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ABCs of CBD

CBD CBD
Kaneka
 
EuroMedica

CBD is touted for many benefits, chiefly for discomfort and relaxation. Here’s a detailed snapshot of this once-mythical category.

As we head into 2022, there is pervasive high-stress and anxiety due to many factors—the enduring and morphing pandemic, inflation and product shortages, and global political unrest.

Adding injury to insult, many of your clients are experiencing some sort of chronic pain or discomfort, exacerbated by heightened stress.

CBD products may help your angst-ridden clients to more calmly navigate the foreseeable future with less aching and nervousness. “The pandemic re-emphasized the importance of stress management, self-care and mental well-being,” asserted Laura Fuentes, co-founder & chief officer of science and innovation of Florida-based Green Roads. “That intersects with a growing interest in plant-based, more natural solutions. CBD sits right at that intersection. Overall, consumers are more familiar and comfortable with CBD than previously.”

Rapidly Evolving Category

The cannabinoid industry is evolving from a one-cannabinoid-fits-all market to personalized optimization focusing on a specific need-state for a specific consumer, according to Nicole Brown, chief innovation officer at North Carolina-based Open Book Extracts. She predicted that research will accelerate this evolution and, eventually, will guide the path for cannabinoids to be regulated as dietary ingredients.

“The market for CBD products is maturing,” stated Jamie Corroon, ND, MPH, medical advisor, CV Sciences, California. He is seeing more sophisticated, condition-specific formulas that include CBD, or a CBD-dominant hemp extract as an ingredient, as opposed to a simple stand-alone product.

According to market research firm, The Brightfield Group, the CBD market is expected to reach $5.3 billion in sales this year representing 15 percent growth over 2020 sales of $4.6 billion (Source: Brightfield 9/29/2021). Currently, noted Jen Palmer, ND, director of education for Charlottes’ Web, tinctures are the largest product type, but the fastest growing product types are ingestible gummies and beverages.

“Growth in the category will be driven by new users—there is a big effort by manufacturers and retailers to raise consumer awareness of CBD and its potential benefits, all trying to build trust in CBD among more hesitant consumers and healthcare practitioners,” she said.

Chase Terwilliger, CEO, Colorado-based Balanced Health Botanicals, observed that when he started the company five years ago, most people didn’t know what CBD was, much less how it could improve their quality of life. Today, CBD is everywhere. Balanced Health Botanicals first launched CBD tinctures and has since expanded into gummies and soft gels. “What you also see a lot of now is the expansion of the CBD category into other minor cannabinoids that are found in the hemp plant,” he added. “When we started the company, it was near impossible to extract minor cannabinoids in the hemp plant and provide it economically reasonable for the consumer. Today, we can extract these minor cannabinoids at a fraction of the cost and now provide products such as CBN, CBDA and CBG.”

Brown elaborated that product formulations with the more novel and rare cannabinoid ingredients such as CBN, CBC, THCV and CBDV can deliver on the product promise for targeting specific need states. For example, recent research showed that CBDA can help manage inflammation response while another study found that CBDA was 1,000 times more potent than CBD for anti-anxiety effects. Other rare cannabinoids such as CBN and CBDV further possess potential for deep relaxation and relief, while THCV can support increased energy and focus.

Brown observed that in the CBD market, significant “groundbreaking” advancements have dominated the cannabinoid market with some of the industry’s largest brands seeing double-or triple-digit year-over-year growth. “Brands are taking a valiant, intelligent approach to product development, with a focus on several key trends.”

There has been an accelerated focus on need states, such as stress and anxiety, she observed. Exploding anxiety rates and associated mental health issues provide new opportunities to promote the efficacy of cannabinoids. There is an increased focus on this niche, need-state market, while “catch-all CBD product development and messaging (eg., ‘CBD is good for everything and everyone’) will be replaced with more targeted product innovation and marketing campaigns.”

Further, she cited, more than 25 percent of new market entrants purchased cannabinoids to cope with pandemic-related stress and anxiety, according to High Yield Insights.

