National CBD Month
National CBD Month:
An internet search for Cannabidiol (CBD) produces more than two BILLION results! In our opinion, it is a bit overwhelming. So, where can you get answers to your questions about CBD? At Maitri, of course!
You know, we hear a lot from patients at the dispensary that they tried CBD, and it didn't work. This may be because the CBD tried was from the hemp plant, not the marijuana plant. Hemp and marijuana are the same plant species but different cultivars.
The hemp plant contains less than 0.3% THC, which does not cause intoxication, and is not considered a controlled substance. The CBD dominant products found in the dispensary will have higher amounts of THC. However, this does not mean you will feel intoxicated. The 2018 Farm Bill legalized the production of high CBD hemp. The FDA regulates cannabis-derived products. Because CBD was first approved as a prescription drug, hemp CBD can't be sold as a nutritional supplement.
The marijuana plant contains over 100 cannabinoids (molecules interacting with specific cannabinoid receptors). THC is the most common plant-based cannabinoid, but CBD is gaining popularity, probably due to its non-intoxicating properties. Since CBD does not cause "euphoria," it is a great option for daytime use.
If you're not buying CBD products at the dispensary, make sure to review the label and company website for the certificate of analysis. This ensures that the CBD product is free of contaminants and contains the amount of CBD per serving. As the ratio of CBD: THC increases, you'll probably need to take more milligrams per dose to control your symptoms. Even a tiny amount of THC may improve the effectiveness of CBD.
Cannabis plants can absorb toxic pesticides and chemicals, which is why a regulated market that is lab-tested is so important for patients' safety.
The Endocannabinoid System
The endocannabinoid system in which the cannabinoids work is an internal cellular regulator that helps us stay in a state of homeostasis, balance, or well-being. When we are in a state of well-being, the ECS works pretty seamlessly. Still, when we are in a disease or inflammatory condition, the ECS works on-demand to get us back to balance. It has been proposed that many of the symptoms that MMJ helps may be caused by a "clinical endocannabinoid deficiency." Because we naturally produce cannabinoids called endocannabinoids, we can supplement with plant-based cannabinoids to restore our state of homeostasis.
The endocannabinoid system comprises three main components:
Endocannabinoids.
Their receptors (where cannabinoids bind).
Enzymes that break down cannabinoids.
How does CBD differ from THC?
CBD is non-intoxicating. It does not cause euphoria (high) like THC. CBD has shown to be alerting in low doses and sedating in high doses. CBD and THC work differently. CBD works mainly in the periphery, internal organs, and immune cells, while THC works primarily in the brain.
CBD has been shown to interact with 65 different pathways in the human body. CBD can reduce the psychoactive effects of THC, and it can also reduce seizures. CBD may increase our own cannabinoids by blocking an enzyme that breaks them down.
Supposing CBD could block enzyme degradation. It could, in theory, increase our natural endocannabinoids and help with pain, inflammation, anxiety, immune function, seizures, and stress. It may also help with nausea and neurodegeneration.
THC may benefit pain relief, nausea, vomiting, appetite stimulation, and muscle relaxation.
Some potential adverse effects include but are not limited to; CBD can cause nausea, diarrhea, and weight loss, while THC can cause anxiety, euphoria, and sedation.
CBD and THC are both metabolized in the liver by the CYP450 enzyme. Please consult your pharmacist for possible drug and food interactions as with any new medication.
How does CBD affect THC?
THC and CBD work differently in the brain. THC binds to CB1 receptors, but CBD can change the shape of CB1 receptors so that the THC can't bind tightly to it. CBD reduces the side effects of THC, like anxiety and heart palpitations, and balances out the euphoria. CBD acts as a remote control volume control to tune down the intoxication. A higher CBD to THC ratio means you'll feel minor intoxication.
Did you know taking CBD with THC can increase the effects of THC by slowing down the breakdown of THC by your liver? Patients have said that taking a CBD tincture an hour or so before THC helps extend the time the THC works to control their pain. This does not imply it extends the intoxication.
The ratios of CBD to THC will help determine whether the effect is additive to THC's action or helps reduce side effects. CBD enhances the effects of THC by complementing its potential therapeutic effects, and the two cannabinoids seem to work best in concert rather than in a single-person band.
Potential Benefits and Ratios
Both THC and CBD are potent antioxidants. Hemp CBD is "legally acceptable," while marijuana remains federally illegal. Therefore, there are limited studies on the exact interaction of MMJ in the body. Nevertheless, initial data and patient feedback suggest both cannabinoids have positive medical benefits.
Patients prefer a higher CBD: THC ratio during the day, when less euphoria is desirable, but prefer to switch to a lower CBD: THC ratio in the evening, at weekends, or on days of symptoms flare-ups. Micro-dosing (2-5 mg) of THC during the day can also reduce symptoms with minor intoxication.
CBD-rich strains will cause minor intoxication and may be beneficial for pain, nausea, appetite, muscle spasms, sleep, neuropathy, PTSD, and anxiety. CBD: THC ratios of 1:1 and 2:1 are typically well tolerated by patients and may be beneficial for inflammation, pain, nausea, digestive disorders, sleep, neuropathy, appetite, and other conditions.
CBD and Terpene Combinations – The Entourage Effect
CBD can be potent when combined with other cannabinoids and terpenes. Let's explore some possible CBD/terpene combinations:
CBD +THC may be suitable for treating pain and inflammation and decreasing anxiety
CBD + Myrcene- maybe good for spasms and pain
CBD + Linalool- this combination may be suitable for relieving anxiety and as an anti-convulsant
CBD + Caryophyllene- anti-ischemic, anti-inflammatory; anti-bacterial
Sleepiness may be a side effect of CBD in combination with Linalool, Myrcene, and terpinolene
CBD products are available in the dry leaf, vape cartridges, RSO, tinctures, capsules, and topicals. Check out the staff picks of the week.
Please call, send an e-mail, or schedule a phone appointment if you have any questions about incorporating CBD into your wellness regimen.
References:
Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol. 2011;163(7):1344–1364. doi:10.1111/j.1476-5381.2011.01238.
McPartland, John & Russo, Ethan. (2001). Cannabis and cannabis extracts: Greater than the sum of their parts? J Cannabis Therapeutics. 1. 103-132. 10.1300/J175v01n03_0
Russo EB (2016) Clinical endocannabinoid deficiency reconsidered: current research supports the theory in migraine, fibromyalgia, irritable bowel and other treatment-resistant syndromes, Cannabis and Cannabinoid Research 1:1, 154–165, DOI: 10.1089/can.2016.0009.https://www.ncbi.nlm.nih.gov/pubmed/28861491
Izzo AA, Borrelli F, Capasso R, Di M,V, Mechoulam R. Non-psychotropic plant cannabinoids: new therapeutic opportunities from an ancient herb. Trends Pharmacol Sci 2009 10;30 (1873-3735; 0165-6147; 10):515-27.
US Agricultural Improvement Act of 2018 (The Farm Bill)
https://www.congress.gov/115/plaws/publ334/PLAW-115publ334.pdf accessed 1-19-2022
The endocannabinoid system in guarding against fear, anxiety and stress https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871913/
Cannabidiol in Anxiety and Sleep: A Large Case Series
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326553/
Cannabidiol and (−)Δ9-tetrahydrocannabinol are neuroprotective antioxidants
https://www.pnas.org/content/95/14/8268
FDA Consumer Updates
*This information is designed for educational purposes only. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional. This information has not been evaluated by the FDA nor is it intended to diagnose, cure or prevent any disease or disorder of any kind.