cbd nutritionDecember 15, 2021
If you’re considering taking CBD, ask your doctor or pharmacist if it can interfere with your medications. (They should be able to tell you if your medication is metabolized by the same enzyme that CBD blocks.)
But even if you find a product that lists CBD, there’s no guarantee that the amount it lists is correct. For example, only about 30 percent of 84 CBD products that Vandrey bought online were accurately labeled.
In animal and test-tube studies, CBD blocks some forms of an enzyme—cytochrome P450—that metabolizes many medicines, including some statins, calcium channel blockers, and antidepressants.
The two most abundant: tetrahydrocannabinol (THC) and cannabidiol (CBD).
Only a few studies have looked at whether CBD relieves anxiety, the most common claim.
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In one trial, 57 Brazilian men were randomly assigned to take a placebo or 150, 300, or 600 milligrams of CBD 90 minutes before giving a speech. Oddly, only those who took 300 mg reported lower anxiety during—but not before or after—the speech than placebo takers. (Most of the study’s authors had ties to the CBD industry.)
And most studies have used doses of 100 mg or more. Few CBD products have more than 20 mg per dose.
The information in this post first appeared in the March 2019 issue of Nutrition Action Healthletter.
“Some contained little to no CBD,” he says. And roughly one in five had detectable levels of THC. “It’s quite possible that the therapeutic benefits people are reporting from CBD are driven by THC, or maybe something else entirely.”
“CBD can produce drug effects, but it’s not the typical marijuana high,” notes Vandrey. “It’s not intoxicating, and it doesn’t come with THC-like side effects.”
“THC drives the hallmark features of feeling high, like getting the munchies and feeling relaxed, as well as the negative side effects, like feeling paranoid or anxious,” explains Ryan Vandrey, associate professor of psychiatry and behavioral sciences at the Johns Hopkins School of Medicine.
Not that CBD is worthless. Last year, the FDA approved a high-dose CBD drug to treat seizures in two rare severe forms of epilepsy. But beyond that, the evidence is preliminary.
Cannabis plants contain a class of compounds called cannabinoids. “We’ve identified just over 100 of them,” says Daniele Piomelli, professor of anatomy and neurobiology at the University of California, Irvine.
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You can buy CBD as an oil, but it’s also sold in everything from water and candy to Willie Nelson’s CBD-infused coffee.
“People are throwing CBD at every condition under the sun at random doses and expecting it to work,” says Vandrey.
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No long-term trials have tested CBD for occasional anxiety or to treat people with a diagnosed anxiety disorder.
Photo: Matthew Brodeur/unsplash.com.
“There are a lot of possibilities for CBD,” notes Piomelli, “but they require controlled clinical trials. The smoking gun isn’t there yet.”
“CBD is promoted as this amazing, natural, healing product,” says Vandrey. “But many claims about CBD haven’t been substantiated in humans.”
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Hemp oil is made from hemp seeds and doesn’t have much CBD unless it’s added, because CBD is found in hemp’s leaves and flowers (not its seeds). If you want CBD, look for CBD or cannabidiol listed on the label. If a label lists “cannabinoids,” there’s no way to know how much of that is CBD or if the product simply contains other types of cannabinoids.
“We know that CBD can affect the metabolism of drugs, though the extent to which that happens is still not well understood,” says Vandrey.
The US Anti-Doping Agency (USADA) puts it this way: “Many products which claim to be pure CBD extract or oil from the cannabis plant have traces of THC (tetrahydrocannabinol) or other cannabinoids. Thus, a consumer who buys a CBD oil, extract, or other CBD product should be aware that there is a high likelihood it is a mixture of CBD and other prohibited cannabinoids, such as THC.”
USADA special advisor Amy Eichner told us anti-doping labs “ can test for and detect other cannabinoids ” of which there are more than 100 in common industrial hemp extracts – and all of which are banned by WADA in-competition except CBD (cannabidiol) along with THC below a certain threshold.
“The sports nutrition category was slow to adopt CBD, but it’s now appearing in various products including pre-workout formulas, recovery drinks, and post-workout products,” said Rick Collins, partner at Collins, Gann, McCloskey & Barry in New York. “But drug-tested athletes use CBD products at their own risk.”
But the complex molecular profile of many CBD products means steadfast anti-doping guarantees remain difficult to achieve for a category seeking a legitimate seat at the table of clean sports performance.
“O ur recommendation to athletes is to not use any cannabinoid product, such as a CBD preparation, during or close to a competition ,” Eichner said.
Separation issues in the close knit cannabinoid family
The main formulation challenge lies in the difficulty in extracting and isolating CBD from industrial hemp – hemp cannabinoids like to stick together and traces of the other 100+ cannabinoids invariably remain.
