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Health Benefits of CBD | What It Can & Can’t Do

The rise of CBD use has been steady over the last 10-15 years. Today, millions of people take CBD in its many forms to improve their health and wellness. Many have heard anecdotal reports from friends or family about the health benefits of CBD and are inspired to try a CBD product for themselves. The hype currently exceeds what we understand based on scientific research. Here is what we know and what we don't.

Early research suggests that CBD is effective in treating a variety of ailments, including anxiety, depression, psychosis, insomnia, some forms of pain, acne, nausea and vomiting, IBD, osteoarthritis, seizure disorders, movement disorders, inflammation, stroke risk, and multiple sclerosis 3 The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. Washington, DC: The National Academies Press National Academies of Sciences, Engineering, and Medicine. . CBD is sought most commonly for its perceived psychological and pain benefits, sleep improvement, and relaxation after stress. 

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A Brief History of Therapeutic Cannabinoids

The use of cannabis or cannabidiol (CBD) for medicinal purposes may seem like a recent trend or fad, but this couldn’t be further from the truth. Cannabis has been used as a traditional medicine for millennia all around the world. The earliest written records of medicinal cannabis use came from China around 100 BCE 1 An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. DOH DCRx. (2015). An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. [PowerPoint Slides]. Retrieved from: https://dchealth.dc.gov/dcrx DOH DCRx . Even back then, knowledge of the therapeutic potential of cannabis had been orally passed down for at least 500 years 1, 2 An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. DOH DCRx. (2015). An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. [PowerPoint Slides]. Retrieved from: https://dchealth.dc.gov/dcrx DOH DCRx . Cannabis made its debut into western medicine in 1840 by Irish physician William B. O’Shaugnessy 3 The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. Washington, DC: The National Academies Press National Academies of Sciences, Engineering, and Medicine. . He documented the use of cannabis in India as an effective treatment for tetanus and convulsions.

 

Ancient, traditional cannabis was more akin to hemp. This is to say that it had very low Tetrahydrocannabinol (THC), the main psychoactive component of cannabis, while being rich in CBD. Hemp was also used earlier and more often than recreational marijuana; it was used for industrial purposes to make fibers, rope, clothing, bricks, and paper 2 Oldest evidence of marijuana use discovered in 2500-year-old cemetery in peaks of western China. Lawler, A. (2019). Oldest evidence of marijuana use discovered in 2500-year-old cemetery in peaks of western China. Retrieved from: https://www.sciencemag.org/news/2019/06/oldest-evidence-marijuana-use-discovered-2500-year-old-cemetery-peaks-western-china Lawler, A. . Despite a sizable 2,500-year history, modern research is only beginning to illuminate the health benefits of CBD and cannabis. Cannabidiol (CBD), the non-intoxicating part of the cannabis plants that is regarded by scientists to have the most therapeutic potential, is at the forefront of the research interest. 

Overview: Health Benefits of CBD

Though the research is mixed, there are many potential medical benefits of cannabinoids. Generally speaking, the evidence most strongly supports that cannabinoids have therapeutic properties for pain (neuropathic, chronic, and cancer in adults), nausea and vomiting after chemotherapy, and improving patients’ reported muscle spasms caused by multiple sclerosis (MS) 11 Cannabinoids for Medical Use: A Systematic Review and Meta-analysis Whiting PF, Wolff RF, Deshpande S, et al. (2015). Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA. 313(24):2456–2473. Whiting PF, Wolff RF, Deshpande S, et al. . There is evidence, although less, concerning CBD for sleep and benefits for people with conditions like obstructive sleep apnea, fibromyalgia, and MS 3 The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. Washington, DC: The National Academies Press National Academies of Sciences, Engineering, and Medicine. . There is some limited evidence to support the use of cannabinoids as a treatment for improving appetite and decreasing weight loss associated with HIV/AIDS, Tourette syndrome tics, public speaking anxiety, and symptoms of PTSD 12 Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review Sarris, J., Sinclair, J., Karamacoska, D., Davidson, M., & Firth, J. (2020). Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review. BMC psychiatry, 20(1), 24. Sarris, J., Sinclair, J., Karamacoska, D., Davidson, M., & Firth, J .

