Aubree Steen, FNTP
CBD oil has been extremely popular in the health world recently, but there have been some deceitful oils flooding the market. There are a ton of CBD oil products out there, but you need to be careful in what you purchase. I’m here to help guide you through this world, show you what to purchase, key words to look for, and our favorite brands we carry in office. Please understand none of this is medical advice, and you must consult your provider if you are wanting to use this medicinally. You are always welcome to purchase our favorite brands from our clinic.
So, what does CBD oil do, and what does the ECS (EndoCannabinoid System) do?
The ECS plays a critical role in maintaining homeostasis. The reason why CBD and all products aimed for supporting a lot of functions in the body is due to the fact that the ECS has influence over a multitude of processes in our bodies. The ECS helps in regulating:
- Immune function
- Motor control
- Pleasure and Reward
- Reproduction and Fertility
- Temperature Regulation
Dysregulation of the ECS:
These receptors are present on nearly every organ and every organ system. You can hit multiple targets by using cannabinoids by manipulating the ECS through these phytocannabinoids. This is showing dysregulation of endocannabinoids and CB2 receptors:
- Hepatitis, fibrosis, steatosis
- Myocardial infarction, atherosclerosis, heart failure, restenosis, stroke, shock
Central Nervous System
- Parkinson’s disease, Huntington’s disease, Alzheimer’s disease, amyotrophic lateral sclerosis, multiple sclerosis, traumatic brain injury, schizophrenia, depression, anxiety
- Allergic dermatitis
- Allergic asthma
- Autoimmune diseases, organ transplantation
- Reproductive dysfunctions, endometritis
- Various tumors (immune-derived skin, uterine, etc.)
- Adipose Tissue and Skeletal Muscle
- Insulin resistance, obesity
- Inflammatory Bowel Disease
Cannabis: Hemp vs Marijuana
There’s a huge misleading rumor that hemp oil and CBD oil are marijuana. Both are types of cannabis – they’re separate legal definitions. It’s important to understand the difference, as marketing teams will use misleading phrases to persuade you or deviate you from purchasing a certain product.
Marijuana – in social injustice history, this was most widely used. Hemp and Marijuana are under the Cannabis umbrella. They are not interchangeable.
Under the Cannabis umbrella, Hemp has .3% Delta-9 THC or less by weight when dried; Anything about that level of THC is considered Marijuana. They’re both cannabis plants.
Hemp Derived – low level of THC, and not intoxicating, is federally legal in the U.S.
Marijuana or higher THC is available in select states, not federally legal.
Full-Spectrum (FS) vs Isolate
Full Spectrum – CBD oil or hemp extract has CBD plus all of the different cannabinoids and biologically active compounds known as terpenes and flavonoids that all exist in the plant itself. Think of a full grape, instead of the resveratrol that can be derived from a grape. These work much better at lower dosages. Unfortunately, for states that don’t have THC legal, THC is a critical component of utilizing the full benefits of full spectrum with CBD, even low doses that aren’t considered intoxicating.
The dose required of CBD alone is 10x higher than when in combination with THC.
Broad Spectrum is used if you have at least a few cannabinoids (more than CBD), but not traces of Delta-9 THC. It works better than isolate, but the full spectrum is most beneficial.
It’s not all about CBD! We have more cannabinoids we should care about. Think about it like an entourage effect. These molecules that exist naturally in the plant work synergistically to promote different therapeutic outcomes and expand on the positive effects of CBD. This is why FS is important. Lower dosage is able to help therapeutically, as opposed to isolates themselves. (CBGa, CBD, THC, CBDa, THCa, CBC, CBN, THCv, CBDv, Delta-8 THC are all synergistic in the plant.)
Isolate – think of it as the resveratrol from the grapes. Crystallized CBD; it’s the isolated cannabidiol – it’s better than nothing, but you would prefer to have the full spectrum.
It’s all about politics, not patient safety or efficacy. Cannabinoids and cannabis in general were the highest prescribed medication in the USA until 1937. It was in the U.S. Pharmacopeia. Marijuana Tax Act was opposed by the American Medical Association at the time.
