When and How to Use CBD
Cannabidiol (CBD) dosing recommendations are evolving. The FDA has not given any guidelines for this nutritional substance. It is not recognized as a medicine just yet. I will give you some of the guidelines that I use to help a patient navigate the use of CBD oil specific to the condition. For healthy people, the experimentation of CBD is relatively safe. For ill patients or those who are on other medications, I recommend an integrative physician to steer them in the correct path to wellness. CBD is a naturally occurring element in the flower portion of hemp. Hemp plants are part of the cannabis family, but they differ from regular marijuana plants in that they produce only trace amounts of tetrahydrocannabinol (THC). In the U.S., the 2018 Farm Bill classified hemp as a cannabis plant that only contains up to 0.3% THC. THC is responsible for the buzz and high associated with marijuana cannabis plants. There are also terpenes (estimated up to 200 varieties) that are also found in both cannabis plants which produce aromatic oils that color cannabis varieties with distinctive flavors and smells like citrus, berry, mint, and pine. This is like wines and how the aromatics give some distinguishable flavors and fragrances. On the medicinal side of terpenes, we are proposing that certain terpenes have their own strengths and medicinal properties. Terpenes have so many medicinal properties that I cannot give enough attention to them without writing a textbook! Benefits run the gamut of acting as an anti-depressant, anti-cancer, anti-bacterial, digestive aid, immune stimulant, mood, and cognitive enhancer. Some terpenes help with sleep, chemotherapy, autoimmunity, diabetes, hypertension, addictions, and pain relief (among other disease states). Knowing that there may be 200 to study, this will take a long time to catalog benefits and organize terpene/CBD blends to cater to an individual’s needs. Terpenes are an essential element of your overall experience with cannabis. They not only influence the smell and taste of a cannabis strain, but also influence the CBD’s specific niche in healing a condition. The “entourage effect,” explains the total effect of the cannabis experience by all parts of CBD, THC, and terpenes (and a few other compounds we will not be discussing today) working together synergistically.
Back to CBD which is the focus of this discussion. Delivery styles of CBD include vaping, ingesting the oil into a food or drink, consuming it sublingually, or applying it topically. There is one pharmaceutical company that is developing a liposomal injectable delivery as well. Vaping can get the quickest and highest concentrations of absorption so long as you have the vape pen mechanism. While there is no harsh smoke there is a vaporized oil. I am not always keen to recommend this for an asthmatic or a person suffering from lung disease. We do not have enough information to date to know whether the lungs can breakdown this oil at the alveolar level. If the lung cannot break oil down it can set up an inflammatory condition and create future pulmonary challenges. Another eloquent approach to delivering CBD oil is through the skin topically. An oil is obviously fat soluble so a fleshy portion of the skin with a fatty layer works nicely. Sometimes carrier oils are used synergistically to help with the penetration and the smell. While this delivery system is the mildest it is also the best tolerated. It lends itself nicely to sore muscles, acne, minor skin conditions, and migraines (rubbed at the temples). The healing benefits of the topical approach do not seem to last as long as the other delivery methods. The edible approach is a fun and tasty approach to wrap the CBD oil in a lollipop or gummy. “Edibles” of CBD are not as potent at the THC edibles. The edible delivery allows some of the full spectrum effect of the CBD (with terpenes) if needed, but it also can be single-isolate based. This usually is a slower delivery system, so if you have put CBD oil in with your olive oil or butter, make sure you know how much you ingested. It may be kicking in 2-4 hours later. The sublingual (under the tongue) delivery is a great way to deliver pure hemp oils to receive CBD benefits. It is discreet and easy to store but also helps the patient and practitioner calculate how much CBD a patient is receiving. For the remainder of the discussion we will focus on direct sublingual ingestion of the oil for our calculations.
