CBD: Interest, Evangelism, or exuberance?
In a recent article by Erik Goldman, editor for Holistic Primary Care News for Health & Healing, Erik cuts through confusion about the therapeutic value of hemp oil, cannabidiol (CBD) because many people are trying to pay attention but left scratching their heads.
He notes the explosive growth of CBD products which is historically unparalleled in the history of holistic medicine.
Complex plant, complex effects, complex history, complex legal environment
Part of the obstacle impeding a better understanding of Cannabis sativa is that it is 'a biochemically complex plant with an equally complex medical social and political history. The species name covers both the THC producing "cannabis" (aka Marijuana) strains and the low-THC hemp forms. Both produce hundreds, if not thousands of potentially bioactive compounds, though the new focus, and the research- have been primarily on THC and CBD.'
From criminal to clear federal legal status
The more astute will point out that further research is necessary to prove a fraction of the claims that are currently being made, however, both camps should agree that preliminary research has been promising if not tantalizing. The lag between interest, research, and evidence-based recommendations is due in part to the above mentioned political history. Hemp was virtually criminal (DEA Schedule I substance- which means it was declared a drug of abuse with no therapeutic value- until the farm bill passed earlier this year in 2019.
World Health Organization
A 2017 UN report stated, "For most indications, there is only pre-clinical evidence, while for some there is a combination of pre-clinical and limited clinical evidence. The range of conditions for which CBD has been assessed is diverse, consistent with its neuroprotective, antiepileptic, hypoxia-ischemia, anxiolytic, antipsychotic, analgesic, anti-inflammatory, anti-asthmatic, and antitumor properties."
Where is the research?
To be sure a flood of research will work its way through the pipeline thanks to the Farm Bill along with a growing interest in natural health and wellness products.
Who are the actors and what are the conflicts?
Erik Goldman brings to narration just how fascinating the story of CBD gets when he talks about this unprecedented situation,
On the regulatory side, cannabis and hemp are subject to a crazy quilt of federal and state regulations—all of which are in flux and subject to variable enforcement. None of this is dampening investor enthusiasm..."There are a lot of unknowns, plus a lot of marketing hype, plus a lot of placebo effect, plus a greatly bubbled investor market putting billions into it. Coca-Cola, Big Pharma, Big Tobacco are all buying in. That’s a convergence we in the nutrition industry are experiencing for the first time,” Almada told Holistic Primary Care. “There’s an enormous gap between what is promised and what is real.”Beneath the scientific, regulatory, and economic complexities are a host of emotionally charged though seldom stated issues: personal health empowerment versus corporate protectionism; free market-ism versus regulation; science versus commerce; states’ rights versus federal mandates; personal freedom versus public good.Like I said, if you’re struggling to figure out what these products are, what they really do, whether they’re legal, and what to tell your patients, you are not alone. Everyone’s trying to get a handle on cannabis, hemp, and CBD."
Growth by Evangelism or Evidence?
Observers say that CBD demand will continue to be fueled more by curiosity and evangelism vs evidence, though evidence (for, against, or neutral is sure to come). The only CBD product to carry FDA level scrutiny with FDA approval based on FDA approved evidence to back claims is Epidolex which is approved to treat two rare conditions known to cause epileptic-like seizures and it has been approved for children older than 2 years of age. That doesn't mean there isn't clinical evidence, it just hasn't met FDA approval and much of it may not yet meet peer-reviewed journal standards.
Mr. Goldman's article draws light on the fact that many retail CBD brands draw connections to research from Europe, but the differences in the products used in those studies are significant. The European studies did use highly purified forms of CBD similar to 99% CBD and the doses of Epidiolex used on average 400mg to 1.3 g per day. However, he concludes that "lower-dose non-Rx hemp oils in the range of 10mg to 15mg per day are not to be written off as having zero health benefits.
"Absence of evidence does not prove evidence of absence." Though, Erik makes a point that we as an industry must balance our efficacy claims as we await further good human data- we join in this call.
The Entourage Effect?
So could millions of people who take hemp oil products with relatively low CBD levels (10-15mg per day) be wrong about the benefits they are feeling for everything from back pain to IBS to anxiety and sleep disorders?
Or is there more to the oft-discussed entourage effect which is a name given to the synergistic effects of the diverse spectrum of 113 known cannabinoids, terpenes-including myrcene, limonene, linalool,β-caryophylline, and α-pinene- and other phytonutrients produced by Cannabis sativa. Full-spectrum CBD oils are biochemically complex natural health products similar to green tea that has many beneficial health properties vs caffeine alone.
Behind many of these are big questions marks and bigger interest. Terpenes, for example, may have psychoactive effects as they bind to receptors throughout the body and/or subtle effects similar to the way essential oils can affect physiology.
“In the future, we’re going to have a much better idea of how the endocannabinoid system works, how we can influence it, how we can push certain buttons, how we can support it naturally without just relying on a single ingredient, CBD,” said Dr. Murray.
“Five years from now, we will be having very different conversations,” Almada said.