CANNABIDIOL (CBD) OIL

Marijuana plants are part of the cannabis genus, and they have plenty of tetrahydrocannabinol (THC), which is the cannabinoid (cannabis-derived compound) responsible for their psychoactive effects (what gets you ‘high’).

In addition, marijuana plants have some CBD, which is the second-most-famous cannabinoid, and is thought to potentially have positive effects on a variety of health-related outcomes and conditions including certain types of epilepsy, anxiety, insomnia, chronic pain, and inflammation.

Hemp plants are also members of the cannabis genus, but hemp plants are cultivated to achieve maximal plant size as quickly as possible, which yields some characteristics that distinguish them from marijuana plants.

Most notably, hemp plants have very low THC content (<0.3% dry weight) and relatively higher CBD content.

CBD is cannabidiol; a compound extracted from hemp. It lacks psychoactive effects because it has the THC removed.

Due to this absence of psychoactive effects and its safety levels assessed in research, it is classed as a supplement.

The problem with CBD is it isn’t a well-researched area currently, however, we may see some more research on this over the next few years but for now, the evidence just isn’t there yet.

Another problem is how poorly these products are manufactured and regulated.

One particular study looked at 46 different CBD oil supplements and found that CBD content varied massively from the label.

57% of the samples had THC present. 39% contained entirely THC, no CBD at all.

Imagine you bought 10 different ibuprofen products and 4 had no ibuprofen; instead, there was another drug with entirely different effects.

https://www.karger.com/Article/FullText/489287

Supplements are deemed safe until proven otherwise (medicines are the other way around). Supplement regulation is lacking, so companies can make poor quality, incorrectly dosed products – with crazy claims attached.

CBD isn’t unsafe – but there is no long-term data on people who regularly use CBD, and as mentioned, it can contain other compounds, which may be unsafe.

CBD is often marked with a ” / natural” narrative. It’s being touted as a ‘natural remedy’ which sounds more appealing than medicine, but there is nothing wrong with medicine – in fact, the classification of CBD could change in the future to be classed as a medicine in some cases. CBD is often targeted to people as a medicine-like substance, for example for pain and anxiety

CBD is effective in treating two forms of childhood epilepsy. In this setting, it could be described as a medicine, not a supplement.

Where else is CBD effective?

There is little high-quality human research on CBD oil. Claims being made by CBD sellers are not based on facts.

The research so far is done primarily with animals, and the limited number of human trials have been done with controlled, high-quality CBD – not the poor standard of CBD available for consumers today.

ANXIETY

There are no long-term studies on the effects of CBD oil on anxiety.

It’s important not to experiment with your mental health. Remember the supplements you can buy are unregulated, the potential doses are not well known, and doses in supplements available vary massively.

There are some human trials for anxiety/depression, that show a reduction in symptoms. However, a big caveat to this research is the dose used.

A typical CBD on the market (5%) will contain approx 460mg for the whole bottle.

In these studies, they are often using a similar amount per day to even see comparable effects to SSRI/SNRI depression/anxiety medications.

There has been a case report about the effect on sleep and anxiety (https://www.ncbi.nlm.nih.gov/pubmed/27768570) and also some anecdotal evidence that suggests it may have some benefits, however, we can’t draw any conclusive data on this as yet.

It’s certainly something to look out for in the future as the availability and research into CBD oil increases.

PAIN

There was no evidence for the use of CBD alone (either as a pure product or containing traces of THC).

Little research for CBD in humans and very small sample sizes. It’s not looking promising as a treatment for pain.

Most of the studies have looked at chronic pain rather than short-term pain, and most of the research has flaws.

Research showing CBD's effectiveness in pain management has often been from studies using a THC/CBD combination which could potentially explain anecdotes of CBD helping with pain.

SLEEP

There is no long-term data supporting that CBD helps sleep. The current studies in humans have mixed effects depending on dose (and because CBD is not regulated, you really don’t know how much you’re getting in a dose – so this is a big pitfall).

Some studies show a negative effect on sleep, some positive effects, and some no effect at all.

From what I’ve seen in the research, a lot of the CBD claims about improving sleep are off the back of studies looking at combined CBD and THC research, or full-on cannabis research, although THC actually reduces sleep quality. When CBD is isolated, the evidence is very weak.

As with the anxiety literature, this is an area that needs more human research, larger control trials, and long-term data.

Most of the research is focusing on sleep disorders (e.g., insomnia), it is not focusing on simply improving sleep in healthy people.

If you do have a sleep disorder like insomnia then consult with your doctor about available treatments, or chat with them about CBD. It’s so early in the literature that if your doctor agrees, then you could try it.

The main issue here is that if you have a medical condition like anxiety or a sleep disorder, these should be treated by professionals and use their opinion when deciding to use CBD.

Avoid trying to self-treat with a ‘plant-based herbal supplement’ with poor research behind it, no quality or dose standards, and potential negative outcomes.

HEALTH

This is a really broad category and a buzz word to sell the product. What facets of health is it supposed to improve?

Mental health? Social well-being? Diet quality?

There is no research (that I have come across) where health markers have been improved by taking CBD.

Increasingly, CBD oil is also being promoted as a prophylactic treatment to prevent certain diseases from developing at all.

The argument used is that the human endocannabinoid system is involved in basic life functions such as appetite, immune response, reproduction, and pain management. What they think is that the presence of CBD prevents these systems from being overly activated, thereby protecting the nervous and immune systems from everyday stress.

Furthermore, CBD is known to be a reasonably potent antioxidant, which further helps to protect against stressful influences.

Although this clearly increases the market for CBD products, it also makes it hard to prove scientifically that a disease was prevented using a health-promoting product.