“Other than one prescription drug product to treat two rare, severe forms of epilepsy, the U.S. Food and Drug Administration (FDA) has not approved any other CBD products.”
Over the last couple of years, CBD has become a household word. CBD can be found in foods, supplements, cosmetic products, and even animal health products. You may have seen CBD products on the shelves of stores that range from 7-Eleven to Whole Foods Market.
CBD is marketed as the latest health miracle, with claims that it will relieve pain, anxiety, and depression. Some companies go so far as to say that CBD can treat cancer, autism, multiple sclerosis, and other serious health conditions. Many of these health claims are unproven and have come under serious scrutiny.
Is CBD Safe?
Companies quickly interpreted the legality of hemp to mean that they could market products containing hemp derivatives and isolates, such as CBD. Despite statements from the US Food and Drug Administration (FDA) in opposition, CBD products began popping up across the country.
CBD stands for cannabidiol. It is one of more than a hundred different active plant compounds in the Cannabis sativa plant. Collectively called phytocannabinoids, these compounds act on cannabinoid receptors in the human body and brain.
For those who want to use the whole plant rather than a CBD isolate, whole-hemp extracts can be purchased as herbal supplements. Reputable companies will source, harvest, and extract hemp with the highest quality standards. They will test their products for active compounds as well as impurities.
Because CBD is so freely available (along with the fact that it does not cause the mind-altering effects of marijuana) many people believe that CBD is a risk-free product. Consumers are using CBD products without medical supervision. They are also asking questions of their natural healthcare practitioners—including nutrition therapists. We answer some of those questions here.
Nutrition therapy means using food and nutrients to support the body for better health. Nutrition therapy begins with food, but many practitioners also recommend vitamins or supplements.
The most reliable information on the safety of CBD comes from the new drug applications and prescribing information for the FDA-approved drugs containing CBD. Those two drugs are Epidiolex (CBD only) and Sativex (CBD and THC).
Marijuana has been cultivated for its recreational use and contains high levels of THC. Hemp has been cultivated for agricultural and nutritional use and contains higher levels of CBD. CBD is only a minor component of marijuana and produces none of the mind-altering effects.
How is CBD different from marijuana?
Until 2018, all cannabis products were considered controlled substances, with no differentiation between hemp, marijuana, or any extracts from these plants. The 2018 Farm Bill changed that. The bill defined hemp as containing less than 0.3% THC and removed hemp from the Controlled Substances Act. Hemp was deemed legal as a food and supplement.
Many of the mechanisms of how CBD acts in the body are not entirely understood. We do know that it modulates the endocannabinoid system by acting on cannabinoid receptors (CB1 and CB2). CBD is commonly used to support healthy immune function and healthy inflammatory pathways. It might reduce stress and occasional anxiety by supporting healthy mood.
The safety information of these products shows that CBD could have potential interactions with drugs because of how it is metabolized and influences the activity of liver enzymes. Another concern posed by CBD is that it may damage the liver, especially in people who already have a liver disease or who consume a lot of alcohol.
CBD is not a whole food or a whole plant. It is an isolated compound from the hemp plant. CBD is extracted from hemp for use in pharmaceuticals and consumer products.
“The FDA is evaluating the regulatory frameworks that apply to certain cannabis-derived products that are intended for non-drug uses, including whether and/or how the FDA might consider updating its regulations, as well as whether potential legislation might be appropriate.”
How is CBD regulated?
Without consistent oversight from the FDA, there are serious concerns about the quality of CBD products. The FDA claims that they have tested the chemical content of some consumer products and found they do not contain the levels of CBD that are claimed. Some products contain unsafe levels of pesticides, heavy metals or other contaminants.
Consumers should be cautious when choose CBD products. Look for reputable companies that source and isolate the CBD with integrity. Ask for third-party documentation of CBD content as well as testing for impurities and contaminants.
Nutrition therapists and their naturally minded clients may be intrigued by the possibilities of CBD. It is a natural compound that is extracted from a plant that appears to offer a range of health benefits.
“We are aware that there may be some products on the market that add CBD to a food or label CBD as a dietary supplement. Under federal law, it is illegal to market CBD this way.”
Taking CBD rather than a whole-hemp extract is similar to taking beta-carotene instead of eating a carrot. CBD comes from hemp, but the whole plant contains more than a hundred related compounds. Many have suggested that a whole-hemp extract offers synergistic benefits that are greater than taking CBD alone.
CBD and THC are present in both the marijuana plant and the hemp plant, but in different amounts. Marijuana and hemp are the same genus and species ( Cannabis sativa ), but they have been cultivated over the years for very different purposes.