Have you been seeing ads for CBD products popping up everywhere? What’s the deal?
You may be wondering, what is a dietitian-nutritionist writing about CBD for? Since there is a lot of confusion, I want you to consider the facts! There are a few dietitians stepping into this space, because it often fits into their practice (for instance, CBD and medical marijuana are useful in bowel disease and cancer treatment – two diseases that have overlap with nutrition management). In my opinion, it seems reasonable for a health professional to branch into learning about medical cannabis, as opposed to someone with no medical background who is only going for the sale.
A Deeper Dive
I admit, while I’m skeptical, the use of medical marijuana and CBD (cannabidiol – a cannabinoid in the cannabis plant) in disease treatment intrigues me. The science is relatively new in regard to the human cannabinoid system, a neuromodulatory system . It was only in 1990 that that the first cannabinoid receptor (CB1) was confirmed (there are cannabinoid receptors throughout the body).
Yet we already know that CBD and THC have anti-nausea properties, and may help with pain and epilepsy. In fact, there are synthetic FDA-approved forms of THC prescribed to treat epilepsy and the nausea and vomiting from cancer treatment. When it comes to CBD oils, medical marijuana/cannabis, and the legalization of recreational marijuana however, things get murky.
CBD VS Marijuana
CBD and Medical Marijuana are derived from a type of cannabis plant. There are a few important things about medical marijuana and CBD to clarify:
- Both hemp and marijuana contain CBD, the non-intoxicating cannabis compound.
- CBD from the hemp plant, contains little (<0.3%) to no THC (it does not get you high)
- Marijuana is derived from a cannabis plant that has >0.3% THC (tetrahydrocannabinolis – the chemical that gets you high)
- Medical Marijuana (or medical cannabis) use requires a physician’s approval (limited for specific diseases). Regulation is determined on a state by state basis. Marijuana possession and use is still a federal crime (yet some states also approve adult/recreational use).
- Both CBD and THC interact with the brain via cannabinoid receptors.
CBD – What is it?
To learn more, I interviewed my colleague Janice Newell Bissex, who is a Holistic Cannabis Practitioner (her certification required her to complete numerous study hours and pass an exam). She offers some answers to common questions, as well as some research and resources for additional information.
Q: Is CBD the next cure-all?
JB: The short answer is no. CBD (cannabidiol) has many incredible health benefits but it is not a cure-all fix for everything. CBD is such a powerful medicine due to its anti-inflammatory power. Many autoimmune and chronic diseases have an inflammatory component, making CBD a potentially effective treatment. Its neuroprotective and neuro-calming effects can help in the treatment of anxiety, depression, autism, Parkinson’s disease, Alzheimer’s disease, TBI and concussion, and more. The analgesic power of CBD has helped many people decrease their dose of pain meds, including opioids. I’m excited about the ongoing research on the use of CBD to heal the gut and improve symptoms of IBD/IBS, and have seen firsthand dramatic improvement in my clients with GI issues.
Q: What is CBD and how is it delivered? Is there a dosing standard?
JB: CBD (cannabidiol) is one of the more than 100 cannabinoids found in the hemp and cannabis plants. THC is another cannabinoid, commonly known for its psychoactive/intoxicating effects.
There are many options for CBD delivery including sublingual tinctures, water soluble tinctures, soft gels and capsules, edibles, topicals, transdermal patches, and suppositories. Many food manufacturers have developed, or are working on foods, containing CBD, but are waiting for the FDA to release regulations. Right now, the FDA says that CBD may not be added to foods.
The therapeutic range for CBD quite large. Some find relief with 5mg and others need 50mg or more to see a positive effect. It’s important to work with a qualified health professional to determine the best product and dosing, especially since CBD may potentially interact with certain medications.
Q: How do you know that the CBD product you are purchasing is legit?
JB: CBD works better in a whole plant formula versus an isolate. Look for a full spectrum (with all components of the plant) or broad spectrum (with all components minus the THC) CBD product. Since hemp and cannabis are bioaccumulator plants, I recommend CBD products made from organically-grown hemp. A study by the FDA showed that 70% of the CBD products sold online were mislabeled, with some containing zero CBD. It’s buyer beware when purchasing CBD! I recommend buying from a trusted source/company that provides independent lab analysis of their products proving that the product contains what is claimed on the label. As a general rule, it’s best to avoid CBD products that are sold in gas stations, convenience stores, and smoke shops, or those that make unproven health claims.
Q: Is CBD regulated?
JB: The problem is, CBD is not regulated at this time. The FDA is working on regulations now and we hope to see them in the coming months. Hopefully, this will remove some of the ‘bad players’ in the CBD industry who are selling mislabeled, poor quality products.
Faye Berger Mitchell is a registered dietitian who is a Patient Care Representative in a medical cannabis dispensary in Maryland, where it’s legal. I asked her about the medical cannabis industry.
Q: How do you know if medical marijuana (or medical cannabis) is available in your state?
