GOOD FOR WHAT AILS YOU?
WHAT SCIENCE AND EXPERIENCED USERS SAY ABOUT THE EFFECTS OF CBD ON SPECIFIC CONDITIONS.
Trained healers and ordinary people have been using the cannabis plant as a treatment for a wide range of purposes for thousands for years. It was listed as an anesthetic in a Chinese book of medicinal plants that has survived since the year 100. In ancient India, cannabis preparations were prescribed for insomnia, headaches, and pain. In the 19th century, cannabis was an ingredient in popular patent medicines sold in the United States and Europe as remedies for headaches, stomach cramps, muscle pain, and other common ailments.
Meanwhile, scientists in recent years have documented the effectiveness of many medicinal plants long used as folk remedies. Published studies have shown, for instance, that ginger relieves nausea and indigestion and white willow bark has been proven to be an effective analgesic. The 80-plus years of prohibition in the United States on growing and processing cannabis prevented or strictly limited research into its potential use as a treatment for any condition. Studies, however, continued in other countries, some with lab animals as subjects, some with humans. Now new research reports about the effects of CBD for specific conditions are being published by researchers in the United States and around the world.
In this chapter, you’ll find out about studies that give credence to the experiences CBD users are reporting and get insights into how the cannabinoid may be affecting their bodies and symptoms. Before looking at what the research says, though, it’s important to remember a few critical facts.
FAIR WARNING
In 2017, the National Academy of Sciences (NAS) published “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations,” a wide-ranging review of the research to that point. It made four conclusive statements.
For adults with chemotherapy-induced nausea and vomiting, oral cannabinoids are effective anti-emetics [substances that control nausea].
In adults with chronic pain, patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms.
In adults with multiple sclerosis (MS)-related spasticity, short-term use of oral cannabinoids improves patient-reported spasticity symptoms.
For these conditions the effects of cannabinoids are modest; for all other conditions evaluated there is inadequate information to assess their effects.
The findings of the NAS carry a lot of weight in the scientific community, but it is the FDA’s responsibility to regulate the marketplace for health and wellness products in the United States. As of 2020, the FDA has approved only one CBD formula for treatment of only one condition. Epidiolex, a CBD-based oral solution, may be prescribed for the treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, in patients two years of age and older. (It is the first drug of any kind approved by the FDA for the treatment of patients with Dravet syndrome.)
In a 2019 public statement, the FDA set parameters around the sale of CBD products, declaring it illegal to market CBD by adding it to a food or labeling it as a dietary supplement. And CBD products may not be labeled or marketed as a cure for any specific health problems. You should be wary of any product that does make such a claim.
While the FDA is protecting American consumers, the World Health Organization (WHO) studied the risks of CBD use and announced its results in a 2017 report: “CBD exhibits no effects indicative of any abuse or dependence potential…there is no evidence of public health related problems associated with the use of pure CBD.” For those reasons, the WHO Expert Committee on Drug Dependence recommended that CBD not be classified internationally as a controlled substance. In other words, the organization stated that CBD should not be treated as a medication with a high potential for abuse.
The conclusions from the WHO report are widely accepted even by experts who are skeptical about CBD: It is not likely to be abused and it’s generally safe for anyone to use. Researchers and CBD users have observed few side effects, which include drowsiness, dry mouth, and diarrhea for some people taking it orally. Still, there are a few cautions to consider before trying it. Most important, CBD may hamper the effectiveness of some prescription drugs—in particular, it appears to interfere with certain medicines that act as anticoagulants or anticonvulsants used to treat seizures. Further, CBD is processed through the liver, so people with liver problems should be especially careful about using it. Regardless of your condition, you should discuss using CBD with your health-care providers before trying it.
Among the most pressing issues for researchers is determining the right dosages for particular people and problems. Right now, most CBD users are relying on the trial and adjustment approach to finding the appropriate dose for themselves. Bryan Doner, D.O., chief medical officer of Compassionate Certification Centers, a health-care provider in Pittsburgh, Pennsylvania, proposes a simple dosage formula as a starting point for any of his patients: 0.5 milligrams of CBD for every kilogram (2.2 pounds) of body weight for oral doses. (For a 150-pound person, that works out to about 35 milligrams.) He recommends dividing the daily total amount into two separate doses—morning and evening. Dr. Doner advises starting with lower doses of inhaled CBD. Topical treatments may need higher concentrations of CBD to be effective.
Age, condition, and experience with cannabis use can all have an effect on how CBD impacts you. That’s why Dr. Doner advocates for the “low and slow” approach. What this means is that patients should always start off with a lower dose and then slowly increase in increments of 5 milligrams. He has observed that underdosing is a common problem for people new to CBD. “Patients tell us they don’t feel any effects,” he says, “so we tell them to gradually increase the dose until they do feel it.”
CONDITIONS AND CARE
In this section, you’ll find references to laboratory and clinical studies that showed CBD treatment provided benefits to a specific (often small) group of test subjects suffering from defined symptoms. Please bear in mind that none of the research conclusively establishes that CBD is a cure for any condition (other than those two kinds of epilepsy) nor is there any reliable determination about how or how much CBD to take to treat any problem. There are no prescriptions here. The science simply doesn’t support those kinds of recommendations. Instead, this chapter can be used as a helpful guide to CBD’s potential for a wide range of conditions, featuring the most compelling research and possible CBD treatment options.
