Dr. French Explains CBD
BY DR. BAYNE FRENCH
I'm not ashamed to disclose that cannabis has alwaysconfused me. I don't mean that I use it and then getconfused. The terminology is just so puzzling. What iscannabis, anyway? Is it a plant, really, or just acolloquially used garbage can word? And hemp? Comeon. Through my day I would go, purposely oblivious,nodding at patients' anecdotes of use like I knew whatthey were talking about. Who has time to learn aboutplants, anyway? I have kids that need to be herded,ducks to butcher, endless government medical regulationto navigate.
Unfortunately, I am both incapable and unable toadvise you. However, there is no question in my mindthat something very powerful is going on herebiologically. There are common reported effects fromCBD use that I feel are very plausible, includingalleviated mood swings, maintained immunefunction, and reduced stress and tension. Joint healthand improved flexibility are also reported. The anecdoteshave reached a crescendo. And I recently heardsomething about a Farm Bill that did something legally,with some stuff, for a thing, with a deal. When notherding my children, I read everything about thesetopics my wife printed off for me.Then when Brian Frank thrust CBD(Cannabidiol): A Clinical Review byMark W. DelBello, M.D., into my handsand said, Learn it, quack, suddenly Ifound the time to begin my study.I am not an expert. How about welearn together? I am going to distill amassively complicated cellular signalingsystem into basic constructs (morefor me than you)and try to figure out what CBD and related compoundsare good for, all the while not riling any governmentagency. Set, hut, hut!
I sat in classrooms for so long rigor mortis set in, andnever did I learn about our endocannabinoid system(ECS). As Dr. DelBello explains, the ECS is a cellularcommunication system that is not unique to Homosapiens. It resides in virtually every cell type we possess,prominently in nerve tissue where it regulates appetite,mood, and pain. In peripheral tissues, the ECS acts onour immune system, purportedly to prevent dysfunctionaland dysregulated immune responses. To simplifythe ECS, it consists of two endocannabinoids (AEA and2-AG, which are produced in our bodies), two receptorson cells (CB-1 and CB-2, which AEA and 2-AG interactwith), and the protein enzymes that produce and degradeAEA and 2-AG. It's interesting to consider how andwhy we have developed this system. We as Homosapiens likely interacted with the cannabis plant for overtwo million years and adapted alongside it. Much ofwhat the ECS is capable of has not yet been elucidated.What we do know is that it interacts with ourendocannabinoids (cannabinoids produced within thebody) as well as phytocannabinoids (from plants) andexocannabinoids (any cannabinoid produced outside thebody, including synthetic ones).Let's turn to the plant itself. Cannabis is Latin for hemp.It appears that it is a general term for a plant of threedifferent species: Cannabis sativa, Cannabis indica,and Cannabis ruderalis. This, however, is a businessdesignation, which is why species is in quotes. Thescientific opinion is that Cannabis exhibits monotypia,meaning it consists of a single species named Cannabissativa L. and the different species are merely subtypes(the L stands for Linnaeus. Carolus Linnaeus is thefather of taxonomy and most likely was an enduranceathlete but records are sparse). Maybe the division ofthe plant is a bit semantical.
What does matter are the chemical differences betweenthe plants, namely drug-type (marijuana) plantsand fiber-type (hemp) plants. Just as how apple treesand wheat are bred to produce a certain yield, so too isCannabis selectively bred to produce a desired profile,and there are more than 700 different cultivars, or plantvarieties, of Cannabis.All subtypes of Cannabis possess a wide array ofcompounds, including both cannabinoids andhydrocarbon terpenes. Of the over 100 differentcannabinoids, the two of largest concentration inCannabis and the most widely studied are delta 9-tetrahydrocannabinol(THC for short) and cannabidiol (CBD).Fiber-type hemp plants possess high ratios of CBD toTHC (with ratios as high as 30:1) and, by legal definition,contain less than 0.3% THC. Drug-type plants obviouslycontain more THC, on average an amount that is about5% of their makeup, and sometimes as high as 20%.CBD and other cannabinoids are oils. They are lipids, andthus not soluble in water. As mentioned, there are verymany different cannabinoids.
There is also a completely different class of compoundsknown as terpenes, which are hydrocarbons. Theindividual constituents and their relative concentrationsare accurately quantifiable using gas chromatography.What is not known is what the heck they are all doing inour bodies!
A quick read-up on hemp informs us of its myriad textileuses and potentially medicinal uses as well. So why hasit been lumped in with drug-type Cannabis? Becausebanning is the easiest method of control: convenient,however not the most effective, as shown withProhibition. But no sociological or philosophicaldigression.
We have to outline hemp's outlaw status, its recentextrication from that status, and more. So what, exactly,is legal? I'm not sure I know, but hopefully we will bothlearn over the next few paragraphs.The Brookings Institution and the National Law Reviewrecently had excellent reviews of the Farm Bill whichexplained hemp's legal status. All Cannabis plant typeswere effectively made illegal in 1937 and made formallyillegal under the Controlled Substances Act in 1970.But change has been recently afoot; the 2014 Farm Billextended protection to hemp research. For the 2018Farm Bill, Senate Majority Leader Mitch McConnell,hailing from the fertile, hemp-happy soil of Kentucky,championed further reform legislation and PresidentTrump signed it on December 20, 2018. This latest billdefines hemp as any part of the Cannabis sativa L. plantthat contains less than 0.3% THC by weight, and offersthe states regulatory authority over its production withintheir borders. Hemp is now like any other agriculturalcommodity - heck, now it's a mainstream crop.This is great news for hemp farmers who may now haveprotection against evil forces like climate andpestilence. CBD, however, is far from legally unfettered.It's exempted from being a Schedule I drug if and only ifits production follows numerous regulations.
