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CBD Answers to Your Questions

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We recently met with a new medical marijuana patient to answer some of her questions regarding CBD and CBD products.

Is CBD legal? 

With the enactment of the 2018 Farm Bill, zero-THC CBD oil and hemp oil is not illegal in any state of the United States.

However, though hemp-derived CBD is legal in all 50 states, ‘marijuana’-derived CBD is not legal federally. Federal law classifies “marijuana” as any plant in the cannabis family that contains greater than 0.3 percent THC.

When referring to CBD, we are referring to the low THC/High CBD products that do not induce any psychoactive (“high”) feeling.

In Medical Marijuana Dispensaries, we see a combination of CBD and THC products. You must be a medical patient to purchase these items. These often run from 40/1 CBD/THC to 1/1 CBD/THC ratios, and also require that you be a medical patient to purchase.

Why so many different brands and price ranges?

Welcome to the wild wild west! The “Green Rush” is a world-wide hustle to get into the CBD/Cannabis business as quickly as possible. This fast pace has caused the industry to be saturated with thousands of businesses trying to get a piece of the pie.

With licensing costing up to hundreds of millions for cannabis licenses, some entrepreneurs opt for the CBD route. As some states do not require much in the way of licensing or testing of products, this is a much less costly involvement.

An interesting angle to the CBD industry—and one of our favorites to be wary of—are the CBD MLM (Multi-Level Marketing) schemes. Under this model, you purchase CBD, then become a “distributor” or “partner” and sell to your friends and family, making a commission off everything they sell. Think back to Amway of the 1960’s—this is a great example of this same model.  I know a few families that got into Amway back then and are millionaires, but I know many more that still have a basement full of products. Be careful when presented with an “opportunity” that sounds too good to be true.

How do I choose a quality product?

We suggest, when selecting a brand and product within a brand, to always require access to batch specific seed-to-sale testing. This means your bottle has a batch number, and you can read (online or on paper) the testing that was performed at each stage of the plant’s development. Here, you can find information on the percentage of CBD, the percentage of THC, contaminants, and pesticides.

This reminds me of my recent visit to the Wine Country of Northern California. The first visit to a local winery landed me at a wine and cheese pairing that was amazing. Who knew there was so much to tasting wine? I found that—without the stigma of types of wines, colors of wines, or my preconceived notions—I let my taste buds determine which wine I enjoyed.  

The same holds true with CBD. Good quality CBD shouldn’t have any chemical taste or aftertaste. It shouldn’t knock you out or give you any side effects. If you are taking some product you bought in a smoke shop or gas station and are having side effects, stop taking it. Research the company and the products before you choose to continue taking it.

I regularly receive bottles of CBD from friends and acquaintances who have purchased from a gas station, online, or from a “friend of a friend.” One bottle recently claimed to be an all-natural formula from the only organic farm in Florida. This sounded great—except that there are no licensed hemp farms in Florida. The company turned out to be a redistribution center that rebottled products purchased. The company was able to date it by the name on the bottle. They hadn’t used that label for 3 years. It was sold to her by a local chiropractor.

Another bottle was from a company claiming to be in Boulder, Colorado. Once again upon closer inspection, there was no company registered in Boulder by that name. In fact, there was no company registered in the entire state of Colorado by that name. Further research showed that the company that sold this bottle is an overseas company. Nothing is tested, and there were no results to measure their worth. A false business name and address is a big hint. Stories like this emphasize why it is so important that we, as patients, do our research before determining the safety or efficacy of any product. 

CBD

CBD + Plant Medicine

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Herbal medicines are defined as “the art or practice of using herbs and herbal preparations to maintain health and to prevent, alleviate, or cure disease.” By this definition, cannabinoids derived from hemp and cannabis plants would be classified as herbal plant medicines. Cannabinoids and other compounds found within the cannabis plant have been proven to work better when used together, but what other plant medicines contain natural benefits that work synergistically with CBD? While the research has a long way to go on synergistic efficacy of plant medicine combinations, herbalists and naturopaths have long recommended specific herbs and plants for certain symptoms.  

What does the research say about CBD along with other natural plant medicines?