“Prior to going to the store to purchase any CBD-containing product, consumers should consider researching CBD and cross-referencing their findings with whatever disease or ailment they are concerned with,” Richard Carmona, M.D., former surgeon general of the United States, told US News and World Report. To help you get started, we quote a lot of research reports from peer-reviewed medical journals in this section so you can see what the scientists are saying about their results. (See the list of studies in the Resources section on this page.)
ADD/ADHD
Attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) refer to a range of symptoms that include difficulty with concentration, impulsive behavior, and constant fidgeting. It primarily affects children, though 3 percent of adults deal with the symptoms on a daily basis. Many sufferers and the caregivers of children with these challenges are using CBD to help calm minds and relieve anxiety.
Research says: Adults with ADHD who used Sativex, a pharmaceutical oral spray that includes THC as well as CBD, reported a “significant improvement in hyperactivity/impulsivity and a trend towards improvement for inattention,” according to a study published in the Journal of the European College of Neuropsychopharmacology. Sativex is available as an over-the-counter product in Canada and Europe, but it is not sold in the United States.
CBD’s potential: Among people with ADD/ADHD, cannabidiol was reported to be most helpful “with staying on task, minimizing distractibility, and mitigating agitation or irritability,” according to a 2019 survey by Project CBD, a nonprofit promoting research into the medical uses of CBD. The cannabinoid “appears less effective at minimizing the tendency to lose things and procrastinate (common to ADD/ADHD) and sometimes made those symptoms worse.”
CBD treatment options: Those seeking all-day symptom management go for oral doses of capsules, tablets, or chewables because the CBD is released gradually. For immediate relief from acute episodes, you can choose more rapidly absorbed tinctures or oral sprays.
Caution: Do not give CBD in any format to children living with ADD or ADHD before consulting their health-care providers. CBD may interfere with the effects of other medications or aggravate specific symptoms.
Related conditions: Oppositional defiant disorder, conduct disorder, learning disorders, anxiety, depression
ADDICTION
CBD alone won’t break the grip of cravings for opioids, alcohol, and nicotine, but it is being used to help ease the symptoms of withdrawal for many who are trying to quit their addictions. Early studies indicate it might help reduce relapses among serious drug abusers and aid tobacco users who are trying to decrease their consumption.
Research says: It took just a single 800 milligram dose of CBD to reduce the craving for heroin among addicts participating in a study published in Neurotherapeutics. The effects were prolonged, “lasting two or more weeks after administration,” the researchers state. “The ability of CBD to inhibit relapse behavior was still apparent weeks after the last exposure, suggesting that CBD could impact the course of heroin dependence even following a potential lapse condition after a period of abstinence.”
Researchers in the UK studied the effects of CBD on cigarette smokers. The participants were given “CBD inhalers” to use whenever they felt an urge for a cigarette. “The main finding of this study was a dramatic reduction in the number of cigarettes smoked across a 7-day period in the individuals using the CBD inhaler, compared to no reduction in the placebo group,” the scientists reported.
CBD’s potential: Pain, anxiety, and insomnia are common causes of substance abuse and they are symptoms that CBD is often used to treat. The cannabinoid also helps control nausea, which tends to accompany withdrawal from opioids.
CBD treatment options: Tinctures, oral sprays, and vaporizing may provide a fast-acting response to the discomforts that incite cravings. Oral doses via capsules and tablets twice or three times daily maintain steady levels of CBD in the body, which are believed to be helpful for controlling pain and anxiety.
Related conditions: Abuse of alcohol, tobacco, or narcotics; anxiety; depression
ANXIETY
About 40 million adults in the United States age 18 and older (about 19 percent of the population) live with anxiety and related disorders, making it the most common mental health problem, according to the National Institute of Mental Health. Veterans and others who have endured traumatic events are especially vulnerable to debilitating anxiety. Anxiety disorders are characterized by excessive nervousness, fear, apprehension, and worry that is out of proportion to the actual danger. Physical symptoms include nervousness, tension, panic, increased heart rate, sweating, fatigue, and trouble concentrating. Easing these types of symptoms is one of the main reasons for trying CBD.
Research says: When patients with generalized social anxiety disorder were given an oral dose of 400 milligrams of CBD, they reported “significantly decreased anxiety” versus a group of control subjects, according to a study published in the Journal of Psychopharmacology. The researchers conducting the study also used neuroimaging to measure blood flow in different parts of the subjects’ brains and found that “CBD reduces anxiety and that this is related to its effects on activity in limbic and paralimbic brain areas.”
Another group of scientists surveyed all of the available research on CBD and PTSD and shared their findings in the journal Frontiers in Neuroscience. They conclude that “Human and animal studies suggest that CBD may offer therapeutic benefits for disorders related to inappropriate responses to traumatic memories. The effects of CBD on the different stages of aversive memory processing make this compound a candidate pharmacological adjunct to psychological therapies for PTSD.”
CBD’s potential: The brain areas responsible for managing heart rate, blood pressure, and other responses to stress have a high concentration of cannabinoid receptors. By activating those receptors, CBD is believed to trigger the release of hormones and enzymes that soothe stress reactions.
