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March 03, 2021 9 min read

Do doctors trust CBD?

According to Dr. Peter Grinspoon, writing for the Harvard Health Blog, “CBD may prove to be an option for managing anxiety, insomnia, and chronic pain.”[1]

Head of Mayo Clinic’s Integrative Medicine and Health Research Program, Dr. Brent Bauer, says that CBD has had the fastest rise in sales and usage of any supplement in US history.[2] He adds, “We know in animal studies and some test-tube studies, it seems to be pretty good for an anti-inflammatory, may have some anti-pain (properties), and it certainly has some effect on mood."

Doctors are optimistic yet guarded about the potential of CBD for treating a range of common ills from anxiety to back pain.

A Gallup poll found 14 % of all Americans (several million) use CBD products, and the CBD market is expected by 2024 to reach a peak of $ 7 billion per year. CBD is extremely popular and profitable.[3]

Gallup also found that 40% of users take CBD to improve pain levels, sleep quality, or for anxiety and stress. Western states used more CBD and had better access than other parts of the United States.

A study published in The Journal of the American Medical Association (JAMA) found 6.4 million searches for information about CBD on Google within a period of one year.

So, what exactly is CBD, why is it so popular, why do doctors prescribe it, and why do people buy it?

What is CBD?

CBD stands for cannabidiol. Cannabidiol is a cannabinoid that comes from the industrial hemp plant. Industrial hemp is a form of cannabis sativa which contains less than 0.3 % THC, and is therefore not psychoactive. CBD has no known addictive properties. CBD has no psychoactive effect and causes no high or euphoria. CBD was legalized in the United States nationwide by the 2018 Farm Bill. While industrial hemp does not contain psychoactive THC, a good CBD product may contain other therapeutic but non-psychoactive cannabinoids such as:

  • CBC - Cannabichromene
  • CBCV - Cannabichromevarin
  • CBD - Cannabidiol
  • CBDV - Cannabidivarin
  • CBG - Cannabigerol
  • CBGV - Cannabigerivarin
  • THCV - Tetrahydrocannabivarin

These cannabinoids boost the effect of CBD in a process called “The Entourage Effect.”

Industrial hemp also contains several terpenes that boost the effect of CBD. They give cannabis plants their pungent aroma. Examples include:

  • Myrcene is the most prevalent terpene in industrial hemp. It smells like fruit and cloves. It is abundant also in mangos, this is why some people eat mangos to boost the effects of herbal marijuana. Myrcene can improve the anxiety relieving effects of CBD and increase the bioavailability of CBD.
  • Limonene is the next most prevalent terpene in industrial hemp. It smells like lemons as it is also present in actual lemons. Limonene can fight bacteria and fungus, as well as boost mood and hamper the effects of being stressed out.
  • Linalool gives marijuana its spiciness and herbal fragrance. It can also be found in lavender and cinnamon. It can induce a sense of relaxation.
  • Caryophyllene can give hemp a peppery flavor. It clings to CB2 receptors in the nervous system, which can have anti-pain, anti-anxiety, and anti-addictive effects. It’s the only terpene that will bind to a cannabinoid receptor.
  • Alpha-pinene, as the name suggests gives hemp the smell of pine. It can fight inflammation, reduce nasal congestion and asthma, and fight the effects of memory loss that results from THC.
  • Eucalyptol is the same terpene that powers the health benefits of eucalyptus. It has a minty flavor. It also has antibacterial properties and can help relieve congestion.

What do doctors prescribe CBD for?

Doctors are familiar with cannabidiol or CBD because it is a prescription medication as well as being available over the counter. The prescription form for cannabidiol alone is the brand name medicine known as Epidiolex.

Epidiolex

Epidiolex is prescribed in the treatment of seizures in people over the age of 1 year.

It can be prescribed for Dravet syndrome, Lennox-Gastaut syndrome or tuberous sclerosis. Dravet is a seizure syndrome that starts from birth and continues throughout life. This syndrome was one of the first illnesses to bring CBD to light when a Colorado girl with the disorder had seizures reduced from 300 per week to zero with a formulation of CBD. Colorado is now one of the biggest producers of CBD and industrial hemp. Tuberous Sclerosis and Lennox Gastaut syndrome both can present with seizures which can be treated with cannabidiol.