Fuentes similarly observed that products with a targeted function are becoming important. Two important needs in the CBD market are in sleep and immune system support. As an example, to meet this demand, Green Roads offers sleep oils and capsules that combine melatonin and CBD. The company’s Rise N’ Shines combine CBD with antioxidant-rich elderberry extract, vitamin B12 and vitamin C.

Dr. Palmer agreed. She commented, “Products incorporating functional ingredients can help bring new consumers to the category as they can help consumers better understand the product and its intended effects. For example, immunity is an area of focus for some brands as they add widely used ingredients like ashwagandha and vitamin C to CBD. Companies are also beginning to incorporate minor cannabinoids like CBG (cannabigerol) and CBN (cannabinol) alongside CBD to produce the ‘entourage effect’ where compounds work synergistically to enhance the effects of each component.”

There are three types of CBD that are sold: full-spectrum, broad-spectrum and isolate, Terwilliger pointed out. Full-spectrum oil is a full plant “squeeze.” Therefore, it has mainly CBD, but also has the essential oil of the plants (terpenes), other minor cannabinoids and a little amount of THC that naturally occurs in the plant (under .3 percent). Since the THC concentration is so low, when the client takes the recommended serving he or she will not feel intoxicated. Broad-spectrum is full-spectrum oil with all THC removed, while isolate is a pure CBD.

There are literally hundreds of choices for CBD and the rate of launches are not abating, according to Palmer, who observed that there are constantly new players entering the market and current players are innovating at a rapid pace. The innovations are in many forms, such as adding new flavors, and bolstering products with other botanicals and functional ingredients. On the flavors side, some companies are experimenting with seasonal/holiday flavors like pumpkin spice and candy cane to add some excitement to their portfolios.

She added that while tinctures still dominate the CBD market, topicals and skincare “have tremendous traction as they’re considered the safest bet in the current regulatory environment. Innovations in this category include cooling salves, sports creams, and facial serum. In beverages, we’re seeing sparking waters, RTD (ready-to-drink) coffees, herbal teas, kombucha and energy shots. The format is convenient and well known to consumers so it’s ripe for continued innovation. Similarly, gummies are rapidly expanding as they provide a fun and friendly format for consumers.”

CBD and Your Clients

Mention CBD and you will receive a host of reactions, from fear, to flummoxed, to excitement. Some clients may profess expertise in this area, but may have obtained that so-called expertise from flimsy or shady sources. Still, most are admittedly not schooled. A July 2021 Consumer Brands/Ipsos poll of 1,000 American adults found that Americans rated their knowledge of CBD as a 3.3 on a scale of 1 to 10.”

However, Dr. Corroon believes that consumers understand the benefits of CBD now more than ever. CV Sciences has invested a lot of resources into health care professional, retailer and consumer education. The conversation, he related, has evolved from basic information, like CBD not being intoxicating, to a more advanced understanding of the endocannabinoids system and the entourage effect. “Now consumers are starting to understand some of the more subtle, yet important, distinctions, like the difference between full-spectrum versus broad-spectrum products.”

New consumers are entering the market regularly as they learn about CBD’s benefits from friends and family, online ads, and their own research, Dr. Palmer observed. “While using online research, they recognize their own limitations and frequently seek support of a naturopath before trying new products for themselves,” she emphasized.

When new users enter the market, they tend to enter on familiar, easy-to-use formats like gummies, or on tinctures to control the dosage more easily, she added. According to the Brightfield Group, nearly 30 percent of CBD users are consuming CBD daily or multiple times per day.

Many of the new CBD consumers may likely have some trust barriers, pointed out Brown, who commented, “The CBD trust gap is one of the biggest barriers preventing the CBD from achieving its full potential.”

To help bridge that gap and to strengthen clear educational pathways between the CBD industry, naturopaths and their clients, there are several new resources available. For example, www.the420areacode.com is a new hub founded by veteran natural products marketing and communications expert Sheldon Baker. “I wanted to build a professional website that offered a wide range of CBD health and wellness information for business, health professionals and consumers, plus what I call a smattering of information about cannabis,” he said. The site contains educational content contributed by researchers and product development companies specializing in CBD, as well as regulatory news updates and interviews with physicians and researchers.