FBM: NORML – The National Organization for Reform of Marijuana Laws – stays up to date on state legalization. The laws change each election cycle as more states are legalizing either medical or adult use cannabis. A general trend seems to be that states first legalize medical cannabis, then legalization of adult use tends to follow a few years later.
The reason it can be legal in your state, yet be federally illegal, is because the Federal Government has given each state the rights to develop their own policies. States have promised not to put Federal funds towards prosecuting cannabis offenses. You can somewhat compare it to health insurance. Each state can determine their own policies as to what they will cover (for example, Maryland mandates that health insurance companies must cover infertility treatments. Other states may not).
Q: Who is qualified to try medical cannabis?
FBM: Again, this varies by state. Once legalized, each state will have a commission, or some sort of governing body, that will mandate the details of the law. Generally, they will provide a list of qualifying conditions for which medical cannabis can be prescribed. In Maryland, for example, the qualifying conditions include: “If the patient has a chronic or debilitating disease or medical condition that causes: cachexia, anorexia, wasting syndrome, severe or chronic pain, severe nausea, seizures, severe or persistent muscle spasms, glaucoma, post-traumatic stress disorder (PTSD), or another chronic medical condition which is severe and for which other treatments have been ineffective”. As you can see, the regulation has been worded to provide a lot of flexibility to the prescriber. Several National and International Organizations support its use.
Q: What is the difference between Medical Marijuana and CBD?
FBM: Many medical cannabis dispensaries do not sell hemp CBD. They sell a large variety of cannabis CBD products which also contain THC. THC is the psychoactive component of the cannabis plant, however in very small amounts it tends not to be psychoactive. Instead, the THC enhances the efficacy of the CBD. This is called the entourage effect. Also, keep in mind, that many patients micro-dose with medical cannabis. The general goal in medicating is to obtain maximum relief or benefit with minimum psychoactivity.
Q: Who could benefit from Medical Marijuana?
FBM: Patients with epilepsy (and other neurological disorders), insomnia, chronic pain, PTSD, digestive issues and disorders, cancer, and anorexia, have found great symptom relief with medical cannabis. Patients with mild depression and anxiety have also found relief. Baby boomers, in particular, are using medical cannabis to help with sleep, chronic pain and inflammation, while turning away from traditional prescription drugs. It is not a panacea though, and patients may still need traditional medications. (Don’t stop taking prescribed medications without consulting with your physician). Keep in mind, the cannabinoids in medical cannabis, including CBD and THC, can potentially interact with other medications. It is important to consult with a health care professional that has some knowledge of medical cannabis.
Q: Where’s the research?
FBM: That is one of the big issues. Because cannabis is federally illegal, researchers have limited access to the plant. There are only a few places in the US that are legally allowed to grow it for research purposes. However, what’s being grown for research purposes, may be nothing like the actual plant/medicine that is being used in practice. There is definitely some research out there, and more is emerging. For example, The Center for Medical Cannabis Research at UC San Diego is currently conducting clinical trials. Some studies indicate that medical cannabis use is growing exponentially in states where it is legal. Overall, when patients ask about using medical cannabis, physicians cite the lack of good research is one of the reasons why they have a hard time recommending it.
A Long and Winding Road
Overall, you’ll want to exercise caution when purchasing CBD products. They are not yet regulated by the FDA or any governing body.
The 2018 Farm Bill included a broader allowance for hemp. The Bill allows hemp cultivation, and allows the transfer of hemp-derived products across state lines for commercial or other purposes. It also puts no restrictions on the sale, transport, or possession of hemp-derived products. That’s why you’re seeing so much CBD popping up.
Before medical marijuana is widely accepted and prescribed, there’s a lot more to learn. There still seems to be a lot of grey area. To understand how it may best replace other medications (particularly opioids) and how it could be part of the treatment of disease, we’re going to need more research. Even though medical marijuana has gained legalization in many states, practitioners may be hesitant to use it since it’s still a federal offense. In addition there’s the issue of regulating products (tinctures, creams, ointments, buds, etc).I plan to keep following this story as more facts emerge, so stay tuned.
Janice Newell Bissex, MS, RDN, is a Registered Dietitian Nutritionist, cookbook author, and Holistic Cannabis Practitioner. Her mission is to help people suffering from chronic pain, anxiety, insomnia, autoimmune diseases, IBD/IBS, and other debilitating conditions, find relief with cannabis/CBD. She partnered with a Colorado manufacturer of organically-grown medicinal grade hemp to provide phytocannabinoid-rich hemp/CBD products for her clients under her Jannabis Wellness label.
Faye Berger Mitchell, RDN, LDN, FAND, is a Registered Dietitian Nutritionist and a Fellow of the Academy of Nutrition and Dietetics. She’s an author, speaker, and cannabis consultant. Faye is transitioning to the cannabis industry. She is currently enrolled in the Holistic Cannabis Academy and holds a position as a Patient Care Representative in a medical cannabis dispensary in Maryland, where it’s legal.