Wading Through the Weeds: What's up with CBD?

I’m always careful in discussing hyper-trendy topics, as the masses come forward with anecdotes and stories, ready to fight. Sometimes I’m not even given the chance to say, “Look! I think it may be a good thing! For x, y, and z. But probably not for your [insert very specific complaint.]” For anyone who reads this and wants to praise CBD as the almighty healer, I urge you to wonder why you may be triggered by objective information of what we know about it so far. I want CBD and other natural plant based products to be effective— how exciting for a direct product from the earth to provide so much healing; but I need to see the evidence to know if it’s both safe and worth our hard earned money. I’d also like to preface this post by recognizing that placebo can be one of the most incredible therapies; but when that placebo is unregulated, and may interact with other medications, there may be more harm than good. I request that anyone who is interested in taking a product systemically, to discuss with their physician first. Furthermore, when a substance is included in such a small quantity, or actually has no possibility of providing a certain claim, yet the powerful affects of marketing have reeled you in, you deserve to know better. Let’s discuss.

Cannabidiol (CBD) is just one of hundreds of cannabinoids, a group of compounds that act on receptors in the Endocannabinoid system throughout cells in our central and peripheral nervous system. This system is an integral part in controlling several neurologic processes including appetite regulation, mood, anxiety, pain sensation, sleep, amongst others. CBD is a phytocannabinoid (meaning it is derived from a plant, specifically cannabis) and although it comes from the same plant as THC (the substance that causes a “high”) CBD extract does not have psychoactive properties. In short, CBD can act on receptors in cells of our nervous system and may affect them in some way.

Wow. Look at all those studies reviewed! Great work,  Whiting et al.

Wow. Look at all those studies reviewed! Great work, Whiting et al.

Based on review of the literature, I feel comfortable in saying that CBD as a prescription dose (and/or other derivatives of cannabis) may be helpful in the following conditions:

—chronic neuropathic or cancer pain

— spasticity in multiple sclerosis

—chemotherapy-induced nausea & vomiting (lower quality of evidence)

^^^ This comes directly from an excellent systematic review [ Whiting et al.,] in JAMA, a well-respected medical journal, that analyzed 79 randomized controlled trials on the effects of cannabinoid derivatives on variable conditions. Rigorous review of the literature revealed that there was either very little evidence, or results suggesting likely no effect, on conditions such as sleep disorders, depression, psychosis, and others. In addition, it should be recognized that utilizing cannabinoids did increase the risk for some short term side effects such as fatigue, confusion, hallucinations, diarrhea, etc.

My take away, is that based on the current most up to date research, I feel comfortable in suggesting regulated, dose-consistent cannabinoid therapy for cancer-related pain and nausea, and spasticity to my patients. As the research expands as I expect it to, my scope of recommendations may change too. I have an open mind to the possibilities of cannabinoids, and quite frankly I’m excited to see the potential benefits we may unveil. But as of right now, I’m skeptical of its cure-all properties that the capitalistic market and trendy bloggers will make you believe. It’s not curing cancer. It’s not reversing diabetes. It’s not likely doing a lot of things. And it probably has no damn clue how it ended up in your skincare line.

but WHY?

but WHY?

I love living in a (mostly) free market where business owners and consumers can directly interact and make decisions of what will sell and what people find worthy of buying. At the same time, I am DISGUSTED when companies will make false claims about a product that could potentially hurt individuals. While I do believe that the consumer needs to hold a level of responsibility for their purchases, the supplement industry is so egregiously unregulated that there is the potential for harm. This happens in a few ways: 1) a substance directly interacting with another substance an individual takes 2) turning down another more effective treatment due to belief via marketing that a certain product will heal (when it may not) or 3) the financial loss from essentially a placebo treatment. It is not beyond me that pharmaceuticals (which are indeed heavily regulated) are also fraught with problems related to direct advertisement, physician influence, and side effects. The difference is, the full disclaimer is there. It’s been heavily studied. We have all the minute details about quantity, interactions, efficacy, etc at our disposal to be used responsibly. I love limiting pharmaceutical prescriptions as much as the next hippie-doctor, but what I’m not about, is replacing it with an unregulated, under-studied, trendy substance simply because there’s a buzz about it.

You can currently find CBD in the most absurd of products: lattes, lotions, makeup, chocolate covered almonds (k that actually sounds good), gummy bears, hair gel, cat treats (lolz), water (!!!!?!?!), etc. My friends, take a deep breath, and THINK about this. Who is profiting from this explosion of trendiness? If you’re being honest with yourself, you’ll know it’s probably not you.

As a side note, I’m not sure if it’s yet professionally appropriate to share my views on the legalization of marijuana at a national level. Unfortunately, this topic is still taboo and my position as a physician is always my highest priority. But let me just say, I’ve witnessed first hand (in likely thousands of patients at this point) the devastating effects of alcohol & tobacco (both legal substances) on both short and long term health/mortality. I have not witnessed the same for marijuana, and I don’t think that has anything to do with it being illegal.

Now excuse me while I secretly go buy that Kush mascara (after I shared that on instagram about 20 of you sent me messages about how great it is.. don’t think it’s because of the microscopic amount of CBD added, but I love a good lash look as much as the next girl :-)

Love Always,

Shanny DO