And because many CBD consumers are asking for scientifically validated information about the products they use, Open Book Extracts has created The Alliance with Radicle Science, what Brown described as “a transformative health-tech B-corp validating natural products for the first time, to advance the development of market-leading, scientifically validated CBD and cannabinoid products. Together, we will redefine how new CBD and cannabinoid products are developed, ensuring the process is backed by large scale, comprehensive and rigorous consumer use data.”

She promised that the group’s rigorous studies into specific formulations of high-quality CBD and minor cannabinoids “will reveal far richer data than ever before to inform a new gold standard for product development that is targeted, trusted and inclusive. Together, we will completely shift how CBD is perceived, powering a movement the industry has not seen to date.”

Research Ramps Up

CBD and other cannabinoid research is ramping up. According to Chris Adlakha, PharmD, of Elevated Wellness, Texas, the lack of longitudinal studies in CBD and cannabis research leaves a lot of room for research including RCTs to be conducted. What we have seen in the interim, has been sensational.

More compelling research Dr. Adlakha pointed to shows “patients with epileptic issues can use CBD safely and as an effective treatment, as long as it contains the right types of minors and terpenes like CBDV, THCV, linalool, etc. Studies of CBD are being done on individuals with psoriasis, multiple sclerosis, and Parkinson’s, among others. With this said, we still have a long way to go with medical controlled testing.”

That said, he added, anecdotal evidence currently points to CBD’s outstanding benefits for relaxation and stress reduction. As an example, according to Dr. Corroon, a recent study published in the JAMA Network Open1 demonstrated that 300 mg of CBD daily reduced emotional exhaustion and burn out symptoms among frontline health care professionals working with COVID-19 patients However, he cautioned, “Most CBD-containing retail products are sold in the 15-30 mg per serving range, which makes it hard to achieve what was used in this study.”

Dr. Palmer agreed that cannabis research is still in its infancy, but there are a few compelling published clinical trials to demonstrate the mechanisms of CBD. She related that one of her favorite studies is a randomized, placebo-controlled study that recreated a situation likely to induce distress in most people, namely public speaking. Participants’ stress levels were measured using subjective self-report and objective physiological measures (e.g., heart rate and blood pressure). The group that used CBD showed significantly less nervousness, cognitive impairment, and discomfort in performing public speaking compared to the placebo group.2

In a case study review, she added, patients who reported stress and sleep issues were given CBD capsules ranging from 25 to 175 mg CBD daily for up to three months. On average, mental resilience and sleep improved for most patients initially in the first month. Over time, anxiety continued to improve in most patients, although sleep improvement was not sustained over the long term.3

She commented, “In addition to these and other studies, the FDA (U.S. Food and Drug Administration) approved a CBD isolate drug called Epidiolex for the resolution of specific severe epileptic conditions, which further supports the therapeutic benefits of this plant-based medicine.”

Along with several other CBD manufacturers, Charlotte’s Web participated in a clinical trial (managed by ValidCare) that included 839 adults who have been using oral CBD for at least 60 days. Participants were required to get liver enzymes tested at end of the study. Researchers found that all of the 839 participants showed zero liver toxicity, demonstrating solid safety.

Charlotte’s Web is working in conjunction with researcher Staci Gruber, PhD, associate professor of psychiatry at Harvard Medical School and Director of The MIND Program at Mclean Hospital in Belmont, MA, Dr. Palmer reported. “Together we are conducting two studies to investigate the efficacy of a custom-formulated, hemp-derived CBD product. Clinical trial results are to be published in 2022. Dr. Gruber is also conducting a number of other studies, including a longitudinal observational study of veterans who use a Charlotte’s Web product.”

Recommending CBD

While the research Dr. Adlakha cited about CBD in disease states is compelling and supportive of its health-promoting abilities, your clients/patients are likely not dealing with such drastic issues but can still experience the benefits.