As of this writing, there is not much research on CBD’s role in complementary and alternative medicine (CAM), nor on its synergistic effects when combined with other herbal remedies. While there is no specific research on which herbs are most beneficial when combined with CBD, there has been research done on specific herbs’ benefits as well as research on the benefits of using CBD that we can use to make educated guesses as to which herbs would provide synergistic effects. Additionally, traditional herbalism practitioners and naturopaths who have been trained in herbal remedies and natural medicines can recommend specific combinations based on the symptoms being treated.  


5 Herbs Recommended for Use with CBD

While scientific studies may have some ground to cover when it comes to herbal CBD combinations, naturopaths, herbalists, and CBD brands are already combining herbs in products like tinctures and topicals. ”Pairing herbs or natural plant medicine with cannabinoids just makes sense,” explains Jordan Person, fellow GRAM writer, herbalist and CBD manufacturer. “Often the plant medicine that you are working with provides a synergistic affect or often even the same effect that a cannabinoid can.” These points are reiterated by naturopaths like Dr. Pepper Hernandez ND, CNHP. These herbal recipes and recommendations are based on existing research on the benefits of CBD as well as traditional plant medicines that would work well with CBD, including common herbs like lavender, rosemary, echinacea, holy basil, and ginger.  

Lavender

Lavender’s main terpene is linalool, a terpene that is also present in hemp and cannabis, and known to be effective at helping with anxiety. “Anxiety is higher than ever and lavender is rich in the terpene linalool,” explains Person. “This terpene has been scientifically proven to reduce anxiety. CBD has also shown to lessen these stress-filled symptoms. Combining this cannabinoid with this herb may provide a beneficial effect for anxiety.” Studies back up these claims, suggesting that tinctures and infusions that combine lavender with CBD may help mitigate anxiety. 

Rosemary

According to Hernandez, rosemary may pair well with cannabinoids as hemp, cannabis, and rosemary plants all contain beta-caryophyllene, a terpene known for its analgesic effects and ability to help reduce inflammation. Rosemary is known to offer similar benefits as well as possessing anti-cancer properties similar to those of CBD. As both rosemary and CBD offer similar benefits, it would be logical to infer their synergistic interaction with one another.  

Echinacea  

Both Hernandez and Person recommended echinacea in combination with CBD. Echinacea, or purple coneflower, contains “certain endocannabinoid-like fatty acid N-alkylamides” that can “potently activate CB2 cannabinoid receptors.” Additionally, evidence suggests that plants with high concentrations of these alkylamides and fatty acid amides could have synergistic interactions with cannabinoids like CBD. 

Ginger

Studies have shown that both CBD and non-psychoactive cannabinoids may be effective in the treatment of nausea. Herbs known to help with nausea work great in conjunction with cannabinoid regimens. “Ginger, for example, is great for relieving nausea the same way that THC and CBD can,” explains Person, and research backs up these claims, further indicating that ginger and CBD would be an effective synergistic combination for treating nausea.

Holy Basil

As with rosemary, holy basil or Tulsi, possesses many anti cancer properties like THC and CBD. Additionally, both CBD and tulsi possess anti-inflammatory, neuroprotective, and antioxidant properties that parallel known benefits of cannabinoids, suggesting a highly synergistic relationship between the two plant medicines. 

While the research on specific combinations may still be in its early stages, traditional medicines and herbal teachings suggest that what we know about certain herbs like ginger, holy basil, and lavender, may work well in combination with cannabinoids like CBD, as we learn more about the effects of these cannabinoids. For now, looking for herbs whose benefits parallel those of cannabinoids like CBD will be your best bet at finding synergistic combinations that work for your needs.  

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CBD + Parkinson’s Disease

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Parkinson’s is a neurodegenerative disease that affects 10 million people worldwide, and cannabinoids such as CBD are being studied for their neuroprotective properties as well as their efficacy with symptom management.1-9 Parkinson’s can have a noticeable impact on quality of life due to symptoms such as tremors, spasticity, and pain that can make everything from walking to talking difficult, which can lead to anxiety—all symptoms that CBD has shown to be helpful in managing.10 Early studies are showing CBD can specifically be effective for managing life with Parkinson’s.1-8

While CBD’s legality on a national level is still relatively new, there are quite a few studies already on CBD’s ability to manage the symptoms of Parkinson’s, helping to improve quality of life for those living with the condition. As discussed at length in previous issues of GRAM, CBD has proved to be helpful in managing muscle spasticity often experienced by patients. Additionally, CBD has been shown to mitigate pain and the inflammation that causes it, also be a source of damage to nerve networks within the body in patients with neurodegenerative diseases. Additionally, CBD has been found to be helpful with anxiety that can arise from a variety of situations, including those where symptoms may become noticeable.  

