Unfortunately, there’s no CBD-specific version of the food pyramid. Dosing depends on body weight, desired effect, and the way a person is taking it. CBD products often come with serving suggestions—but those can be misleading, given that the FDA doesn’t test every supplement against its labels and claims. (The agency has issued warnings to dozens of companies who’ve listed incorrect information about CBD and THC levels in their products; see the full list here.)
There are concerns that CBD might interact negatively with other drugs, specifically blood thinners like wafarin. But there’s no specific guidance on which medications to avoid mixing with the extract.
“There are many unanswered questions about the science, safety, quality, and physiological effects of CBD that need to be addressed before one can identify the effects of various chemical reactions on its efficacy,” Shelke says. Part of the issue with cooking with the extract is that the purity and the concentration is often unknown. This makes it even harder to know how it will interact with other ingredients, and whether that combination will help or harm a person. Bottom line: It’s better to avoid highly processed products or prepared meals with CBD, especially if you’re new to the compound.
How much should people take?
There’s also the question of which forms of CBD are safe enough for consumers but strong enough to make a difference. For neurological conditions like anxiety or apnea, the chemical needs to be absorbed into the bloodstream to have maximum impact. That means it needs to be ingested, inhaled, or rubbed in at high concentrations. But as health reporter Sarah Jacoby wrote in Self while vetting her own CBD buys, many of the proteins that trigger pain and inflammation are located between the skin and veins. So, any cream or gel that wants to counter aching joints and tight muscles needs to be able to get through the dermis but not as deep as the blood vessels. That’s a tall order for any drugstore formula.
All that variability, both in the plants and the products that are derived from them, makes CBD more challenging to test for medicinal purposes. It’s also often mixed with THC when treating chronic pain or life-threatening illnesses, so it take many extra layers of research to isolate the purely physical perks from the psychoactive ones.
The cannabis and hemp extract can be found in everything from lattes to kids’ vitamins. But doctors are still trying to learn if it’s healthy.
The Food and Drug Administration (FDA) recently updated its CBD regulations to state that it supports further research on benefits, safety, and use. For now, the extract is considered a controlled substance if it comes from cannabis plants. It’s less restricted when it’s harvested from hemp.
Three well-vetted studies provide the basis of support for the FDA’s decision. In these trials, 516 patients with Lennox-Gastaut syndrome or Dravet syndrome received either Epidiolex or a placebo. Epidiolex, when taken along with other prescribed medications, decreased the frequency of participants’ seizures compared to the placebo.
In 2018, in a study of more localized treatment, researchers administered a synthetic CBD gel in either 250-milligram or 500-milligram doses daily or a placebo to patients with knee pain due to osteoarthritis. Patients also stopped taking any other anti-inflammatory medications or painkillers, with the exception of acetaminophen, before and during the study period.
3. Reduce PTSD Symptoms
In 2005, Canada approved the use of Sativex, an oromucosal (absorbed in the lining of the mouth) spray with equal proportions of THC and CBD, for the treatment of multiple sclerosis-related central neuropathic pain. In 2007, Canada approved the medicine’s use again for cancer pain that proved unresponsive to other medications.
CBD’s ability to calm is perhaps its most popular effect and the reason its use is so widespread. A 2017 study in the Brazilian Journal of Psychiatry tested the anxiety levels of 57 men in a simulated public speaking test. Some received a placebo while others received either 150 milligrams, 300 milligrams or 600 milligrams of CBD before their speeches. Those who received 300 milligrams of CBD experienced significantly reduced anxiety during the test compared to those who received the placebo. Interestingly, participants who received either 150 or 600 milligrams of CBD experienced more anxiety during the test than the 300 milligrams group.
Amyotrophic lateral sclerosis (ALS) is a disease that causes nerve cells in the brain and spinal cord to deteriorate, resulting in loss of muscle control that worsens over time. It’s not yet understood exactly why ALS occurs, although it can be hereditary in some cases. There’s no known cure, and there are only two FDA-approved medications to help treat ALS symptoms.
At Golden State Greens shop, Jake C. told me that CBD containing THC is highly regulated by the state of California, and he believes the products to be safe and labeled appropriately. However, he said over-the-counter hemp-derived CBD (depending on state regulations) or black-market cannabis product, could have wildly varying amounts of THC and CBD, to say nothing of potential contaminants.
Before we go any deeper, let’s cover the basics. I mentioned marijuana above, and that plant does have more than 100 different compounds within it called cannabinoids. Its primary component is THC, which has the psychotropic properties that give users the feeling of being “high.” CBD is the second-most prevalent component, and does not have this same effect.
Though CBD is legal to sell, the FDA has made it clear that unapproved CBD products cannot be in food, beverages, cosmetics or sold as a dietary supplement; neither can they be marketed with unsubstantiated health claims. CBD can be purchased as oils, tinctures, sprays, creams, capsules, lollipops, chocolates, energy bars, trail mix and gummies, among other things. It can even be vaped. (According to Pam Miles, past president of the Association of Food and Drug Officials, one restaurant chain offered sandwiches infused with CBD as part of a promotion, so you know we’re already there in terms of availability.)
“You don’t know the dose, you don’t know the formulation and therefore [you don’t know] the absorption,” White told me. “In a lot of places, it’s essentially a backyard pharmacy where people just sort of make it up…. When you get in a situation where people are kind of doing it themselves then that is really out of control.”
CBD’s popularity has skyrocketed because of its purported therapeutic benefits, along with a low potential for abuse. There’s also plenty of it, and it’s profitable. According to Julian Wright, Founder of Science and Recreation, farmers can make $60,000 per acre to produce hemp high in CBD, versus $750 per acre in hemp sold for fiber. The commercial market for CBD, meanwhile, is projected to rise from an estimated $500 million in 2018 to $1.8 billion by 2022.
But as the days passed, I began to glimpse the other side of the conversation. In the end, I spent quality time with the supervisors of three CBD stores in my area, and each had inspiring stories to share of customers who alleviated their aches, overcame chronic pain, reduced stress, had a good night’s sleep or got a semblance of their lives back. They told me stories like that of Lorraine, who had been bucked off a horse, broke some vertebrae, was ridden with chronic pain, yet experienced such dramatic improvement with CBD that after a month, she rode her horse 400 miles through the south of Spain.
When a shop selling cannabidiol (CBD), a compound found in marijuana, opened near the place where I get coffee in my Southern California neighborhood, I was of two minds. Actually, for several weeks I was of one mind, which was to wish for the speedy demise of the business. As a physician, I just know too much about some of the deleterious consequences associated with marijuana use: memory issues, altered judgment, addiction, longer-term cognitive issues, chronic bronchitis symptoms, and so on.