According to Dr. Corroon, there are three conditions where scientific evidence and clinical experience suggest effectiveness of CBD as a treatment option—stress/anxiety, sleep disturbances and neurological disorders; he recommends practitioners to read a recent review article, “Cannabidiol, A Race to Relief” by Ethan Russo, MD, a neurologist and cannabis researcher, in HerbalGram, #127.

“It’s important for people to understand that CBD is not a magic bullet,” he emphasized. “It doesn’t solve every problem. It can be very effective, however, especially when used in combination with other diet and lifestyle interventions.”

Based on results of a blind survey answered by CBDistillery (Denver, CO) customers, CBD is typically used for better sleep, improved relaxation as well as reduced stress and discomfort, Terwilliger reported. Specifically, according to the survey, eight out of 10 CBD users report that they found relief for pain after physical activity with CBD; 88 percent of CBD users report that CBD helps with mild or temporary anxiety, and nine out of 10 CBD users calm their mind with CBD. Other data included 73 percent of CBD users prefer CBD over a glass of wine to relax, and 89 percent of CBD users reported that CBD helped get better sleep.

“As naturopathic doctors we pride ourselves on identifying the root cause of imbalances, but too often, we overlook the endocannabinoid system in that process,” related Dr. Palmer. “When we fail to include ECS function in a clinical assessment, we risk missing a significant piece of the puzzle, especially considering the types of chronic conditions that land in naturopathic offices. Clinical endocannabinoid deficiency syndrome may not yet be an ICD-10 code, but it should still be part of our holistic diagnostic approach.

She pointed to a theory proposed by prominent cannabis researcher Ethan Russo, MD, who believes there exists a possible link between endocannabinoid deficiency and common, chronic, and complex ailments such as fibromyalgia, gastrointestinal and neurological conditions. While naturopaths have widely encompassing toolboxes for addressing these conditions, failing to address the role of the endocannabinoid system in healing may eliminate the opportunity for more expedient and complete symptom resolution.

She commented, “One of the pivotal factors preventing doctors from standardizing endocannabinoid diagnostics in their clinical assessment is a lack of effective testing methods to measure endocannabinoid production. The endocannabinoids anandamide and 2-AG are metabolized quickly after they initiate actions, making it impossible to quantify them in real life settings.”

What to Expect

The CBD space is hot and more of your clients will be curious and eager to learn how the CBD products you recommend can help them restore, revitalize and tackle any issues. Stated Brown, “The future of cannabinoid products is bright due to the countless applications of pure, isolated minor cannabinoids, including CBG, CBN, CBC, THCV and CBDV. There is still a great deal to be discovered and understood about the therapeutic potential of cannabinoids such as THCV and CBN. As research institutions continue to garner the resources to organize and publish clinical trials and rare cannabinoid processors begin to yield consistent purity and scale in the production of these powerful cannabinoids, we believe there is a great deal of potential for rare cannabinoids to transform health and wellness.”

According to Dr. Adlakha, researchers are learning more and more about all the chemical compounds in cannabis/hemp, which there are many. A primary goal in understanding the hundreds of chemical compounds in cannabis/hemp is to gain the ability to make products that better cater to specific ailments, needs or health issues, providing a higher rate of success with patients and users, he related.

CBD and the myriad other cannabinoids have a strong future in the naturopathic practice.

References:

1 JAMA Network Open, 2021 Aug 2;4(8):e2120603.

2 Neuropsychopharmacology 2011 36,6, 2011, 1219-26.

3 Perm J 2019;23:18-041)\.

Healthy Take Aways

• Recent research showed that CBDA can help manage inflammation response.
• There are three types of CBD that are sold: full-spectrum, broad-spectrum and isolate.
• Nearly 30 percent of CBD users are consuming CBD daily or multiple times per day.

For More Information:

Balanced Health Botanicals, www.balancedhealthbotanicals.com
CBDistillery, www.cbdistillery.com
Charlotte’s Web, www.charlottsweb.com
CV Sciences, www.cvsciences.com
Elevated Wellness, www.elevatedwellness.com
Green Roads, www.greenroads.com
Open Book Extracts, www.openbookextracts.com