 

The most substantial evidence backs the ability of CBD to treat specific forms of epilepsy and seizures, more specifically in Lennox-Gastaut and Dravet syndrome 7, 8 Epidiolex GW Pharmaceuticals, Inc. (2018). Epidiolex [package insert]. GW Pharmaceuticals, Inc. . Smaller, limited studies suggest CBD has the potential to benefit people suffering from anxiety disorders, depression, psychosis, insomnia, ADHD, movement disorders, and MS 3, 12 The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. Washington, DC: The National Academies Press National Academies of Sciences, Engineering, and Medicine. .

Benefits of CBD for Mental Health

Ever since the 1970s, scientists have recognized the psychological benefits of CBD. Since then, several literature reviews contend that the strongest psychological potential uses of CBD are for its anti-anxiety and anti-psychotic properties 12 Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review Sarris, J., Sinclair, J., Karamacoska, D., Davidson, M., & Firth, J. (2020). Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review. BMC psychiatry, 20(1), 24. Sarris, J., Sinclair, J., Karamacoska, D., Davidson, M., & Firth, J . Pre-clinical evidence and case reports also support CBD’s promising use in acute symptoms of generalized anxiety disorder, panic disorder, social anxiety disorder, OCD, depression, insomnia, and PTSD 13 Cannabidiol as a Potential Treatment for Anxiety Disorders Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015). Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 12(4), 825–836. Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R . By contrast, it appears high-THC is undoubtedly not advisable for anxiety, depression, or schizophrenic patients 12 Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review Sarris, J., Sinclair, J., Karamacoska, D., Davidson, M., & Firth, J. (2020). Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review. BMC psychiatry, 20(1), 24. Sarris, J., Sinclair, J., Karamacoska, D., Davidson, M., & Firth, J

CBD for Anxiety

CBD’s anxiety relief most likely relates to its activation of regions of the brain responsible for mood and anxiety states, more specifically the brain’s serotonin receptors and CB1 receptors (to a lesser degree) 13 Cannabidiol as a Potential Treatment for Anxiety Disorders Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015). Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 12(4), 825–836. Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R . Brain imaging gives us more clues about CBD for anxiety relief. In one study that used a mice model, CBD was found to reduce the activation of brain areas responsible for producing fear 14 Translational Investigation of the Therapeutic Potential of Cannabidiol (CBD): Toward a New Age. Crippa, J. A., Guimarães, F. S., Campos, A. C., & Zuardi, A. W. (2018). Translational Investigation of the Therapeutic Potential of Cannabidiol (CBD): Toward a New Age. Frontiers in immunology, 9, 2009. Crippa, J. A., Guimarães, F. S., Campos, A. C., & Zuardi, A. W . This indicated the potential use of CBD in treatment for PTSD 12 Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review Sarris, J., Sinclair, J., Karamacoska, D., Davidson, M., & Firth, J. (2020). Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review. BMC psychiatry, 20(1), 24. Sarris, J., Sinclair, J., Karamacoska, D., Davidson, M., & Firth, J .  In another study, CBD was found to enhance our brain’s own endocannabinoid signaling, which is a process in the brain responsible for important functions like sleep, mood, and appetite 15 Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Leweke, F. M., Piomelli, D., Pahlisch, F., Muhl, D., Gerth, C. W., Hoyer, C., Klosterkötter, J., Hellmich, M., & Koethe, D. (2012). Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Translational psychiatry, 2(3), e94. Leweke, F. M., Piomelli, D., Pahlisch, F., Muhl, D., Gerth, C. W., Hoyer, C., Klosterkötter, J., Hellmich, M., & Koethe, D. . This study also highlighted the potential benefit for schizophrenic patients by decreasing their psychotic symptoms 15 Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Leweke, F. M., Piomelli, D., Pahlisch, F., Muhl, D., Gerth, C. W., Hoyer, C., Klosterkötter, J., Hellmich, M., & Koethe, D. (2012). Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Translational psychiatry, 2(3), e94. Leweke, F. M., Piomelli, D., Pahlisch, F., Muhl, D., Gerth, C. W., Hoyer, C., Klosterkötter, J., Hellmich, M., & Koethe, D. .