The take-home is that under the 2018 Farm Bill, CBDwill be much more available and legal. But knowing thelegitimacy of your source or the brand you buy from iscritical.The CBD industry is burgeoning. According to theresearch firm Brightfield Group, legalization of hempcould result in a CBD market of $22 billion by 2022, andthis group considers themselves highly conservativeanalysts. Brightfield states, CBD is the next healthcarephenomenon. They recognize that, in the currentenvironment, CBD's impressive growth has beenprimarily word-of-mouth given heavy FDA regulation.The United States Food and Drug Administration (FDA)has issued statements clarifying its role as a result of theFarm Bill changes. ANY cannabis product whose marketingmakes medical claims must be approved by the FDAbefore it can be sold.
If you know anything about the medicine approvalprocess you'll know that it's daunting. Expensive andtime-consuming are understatements, so manyproducts now exist with no associated explicit claims oftheir medicinal value. And in an appeal to lots of folkswith lots of problems, numerous formulations anddelivery mechanisms for CBD exist. Transdermal,transmucosal, inhaled, and oral methods, nasal routesvia oral disintegrating tabs (known as ODT), lollipops,sprays, gel caps, and lozenges exist. Self-emulsifyingdrug delivery systems (SEDDS) are researched and water-soluble versions and nanoscale-range powders haveenhanced bioavailability. The bioavailability of CBD hasbeen a problem. Only 6% of orally ingested CBDactually reaches the blood stream and sublingual (underthe tongue) and transmucosal methods from lozengesand sprays also offer relatively poor absorption. One ofthe few reliable intake methods for CBD appears to betaking it with a high-fat meal (we're going to nail thisone in future articles), which results in much-enhancedbioavailability, especially when the dose is dividedtwice daily, as pharmacokinetic studies cited in Del-Bello's text would suggest.Not unlike readily accepted indications for use, soliddosing guidelines for CBD products are also lackingand usually just empirical. Many patients galvanizethis sentiment, reporting a dizzying array of maladieshelped by their CBD du jour. Dr. DelBello, thankfully,is a voice of reason. In his excellent Clinical Reviewhe outlines the evidence behind these anecdotes andobjectifies what is known, what we think is occurring,what isn't known, and the research involving dozens ofhealth conditions.Dr. DelBello outlines a study that I have obtained andread comparing purified CBD vs. Cannabis extracts(mixture of compounds). There was a considerablyhigher number of patients reporting improvement usingthe extracts. Furthermore, the average dose of theextracts was more than four times lower than the purifiedCBD dose and had fewer adverse effects. Thesefindings certainly raise questions about potential synergybetween components. Synergy is a well-knownphenomenon describing the enhanced effect of combiningmore than one agent when compared to theeffect seen from the agents individually. In relation toCannabis, synergy was termed the entourage effectin a 1998 study. The internet is filthy with referencesto the entourage effect, but that study showed only anassociation of enhanced effect from one chemical withanother. In no way has extensive scientific investigationbeen done or true causality established for the effect.Full spectrum CBD is a common term of trade,signifying the product has undergone less processing,and that a mixture of compounds exist in it.Some insight into the potential and physiologicalpotency of CBD may be had by looking at two of thethree FDA-approved Cannabis medications.Epidiolex, approved just last year, is a purified form ofCBD oil and treats two rare and severe seizure disorders.Dronabinol (Marinol), with its two indications approvedin 1985 and 1992, is a synthetic cannabinoidwith THC qualities. It is approved to treat nausea andvomiting that occurs due to chemotherapy and, morerecently, for weight loss associated with AIDS. Nabiximols(Sativex) is not approved in the US but is usedin numerous other countries as an anti-inflammatorytreatment against muscle spasms that come with multiplesclerosis. Nabiximols is a 1:1 ratio of CBD and THC.To quote Dr. DelBello, Because CBD and cannabinoidsare a new field of therapeutics, even physicians feeluncomfortable and not knowledgeable about advisingpatients. I'm not that guy. With all the medications wedon't bat an eye at prescribing every day, sometimes incombination, I have no personal reservations about thesafety of a broad spectrum CBD compound. The risk/benefit ratio I view as being very favorable.So, as we conclude, what have we learned? Pleasedon't say, To never read another Dr. French article. Weall possess a well-developed internal system of cellularcommunication and signaling that utilizes synthesizedcannabinoids and we have definitive evidence of theirnumerous favorable effects on health.
It seems to me that encountering similar compoundsin nature or our food supply is not at all an unnaturaloccurrence. Many within my profession feel that supplementationis unnecessary, and warn patients that itonly results in expensive urine. Well, my urine representssuch a goodly sum that I almost hate to part withit. Given our brief insertion at this time in history, intothe glorious theatre of humanity, I find it highly probablethat many important nutrients are deficient and improbablethat they may be adequately replaced via food. Althoughas-needed CBD appears to help a wide arrayof ailments, I feel its regular supplementation is akin tothat of omega-3, trace minerals, vitamin D, etc.
In addition to an outstanding diet of human animalfood, the uniqueness of this compound may offer anotheradvantage in our quest for well-being and diseaseavoidance.There is much that is still unknown. What seems clearis that a reputable source of CBD is critical. It is safeand legally available. Twice daily dosing with a mealcontaining fat seems to offer the best absorption andbioavailability. Beyond that, fellow sapiens, as with allthings involving your health, it's up to you.View PDF