As a natural practitioner, you’re very aware of the cannabidiol (CBD) boom. Your patients are asking you about it and you’ve already done quite a bit of reading. Maybe you’re excited about CBD, maybe you’re skeptical.
My story is similar. After practicing traditional medicine for decades with an emphasis on family medicine, then, on disease management, I felt there was something missing in my treatment plans and in traditional medical treatments, so I researched diet as a disease management tool and that lead me to hemp. As a food, hemp’s natural omega-3, protein and fiber profile is exceptionally complete. But it wasn’t until around 2014 I researched and started using hemp extracted CBD—combined with diet, exercise and sometimes other therapeutics—with my patients that had surprisingly effective results. I knew then that ignoring CBD was a disservice to my patients.
Many of my patients remained skeptical of CBD, as did many traditional medicine colleagues, but we’ve now turned a corner. The entire world is paying attention to CBD’s beneficial health properties. Even global organizations are embracing the natural benefits of CBD.
In 2017, the World Anti-Doping Agency reversed its position on CBD with the following statement “In reviewing the Prohibited List, experts examine such sources as: scientific and medical research; trends; and, intelligence gathered from law enforcement and pharmaceutical companies in order to stay ahead of those that endeavor to cheat the system.” Further distinguishing CBD from its cannabinoid cousin, THC remained on “the List.” In early 2018, the World Health Organization (WHO) issued a report stating it found no adverse health outcomes and several medical applications for CBD.
Human clinical trials of naturally derived CBD are lacking due in large part to laws and regulations surrounding research, even for hemp products. Regardless, today, my patients have moved from skeptical to curious. I find myself in a unique position of educating both patients and medical professionals, both of whom are understandably confused about CBD. I have read research and conducted pre-clinical trials of CBD since 2014, and I could not agree more strongly with WHO, that CBD is a powerful and benign compound.
One note, I work with hemp-extracted CBD. There are marijuana-derived CBD or CBD/THC combinations on the market, sold in dispensaries. All hemp-derived products on the U.S. market today use industrial hemp which is .03 percent or less THC. Using hemp-derived CBD removes concerns about the “high” associated with THC and allows me to refer patients to products which can be shipped directly to their home. For the vast majority of my patients, I have seen no advantage to using marijuana-derived CBD, so long as one is using a full spectrum CBD product. More on that later. If you wish to carry CBD products for your patients, you need not be in a medical marijuana or recreational marijuana state.
To understand CBD, it’s important to understand why it works and how it can be applied to your patients.
The ECS is the Body’s Master Regulator
Only discovered in 1992, the endocannabinoid system (ECS)—a connected system of ligands, receptors, and enzymes—is present throughout the entire body, regulating sleep, eating, mood and metabolism. Even today, few medical practitioners understand the ECS.
The body doesn’t see cannabinoids as drugs, the body sees cannabinoids as natural signaling molecules essential for optimal health. And, it sees plant-derived phytocannabinoids in the same way as valuable compounds necessary for special functions. But, the body doesn’t “crave” cannabinoids; it simply needs them in the same way it needs a full range of vitamins and minerals.
Cannabinoids have played a major role in human evolution. In fact, all mammals have an ECS. There is no doubt our bodies need cannabinoids to achieve homeostasis. Throughout history, humans probably did not suffer from cannabinoid deficiency until the 20th century when healthy foods became highly processed and [all cannabis species] hemp and marijuana became classified as drugs.
But consider the multitude of previously unknown illnesses that have surfaced during the late 20th century. Modern research discovered many conditions, but many others appear to have emerged because of modern-day changes in diet, exercise and societal demands. I do not believe the ever-growing list of health conditions coinciding with clinical endocannabinoid deficiency is a coincidence.
Research shows clinical endocannabinoid deficiency is found in a broad spectrum of syndromes, developmental, behavioral, degenerative and inflammatory conditions.1,2
Endocannabinoid signaling regulates a host of physiological processes throughout the body. In the brain, endocannabinoids regulate mood, memory, appetite, pain levels and reward.
Evidence shows that the ECS is integral to regulating neurotransmitters, immunity and even hormonal regulations through the hypothalamic-pituitary-adrenal axis.3 In addition, cannabinoid molecules get all the way down to the level of cellular metabolism in mitochondria.4 Cannabidiol actually reduces diabetes damage by enhancing mitochondrial bioenergetics and shifting glucose metabolism into the protective pentose-phosphate pathway in neurons.
Endocannabinoids also regulate insulin release5 and resistance along with a variety of gastrointestinal processes including gastric emptying and motility.