CBD for Depression

In the case of depression, CBD may also prove beneficial. In a single small mice study, CBD was shown to cause antidepressant-like effects in as short as 30 mins that were sustained for seven days 16 Cannabidiol Induces Rapid and Sustained Antidepressant-Like Effects Through Increased BDNF Signaling and Synaptogenesis in the Prefrontal Cortex Sales, A.J., Fogaça, M.V., Sartim, A.G. et al. (2019). Cannabidiol Induces Rapid and Sustained Antidepressant-Like Effects Through Increased BDNF Signaling and Synaptogenesis in the Prefrontal Cortex. Mol Neurobiol 56, 1070–1081 Sales, A.J., Fogaça, M.V., Sartim, A.G. et al. . This positive reaction of CBD for depression was caused by a mechanism similar to ketamine, but without ketamine’s psychoactive effects. 

Benefits of CBD for Bone & Joint Health

When it comes to bones and joints, CBD has many potential benefits as an add-on to current arthritis medications. The non-profit arthritis organizations of the U.S. and Canada have taken a position stating how CBD could be helpful to relieve pain from arthritis in addition to traditional medication 22, 23 CBD for Arthritis Pain: What You Should Know Arthritis Foundation. CBD for Arthritis Pain: What You Should Know. Retrieved from: https://www.arthritis.org/health-wellness/healthy-living/managing-pain/pain-relief-solutions/cbd-for-arthritis-pain Arthritis Foundation. . However, they acknowledge that the data is limited to animal studies and anecdotal reports. 

 

In a 2017 study of mice, CBD was investigated to gauge its anti-inflammatory, nerve-protecting, and pain-relieving properties in the most common type of arthritis, osteoarthritis (O.A.). Researchers found CBD was able to reduce joint inflammation and lessen the development of further pain and nerve damage 24 Attenuation of early phase inflammation by cannabidiol prevents pain and nerve damage in rat osteoarthritis. Philpott, H. T., OʼBrien, M., & McDougall, J. J. (2017). Attenuation of early phase inflammation by cannabidiol prevents pain and nerve damage in rat osteoarthritis. Pain, 158(12), 2442–2451. Philpott, H. T., OʼBrien, M., & McDougall, J. J. . While the study isn’t conclusive, it does suggest the possible role that CBD may play in O.A. relief. There is minimal data for CBD and osteoporosis, but one study that shows there is some protection against osteoporosis when endocannabinoid receptors are present and activated 26 Cannabinoid receptors as target for treatment of osteoporosis: a tale of two therapies. Idris A. I. (2010). Cannabinoid receptors as target for treatment of osteoporosis: a tale of two therapies. Current neuropharmacology, 8(3), 243–253. Idris A. I. . However, it is far too early to recommend cannabinoids for osteoporosis reasonably. There are also potential benefits of using CBD in treating rheumatoid arthritis, but likewise, the data here is also very limited 19 Pharmacotherapeutic considerations for use of cannabinoids to relieve pain in patients with malignant diseases. Darkovska-Serafimovska, M., Serafimovska, T., Arsova-Sarafinovska, Z., Stefanoski, S., Keskovski, Z., & Balkanov, T. (2018). Pharmacotherapeutic considerations for use of cannabinoids to relieve pain in patients with malignant diseases. Journal of pain research, 11, 837–842. Darkovska-Serafimovska, M., Serafimovska, T., Arsova-Sarafinovska, Z., Stefanoski, S., Keskovski, Z., & Balkanov, T .

 

Topical CBD products are the most popular product form for arthritis and are applied directly to the skin for targeted relief. There is one study in mice that indicates the potential benefit of the use of topical CBD treatment for arthritis 25 ansdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. European journal of pain Hammell, D. C., Zhang, L. P., Ma, F., Abshire, S. M., McIlwrath, S. L., Stinchcomb, A. L., & Westlund, K. N. (2016). Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. European journal of pain (London, England), 20(6), 936–948. Hammell, D. C., Zhang, L. P., Ma, F., Abshire, S. M., McIlwrath, S. L., Stinchcomb, A. L., & Westlund, K. N. . The advantage of topical medication is that you may be able to apply it more directly to affected joints. Topicals work quickly and directly on application sites because they don’t need to be metabolized by the gut like edibles. 