CBD treatment options: People who experience periodic panic attacks and other acute symptoms of anxiety often rely on the fast absorption and action that results from inhaling vaporized CBD oil. For those trying to maintain a healthy balance all day long, taking capsules or other slow-release oral products two or three times a day may provide more consistent, longer-lasting effects.
Related conditions: Panic disorder, post-traumatic stress disorder, social anxiety disorder (social phobia), obsessive-compulsive disorder
ARTHRITIS
The daily pain of stiff, swollen joints hampers the regular activities of about one in five people. Older people are especially prone to osteoarthritis, the result of deteriorating cartilage that begins in middle age. Rheumatoid arthritis is an autoimmune disorder that causes painful swelling in the joints. It affects children as well as adults. CBD’s reputation as an anti-inflammatory treatment has made it popular for both short-term and long-term relief among arthritis sufferers.
Research says: “Transdermal administration of CBD has long-lasting therapeutic effects without psychoactive side effects,” say researchers who studied lab animals with the symptoms of arthritis in a report in the European Journal of Pain. “Thus, use of topical CBD has potential as effective treatment of arthritic symptomatology.”
CBD’s potential: Cytokines are proteins that are secreted by immune system cells. They trigger the responses to injury or illness that cause inflammation. Endocannabinoids disable the cytokines when their work is done, preventing the persistent inflammation that causes joint pain.
CBD treatment options: CBD balm or lotion applied directly onto swollen joints are designed to bring quick relief directly to the pain spot. Twice daily oral doses of CBD fortify the whole body to protect it against autoimmune reactions.
Related conditions: Rheumatism, psoriatic arthritis, osteoarthritis, autoimmune disorders
AUTOIMMUNE DISORDERS
This term covers a wide range of conditions that are linked because they cause the immune system to attack healthy tissue. Rheumatoid arthritis, lupus, inflammatory bowel disease, multiple sclerosis, and psoriasis are among the most common. People with these chronic problems are trying CBD to relieve the pain, swelling, and rashes that come with these conditions.
Research says: “Cannabidiol reduces spasticity, pain, inflammation, fatigue, and depression in people with multiple sclerosis,” state researchers in a report in Frontiers in Neurology. The scientists also observed reduced use of opiates and other pain relievers among MS sufferers who took CBD.
CBD’s potential: The common factor among these disorders is chronic, unwarranted inflammation, which is regulated by the endocannabinoid system. CBD is also believed to slow down T-cell production and suppresses immune system memory, which could decrease the likelihood of future autoimmune attacks.
CBD treatment options: Proponents believe oral doses two or three times daily would have the best chance of keeping the immune system supplied with cannabinoids to control symptoms. Topical creams and balms applied to the surface of skin may help soothe rashes and other kinds of outbreaks.
Related conditions: Crohn’s disease, inflammatory bowel disease, lupus, multiple sclerosis, psoriasis, psoriatic arthritis, rheumatoid arthritis, and many others
CHRONIC PAIN
Serious injuries, surgery, disease, and muscular and nervous system ailments can cause pain that is persistent and long-lasting. Opioid drugs are commonly prescribed for people suffering from daily pain, but those medications come with unwelcome side effects, and they can be addicting. CBD has become an appealing alternative for those seeking relief.
Research says: “Clinical and preclinical studies have highlighted the ability of CBD to treat pain conditions. For instance, oral administration of CBD abolished thermal hyperalgesia [in this case abnormally painful sensitivity to cold] in an acute inflammatory pain model. Moreover, oral treatment with CBD has antihyperalgesic effects [relieving abnormal pain sensitivity] in models of neuropathic and inflammatory pain in rats,” state a team of scientists in the journal Pain.
CBD’s potential: TRPV, the technical abbreviation for transient receptor potential cation channel subfamily V, is a key link in the nervous system’s communication chain that brings pain sensations to the brain. CBD binds to TRPV1, which suggests it can influence pain perception.
CBD treatment options: CBD users are treating “hot spots” of pain with topical applications of CBD balm or lotion to get quick, direct relief to those places. Oral doses, in many cases two or three times a day, are the typical choice for relief from aches throughout the body.
Related conditions: Post-injury or surgical pain, cancer, neuropathy
DIABETES
Type 1 (or juvenile) diabetes is a unique autoimmune disorder caused by the destruction of insulin-generating beta cells in the pancreas. It prevents the body from safely managing blood sugar levels. People with type 2 diabetes are also unable to produce sufficient insulin as needed because of factors such as diet, obesity, and activity level. The symptoms of both types of diabetes include fatigue, blurred vision, slow healing cuts and bruises, chronic thirst, and tingling, pain, or numbness in the hands and feet. Almost 10 percent of people in the United States have one of the two types of diabetes. CBD is showing promise in helping control the causes and alleviate the symptoms.
Research says: Only 30 percent of obese mice treated with CBD developed diabetes versus 86 percent of a control group, report researchers in the medical journal Autoimmunity. “Our results indicate that CBD can inhibit and delay destructive insulitis,” the scientists state.
CBD’s potential: CBD appears to inhibit resistin, a hormone released by fat cells that suppresses the body’s ability to take in glucose (or sugar) and to make and use insulin. Research has linked the presence of excessive resistin with obesity and diabetes in rats.
CBD treatment options: Daily doses of CBD capsules or tablets would be most likely to provide the system-wide support needed for managing the ups and downs of insulin production.
