What is CBD Oil - AND should you use it?Bookmark this
ISA HERRERA HEARD IT from her patients first. "I have less pain." "I'm having less anxiety." "My menstrual cramps are less intense," they told the New York City physical therapist about taking CBD oil, a product containing cannabidiol, one of many chemicals found in the cannabis plant. "I was like, 'I need to find out more about this,'" recalls Herrera, who specializes in integrative pelvic floor therapies.
So Herrera, who's experienced her own share of pain due to a shoulder injury followed by a bout of Lyme disease, went to a local herb shop and bought a vial of the oil, which, by some definitions, is legal in all states if it doesn't contain more than 0.3 percent THC – the psychoactive component of cannabis. She began putting seven to nine drops under her tongue first thing most mornings – and was startled by the results. "It's changed my pain level, my anxiety level and my stress level," says Herrera, who already practiced yoga, meditated regularly, ate a healthy diet and tried conventional medical treatments for pain and mobility. "It was shocking," she says, because she thought her patients' reports were due to the placebo effect. "Right now," she adds, "I feel pretty amazing."
Herrera and her patients aren't the only ones doling out rave reviews for CBD oil, which can be found online and in cannabis dispensaries, as well as in some grocery stores and even as an optional add-in alongside protein powder at your local juice chain. The oil has been riding the coattails of the growing legal cannabis industry, with one industry expert, Matt Karnes, telling Forbes in 2016 that he expected CBD products to become an almost $3 billion market by 2021.
The appeal? Proponents claim CBD can help ease pain, anxiety, depression and stress, boost focus and productivity, improve the immune system, reduce inflammation and more. And – unlike its psychoactive cousin THC – CBD, they say, is harmless, legal and can't get you high. "The known is it's good for you, it helps a lot of people and a lot of things, and you can't hurt yourself," says Phil Asquith, a farmer and producer of extra-virgin olive oil in California, who founded one of the first companies in the CBD space. "The unknown is all the details."
At least one benefit of CBD is well-supported by science: It can be effective in treating children with rare, genetic seizure disorders. Adults, children and even animals with epilepsy have been shown to benefit from the chemical too, the World Health Organization reports. There's also some evidence that CBD can help with anxiety, says Dr. Robert Carson, an assistant professor of neurology and pediatrics at Vanderbilt University who focuses on children with epilepsy. "In children, especially those with autism spectrum disorders, this may manifest as improved interactions with others," he says. Other preliminary research shows CBD holds promise for conditions including Alzheimer's disease, cancer, psychosis and Parkinson's disease – and is pretty much impossible to abuse or become addicted to, WHO says.
"If it proved effective for anxiety, depression and panic disorder, it may have other effects as well that could be useful and beneficial [but] this is a really early stage," says David Shurtleff, the acting director of the National Center for Complementary and Integrative Health. His organization's stance: "Take it one step at a time and do the work and really state where we are right now with the research," he says.
In other words, many popular claims remain unfounded – and overlook the fact that there's a difference between CBD that's studied in labs for particular conditions and CBD products that are sold to consumers for general well-being. "What happens is people say, 'Look, CBD is harmless and it doesn't get me intoxicated, so I'm going to take it for what ails me," says Dr. Jordan Tishler, a Harvard physician and CEO of InhaleMD, a Boston-area practice specializing in cannabis therapeutics. "Then they're going to get some perceived benefit because that's the way the placebo effect works, and then they go and trumpet this."
What's there to lose?
So, many of CBD's popularized benefits aren't well-proven. But are there any harms in trying CBD-containing products? In a word, yes. While any reported side effects from CBD alone are minor (think dry mouth and dizziness), they can be serious if the CBD products interact with other medications, experts say. Since CBD is metabolized by the same enzyme in the liver that metabolizes many conventional medicines and supplements, the chemical can cause the levels of other drugs in the system to rise; in some cases – like for those taking a drug to prevent their bodies from rejecting a donor organ – to a deadly level, Tishler says.
"Please be open with [your] physicians regarding what [you] are taking," says Carson, who also worries about patients who turn to CBD products instead of well-proven treatments for conditions like depression.
Keep in mind, too, that CBD product companies use different CBD sources, extraction methods and production techniques – and not all resulting products are created equal. You'll have to do your own research to determine which companies you're willing to trust, Asquith says. Plus, how the products are packaged and consumed – be they in oils, creams or capsules – affect how they're absorbed in the body. Edibles, for example, are well-absorbed, while oils taken under the tongue are "baloney," Tishler says. And of course, salespeople at herb shops don't have the same mission, knowledge, training or oversight as physicians and pharmacists. "We have spent the last 100 years or so developing the pharmaceutical system because it works," Tishler says.
There's also the question of CBD's legality – something that's a lot grayer than the black-and-white picture most companies paint. The U.S. Drug Enforcement Administration considers CBD, like all cannabinoids, a schedule 1 drug. That means it's just as illegal as heroin and ecstasy. Meanwhile, hemp – a variety of the cannabis plant regulated by the U.S. Department of Agriculture – is legal , so long as its THC content is negligibly low. But because the agriculture department doesn't test for CBD – only THC – in hemp, more companies are getting away with selling products they say contain CBD, says Sara Jane Ward, an assistant professor of pharmacology at the Temple University Lewis Katz School of Medicine who's been studying CBD in rodent models for more than 10 years. Needless to say, the legality of CBD is "very confusing and very gray," she says.
The same terms could be applied to what's actually in CBD products. While some do contain CBD, others (often marketed as "CBD-rich hemp oil") may have barely any, Asquith says. And depending on state laws, they can include varying levels of THC too – a combination shown to have some benefits, but also drawbacks, of course, if you're not looking for a high. "People will play all these games with the numbers because the consumers aren't really educated in this space yet and it's easy to get taken advantage of," he says. "It's the milligrams of the actual CBD molecule that matter."
And, if you do luck out and get a tincture truly containing CBD, you'll likely dish out $200 or so to take 10 to 40 milligrams daily. Since research participants take closer to 1,000 milligrams a day, it's hard to imagine a benefit without drinking the whole (expensive, calorie-dense) bottle, Tishler says. "Most people will adjust their doses based on what they're comfortable spending," Asquith says.
"We need to swing the conversation back to cannabis and understand that cannabis is where we're really getting a benefit that's demonstrable," Tishler says. "And right now, CBD is mostly marketing."