Benefits of CBD for Skin Health

Skin glands are responsible for making the oils in our skin. When they over or underproduce oils, we can end up with things like acne or dry skin. When CBD interacts with the ECS, it may help regulate skin glands 27 Endocannabinoids enhance lipid synthesis and apoptosis of human sebocytes via cannabinoid receptor-2-mediated signaling. Dobrosi, N., Tóth, B. I., Nagy, G., Dózsa, A., Géczy, T., Nagy, L., Zouboulis, C. C., Paus, R., Kovács, L., & Bíró, T. (2008). Endocannabinoids enhance lipid synthesis and apoptosis of human sebocytes via cannabinoid receptor-2-mediated signaling. FASEB journal : official publication of the Federation of American Societies for Experimental Biology, 22(10), 3685–3695. Dobrosi, N., Tóth, B. I., Nagy, G., Dózsa, A., Géczy, T., Nagy, L., Zouboulis, C. C., Paus, R., Kovács, L., & Bíró, T. . CBD for skin care has therefore been investigated, with the most positive results being for acne. 

 

An extensive study on CBD’s effects on acne found that CBD had a significant anti-acne impact through three different modes of action 28 Cannabidiol exerts sebostatic and antiinflammatory effects on human sebocytes Oláh, A., Tóth, B. I., Borbíró, I., Sugawara, K., Szöllõsi, A. G., Czifra, G., Pál, B., Ambrus, L., Kloepper, J., Camera, E., Ludovici, M., Picardo, M., Voets, T., Zouboulis, C. C., Paus, R., & Bíró, T. (2014). Cannabidiol exerts sebostatic and antiinflammatory effects on human sebocytes. The Journal of clinical investigation, 124(9), 3713–3724. Oláh, A., Tóth, B. I., Borbíró, I., Sugawara, K., Szöllõsi, A. G., Czifra, G., Pál, B., Ambrus, L., Kloepper, J., Camera, E., Ludovici, M., Picardo, M., Voets, T., Zouboulis, C. C., Paus, R., & Bíró, T . First, CBD prevents the overgrowth of skin cells responsible for making skin oils without killing healthy cells. Next, its anti-inflammatory activity prevents further cascades and development of acne. Finally, CBD is known to possess antibacterial properties, but its exact effect on acne-causing bacteria is yet to be studied. However, there are two known cannabinoid terpenes that have been shown to inhibit such bacteria 5 Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects Russo E. B. (2011). Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British journal of pharmacology, 163(7), 1344–1364. Russo E. B. . These findings help support further research into CBD as a treatment for acne. Somewhat contradictory, other cannabinoids like CBG may increase the production of oils – so a CBD isolate with added citrus terpenes may be ideal for mitigating this. Other inflammatory skin diseases are still currently being examined 29 Cannabinoids in the Pathophysiology of Skin Inflammation. Scheau, C., Badarau, I. A., Mihai, L. G., Scheau, A. E., Costache, D. O., Constantin, C., Calina, D., Caruntu, C., Costache, R. S., & Caruntu, A. (2020). Cannabinoids in the Pathophysiology of Skin Inflammation. Molecules (Basel, Switzerland), 25(3), 652. Scheau, C., Badarau, I. A., Mihai, L. G., Scheau, A. E., Costache, D. O., Constantin, C., Calina, D., Caruntu, C., Costache, R. S., & Caruntu, A. .

Young woman cleaning her face with cbd facial cleanser

Benefits of CBD for Gut Health

Since the 1970s and 80s, the anti-nausea and anti-vomiting properties of cannabinoids are among their most established therapeutic benefits. Synthetic THC was FDA-approved around that time in the forms of Cesamet and Marinol to decrease nausea and vomiting in chemotherapy patients 1 An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. DOH DCRx. (2015). An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. [PowerPoint Slides]. Retrieved from: https://dchealth.dc.gov/dcrx DOH DCRx . Marinol is also approved to stimulate appetite in patients with AIDS-associated anorexia and weight loss. However, these medications are very expensive, and consumers still tend to prefer smoking cannabis over ingesting pills when nauseous. In some cases, high-THC can cause long episodes of vomiting called cannabinoid hyperemesis syndrome. CBD, however, is a special case because it has a different method of preventing nausea and vomiting. Rather than acting on cannabinoid receptors like THC does, CBD instead interacts with our gut’s serotonin receptors to prevent nausea and vomiting 30 Regulation of nausea and vomiting by cannabinoids Parker, L. A., Rock, E. M., & Limebeer, C. L. (2011). Regulation of nausea and vomiting by cannabinoids. British journal of pharmacology, 163(7), 1411–1422. Parker, L. A., Rock, E. M., & Limebeer, C. L. . This insight into CBD’s pathway for activity could provide new possibilities for treating nausea and vomiting with further research.