Evidence-based Uses of CBD Hemp Extract
Inflammation and immune:
- CB1 and CB2 influence inflammation and immune response throughout the body. This happens both in the acute and chronic phase of tissue injury.
- Adding CBD immediately within tissue damage or injury has been shown to help in a pre-treatment method (athletes and concussion patients) with neurological impairment and reducing cerebral edema. Tissue loss was decreased with immediate treatment of CBD (within one hour of injury).
- Cannabidiol is incredible for neuroprotective and slowing of neurodegenerative diseases. There is potential for reversal over time. They promote the formation of synapses and stop the degradation of neurons over time. There are still studies that are being conducted with humans in regards to this.
- Beta-caryophyllene (BCP – aterpene present in a lot of cannabis plants) was shown to help improve dental pain as much as CBD in studies with pulp exposure-induced orofacial sensitivity.
- Takeaway: BCP is a wonderful additive for CBD that can help in a way similar to THC for states who don’t legally carry THC.
Chemotherapy Induced Neuropathic Pain (CIPN) :
- A study showed CBDs efficacy in debilitating peripheral neuropathy
- Chemo agents used in breast, ovarian, and colon cancer were used. CBD before chemo agents were injected prevented 100% of neuropathy in animals in time of treatment. Human studies are being conducted now.
- Inhibits inflammatory and neuropathic pain – two of the most difficult pains to treat
- CBD is a firstline option for pain management
- Efficacy for treating pain
- Safe to use as an adjunct for those consuming an opioid
- CBD helps with withdrawal symptoms
- Can lower inflammation due to arthritis (topically)
The most abundant studies for cannabinoids and pain most point to the efficacy of CBD for pain relief. NIH, JAMA, and NASEM all condone the use of CBD for pain management. NASEM concluded paint relief but also prevention of seizures.
- Activity on TRP1 channels, CB1 receptors, anxiolytic, anti-inflammatory, antinociceptive (the action or process of blocking the detection of a painful or injurious stimulus by sensory neurons) components
- CBD significantly increased total sleep time, including REM sleep. Those with insomnia.
- If someone has a healthy sleep cycle, and they’re adding CBD for another reason (like pain or anxiety), we don’t want to disrupt healthy sleep and make people more drowsy if using CBD for another reason. However, it’s adaptogenic. This doesn’t disrupt sleep cycles if already healthy.
- CBD improved REM sleep in patients with PTSD
- There’s limited primary research on studies with humans and mood. Human social phobia used a high dose of CBD and showed improved social interactions.
- Secondary outcomes of larger trials (in regards to pain or other factors), they monitor mood to improve over time, but it’s unable to identify if it’s correlation or causation.
- Anecdotally, there’s activation of 5HT1-A serotonin receptor, which correlates to mood improvement in individuals.
Consistency is key. Remember to work with your doctor, as this is not medical advice.
- Anxiety: 300mg/day (studies showed not effective at 150 or 600mg)
- Sleep: 160mg/day has been shown to increase sleep duration in patients with insomnia. No noticeable effects at 25mg. 300/mg had no effect on the sleep-wake cycle. 75mg to 300mg was shown to help patients with REM behavior disorder. If a patient isn’t responding to up to 50mg, you can try 100 to 200mg of CBD for sleep.
- The highest doses (not recommended) that are safe can be up to 6,000mg, so reassure the patient they can play with up to 200mg safely.
With full spectrum products, the starting dose would be 15mg oral, or 10mg sublingual. The therapeutic window is 10-60mg a day. You’ll capture 90% of people using it under the tongue with 15-60mg a day of noticeable effects. Some outliers will have to start at 90mg a day. You’ll use less of the tincture due to its effect to bypass first-pass metabolism. They’re lipophilic with a first pass effect. You want to find the peak dosage without going over it.
- Start at night and every 2 to 3 days, titrate up. (Most patients are impatient and will end up titrating up every night)
- Start with 10mg sublingual. Increase by 10mg every 2 to 3 days.