Related conditions: Metabolic syndrome, neuropathy, retinopathy
EATING DISORDERS
The causes of anorexia, bulimia, and binge eating are complex so it is unlikely that CBD alone would cure them. However, researchers are beginning to investigate if it can help manage its symptoms, which include anxiety, stress, and, for some patients, a disruption of normal appetite.
Research says: In 2018, the Center for Medicinal Cannabis Research (CMCR) at the University of California (UC) San Diego School of Medicine announced plans to study CBD as a treatment for anxiety associated with anorexia nervosa in adult patients. “Anorexia nervosa is difficult to treat and, in some cases, may be a fatal condition,” said Emily Gray, M.D., clinical assistant professor of psychiatry, in a press release from the university. “There is preliminary research that suggests cannabinoids may be beneficial in treating this and other eating disorders. The administration of CBD is of interest because of the possibility that this drug might reduce anxiety and perhaps normalize reward and motivation.”
CBD’s potential: The use of CBD to control anxiety and its related symptoms is the primary reason why researchers believe it may be beneficial for people with eating disorders. The endocannabinoid system also manages two hormones, ghrelin and leptin, which play a central role in controlling appetite and feeling satisfied when eating. This might make CBD useful for people who are trying to gain control of excessive eating.
CBD treatment options: Oral spray, tincture, or vapor are rapidly absorbed so they may offer quick help in high-stress situations. Capsules, tablets, or other ingestible products have longer-lasting effects but are better not taken on an empty stomach.
Related conditions: Anorexia, bulimia, binge-eating disorders
FIBROMYALGIA
The causes and mechanisms of fibromyalgia are not fully understood, but the symptoms are. They include chronic joint pain, headaches, anxiety, and trouble sleeping—the problems for which CBD is a popular treatment.
Research says: The studies of cannabis treatments for fibromyalgia patients specifically have so far included both THC and CBD, not CBD alone. Still, the results are encouraging. “We observe significant improvement of symptoms of [fibromyalgia] in patients using cannabis,” report researchers at the Human Pharmacology and Neurosciences Unit, Institut de Recerca Hospital del Mar in Barcelona, Spain. “The present results together with previous evidence seem to confirm the beneficial effects of cannabinoids on [fibromyalgia] symptoms.”
CBD’s potential: CBD seems to reduce brain inflammation, which is linked to the pain and brain fog that afflict fibromyalgia patients. The endocannabinoid system also manages the body’s response to stress, which often triggers outbreaks of fibromyalgia symptoms.
CBD treatment options: Edibles or other forms of oral doses gradually release CBD to the whole body. Topical applications such as creams and balms are formulated to treat pain in specific spots. For an all-over topical treatment, the CBD in bath bombs is absorbed through the skin while you soak in soothing warm water.
Related conditions: Autoimmune disorders, chronic fatigue syndrome, hyperthyroid syndrome, migraine headaches
HYPERTENSION
CBD hasn’t been tested as a treatment for chronic high blood pressure, but it is often used to help relieve stress, a contributing factor to hypertension. By reducing inflammation in the cardiovascular systems, CBD may also reduce the risk of blockages that can result in acute high blood pressure and strokes.
Research says: Healthy men given 600 milligram capsules of CBD showed reduced blood pressure in a study in the UK. “Our data show that a single dose of CBD reduces resting blood pressure and the blood pressure response to stress,” the researchers report in the journal JCI Insight.
CBD’s potential: “The endocannabinoid system has emerged as a central integrator linking the perception of external and internal stimuli to distinct neurophysiological and behavioural outcomes (such as fear reaction, anxiety and stress-coping), thus allowing an organism to adapt to its changing environment,” states an article in Nature Review Neuroscience.
CBD treatment options: CBD users looking for quick relief in stressful situations rely on fast-absorbed products, such as tinctures and oral sprays. Capsules or tablets taken once or twice daily release a steady supply of CBD that can be available whenever a stressful situation arises.
Caution: CBD may interfere with certain types of anticoagulant medications. If you take those drugs or any others to control heart conditions, check with your health-care provider before trying CBD.
Related conditions: Heart disease, stroke
INSOMNIA
Common problems such as pain and anxiety can disrupt healthy sleeping patterns for many people, but daily stress, hormonal changes, irregular work schedules, and lots of other causes can keep us up at night, too. CBD has become a welcome alternative to prescription and over-the-counter sleeping pills. CBD users report that it works quickly to get them back to sleep and it doesn’t leave them feeling groggy the next day. In a national survey by Consumer Reports, about 10 percent of Americans who reported trying CBD said they used it to help them sleep, and a majority of those people said it worked.
Research says: “Cannabinoids could improve sleep quality, decrease sleep disturbances, and decrease sleep onset latency,” conclude the authors of a review of published studies of CBD and sleep in the journal Experimental and Clinical Psychopharmacology. One of the studies found that subjects with insomnia taking 160 milligrams of CBD before bed slept longer and more deeply than those who had taken a placebo. (The study also found that lower doses of 40 milligrams and 80 milligrams of CBD were not effective.)
CBD’s potential: Cannabinoid receptors in the brain are thought to be directly connected to the mechanisms managing the body’s sleep/wake cycle.