 

There is a lot of new interest in treating conditions like irritable bowel syndrome (IBS) and irritable bowel disease (IBD) with cannabinoids. Cannabis use for easing such symptoms is commonly reported among patients. In fact, cannabis use among populations of people afflicted with IBD are found at higher rates than the national average 31 Role of cannabis in inflammatory bowel diseases Perisetti, A., Rimu, A. H., Khan, S. A., Bansal, P., & Goyal, H. (2020). Role of cannabis in inflammatory bowel diseases. Annals of gastroenterology, 33(2), 134–144. Perisetti, A., Rimu, A. H., Khan, S. A., Bansal, P., & Goyal, H . The proposed way CBD for IBS and IBD works is through a specific set of cannabinoid receptors in the gut. When these receptors are activated, they play a role in things like reducing gut motility, decreasing inflammation, and lessening gut secretions, which are all critical in managing IBS and IBD. 

 

However, the overall data is insufficient to make a concrete conclusion as to whether or not CBD is an effective treatment in this case. This is because while the patient’s reported symptoms are improved, the physical evidence to corroborate the reported improvements are yet to be seen 3, 31 The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. Washington, DC: The National Academies Press National Academies of Sciences, Engineering, and Medicine. . Still, it may be reasonable for people who have found that all avenues of conventional treatment for IBS and IBD are not working for them, to try cannabinoids as some other patients have reported relief 32 Therapeutic Use of Cannabis in Inflammatory Bowel Disease. Gastroenterology & hepatology Ahmed, W., & Katz, S. (2016). Therapeutic Use of Cannabis in Inflammatory Bowel Disease. Gastroenterology & hepatology, 12(11), 668–679. Ahmed, W., & Katz, S. .

 

CBD & the Immune System

Our immune cells are part of the endocannabinoid system as they contain receptors in this system called CB2 receptors 1 An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. DOH DCRx. (2015). An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. [PowerPoint Slides]. Retrieved from: https://dchealth.dc.gov/dcrx DOH DCRx . However, the possible immune and defense effects of CBD are too early to be understood, and so far, do not offer promising benefits. Small studies have shown that cannabinoids may decrease the amount of pro-inflammatory cells 1, 3 An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. DOH DCRx. (2015). An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. [PowerPoint Slides]. Retrieved from: https://dchealth.dc.gov/dcrx DOH DCRx . However, the NAS has concluded there can’t be any general health conclusions to be drawn at this point 3 The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. Washington, DC: The National Academies Press National Academies of Sciences, Engineering, and Medicine. .

 

CBD & the Endocrine System

With conditions like obesity and type 2 diabetes on the rise, researchers are urgently seeking new therapies. Central obesity can lead to insulin resistance, which is the primary driver of type 2 diabetes. An extensive, national study of almost 4,700 patients compared fasting insulin levels of non-marijuana users, past users, and current users. Current marijuana use was associated with 16% lower fasting insulin levels and a smaller waist circumference 33 The impact of marijuana use on glucose, insulin, and insulin resistance among US adults. Penner, E. A., Buettner, H., & Mittleman, M. A. (2013). The impact of marijuana use on glucose, insulin, and insulin resistance among US adults. The American Journal of Medicine, 126(7), 583-589. Penner, E. A., Buettner, H., & Mittleman, M. A . This suggests that marijuana may have a positive impact on combating obesity. 