In addition to general research supporting CBD’s efficacy in symptom management for conditions such as Parkinson’s, researchers are specifically studying CBD’s ability to help Parkinson’s patients with sleep-related issues and psychosis.1-3 In a pilot study, researchers studied a small sample of men and women with Parkinson’s who had psychosis for at least three months. Participants were given 150 mg of CBD every day for four weeks and showed a “significant decrease” in psychosis during treatment without worsening motor function or other adverse effects.1 Another study examined four Parkinson’s patients experiencing REM sleep behavior disorder (RBD) who were treated with CBD and found the treatment had “prompt and substantial reduction in the frequency of RBD‐related events without side effects” and indicated “CBD is able to control the symptoms of RBD” in those with Parkinson’s.2 Furthermore, a larger sample of 21 patients examined the effects of various daily dosages compared with a placebo and found CBD could improve quality of life in Parkinson’s patients, but the authors reiterated that larger samples in future studies are needed to corroborate these early findings.3

A literature review of current research on CBD and neurodegenerative disorders suggests CBD’s neuroprotective and anti-inflammatory properties could prove promising for treatment of neurodegenerative disorders across the board, including Parkinson’s.5 This review found that “at preclinical level, accumulated findings appear more exhaustive and convincing for a possible medical utilization of CBD to improve symptoms and/or delay disease progression” as well as helping to prevent damage to nerve cells.5 These neuroprotective properties are mainly associated with CBD’s anti-inflammatory and antioxidant properties, and early investigations have found that CBD might have a neurorestorative component as well.4 CBD’s ability to target the CB2 receptors without activating CB1 receptors, in addition to its other properties, has suggested that CBD could prove to be helpful in the treatment of Parkinson’s.7  

Early studies are showing CBD can specifically be effective for managing life with Parkinson’s.

Specific to Parkinson’s, CBD has also been shown to be effective with dystonic movement disorders and the motor and cognitive impairments often brought on by the disease.6,8,11 In a small pilot study of five patients with dystonic movement disorders, patients were administered “oral doses of CBD rising from 100 to 600 mg/day over a 6 week period” and found “dose-related improvement in dystonia was observed in all patients.” The authors conclude that “CBD appears to have anti-dystonic and Parkinsonism-aggravating effects in humans.”6 Animal studies designed to model the effects of Parkinson’s disease resulted in findings that suggest CBD is effective in treating motor and cognitive impairments in Parkinson’s patients.8  

To date, most of the research available has been done in preclinical settings with small sample sizes. These findings need to be corroborated by much larger clinical studies for accurate generalization, but these early results suggest CBD could be effective in the treatment of Parkinson’s disease and the management of its symptoms. If you’re considering CBD as an alternative or complementary treatment for Parkinson’s for you or someone you know, talk with a physician who is familiar with the patient’s case and treatment program to see if CBD may be an option that could help improve quality of life.


REFERENCES:

1. Zuardi, A.W., et al. Journal of Psychopharmacology 23, no. 8. 2009.doi:10.1177/0269881108096519.

2. Chagas, M.H.N., et al. Journal of Clinical Pharmacy and Therapeutics, 39. 2014. doi: 10.1111/jcpt.12179

3. Chagas, M.H.N., et al. Journal of Psychopharmacology, 28, no. 11. 2014. doi: 10.1177/0269881114550355

4. Santos, N.A.G., et al. Toxicology in Vitro, 30(1B). 2015. doi: 10.1016/j.tiv.2015.11.004

5. Iuvone, T., et al. CNS Neuroscience & Therapeutics, 15: 65-75. 2009. doi: 10.1111/j/1755-5949.2008.00065.x

6. Consroe P., et al. International Journal of Neuroscience, 30:4. 1986. doi: 10.3109/00207458608985678

7. Fernández‐Ruiz, J., et al. British Journal of Clinical Pharmacology, 75: 323-333. 2013. doi: 10.1111/j.1365-2125.2012.04341.x

8. Peres Fernanda F., et al. Frontiers in Pharmacology, 28 September 2016. doi: 10.3389/fphar.2016.00343

9. Devore, C. Fatal Employment: Men 10 Times More Likely Than Women To Be Killed At Work. Forbes. www.forbes.com

10. “Symptoms of Parkinson’s.” American Parkinson Disease Association. www. apdaparkinson.org