CBD treatment options: Users who suffer from chronic insomnia often take oral doses of CBD before bedtime. Those who have trouble going back to sleep find relief from rapidly absorbed vaporized CBD oil or sublingual drops.
Caution: In at least one study subjects reported that sleeplessness improved in the first month of taking CBD daily, but the benefits faded during the following months. This suggests CBD’s ability to improve sleep may diminish the longer you use it. Other studies have not shown the same drop-off in effects.
Related conditions: Restless legs syndrome
MENOPAUSE
During the transition to and experience of menopause, women typically live with symptoms that include sleep disruption, pain and inflammation, anxiety, and hot flashes. Menopausal women are turning CBD to help moderate these daily discomforts.
Research says: No published studies have assessed the impact of CBD on menopause specifically, but “many of my patients report that it helps with sleeping and anxiety,” says Lauren Streicher, M.D., clinical professor of obstetrics and gynecology at the Northwestern University Medicine Center for Menopause. “I’ve also seen some evidence CBD may influence bone metabolism, but at this time it is not a treatment for osteopenia or osteoporosis.
“There is currently no scientific data that CBD makes any difference with hot flashes beyond a short-term placebo effect,” Dr. Streicher adds.
CBD’s potential: The endocannabinoid system is involved in regulating hormone activity as well as body temperature, so some experts theorize that it could relieve symptoms caused by rapid changes in hormone levels. Serotonin, a hormone that manages mood and can ward off depression, is also linked to the endocannabinoid system.
CBD treatment options: Sublingual strips and tinctures dissolve quickly through the membranes in the mouth and release CBD into the system, which may help bring fast relief when the discomforts are acute. Be aware, Dr. Streicher emphasizes, that the metabolism of menopausal women is altered and they may experience a “delay in the onset of action. I recommend that menopausal women who are trying CBD stick to low to moderate doses.”
Related conditions: Perimenopause
MENSTRUAL CYCLES
For so many women, their monthly periods and the days leading up to them bring a variety of discomforts, including painful cramping, bloating, sleep disruptions, and anxiety. CBD has become a popular treatment for women seeking a natural remedy for these symptoms and many are reporting that “CBD appears to be highly effective in addressing mood and pain issues associated with female hormonal cycles,” according to a 2019 study by the nonprofit Project CBD.
Research says: “There are many anecdotal reports that CBD helps with the symptoms that come with periods or premenstrual syndrome, but we don’t have any conclusive evidence in the scientific literature,” says Dr. Streicher, the professor of obstetrics and gynecology and also a member of the Prevention Medical Advisory Board.
CBD’s potential: “I tell my patients that they can try CBD if they wish and it might be helpful,” Dr. Streicher says, “though it is possible that many of the women who are touting it may be experiencing a placebo effect.”
CBD treatment options: Topical preparations, such as balms and lotions, applied directly to pain spots may help relieve inflammation and the discomforts it causes.
Related conditions: Premenstrual syndrome
My Take
I was involved in two rear-end collisions (neither my fault) and both times, my neck was broken. Each time, I required extensive surgeries to help minimize the damage. More than 15 years later, I am left with chronic pain that I refuse to take opioids to treat. But while I can’t afford to be “stoned” on pain pills, I also can’t afford to be “high,” so medical marijuana is not an option.
Several years ago I turned to CBD and have used CBD pain cream, CBD oil, CBD gummies, CBD bath bombs. If it has CBD, I’ve tried it. Most brought very little relief for my pain issues. Some helped with sleeping. Nothing was effective for all my symptoms. The best has been some strips and pain cream, which has given me promising results. An added bonus on the pain cream is the instant relief from menopausal hot flashes. Who would have thought??? —Tammy Vietti, Springfield, Missouri
NAUSEA AND APPETITE
One of the first medical applications of cannabinoids was to help restore the appetites of cancer patients undergoing chemotherapy. That led to the development of synthetic THC medications, such as Marinol. More recently, people experiencing chronic nausea or loss of appetite have been turning to CBD for the same purposes.
Research says: “CBD effectively prevented conditioned retching,” report researchers in the British Journal of Pharmacology (BJP). “Preclinical research indicates that cannabinoids, including CBD, may be effective clinically for treating both nausea and vomiting produced by chemotherapy or other therapeutic treatments.”
CBD’s potential: “The blockade of one subtype of receptor, the 5-HT3 receptor, could suppress the acute emetic response (retching and vomiting),” according to the same article in the BJP.
CBD treatment options: Sublingual drops or inhaled vaporized CBD oil are absorbed quickly, so they may be able to bring fast relief to acute nausea without causing further digestive distress.
Related conditions: Cancer treatments, motion sickness, and chronic nausea
OSTEOPOROSIS
Approximately 30 percent of postmenopausal women in the United States experience gradual decline in the density and strength of their bones, the condition known as osteoporosis. It leads to an increased risk of bone fractures, as well as back pain and imbalanced posture. We found no research so far on CBD as a treatment for it, but scientists have linked the endocannabinoid system to skeletal development and maintenance.
Research says: “Our recent studies in mice and humans suggest an important role for the endocannabinoid system in the regulation of skeletal remodeling and the consequent implications on bone mass and biomechanical function,” says a report in the British Journal of Pharmacology. They note that CB2 cannabinoid receptors are present in bone cells and that malfunctioning of a key gene involved in production of those receptors appears in analyses of people suffering from osteoporosis. (Read about the different types of receptors and their functions on this page.)