 

Insulin is made by β-cells in the pancreas, and those cells begin to die off after overproducing insulin leading to type 2 diabetes. A single study of obese mice found that a dose of cannabis extract protected these β-cells and promoted weight loss 34 Cannabis exposure associated with weight reduction and β-cell protection in an obese rat model. Levendal, R. A., Schumann, D., Donath, M., & Frost, C. L. (2012). Cannabis exposure associated with weight reduction and β-cell protection in an obese rat model. Phytomedicine, 19(7), 575-582. Levendal, R. A., Schumann, D., Donath, M., & Frost, C. L. . Interestingly, when CBD was given to humans who concurrently smoked cannabis, the result was a reduced appetite 35 Cannabidiol attenuates the appetitive effects of Δ 9-tetrahydrocannabinol in humans smoking their chosen cannabis Morgan, C. J., Freeman, T. P., Schafer, G. L., & Curran, H. V. (2010). Cannabidiol attenuates the appetitive effects of Δ 9-tetrahydrocannabinol in humans smoking their chosen cannabis. Neuropsychopharmacology, 35(9), 1879. Morgan, C. J., Freeman, T. P., Schafer, G. L., & Curran, H. V. . The NAS in 2017 also concluded that there is limited evidence to show any significant relationship between cannabis use and decreased risk of metabolic syndrome, prediabetes, and diabetes 3 The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. Washington, DC: The National Academies Press National Academies of Sciences, Engineering, and Medicine. .

 

A few studies have tried further to examine the potential relationship between cannabis and obesity. A 2020 review article gathered results showing CBD may actually affect both fat and sugar metabolism, and is, therefore, a potential agent against obesity, insulin resistance, and metabolic syndrome 36 Phytocannabinoids: Useful Drugs for the Treatment of Obesity? Special Focus on Cannabidiol. 36. Bielawiec, P., Harasim-Symbor, E., & Chabowski, A. (2020). Phytocannabinoids: Useful Drugs for the Treatment of Obesity? Special Focus on Cannabidiol. Frontiers in endocrinology, 11, 114. Bielawiec, P., Harasim-Symbor, E., & Chabowski, A . However, there should be some caution when using very high dose cannabinoids as a possible treatment because over-activation of the endocannabinoid system in the liver may lead to the development of fatty liver disease in mice and humans 37, 38 Role of cannabinoids in the development of fatty liver (steatosis). Purohit, V., Rapaka, R., & Shurtleff, D. (2010). Role of cannabinoids in the development of fatty liver (steatosis). The AAPS journal, 12(2), 233–237. Purohit, V., Rapaka, R., & Shurtleff, D. .

CBD and Cardiovascular Health

When it comes to heart health, the data on cannabis and CBD can be quite contradictory. If you have heart risks, it probably isn’t a good idea to smoke cannabis as it could potentially trigger serious events like a stroke or a heart attack 3 The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. Washington, DC: The National Academies Press National Academies of Sciences, Engineering, and Medicine. . These effects are more likely caused by the combustion of cannabis, which releases free radicals, rather than as a result of cannabinoids themselves 39 Harmful Effects of Smoking Cannabis: A Cerebrovascular and Neurological Perspective. Archie, S. R., & Cucullo, L. (2019). Harmful Effects of Smoking Cannabis: A Cerebrovascular and Neurological Perspective. Frontiers in pharmacology, 10, 1481. Archie, S. R., & Cucullo, L . THC is known to raise heart rate and thus put a strain on the heart, so it may cause more harm than good for people with heart conditions. CBD, on the other hand, shows promising benefits on the cardiovascular system. So, in the case of heart health, it’s best to avoid smoking altogether, but other forms of high CBD cannabis may be appropriate.

 