In doses in excess of 1 gram, cannabidiol can be used as an antipsychotic. Though more studies are needed, it can potentially have significantly fewer side effects than the usual prescription antipsychotics which are known to cause excessive weight gain, fatigue, emotional flatness, and movement disorders like tardive dyskinesia.

Sativex / Nabiximols

The other CBD containing product prescribed by doctors in the United States is called Sativex. Unlike Epidiolex, Sativex also contains THC, in a 1 to 1 ratio with CBD. Also, unlike Epidiolex, Sativex contains other cannabinoids and terpenes such that it produces an entourage effect. This may improve its efficacy in treating disorders other than seizures. It is indicated for spasticity, neuropathic pain, overactive bladder, and multiple sclerosis symptoms. Doctors may prescribe it off-label for other painful conditions, especially since opioid prescriptions are being less and less favored for pain due to an opioid epidemic in the United States and other parts of the world.

Non-prescription CBD products

Since CBD is legal in all 50 states of the United States, companies can sell products made from industrial hemp directly to consumers and not require a prescription from a doctor. People use non-prescription CBD for conditions like everyday pain, skin outbreaks, stress, muscle aches, back pain, anxiety, and insomnia.

While a doctor’s prescription is not required, doctors may sometimes recommend CBD to patients for non-disease related ills like stress, everyday chronic pain, lack of appetite, and inability to get to sleep and remain asleep.

Not all CBD products are created equal however. The FDA has again and again found CBD companies whose products did not contain the stated amount of cannabinoids. In order to make sure you get the right product always ask the following questions:

Does the certificate of analysis show the stated amount of CBD, cannabinoids, and terpenes?

Some CBD companies will tell you their product has for example 400 mg of CBD hemp seed oil. This may not mean 400 mg of CBD, rather most of the weight will simply be hemp seed oil. This is a trick bad companies have used to confuse consumers who get ineffective CBD products. Most of these companies will not post the certificate of analysis or they will post one done by their own in-house lab which may not be accurate. Be sure to get a certificate of analysis done for your batch and done by a 3rd party lab to make sure your product has the right amount of CBD, other cannabinoids, and terpenes.

Is your CBD bioavailable?

In order for your CBD to be bioavailable (meaning it can be absorbed and used by the body, rather than just expelled), it may need to be decarboxylated. CBD exists in industrial hemp as CBDA or cannabidiolic acid. CBDA can have anti-inflammatory effects of its own, but to get full effects, it needs to be heated to a certain temperature to yield CBD. Some products will contain CBDA and CBD, these products can be effective. Since CBD is fat soluble, it may need to be taken with food or dissolved in oil to be effective. Many companies use MCT oil or medium chain triglyceride oil to make the CBD bioavailable and this is a good choice. MCT oil is a healthy fat found in coconut oil and real butter. It is used directly by the liver and converted into energy rather than being broken down and stored as fat.

The other way CBD is made bioavailable is when it is disintegrated into nanoparticles, but this can be costly and put such products out of the affordability range of the ordinary consumer.

Does your CBD have the right dosage and is it affordable at that dosage?

Non-prescription CBD is used for non-medical symptoms associated with different diseases. The Mayo Clinic has produced a chart that shows the CBD dosage used for common conditions. This can be used to estimate how much CBD will be needed for non-medical symptoms in a person who has the same conditions. Non-prescription CBD is technically to be used for non-medical complaints and CBD companies can land in hot water for making medical claims, so dosages may vary when used for everyday stress and pains in persons with medical conditions. Use the chart below to estimate how much CBD you will need. Remember, often times when a CBD label says 1000 mg of CBD, this the dosage in the entire container, not per pill.

CBD Dosage Recommendations

What are the risks?

Some doctors are cautious about prescribing CBD and waiting for more studies to be performed and replicated. They may also point out the risks of CBD. CBD is generally well-tolerated, even at high doses, and there is no known overdose death of CBD.

The most common side effect of CBD appears to be drowsiness aka somnolence. This is a result of the sedative effect. This is also what makes CBD effective for insomnia. This is a side effect you can expect to go away after a few days of dosing. It may return when the dose is raised until a tolerance is built. Although tolerance can build, CBD has no known addictive properties.