CBD’s potential: Osteoblasts and osteoclasts are two unique types of cells that play a primary role in building and maintaining our bones. Scientists have observed that these cells produce key endocannabinoids (anandamide and 2-arachidonoylglycerol) and the CB2 cannabinoid receptors they attach to. Research indicates that the activation of these CB2 receptors slows bone loss and encourages new bone formation. CBD’s link to the CB2 receptors might make it useful in protecting against osteoporosis.
CBD treatment options: Swallowing a CBD capsule or tablet each day provides a constant supply of the cannabinoid for the body to use as needed.
Related conditions: Autoimmune disorders, including type 1 diabetes, rheumatoid arthritis, lupus, and hyperthyroidism, all increase the risk of osteoporosis.
PARKINSON’S DISEASE
A progressive nervous system disorder, Parkinson’s disease affects movement, leading to tremors, rigid muscles, difficulty with walking normally, limited facial expressions, and trouble speaking and writing. Chronic pain, anxiety, trouble sleeping, and hallucinations or delusions are common symptoms as the disease advances. Researchers and caregivers are trying CBD to help alleviate some of these difficult-to-treat symptoms.
Research says: Hallucinations and delusions were reduced in Parkinson’s patients who do not suffer from dementia after taking CBD capsules for a week, according to a study published in the Journal of Psychopharmacology. Another group of researchers, who reported their findings in the Journal of Clinical Pharmacy and Therapeutics, documented improvement in sleep quality, including fewer nightmares, among a small group of Parkinson’s patients after taking a single dose of CBD.
CBD’s potential: CBD acts as an antioxidant that scientists theorize provides protection against the rapid deterioration of neurons, which is a contributing factor to Parkinson’s disease. The cannabinoid is also a popular treatment for anxiety and pain, two of the disease’s most persistent symptoms.
CBD treatment options: Edibles, such as gummy bears or chocolate bars, are an appealing way to get Parkinson’s patients to take daily doses of CBD.
Related conditions: Supranuclear palsy, multiple system atrophy, Lewy body disease, anxiety, sleep troubles
PREGNANCY
The discomforts of pregnancy and postpartum recovery often include pain and inflammation, nausea, trouble sleeping, and anxiety, the symptoms commonly treated with CBD. When seeking relief from these everyday problems, many women believe that a natural, plant-based remedy like CBD is safer for them and their baby than over-the-counter medicines.
Research says: “We definitively know that cannabinoids cross the placenta and are found in breast milk. And there have been credible published reports in the medical literature of problems with fetal growth and development related to the use of cannabis,” says Dr, Streicher. Dr. Streicher, as well as the American College of Obstetrics and Gynecology, stress that pregnant women and those who are breast-feeding should not use CBD under any circumstances.
CBD’s potential: Pregnancy is not the time to use CBD.
SEIZURES
As we explained earlier in this chapter, the FDA has approved a CBD-based drug for treatment of people with either of two rare and severe forms of epilepsy, Lennox-Gastaut syndrome (LGS) and Dravet syndrome. LGS is usually diagnosed in children ages 2 to 8 years old, and Dravet syndrome typically begins in the first 18 months of life. The medications that are typically prescribed to control seizures in people with other forms of epilepsy have not been effective for these patients.
Research says: Several research teams at different locations participated in clinical trials of CBD as a treatment for children with Dravet syndrome and LGS. These double-blind, placebo-controlled trials (the highest standard for medical research into treatments) were the first such studies of CBD in the United States. For the patients in the study suffering from Dravet syndrome, seizures were reduced by 39 percent in children treated with CBD versus a reduction of only 16 percent in the placebo group. “That’s a modest difference, but statistically significant,” says Elaine C. Wirrell, M.D., a consultant in pediatric neurology at the Mayo Clinic in Rochester, Minnesota, one of the institutions that participated in the study.
“The results of these studies demonstrate that, at a dosage of 20 [milligrams per kilogram of body weight per day], CBD added on to pre-existing [antiepileptic drug] treatment is superior to placebo in reducing the frequency of convulsive seizures in patients with Dravet syndrome, and the frequency of drop seizures in patients with Lennox-Gastaut syndrome. In the latter patients, a dosage of 10 milligrams/kilogram/day treatment was also superior to placebo,” according to a report in the Journal of Epilepsy Research.
Bear in mind that these two specific types of epilepsy affect a small portion of the estimated 4 percent of people who suffer from epilepsy. CBD also helped control seizures among people with the more common forms of epilepsy in a small study published in the US-based journal Pediatric Neurology.
Seizures are a common symptom of epilepsy, but about one in every hundred people will have seizures in their lifetimes that are unrelated to the condition. The symptoms can include temporary confusion, a staring spell, uncontrolled jerking of arms and legs, loss of consciousness, and sudden rapid eye movement.
CBD’s potential: Seizures appear to be related to inflammation in the brain, which may be reduced by CBD. The endocannabinoid system also triggers the receptors for GABA (gamma-aminobutyric acid), a neurotransmitter that calms excited neurons, particularly those related to motor control. Researchers can’t say definitively how Epidiolex works, but it appears to use different pathways in the nervous system than other epilepsy drugs. One theory is that CBD regulates the amount of calcium inside of nerve cells. Too much calcium causes them to fire electric pulses too fast, leading to an overload in the brain. CBD may help maintain a healthy balance of calcium in nerve cells.