Atherosclerosis is an inflammatory condition affecting the arteries, causing heart disease and severe complications. CBD is a key research interest in this department because of its anti-inflammatory and antioxidant properties, which can affect the inflammatory cells driving atherosclerosis 40 Cannabidiol as an emergent therapeutic strategy for lessening the impact of inflammation on oxidative stress. Booz G. W. (2011). Cannabidiol as an emergent therapeutic strategy for lessening the impact of inflammation on oxidative stress. Free radical biology & medicine, 51(5), 1054–1061. Booz G. W. . The underlying mechanisms and effects on overall cardiac outcomes remain to be studied. So it is not known if CBD can help prevent heart attacks, however, there is evidence that CBD may be protective after a heart attack. In 2007, a study at Massachusetts General Hospital found that CBD reduced the extent of tissue injury in mice who suffered heart attacks 41 Cannabidiol, a nonpsychoactive Cannabis constituent, protects against myocardial ischemic reperfusion injury. Durst, R., Danenberg, H., Gallily, R., Mechoulam, R., Meir, K., Grad, E., Beeri, R., Pugatsch, T., Tarsish, E., & Lotan, C. (2007). Cannabidiol, a nonpsychoactive Cannabis constituent, protects against myocardial ischemic reperfusion injury. American Journal of Physiology-Heart and Circulatory Physiology 2007 293:6, H3602-H3607 Durst, R., Danenberg, H., Gallily, R., Mechoulam, R., Meir, K., Grad, E., Beeri, R., Pugatsch, T., Tarsish, E., & Lotan, C. . Since then, further studies have shown CBD is also beneficial to the liver and brain after similar oxygen-loss events 42 Is the cardiovascular system a therapeutic target for cannabidiol?. Stanley, C. P., Hind, W. H., & O’Sullivan, S. E. (2013). Is the cardiovascular system a therapeutic target for cannabidiol?. British journal of clinical pharmacology, 75(2), 313–322. Stanley, C. P., Hind, W. H., & O’Sullivan, S. E.

 

The positive effects of CBD observed in cardiovascular health may be, in part, due to the relaxation of blood vessels by CBD, which reduces blood pressure. Yet, CBD does not appear to have an impact on blood pressure in healthy people 42 Is the cardiovascular system a therapeutic target for cannabidiol?. Stanley, C. P., Hind, W. H., & O’Sullivan, S. E. (2013). Is the cardiovascular system a therapeutic target for cannabidiol?. British journal of clinical pharmacology, 75(2), 313–322. Stanley, C. P., Hind, W. H., & O’Sullivan, S. E.

CBD and Neurological Disease

In the review studies mentioned above, there is limited evidence that CBD may potentially help lessen brain tissue injury either before or after suffering a stroke 3, 40, 42 The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. Washington, DC: The National Academies Press National Academies of Sciences, Engineering, and Medicine. . There also appears to be some benefit in cases of traumatic brain injury treated with cannabinoids 3 The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. Washington, DC: The National Academies Press National Academies of Sciences, Engineering, and Medicine.

 

Neurodegenerative diseases are another type of brain disease that are of increasing research priority. These include neurodegenerative diseases like Parkinson’s, Alzheimer’s dementia (A.D.), Huntington’s, amyotrophic lateral sclerosis (ALS), and multiple sclerosis (M.S.). An exciting area of research is CBD and A.D. While the date is limited and preliminary, . Significantly more research is needed before any beneficial claims can be made regarding CBD and A.D. 

 

Unfortunately, the data is also still insufficient to support or refute the use of cannabinoids or CBD in Parkinson’s, Huntington’s, dementia, spinal cord injury, and ALS 3 The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. Washington, DC: The National Academies Press National Academies of Sciences, Engineering, and Medicine. . In general, there is minimal evidence to support CBD as a treatment for neurological disease. This means that researchers do not have a strong foundation to continue to build and investigate CBD as a possible treatment. 

 

An area where the data is substantial is CBD, as it relates to improvements in patient-reported spasticity from MS 3 The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. Washington, DC: The National Academies Press National Academies of Sciences, Engineering, and Medicine. . Sativex is an approved drug for MS-related spasticity, as mentioned in the above section on psychological benefits. Significant research on CBD has also been done in the area of therapy for severe epilepsy; the FDA has approved CBD in the form of Epidiolex for clinical use in rare childhood seizure disorders 7 Epidiolex GW Pharmaceuticals, Inc. (2018). Epidiolex [package insert]. GW Pharmaceuticals, Inc. . Those conditions are Lennox-Gastaut and Dravet syndrome, in which CBD can significantly reduce the incidence of devastating drop-seizures. 