I have a physician’s understanding of CBD as it relates to a known CBD medicine on the market called Epidiolex. This medication is used for certain seizure disorders because that’s how well CBD works at calming erratic electrical charges in the brain. This CBD has indeed been researched as a drug and not a food substance, and since it has gone through the patient trials and FDA approval, I feel confident in the dosing strategies which I use to extrapolate to non-seizure patients looking for some guidelines on usage. As with many medications there is a titration schedule which means that there is a gradual climb to the therapeutic dose. I will keep the math simple. Epidiolex recommends starting at 2.5mg/kg twice daily. Therefore, if you weighed 50 kilograms, your dose would be 125 mg twice a day. It just so happens to come concentrated at 100mg/ml. That also means that in 5ml (one teaspoon) there would be 500 mg of the medicated CBD. If you weigh 50 kilograms, you will need no more than half of a teaspoon per day to get started. The proposed schedule would allow raising the dose to a recommended end point of 10mg/kg twice a day. Still using 50-kilogram weight, the maximum recommendation (that does not go “off label”) would be 500mg twice a day. This would mean a total of one teaspoon (5ml) twice a day. To extrapolate this data over to commercial CBD products on the market gets tricky, mostly because the regulation of the CBD is of a food and not a drug substance. You must choose your CBD manufacturer wisely. Some CBD oil is cut with other oils and the concentration in each milliliter or teaspoon may be quite low. Exceptional companies will use outside independent labs to evaluate the concentrations of the THC, CBD, and terpene components. It is always wise if that data is available to the consumer. Since I treat vulnerable populations with multiple medical problems, I use the adage of “starting low and going slow.” There are some non-pharmaceutical guidelines that I extracted from online sources using the following graph. I view this guideline as conservative and harmless to the lay person, however, it may miss some great opportunities for healing in those seeking resolution of their conditions. When patients see me in consultation, I can help them navigate dosing much more therapeutically.
It is not simple enough to explain CBDs effects as working on the CB1 and CB2 receptor. Furious research in underway to discover that CBD affects serotonin reuptake, alters the synapse to affect the way THC can work in the brain, enhances how anandamide (our own endocannabinoid) gets broken down to enhance more of it in our brains, and shapes the GABA receptor in our brains to promote more of the calming effects using GABA as the modulator. In fact, up to 60 different mechanisms are proposed as to the benefits of CBD including effects on acetylcholinesterase. Therefore, CBD has such a wide breadth of therapeutic indications including benefit in nausea, vomiting, seizures, inflammatory bowel conditions, migraines, anxiety, PTSD, insomnia, and depression. When I do a lot of integrative work with cancer patients, we are unearthing the power of CBD to stimulate casperase and ceramide enzymes which will program a cancerous cell to undergo apoptosis (death). CBD can also downregulate gene expression responsible for a cancer’s ability to metastasize. CBD is robust enough, especially at higher levels, to work adjunctively for these extremely sick patients. Therefore, I turn to a great product to work with patients with so many of these health conditions.
This is where nanotechnology meets CBD. Not all milligrams are created equally! The real name of the game is to get the best absorption so all the CBD product can get to work in the body. I work very closely with a company that uses the nanotechnology (NuLight) that infuses energy to break the CBD particles down to such small levels (nanoparticles) so that carrier oils and THC are used far less to drive the CBD into absorption. It also can be concentrated in such a way that a large amount of CBD can be in a small amount of oil. In NuLight’s “RX” formulation nanotechnology is used to create 80mg CBD/ml. This is close to the prescription dose discussed earlier. And with this exquisite formulation of those nanoparticles all of it can be absorbed. Keep in mind that when prescription drugs are failing patients to treat their conditions, or those same medications are causing too many side effects, patients need something to fix their problems with minimal side effects. I have found that many patients have given up on CBD because they have gotten products that have low concentration with poor absorption. They have reaped no benefit, wasted their money, and continue to suffer. Since I need to push doses for patients to get consistent benefits, I rely on a product that can deliver results. In this nanotechnology through NuLight, we safely recommend 40mg (0.5 ml) per dose twice a day. Depending upon the medical condition I may titrate up to 80 mg twice a day, but as with all medications, more does not mean better. Most medications have a plateau level in which there is no more absorption the higher the dose is pushed. In these cases, if more is needed, sometimes more times per day is better than more amount per dose. Consult your integrative provider. Keep CBD in your arsenal for your health conditions. Go for companies using robust research and expertise with nanotechnology. NuLight has consistently delivered results and is my exclusive go-to CBD oil when efficacy matters.