Decreased appetite is another common side effect. Some users have claimed that this side effect has resulted in unexpected and sustained weight loss. CBD can improve metabolic rate by interacting with CB1 and CB2 receptors in the nervous system. Combined with a reduction in food intake due to a reduction of appetite, this can lead to weight loss.

CBD can cause dry mouth. This is a common side effect of any cannabis derived product. This side effect is rarely bothersome enough to cause a discontinuation of usage.

Diarrhea is another reported side effect of CBD in some individuals. This may be caused by the CBD itself or the various fillers in different products.

What Might a Doctor Recommend CBD Products For?

To aid in weight loss

There is some evidence that CBD can aid in losing weight. A 2016 study published in Molecular and Cellular Biochemistry showed that CBD’s activation of cannabinoid receptors may help to convert white fat into brown fat.[4] White fat is the unsightly and unhealthy stored fat that accumulates along areas like the belly and thighs due to excessive calorie intake. High levels are associated with numerous health problems including diabetes and heart disease. Brown fat is the fat the body uses to burn to keep you warm. It is not associated with health problems. Having higher levels of brown fat versus white fat can be healthy. Brown fat cells contain many more mitochondria, the energy powerhouse of cells, that white fat. These structures produce energy from the fat to produce heat and power muscles. By turning white fat into brown fat, CBD can aid weight loss and improve metabolic health.

For chronic stress

Chronic stress from work, school, and family life can cause or exacerbate health problems and reduce quality of life. CBD has shown promise in reducing anxiety and has no abuse potential and a low incidence of side effects, unlike prescription anti-anxiety medications such as Xanax and Klonopin which doctors have become wary of prescribing for anxiety issues due to the potential for abuse and addiction. CBD can be a more benign way of lowering anxiety and being able to wind down after a stressful day.

Insomnia

CBD’s side effect of causing drowsiness and sleepiness has been leveraged as a way to fight insomnia. Nearly half of adult Americans report some trouble falling asleep. 70 million Americans have a sleep disorder. A whopping 30 % of Americans have had short bouts of insomnia. A full 10 % have chronic insomnia. 40 % of Americans will fall asleep during the daytime as a result of inefficient sleep at night.

For aches and pains

CBD can reduce the intensity of everyday aches and pains from bad posture required to fulfill various work duties in cubicles or on factory floors and other causes. It can help address muscle pain and cramps associated with conditions like fibromyalgia and Stiff Person Syndrome.

For headaches

Studies are currently being done to determine if CBD may be effective for migraine headaches. It has already shown promise as a topical remedy for the muscle strain that may be associated with headaches. Unlike many snake oil type supplements, CBD has been shown to be effective when applied topically if the right formulation and product is chosen.

For anxiety and agitation in persons with autism spectrum disorders

CBD can help ease agitation in children and adults with autism spectrum disorders. It is not a treatment for the autism itself, but for stress and agitation. It is imperative that an effective product is used. Fully 2 out of every 3 CBD products on the market do not contain the stated level of CBD in an effective form, according to analyses released by the FDA every year. Though these companies receive warnings from the FDA, many continue to operate, flooding the CBD market with ineffective products. If you receive a CBD product which is ineffective, ask yourself each of the questions listed above, and keep looking. Don’t give up! CBD is clinically proven to be effective, you just have to find the product that works for you and your loved ones!

[1] "Cannabidiol (CBD) — what we know and ...." 15 Apr. 2020, https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476. Accessed 1 Feb. 2021.

[2] "Mayo Clinic Q and A: Research needed into treating anxiety with CBD." 19 Mar. 2019, https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-research-needed-into-treating-anxiety-with-cbd/. Accessed 1 Feb. 2021.

[3] "14% of Americans Say They Use CBD Products - Gallup Poll." 7 Aug. 2019, https://news.gallup.com/poll/263147/americans-say-cbd-products.aspx. Accessed 1 Feb. 2021.

[4] "Cannabidiol promotes browning in 3T3-L1 adipocytes - PubMed." https://pubmed.ncbi.nlm.nih.gov/27067870/. Accessed 3 Feb. 2021.