- Once they add more and don’t feel any different/feel the same, they’ve hit their peak at the dose when they stopped feeling the increase of effects.
- Assess the drowsiness factor.
- If they don’t get drowsy, and want to use it for anxiety, inflammation, overall systemic preventative health, using it BID will be optimal.
- This will be an “experimental” game with patients, as everyone’s tolerance, symptoms, and bodies are different. If a patient isn’t feeling any effects (or have any changes on an Oura ring, sleep app, etc.), they’re not taking enough.
Pediatricians use .2mg/kg a day – it’s important to stay close to this dose if you’re dealing with children.
Soft gels are a bit more difficult. Heartburn is aggravated and there’s less absorption depending on the status of the patient’s gut, and the metabolism of the supplement itself. Metabolism will be different, so dosage will vary and need to increase most lily.
CBD interacts with the CYP 450 pathway in the body which affects the metabolism of certain pharmaceuticals. There have only been significant clinical drug interactions recorded when taking 20mg/kg of body weight per day. There has been no data showing damage up until this dosage. That’s where liver injury is to occur. This can aggravate patients with previous liver injury/damage – not all, some. If you have a 180lb patient, that’s appx 82kg, which would be 1,640mg of CBD. The dosage for patients will fall way below that amount in practice.
If you stay below 20mg/kg/day, side effects are appx 1%. You’ll see drowsiness, nausea, and potentially hives due to the other ingredients in the product.
What about pregnancy? Negative outcomes to mother or fetus occurred with levels that were 250mg/kg, which is an outrageously high dose (10x the dosage of an FDA approved medication that has extremely high use). It was mostly liver injury. Below that dosage, no negative outcomes. This is in animal studies, but not human. In humans, the relative maternal dosage is well under the 10% threshold. It’s readily available in breastmilk, but at about 1%.
Finding a Brand/Why we Carry the Brands in Office:
When finding a product, you’ll want to make sure the product is:
- Be done by an ISO certified third party lab
- Include cannabinoid content for proper dosage
- Include tests for pesticides microbes chemicals
- Be lot specific
- Be evaluated for efficacy and puracy
There are a ton of products on the market that have molds, microbes, chemicals, heavy metals, and toxic additives. They need to be evaluated and from trusted sources. There are many products that have hemp oil, but may not disclose the active amount of CBD and other cannabinoids. We carry ECS Care for oral consumption, and CBD Clinic for topical! These are my favorite.
- Full spectrum, whole plant hemp extract blended in organic, cold-pressed hemp seed oil
- Supplies naturally occurring hemp-derived cannabidiol (CBD) as part of a phytocannabinoid complex
- Dozens of cannabinoids, but also includes hundreds of phytochemicals such as terpends, vitamins, trace minerals, polyphenol antioxidants, flavonoids, and essential fatty acids that contribute a nutritional effect, as well.
- Tinctures are sublingual
- ECS Care uses organically grown agricultural hemp plants to extract phytonutrients ant natural molecules that exist in the plants without harmful solvents
- Clean, safe extraction method minimizes degradation of the plant material and extracted oil
- Blended with organic hemp oil that is cold pressed from hemp seeds; the oil is rich in gamma linoleic acid (GLA) and high in balanced Omega-6 and 3 fatty acids
- Rigorously tested for identity, potency, and purity; GMP compliant
- Every batch is third-party tested bye an ISO-certified laboratory
- Complete Lab Analyses and testing results are available by scanning the QR codes on each product
CBD Clinic Topical:
- CoA on website for analytics and purity
- The oil is combined with camphor, menthol, and other ingredients that penetrate to the site of the more severe muscle and joint pain, utilizing high-dose natural pain killers. Deep tissue is penetrated to deliver relief directly to the joint and muscle by reducing inflammation and swelling. Blood flow and circulation is increased to the area.
- Ingredients are naturally derived and include beeswax (organic), clove oil, cottonseed oil, eucalyptus oil, hemp extract, jojoba seed oil, peppermint oil, tea tree oil