May 2020 Issue
CBD Forum: Common Questions Answered About CBD
By Janice Newell Bissex, MS, RDN, FAND
Today’s Dietitian
Vol. 22, No. 5, P. 11
Q: CBD seems to be everywhere, from my local gas station to Bed Bath & Beyond. What is CBD, and is it really the miracle cure it’s purported to be?
A: Cannabidiol (CBD) is one of more than 100 cannabinoids found in the cannabis and hemp plants. Many of the compounds in cannabis, including CBD, have been shown to reduce symptoms in various disease states. In particular, CBD has been shown to provide relief for many people suffering from pain, anxiety, insomnia, seizure disorders, neurological conditions, arthritis, autoimmune disorders, irritable bowel syndrome/inflammatory bowel disease, muscle spasms, and brain injuries.1-3 CBD is not, however, a miracle cure. While it can provide relief for many people and for a wide variety of medical conditions, it isn’t effective for everyone, nor for every condition.
Q: How does someone know whether CBD will work for them?
A: It’s best to advise clients to do their research and speak with a medical professional who has experience with CBD options and dosing. There are topical, sublingual, ingestible, inhalation-based, transdermal, and suppository options. The appropriate format depends on the condition and individual. For example, someone taking warfarin or other medications with a narrow therapeutic window and a contraindication with grapefruit may want to avoid ingestible CBD. The CYP450 enzyme system in the liver metabolizes these compounds similarly, so there may be a potential for an interaction.
In addition, the therapeutic range for CBD dosing is quite large, with some people finding relief with a 2-mg or 3-mg dose and others requiring 50 mg or more. It can take some trial and error to find the right dosage and administration method for maximum efficacy. That’s why it’s best for clients to find a trained professional who’s knowledgeable in CBD therapeutics.
Q: Is it true that CBD is nonpsychoactive?
A: It’s incorrect to say CBD is nonpsychoactive, as it does produce a neurocalming effect on the brain.3-5 However, CBD is nonintoxicating and nonpsychotropic (ie, it won’t make you high), unlike the cannabinoid tetrahydrocannabinol, or THC, found in cannabis, which is psychotropic.
A psychoactive substance is defined as a substance that affects the brain resulting in altered perception, mood, consciousness, cognition, or behavior. Caffeine, nicotine, and some pain medications have psychoactive properties. CBD also fits this definition due to the following effects5-8:
• increases the neurocalming neurotransmitter GABA (gamma-aminobutyric acid);
• boosts serotonin levels by activating serotonin receptors;
• deactivates the fatty acid amide hydrolase enzyme that breaks down anandamide, the endogenous cannabinoid dubbed the “bliss molecule”;
• decreases cortisol, the body’s main stress hormone; and
• positively impacts the endocannabinoid system to help regulate pain and maintain homeostasis in the body.
So while CBD won’t make you “high” or render you “stoned,” it is, in fact, a psychoactive substance that has potential to provide relief for many people suffering from a variety of debilitating conditions.
— Janice Newell Bissex, MS, RDN, FAND, is a holistic cannabis practitioner at Jannabis Wellness.
References
1. Grinspoon P. Cannabidiol (CBD) — what we know and what we don’t. Harvard Health Publishing website. https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476. Updated August 27, 2019. Accessed January 27, 2020.
2. Atakan Z. Cannabis, a complex plant: different compounds and different effects on individuals. Ther Adv Psychopharmacol. 2012;2(6):241-254.
3. Pretzsch CM, Freyberg J, Voinescu B, et al. Effects of cannabidiol on brain excitation and inhibition systems; a randomised placebo-controlled single dose trial during magnetic resonance spectroscopy in adults with and without autism spectrum disorder. Neuropsychopharmacology. 2019;44(8):1398-1405.
4. Linge R, Jiménez-Sánchez L, Campa L, at al. Cannabidiol induces rapid-acting antidepressant-like effects and enhances cortical 5-HT/glutamate neurotransmission: role of 5-HT1A receptors. Neuropharmacology. 2016;103:16-26.
5. de Mello Schier AR, de Oliveira Ribeiro NP, Coutinho DS, et al. Antidepressant-like and anxiolytic-like effects of cannabidiol: a chemical compound of Cannabis sativa. CNS Neurol Disord Drug Targets. 2014;13(6):953-960.
6. Deutsch DG. A personal retrospective: elevating anandamide (AEA) by targeting fatty acid amide hydrolase (FAAH) and the fatty acid binding proteins (FABPs). Front Pharmacol. 2016;7:370.
7. Bakas T, Van Nieuwenhuijzen PS, Devenish SO, McGregor IS, Arnold JC, Chebib M. The direct actions of cannabidiol and 2-arachidonoyl glycerol at GABAA receptors. Pharmacol Res. 2017;119:358-370.
8. Manzanares J, Julian M, Carrascosa A. Role of the cannabinoid system in pain control and therapeutic implications for the management of acute and chronic pain episodes. Curr Neuropharmacol. 2006;4(3):239-257.