturers are free to do and say whatever they please!

This can make shopping for CBD products extremely difficult. In fact, a study by Penn Medicine found that only 30% of CBD products sold online contained a CBD content that was within 10% of the advertised amount. To make matters worse, a number of these products also contained notable levels of THC. (So ALWAYS buy your CBD from a manufacturer that provides third party lab analysis reports!)

Anecdotally, I have found that many CBD manufacturers overstate the benefits of their edibles and do not provide information on CBD’s highly variable level of bio-availability in different forms. They often also downplay the potential/unknown risks of vaping.

Unfortunately, many manufacturers also downplay the potential risks of using CBD in ANY form.

While CBD is generally well-tolerated, even in high doses, it may cause side effects in certain people. These include: dry mouth, dizziness, nausea, diarrhea, fatigue and low blood pressure.

Secondly, it is EXTREMELY important to note that CBD acts as a competitive inhibitor for certain liver enzymes. Namely, CP450 enzymes. These are important for the metabolisation of a number of medications. While companies may be quick to point out the risk of combining CBD with potent medications such as blood thinners, they often gloss over the high number of OTC medications which rely on this same mechanism to be broken down in the body.

The primary risk in this situation is that your body may be forced to slow down the rate at which it processes your other medications. This may initially lead to your medications being less effective, but can also lead to them building up in your system over time, eventually resulting in unwanted side effects, liver damage or even an overdose.

ALWAYS tell your doctor about all medications (including OTC) and supplements you are taking before starting CBD. They may be able to suggest a safe starting dose based on your height and weight, and may even wish to carry out regular checks of your liver function or of the blood plasma levels of your other medications.

So, why are so many people still turning to CBD?

There are many reasons why someone may still choose to try CBD products, but one of the primary ones is dissatisfaction with mainstream treatments. For example, many people dislike the side effects of traditional pain medications or are concerned about the risk of physical dependency. Patients who suffer with severe, long term pain may also find that they quickly build a tolerance to medications such as opiates, rendering them ineffective in the long run.

The sad reality is also that many chronic pain and illness sufferers are denied adequate care in a formal medical setting and may turn to CBD when it can be bought without a prescription. In the case of less serious health complaints, it may also be viewed as a more affordable and more convenient option than seeking out professional care.

You will have likely also noticed the trend of some consumers favouring “natural” ingredients above all else. This is likely a big part of why we are seeing CBD in all kinds of foodstuffs, cosmetics and other “wellness” products.

I personally started using CBD as I was rapidly running out of options when it came to effective pain relievers that did not cause intolerable secondary effects. I have been extremely fortunate to have a doctor who supports the ongoing research into CBD and believes in its potential benefits. She was willing to work with me on finding a safe dose that would suit my concerns and work with my other medications. Sadly, not everyone is so lucky.

Conclusions

There is evidence that topical CBD may be an effective treatment for localised pain and certain skin conditions. There is also evidence that when absorbed directly into the bloodstream, CBD may be an effective treatment for widespread pain, insomnia, certain types of seizures, and both psychiatric and psychological conditions. However, significantly more research is needed to confirm the efficacy of CBD as a treatment for these conditions.

We do not currently know the optimal dosage of CBD for different people in different situations, nor can we be sure how long a patient should expect to take CBD for before seeing results. Unfortunately, we also do not yet know if there are any long-term risks associated with chronic CBD use.

Many with people with chronic health conditions are turning to CBD due to a lack of formal support from within the medical framework, and information on CBD is being passed between patients via word of mouth. While personal accounts are a great way for chronic illness patients to find new hope and options, they are not the sole way that we should be getting our information about a potential treatment. Doctors need to stay up to date with the current research into CBD (and its limitations) in order to help patients weigh up the risks and benefits of CBD in their specific situation.

CBD is generally well-tolerated, but may cause side effects in some people. It is also a competitive inhibitor for certain liver enzymes, creating a significant risk of problems such as overdose or liver damage in some patients. Patients should always tell their doctor about any medications (including OTC) or supplements they are taking before trialing CBD.

I also believe that doctors have a responsibility to provide their patients with adequate pain relief and (where appropriate) support them in their endeavours to find alternative treatments, so that they are not driven to self-medicate without supervision.

When shopping for CBD products, patients should only purchase from a reputable brand that supplies third party lab analysis reports on the contents of their products. They should also balance their expectations by cross-checking manufacturer claims against the growing body of scientific evidence for CBD. While the list below is far from complete, it may be a good starting point for this.

I hope that today’s post has been helpful and makes it easier to navigate the huge, online abyss of conflicting information about CBD. Although I have some concerns about the current state of the global CBD market, I have also found it to be extremely helpful and want to provide other people with chronic conditions with the resources they need to make informed decisions.

If you interested in CBD products, please come back next week for a follow up article with a more personal touch. I’ll be discussing my own experience with CBD. In particular, my recent experience trying transdermal CBD patches – a trendy new way to receive a long lasting, slow-release dose of CBD. I will be reviewing two quality brands that provide responsible information and third-party lab analysis to consumers.

Further Reading

Learning CBD – information about the extraction process of CBD isolate and the additional cannabinoids that are lost in the process.

Healthline – a simple explanation of the “entourage effect.” Also the current evidence for topical CBD in the treatment of skin concerns.

US National Library of Medicine – a review of the existing literature surrounding the entourage effect in the treatment of mood and anxiety disorders.

Scientific Reports – the emerging evidence that Terpenes contributing to the overall theraputic benefits of cannabinoids.

CBD Path – information on topical CBD use.

National Library of Medicine – the evidence for topical CBD in the symptomatic relief of pain associated with Peripheral Neuropathy, also the evidence for the use of CBD as a treatment for certain types of Epilepsy.

The Arthritis Foundation – the potential ways to use CBD for Arthritis pain.

National Eczema Assocation – the limited evidence for CBD in the treatment of Eczema.

American Migraine Association – the lack of clinical evidence for CBD as a migraine treatment but suggestions as to why it may still help some people.

Medical News Today – a summary of how some of the existing research into CBD as a pain-reliever may be used to inform its use as a migraine treatment.

Consumer Reports – it it safe to vape CBD? Spoiler alert: probably not.

Project CBD – an easy to read explanation of how CBD inhibits CP450 enzymes and how more research is needed to determine if there is any consistently safe dose at which this does not occur.

Indianna University (Department of Medicine) – CP450 drug interaction table (NOT A SUBSTITUTE FOR TALKING TO YOUR DOCTOR)

Healthline – explanation of the endocannabinoid system and how it is impacted by CBD.

For the Ageless – A CBD manufacturer that provides an in depth explanation of the factors affecting CBD bioavailability and rates the efficiency of different methods of CBD consumption.

Mashable – an article about the limitations of CBD edibles and the potential advantages of oils. Also highlights the important fact that clinical studies about the benefits of CBD are often performed at a much higher dose than what is currently available in consumer products.

CBD Awareness Project – common side effects of CBD.

Some of the images in today’s post are courtesy of Unsplash.

Love this discussion and want to learn more? Reach out!