PERFORMANCE ENHANCING.

So far, the evidence linking CBD oil to soreness reduction (DOMS) and recovery enhancement isn’t very promising. Neither exercise nor recovery has been shown to benefit from CBD.

Nonetheless, with such a small body of literature and some notable methodological limitations in a couple of the studies, it’s possible that future studies may identify different dosing protocols or circumstances in which CBD is more effective.

This review article outlined the applications that CBD might have for athletes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7338332/

Remember as well when it comes to banned substance policies for competitive athletes, even though CBD was removed from the prohibited list in 2018, this assumes that the CBD product was manufactured in a manner that effectively keeps THC content below the level that would return a failed THC test.

Other medical indications that may be treated with CBD, include Parkinson’s disease, schizophrenia, and MS. However, although research into the therapeutic effects of CBD is rapidly increasing, most current uses of CBD are not (yet) supported by clinical data.

SUMMARY

Unfortunately, as of 2021, there are still very few human trials for CBD.

Many of the claims being made about CBD are unsubstantiated. However, we can’t completely dismiss something when the literature is still emerging and there are some positive trends being shown.

All positive outcomes seem to be from a combination of THC and CBD, rather than CDB alone.

This is often referred to as the “entourage effect” – that a single ingredient might do a little something, but you need the whole crew of compounds in the plant to have full efficacy.

However, THC is still currently illegal and not available in the UK.

Most of the studies come from the USA where the most popular medical drug is “sativex” which is 50/50 THC/CBD

This shows good and promising results in some groups of people, particularly for the relief of multiple sclerosis symptoms (again, more studies need to be done and are being done currently) but CBD alone shows far fewer positive outcomes.

[NB: Sativex is available in the UK, but NHS prescribing is very limited and varies across the country. This is something that can only be prescribed by a specialist doctor. Prescriptions of cannabis-based medicinal products for chronic pain are currently rare].

At this point, CBD may play a role in acute anxiety scenarios, but for generalised anxiety or other chronic anxiety disorders, we can’t definitely say that it works.

It may be the case that in a few years, after more controlled trials, things may have changed – but right now there are no recommendations for someone to supplement with CBD without consulting a medical professional first and making sure ALL other avenues have been explored first.

If you are going to supplement you need to make sure it’s in the right dose, high-quality CBD and you know when/how to take it.

The supplements available in Holland and Barratt’s are at a very low concentration level and CBD marshmallows and CBD lemonades you see around probably aren’t going to do anything.

There is also preliminary human data from small clinical trials that suggest CBD may have the potential to be used for conditions like anxiety, schizophrenia, opioid addiction, and Parkinson’s disease.

But the participants in these studies generally received several hundreds of milligrams of CBD a day, meaning the 5mg to 25mg of CBD per serving in popular CBD products may likely be inadequate.

And even if you took dozens of servings to reach the dosage used in these clinical trials, there is still no guarantee of benefit because of how preliminary these findings are.

BOTTOM LINE: Currently, outside of childhood epilepsy, and some anxiety reductions, there is not much evidence to support CBD supplementation.

It seems to be showing positive outcomes in more and more studies, so definitely something to keep an eye on for future research.

I understand that CBD is already quite popular, and you will always find someone with a positive anecdote to defend its effectiveness. Maybe some of those anecdotes may be a little bit ahead of the literature and this information isn’t intended as an attack on you or your experiences if you have had positive experiences with CBD.

As with any form of supplement, as long it is safe, and you aren’t being sucked into spending loads of money on something that is useless, then it shouldn’t be an issue for you if you feel the benefits. However further studies are needed to evaluate the full safety profile.

Remember also,

There are a number of potential drug interactions with cannabis-based medicinal products and other medications or substances so please speak to a doctor if you are interested in taking CBD.

Just because CBD-containing products are advertised to be free from THC, they still have the potential to contain traces of THC, even after the manufacturing process. It is this THC that may contribute to potential adverse effects.

Anyone wanting to use a CBD containing supplement should make sure they buy it from a reputable source.

In fact, the World Health Organization concluded in a review: “To date, there is no evidence of recreational use of CBD or any public health-related problems associated with the use of pure CBD”

So, there you go- the choice is yours.

Current legislation:

Despite the immense popularity of CBD oils, there is currently no industry-level regulation on their manufacturing process or quality standards.

Consequently, there are no reliable CBD selection guidelines or criteria that can help people identify high-quality and safe products.

As a recreational product, CBD oils are loosely regulated by labelling accuracy of CBD content and compliance with the legal regulatory limit regarding THC content.

The Food Standards Agency (FSA) is advising people who are pregnant, breastfeeding or taking any medication not to consume non-prescription CBD products.

Healthy adults are advised by the FSA to think carefully before taking these products, and to keep their daily intake at, or below, 70mg (about 28 drops of 5% CBD) unless otherwise advised by a healthcare professional.

The most significant side effect of CBD is its interaction with other drugs. CBD impacts how the human liver breaks down other drugs, which means it can elevate the blood levels of other prescription medications that people are taking and therefore increase the risk of experiencing their side effects.

While there is a lack of concrete and conclusive evidence about CBD’s effects, there is considerable hope.

Recent legislative changes around hemp and CBD in the US and across the world have enabled numerous human clinical trials to begin investigating the use of CBD for conditions such as autism, chronic pain, mood disorders, alcohol use disorder, Crohn’s disease, arthritis, and cancer-treatment-related side effects such as nausea, vomiting and pain.

The results of these studies should become available over the next few years.

Further research

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071207/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011465/

https://www.ncbi.nlm.nih.gov/pubmed/29442178

https://www.karger.com/Article/FullText/489287#ref14

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