CBD treatment options: The prescription for the approved drug, Epidiolex, has substantially more CBD than the standard dosage recommendation we shared earlier in this chapter. It calls for 2.5 milligrams for every kilogram of body weight (or about 180 milligrams for a 160-pound person) each day for one week, increasing to 5 milligrams per kilogram for maintenance. Oil or tincture are the most frequently cited forms for using CBD to control seizures in the online discussion group hosted by the Epilepsy Foundation (epilepsy.com). For both prescriptions and self-treatment, the doses are typically spread out over two or three times of the day.
Caution: In the studies that led to FDA approval of Epidiolex, the subjects took CBD in conjunction with other seizure control medications. Talk to your physician about your antiseizure medications before trying CBD.
Related conditions: Epilepsy, sleep apnea and narcolepsy (another sleep related condition), Tourette’s syndrome, and migraines are other conditions that may cause occasional seizures.
SKIN DISORDERS
Skin that is chronically itchy, dry, flaky, crusty, blistering, oozing, or reddened can be a source of both physical and emotional discomfort for people of all ages. These conditions can also lead to open sores and persistent infections. There are many causes of these conditions, from allergic reactions to autoimmune disorders. Patients report that CBD is proving helpful for relief from both the underlying causes and the visible symptoms.
Research says: Test subjects were provided with CBD-enriched ointment and instructed to apply it to lesioned skin areas twice daily for three months, in a study published in Journal of the American Academy of Dermatology. The treated areas showed significant improvement based on skin evaluations by the researchers, and the subjects reported an 86 percent improvement in itching over the three months.
CBD’s potential: Mast cells are immune cells that release histamine when activated, which leads to intense itching and inflammation. The endocannabinoid system directs the activation of mast cells.
CBD treatment options: Topical applications of CBD balms or creams are used to treat the outbreaks on the skin’s surface. Daily doses of capsules or tablets may work to prevent the inflammation and release of histamines that trigger appearance of the symptoms.
Related conditions: Acne, eczema, inflammatory skin disease, pruritis
WOMEN’S SEXUAL HEALTH
Women of all ages and various medical conditions experience vaginal dryness, pain during sex, and orgasmic dysfunction. CBD oil applied topically acts as a “vasodilator,” meaning it expands blood vessels and increases blood flow. That has encouraged women to try it as a treatment for these discomforts.
Research says: No high-quality research has demonstrated that CBD improves sexual response in women, but Dr. Streicher, author of the bestselling book Sex Rx, has suggested topical CBD treatments to her patients to increase vaginal lubrication and orgasmic function. “I tell my patients, especially diabetics who have small vessel disease and clitoral neuropathy to try it,” she says.
CBD’s potential: “Clitoral neurons and vaginal lubrication depend on capillary action, so CBD’s function as a vasodilator may improve blood flow and sensation to their genitals,” Dr. Streicher says.
CBD treatment options: Topical treatments, such as lotions or lubricants infused with CBD, are the most effective way to increase blood flow in the areas where it can help relieve discomfort and increase sensation.
CBD AND PETS
Dogs and cats are like four-legged family members, so their well-being tends to get as much attention as that of the rest of the household. And pets suffer from many of the same hard-to-treat health problems that humans do, including chronic pain, anxiety, seizures, and trouble sleeping. What’s more, dogs and cats have an endocannabinoid system, just as we do. That’s encouraged pet owners to try treating their animals with CBD, and many report that it has helped in a variety of ways.
Be aware that California is the only state so far to permit veterinarians to discuss the therapeutic use of cannabis-derived supplements for animals, though bills are pending in other states. But pet owners around the country are asking about it, according to a 2019 poll by the Veterinary Information Network (an online community for professionals). Nearly 30 percent (of the more than 2,000 vets who participated in the poll) reported that they are questioned about CBD for animals at least once a week by pet owners. Fifty-six percent of the vets acknowledge that they have had clinical experience with CBD products for dogs. And a solid majority believe it is beneficial: Fifty-six percent indicated that CBD products were somewhat helpful for chronic pain in their patients and 66 percent said they found CBD somewhat helpful for anxiety in pets. Most reassuring, 80 percent of the vets reported no side effects in pets except for mild sedation.
RESEARCH SAYS
Research into treating pets with CBD is just beginning—there’s even less known about its effects on these animals than there is on people—so nearly all of the information about it is anecdotal. However, two ongoing (and as yet unpublished studies) do offer some support for giving pets CBD.
Dogs suffering from epilepsy received doses of CBD oil in a trial by Stephanie McGrath, D.V.M., a neurologist and assistant professor at Colorado State University’s College of Veterinary Medicine and Biomedical Sciences. She reported that the canines had an 80 percent reduction in the frequency of seizures. “Overall, what we found seems very promising,” Dr. McGrath said.
Dogs experiencing pain from osteoarthritis were given CBD as part of a study at the Cornell University College of Veterinary Medicine. The researchers noted that 80 percent of those taking CBD showed “significant improvement in pain levels and quality of life without discernible side effects.”
