CBD Crash Course: The Basics

Cannabidiol (CBD) is popping up all over, from every corner store to mattresses to infused burgers.  Sales Reps are everywhere, seemingly hinting that their CBD product has the power to grant immortality and perfect health.   As patients, we need to be able to cut through the hype and figure out what this means for us.  It’s great that my healthy friend felt fabulous after her workout by taking a couple drops of CBD, but she doesn’t have health issues.  I have rheumatoid arthritis, lupus, Sjogren’s, Ehlers-Danlos Syndrome, and I’m pretty darn skeptical.  Here is a great podcast by The International Foundation for Autoimmune and Autoinflammatory Arthritis on CBD and the hype! I’ve been told that everything from tart cherry juice to tantric yoga will cure my incurable illnesses.  So, what is the skinny on CBD?

The Endocannabinoid System

CBD is a molecule found in the cannabis plant that interacts with our endocannabinoid system.  Preclinical evidence is showing that the eCS has a strong role in the regulation of our immune function including t-cell modulation.  If you have any form of autoimmune arthritis, then you’ve heard about t-cells since most of the biologics available impact them.  This is what a 2009 study had to say about the role of the endocannabinoid in t-cell moderation, “T cells: Cannabinoids can influence T cell immunity in various manners: they can affect T cell number and proliferation, but may also have important effects on T helper 1- and 2-specific cytokines and TGF-b secretion.”  This study wasn’t specific to CBD, as nearly all the cannabinoids have shown some anti-inflammatory properties.  There are dozens more just like this one showing that the use of cannabinoids may be an important tool in our toolbox when it comes to therapeutic options.  For more information, check out Canna-Patient Resource Connection’s Patient Place section on autoimmune diseases and cannabis

What Does it all Mean?

A new industry means new words.  It also means that there is no accepted standard of what each term defines, so to be sure you understand what the label is saying – always ask the manufacturer how they define each term.   For this section, we are sticking to terminology specific to hemp CBD and CBD products. 
·        Isolate – usually refers to a product that has 99.9% or greater CBD and nothing else in the product.  Isolates don’t have other cannabinoids or terpenes, but they can be combined with other things like essential oils.  Even an isolate can contain trace tetrahydrocannabinol (THC) that doesn’t show up on labs, so be mindful.  Even CBD isolate requires a minor (under 18) patient to be registered on the state registry.  
·        Broad spectrum – more and more people are using the term “broad-spectrum” to describe a product that is a full hemp extract, but specifically has as much THC taken out as possible.  This means there could be other naturally occurring cannabinoids like cannabigerol (CBG) and the product should have a full profile of terpenes.  
·        Full spectrum – When a hemp CBD product claims to be a “full-spectrum” product, this means that the product contains all the cannabinoids (including the allowed THC amount of up to 0.3%) and all the terpenes/flavonoids also extracted from the hemp plant.  

What is more effective?
In the cannabis/hemp product world, the term “The Entourage Effect” tends to get thrown around.  What does this mean exactly?  Basically, this theory says that CBD works better when it has all its friends around.  It also means that effects can vary depending on what friends CBD is choosing to hang out with.  You know how Mom is always claiming who you hang out with matters?  When you are hanging out with your friends in the club, you may act very differently than if you were hanging at your Mom’s quilting bee with her friends.   Same thing here.  Hands down, the preclinical data suggests that using The Entourage Effect has the most efficacy in any disease category.  From this study on the anti-inflammatory effects to this one on breast cancer, all the current research points to patients getting the best results when they have access to everything the cannabis plant has to offer.  Even when using a CBD dominant regimen, the outcomes tend to be better when the product has a little of everything.  If you can’t have THC, then a broad-spectrum product would be the next best option, as isolates often require higher doses and are less effective. 

How should I decide which to use?