CBD Side Effects

If you have no health stressors, taking a dose of CBD will most likely have no effect on you. You should be as calm and focused as you were before taking the CBD dose. Studies further assert that no dose of CBD can ever make you feel high like THC does 4 Even High Doses of Oral Cannabidiol Do Not Cause THC-Like Effects in Humans: Comment on Merrick et al. Cannabis and Cannabinoid Research 2016 Grotenhermen, F., Russo, E., Zuardi, A. (2017). Even High Doses of Oral Cannabidiol Do Not Cause THC-Like Effects in Humans: Comment on Merrick et al. Cannabis and Cannabinoid Research 2016;1(1):102-112 Grotenhermen, F., Russo, E., Zuardi, A. . In fact, CBD is generally known to feel more like the opposite of taking THC – and may even reduce THC’s high and other adverse side effects if taken together 5, 6 Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects Russo E. B. (2011). Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British journal of pharmacology, 163(7), 1344–1364. Russo E. B. . However, for people suffering from situational stress or other afflictions, the notable effects of CBD can last from minutes to weeks. 

 

CBD may uncommonly cause side effects like drowsiness, reduced appetite, diarrhoea, irritability, and high liver enzymes 7 Epidiolex GW Pharmaceuticals, Inc. (2018). Epidiolex [package insert]. GW Pharmaceuticals, Inc. . Usually, these adverse effects are associated with very high doses of CBD. Long-term studies are needed to better describe CBD’s side effects, particularly for special patient populations.

Cautions Before Taking CBD

During my training as a medical doctor, I took a special interest in how alternative and natural medicines, like CBD, can be useful additions to your treatment toolbox. I also understand the importance of thorough studies, clinical trials, and regulatory bodies like the FDA to define any medicine’s use and limitations. Such measures are meant to protect the general public. 

 

You may wonder, “What’s the harm in treating myself with CBD?”. It is true that, aside from certain non-severe CBD side effects, it is safe, well-tolerated, and does not cause dependence 8 Cannabidiol Critical Review Report World Health Organization. (2018). Cannabidiol Critical Review Report. Retrieved from: https://www.who.int/medicines/access/controlled-substances/CannabidiolCriticalReview.pdf World Health Organization. . The harm won’t likely come from taking CBD itself, but rather from delaying seeking proper medical care for a disease that already has an approved, effective treatment. Here, we run into the possibility of having a worse outcome as a result of attempts at self-medicating without consulting your doctor first. CBD can also interfere with certain medications if taken in parallel, so you should review your prescriptions with your doctor or pharmacist before receiving CBD treatment. 

 

You should never diagnose or treat yourself using CBD without first consulting a qualified, supervising doctor who knows your health history. Always keep in mind that CBD is by no means a ‘miracle cure’ for any disease and that CBD cannot replace approved disease targeting drugs 9,10 What to Know About Products Containing Cannabis and CBD. U.S. Food & Drug Administration. (2020). What to Know About Products Containing Cannabis and CBD. Retrieved from: https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis U.S. Food & Drug Administration

CBD Research Limitations

 

The evidence surrounding CBD for health and wellness is promising, but further clinical investigation is needed before definitive claims can be made. However, the preliminary findings are valuable in highlighting the worthwhile directions that research should keep pursuing. 

 

The therapeutic potential of CBD is clear, but there is a standardization issue across studies that seek to specify its effectiveness. CBD comes in many different varieties and products. Researchers are also using CBD and cannabinoids in their various forms when conducting investigations. This makes it challenging to come up with precise, consistent data.

 

Many studies include CBD & THC combinations that have different chemical characteristics. This can range from the dose used, to the actual contents of each defined dose. Some studies use other active phytocannabinoids and terpenes in addition to CBD and THC. 

 

Also, most studies are pre-clinical, meaning they are done using mice as subjects. Mice are scientifically valid models, but larger and longer human studies are needed to validate all of the therapeutic effects observed in mice studies. All of this, coupled with strict laws against cannabis that were only recently loosened makes for limited data when it comes to strictly looking at CBD. Therefore, it is hard to parse out CBD’s therapeutic effects accurately. This is why, for nearly all afflictions, there are no “standard” dosages, indications, or guidelines on CBD for doctors yet. The only present exception being Epidiolex. 

Woman relaxing at home

CBD is seemingly everywhere you turn, from online vendors, to CBD retail shops, medical marijuana dispensaries, and even your neighborhood café that now sells CBD-infused coffee. So what’s all the hype about?

Cannabis Gummies

CBD is fast becoming one of the most popular cannabis products on the market. There are a few main reasons for this.

Sources
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