CONDITIONS AND USES
Pain: Aging and injuries can leave pets with chronic discomfort, limited mobility, and reduced activity. Pet owners who have treated pets in pain are saying they are seeing the animals perk up and regain their energy and vitality. That’s far from conclusive evidence, but it’s interesting to note because dogs obviously aren’t subject to the placebo effect (although their owners are). In a way, this observed improvement may be quite telling about what CBD can really do because the patient isn’t aware of the treatment.
Anxiety: Whether because of unfamiliar situations, fireworks and other loud noises, traveling, visiting the vet, predisposition, and other reasons, both dogs and cats can experience intense stress and persistent anxiety. Many pet owners are reporting that CBD calms anxious animals. Horses are also prone to anxiety, so their owners are trying CBD for those symptoms and saying that it’s soothing even for large animals.
Seizures: Epilepsy afflicts dogs and cats with symptoms similar to those that humans endure, including seizures. Animals may also be struck with seizures for other reasons, such as low blood sugar or brain and nervous system disorders. The research at Colorado State University and the experience of pet owners offers hope that CBD can help to reduce the frequency of the seizures.
Appetite: The National Institutes of Health has acknowledged that cannabinoids act as an antiemetic, helping to ease symptoms of nausea or vomiting, for people. When medications, illness, motion sickness, or other conditions cause pets to vomit repeatedly or to lose their appetite, pet owners are trying CBD to help.
SAFE TREATMENT
Just as with people, determining safe, effective CBD dosage levels for pets is a challenge. A good starting point is 0.5 milligrams of oral CBD for every kilogram (2.2 pounds) of the animal’s body weight, says Angie Krause, D.V.M., who has a veterinary practice in Boulder, Colorado. (For a 20-pound dog, that works out to about 4.5 milligrams per dose.) Dr. Krause suggests trying small amounts first to gauge pets’ reaction before giving them full-size, regular doses. Breaking up the total dosage into two separate servings—morning and evening—is also recommended.
You’ll find CBD in all kinds of products for pets such as crunchy or chewy treats infused with CBD, flavored drops, pet-grade peanut butter, and coconut oil infused with CBD. You can also go with a basic CBD tincture, which you can squirt right onto your pet’s tongue or onto a favorite food. “You can buy dog treats containing CBD, but the best form to administer is an oil or tincture,” according to Jerry Klein, DVM, chief veterinary officer of the American Kennel Club. “This way, you can adjust your dog’s dose drop by drop.”
CBD oil drops squirted under an animal’s tongue will be absorbed fastest. Of course, that’s not always possible with pets. So, adding the drops to treats or regular meals works, too, but the CBD is absorbed more slowly and its effects are more gradual since it goes through the digestive system. Though there is no published research on topical CBD treatments for pets, you can find CBD balms and lotions formulated for dogs and cats suffering from joint or back pain, skin irritations, and wounds. To be absorbed, a topical treatment needs to go directly on the animal’s skin.
While the researchers who have studied CBD treatments for dogs and cats have found no significant side effects for the animals, all the experts still advise monitoring pets closely for their reactions. Some animals will become groggy or lethargic from even a small dose of CBD, and they may even experience low blood pressure. Dry mouth is another side effect to watch out for—unlimited access to drinking water is always important, but especially after giving CBD to a pet. If an animal shows any adverse effects from taking CBD, the safe and smart response is to stop the treatment and contact your vet if any problems persist for more than an hour or two after you stop the treatment.
Before giving CBD to any pet, especially those that are taking prescribed medication, be sure to tell your veterinarian about it. This will help ensure that the CBD doesn’t counteract or otherwise hamper the effectiveness of the drugs.
Interestingly, CBD may enhance the effects of pharmaceuticals, according to a vet quoted in a 2019 article by Consumer Reports. “We do see the strength of pharmaceuticals increase when dogs are taking CBD, so we can often taper down some of those pharmaceuticals,” says Casara Andre, D.V.M., founder of Veterinary Cannabis Education and Consulting, a resource for pet owners and veterinarians. “For example, CBD often [amplifies] the effects of antiseizure medications, which is why a lot of times when we combine those with cannabis, we get better control.”
PRODUCT CONCERNS
CBD products for pets are not subject to any more regulation than those for humans. That is, manufacturers are not required to test their products on pets or adhere to any quality standards. Pet owners need to read labels and online product information carefully before buying and giving CBD to their dogs and cats. The first step is to look for the seal from the National Animal Supplement Council, which increases the likelihood that a product has been made with safe ingredients in a clean, high-quality environment.
Check for THC content in any CBD pet product and avoid any with more than 0.3 percent THC (the legal limit for hemp-derived products) unless a veterinarian advises otherwise. Independent studies have found more THC in pet products than labels indicate. Evaluations of pet products have also uncovered that some have far less CBD than promised. If the label isn’t clear, ask to see a certificate of analysis for any pet product under consideration—it will list the CBD and THC content as well as other ingredients. Reputable brands willingly share this information.
Whether you shop for CBD products for people or pets, online or in stores, you’ll notice that oils can be costly. But the AKC’s Dr. Klein warns against buying bargain basement products. “The higher the quality and purity, the higher the cost,” he says. “You don’t want to go for a cheaper option that could have toxic substances such as pesticides, herbicides, or heavy metals. Make sure you buy CBD oil that is free of additives.” The best way to be sure of that, he adds, is to buy products made from certified organic hemp.