When choosing between isolate, broad-spectrum, and full-spectrum, there are 3 questions you need to honestly answer.  First, do you have legal access?  Second, do I need to pass a drug test?  Lastly, are the benefits worth the risks?  For trying to match product type (inhaled, ingested, topical, etc.), check out this article about how to apply the different products to help your symptoms
·        Do you have legal access?  The 2018 Farm Bill did legalize hemp, but it placed CBD under the FD&C Act and FDA regulation.  The Farm Bill also requires states to opt in by submitting state plans for hemp production and allows states to keep CBD illegal.  Laws are changing so fast we can’t keep up.  If you have legal access, then choose your most robust option if you have no concerns about drug testing.  If your area has gray area or ambiguous laws, it may be more prudent to purchase options with as little THC as possible (though those are even illegal in many areas). 
·        Do I need to pass a drug test?  Ultimately, all CBD products carry a risk of trace THC and failed drug tests.  ALL OF THEM.  Yes, I know we will get comments about how X product is THC-free because of some amazing technology they have but understand that their testing labs only measure to 2 or 3 decimal points for a reason.  That doesn’t make a product THC free, it just means that the lab wasn’t measuring far enough for it.  If your job, medical care, housing, or any other important aspect of your life requires you to pass a drug test, then CBD products may not be the best option. 
·        Is the benefit worth the risk?  There are a lot of people who get caught up in unsuspecting scenarios.  You can find that CBD interacts with meds that are working and you don’t want to change that, or your pain management doctor won’t see you if you use CBD, legal or not.  Some areas still arrest for CBD and CBD isolate, and you may find that risk isn’t worth the potential benefit.  On the other hand, you could be at the end of the medication list and desperately need something to function.  Make sure you always weigh in any risks and bounce them off the potential benefits before deciding if a CBD product is right for you.  

Questions to Ask the Manufacturer

Finding a product can be extremely overwhelming.  Every salesperson claims their products are the best, and it is hard to know what we should be looking for in a product.  Here are some tips for finding a reputable product.  You can always be polite and listen to the sales pitch, but before you purchase anything – be sure you contact the manufacturer directly.  Always ask these questions, and any other questions you find you have.  Don’t purchase a product until they have satisfied your requests for information.  Then take their answers and verify they are true.  Companies tend to use phrases and symbols that are misleading.  If you find a company lies to you, don’t give them your business even if the product passes inspection.  
1.      Does the company test every batch and supply those results to the consumer?  Ask for test results from every manufacturer that include potency of all cannabinoids (CBD, CBDa, THC, THCa, CBG, CBGa, CBN) and terpenes.  Also look for heavy metals testing, toxin testing, solvent residue, and other contaminants like mold and fungus.  
2.      Where is the hemp or CBD coming from?  Try for a manufacturer that uses clean farming practices as locally as possible.  Look for organically grown hemp.  
3.      What part of the plant was processed?   CBD is not found in hemp seeds, and very little is on the stalks.  The stalks of hemp can also suck in toxins present in the land, even on organically grown land.  Avoid products sourced from seed and stalks if possible.  Look for products made with leaves and flowers, since most cannabinoids are found in resin glands there.  
4.      How was the hemp CBD extracted?  Just say no to harsh solvents like hexane and butane.  The liver doesn’t like those so much and solvents can interact with medications like methotrexate. 
5.      Make sure you can easily tell how many milligrams you are taking.  Look for products that have labeled droppers and give a specific milligram amount per milliliter.   “A couple drops” or “a dropper full” is not a metered dose, and it is hard to translate that from product to product.  You also need to know what dose is helping and if a dose is potentially too much. 
6.      Don’t pay more than $0.12USD (12 cents) per milligram of CBD.  There are hundreds of CBD companies out there.  Many now have batch test results and are more affordable.  Don’t overpay because you feel that will buy a better product.  That isn’t always true.  

This new world of “CBD Everything” is overwhelming and difficult to navigate in.  Unfortunately, it is our responsibility to drive the markets towards a more ethical and quality service.  These companies feel it is the consumer’s responsibility to keep up with the details like legalities and interactions, yet rarely provide easy-to-find and accurate information on the topic.  Being an educated consumer can help you avoid scams and products that are potentially dangerous.  Hopefully this information is a first step in that education process.  This information is not medical or legal advice and serves educational purposes only.  If you have medical or legal questions, be sure to consult with your medical and legal teams. 

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