11. Lastres-Becker, I., et al. (Abstract) Neurobiology of disease, 19(1-2), 96–107. 2005.

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CBD + MS

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Multiple Sclerosis (MS) is a disease that affects more than 2.5 million people worldwide.1 Typically treated with prescriptions for symptoms, many living with MS seek alternative treatments. As CBD has become more accessible, many MS patients are looking to this non-psychotropic cannabinoid as an option for easing the impact of symptoms like fatigue, spasticity, and emotional anxiety and depression that stems from living with the disease. Studies have started to show CBD is effective in aiding in the treatment of the symptoms of MS, helping to improve the quality of life.2,3,4

CBD + MS: Studies show promise for cannabinoid treatments

Studies are showing that CBD has a variety of applications and can be helpful with symptom management, helping with fatigue, pain, spasticity, and mobility, making it a potential alternative to pharmaceutical symptom management. One of the most common and most distressing symptoms to MS patients is spasticity, or involuntary, uncontrollable movements of the body. Cannabis products containing significant amounts of CBD have been shown to be effective at reducing muscle spasticity in addition to pain and other symptoms.9,10,11,12

In small preliminary trials, CBD has actually been tested on MS patients and has been found to improve neurogenic symptoms that are typically unresponsive to standard treatments.10 Additionally, CBD has been found to be an effective anti-inflammatory,11 which could prove helpful not only with painful symptoms of MS, but also in the treatment of inflammation in the CNS before damage is done.  

Another common symptom of MS is a change in emotional and mental state, often as a result of stress and social anxiety about the condition that can even lead to bouts of depression. In fact, CBD has been found to prevent “long-lasting anxiogenic effects.”13 Preliminary reports on an anxiolytic effects of CBD for social anxiety disorders report “CBD was associated with significantly decreased subjective anxiety.”14 Trials involving CBD administration to mice found CBD to be a quick-acting antidepressant, helping to combat depressive actions.15,16

As more studies are done on the efficacy of CBD in MS treatment, the more comfortable physicians will be offering advice and insight to patients. Currently, the preliminary body of evidence suggests CBD could be an effective treatment option for symptom management of MS. If you have access to CBD and are considering adding a CBD supplement to your treatment regimen, talk with your doctor or consult a health professional who is familiar with your condition. He or she may recommend specific products and offer advice on titrating a dose to fit your needs.


REFERENCES:

1. Lisak, Robert P. et al.“Multiple Sclerosis.” National Organization for Rare Disorders. 2017. https://rarediseases.org/rare-diseases/multiple-sclerosis/
2. “Medications.” National Multiple Sclerosis Society.
www.nationalmssociety.org
3. Malfitano, A. M., Proto, M. C., & Bifulco, M. Neuropsychiatric disease and treatment, 4(5), 847–853.2008.
4. Rudroff, T., & Sosnoff, J. Frontiers in neurology, 9, 183. 2018.
5. “What is MS?” National Multiple Sclerosis Society.
www.nationalmssociety.org
6. “Definition of MS.” National Multiple Sclerosis Society.
www.nationalmssociety.org
7. “Types of MS.” National Multiple Sclerosis Society.
www.nationalmssociety.org
8. “MS Symptoms.”National Multiple Sclerosis Society.
www.nationalmssociety.org
9. “Cannabinoid Spray Effectively Relieves MS-Related Spasticity.” MD Edge. November 2015.
10. Wade D.T., Et. al.  Clinical Rehabilitation 2003; 17: 18– 26. 
11. Malfait M, Gallily R, Sumariwalla P, et al.  Proceedings of the National Academy of Sciences of the United States of America 2000; 97: 9561– 6
12. Malfitano, A. M., Proto, M. C., & Bifulco, M. Neuropsychiatric disease and treatment, 4(5), 847–853. 2008.
13. Campos, A.C. Et al. Journal of Psychiatric Research. Volume 46, Issue 11.2012,
14. Crippa, J. A. S. Et al. Journal of Psychopharmacology, 25(1), 121–130.2011. doi: 10.1177/0269881110379283
15. “Treating Depression with CBD Oil.”CBD Psychiatrist. February 13, 2019.
16. Linge, R., Jimenez-Sanchez, L., Campa, L. et al. Creative Commons. 2016.

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