Let us not forget about the impact of inflammation on the entire body, including the immune system. The CB2 cannabinoid receptor is found primarily in the immune system. A dysfunctional immune system impacts all the body’s other systems including the central nervous system, adrenal axis, vascular system, digestive system, as well as tissues and organs. Clinical research on mice has even shown that cannabinoids can even help recovery from immune-mediated injury to organs such as the liver.6 Since so much disease today is due to inflammation, perhaps one of CBD’s most promising effects is its anti-inflammatory properties.
Like other systems in the body, the ECS can be thrown out of balance from trauma, stress and toxins. The foundational principles of health—diet, exercise, sleep and close relationships—normally help restore the ECS balance. Those principles may not be enough to make us or our patients healthy, because, for many people, the ECS is starving. Cannabinoids can nourish the ECS. That’s where CBD comes to the rescue.
CBD helps to restore the ECS by increasing levels of natural ECS substances, by inhibiting the FAAH (fatty acid amide hydrolase) enzyme that metabolizes cannabinoids. Additionally, CBD mimics some of those ECS modulating receptors that regulate neurotransmitters or excessive immune responses. CBD has been shown to have unique connections to receptors at the nucleus and mitochondria to make positive changes in energy production while protecting the cell from reactive oxygen species that can damage intracellular systems. We continue to learn more about the connections, right down to individual cells.7-9
Can you think of a single condition you treat which can’t benefit from a positive change at the cellular level? That’s what makes CBD so compelling to the medical community. CBD is a real boon to natural practitioners they can now use a highly effective full spectrum substance for a wide range of common health issues with no significant risk of interactions or adverse effects. Full-spectrum CBD is a natural addition to every practitioner’s medical bag.
Why Full-spectrum CBD Matters for Your Patients
The number of CBD products may overwhelm you. The most important piece of advice for natural practitioners is to use products that are organic and maximize the compounds of the entire plant.
As a natural practitioner, you understand how natural ingredients can work synergistically together. Such is the case with cannabinoids. The WHO report from last year specifically stated that “naturally occurring” CBD is safe and well tolerated in humans (and animals) with no negative public health effects.
Full spectrum (also referred to as “whole plant”) products keep all the cannabinoids, flavonoids, and terpenes in the hemp plant, as opposed to isolating them through an overwrought and sometimes solvent-based extraction process. Keeping this bounty of compounds together ensures they work together better for balanced health, performance and wellness.
Natural practitioners should look for full spectrum CBD extracted using C02 extraction, which is a natural, non-toxic, food-approved extraction process that protects the plant’s compounds during extraction. Beyond the Plant: Other CBD Considerations
Because of impending legislation, soon, we’re likely to see a huge increase of CBD products on the market. As a natural practitioner, what should you be looking for when treating or recommending CBD to your patients?
Besides full spectrum products, I recommend working only with brands who can show a third-party certificate of analysis (COA). Natural practitioners should look for results which include mold, bacteria, heavy metals and pesticide testing.
I am also an advocate for CO2 extraction. This extraction method is not only more environmentally friendly, but it also doesn’t use fossil fuels and it’s non-toxic. There are still products on the market extracted using solvents such as butane and alcohol. I see this as unnecessarily harsh and toxic if less expensive. Why expose a plant so naturally beneficial to such menacing additives?
Starting Your Patients on CBD—What to Expect
Unlike other treatments, “one size fits all” doesn’t work with CBD. The serving size you choose for your patient may have nothing to do with body size.
To find the right amount for an individual, start with the suggested serving size on the bottle and adjust the dose right away to control that person’s symptoms. Expect a clinical response in minutes after using sublingual formulations or one to two hours after capsules.
I have treated a wide range of conditions in patients using CBD. I’ve conducted a number of pre-clinical trials with my patients and almost universally they see improvements; sometimes they even experience what I like to call “side benefits,” unexpected positive improvements in mood, alertness, memory and activity.
Adverse reactions are rare with only occasional headaches and fatigue. In those cases, cut the next dose in half to optimize performance.
Drug interactions are a huge problem for all of us in the medical community, causing more than 2.2 million hospitalizations and 100,000 deaths annually. With CBD, drug interactions are rare and generally related to higher dosages above 200 mg. And rest assured, there is no such thing as CBD tolerance, addiction or withdrawal. Occasionally, I find my patients need less CBD over time to maintain the same effective results they received initially.
Timing is irrelevant as well unless the patient has some special issues. CBD can be taken with or without food, throughout the day and even before sleep. CBD won’t make someone sleepy but it will help get better quality sleep and recovery.
As for delivery methods, there’s no “wrong way” to treat endocannabinoid deficiency with CBD. That said, I prefer sublingual and vaping applications for their increased bioavailability. I have numerous patients who prefer capsules and I won’t discourage their use. Full spectrum topical applications can be incredibly beneficial to treat target areas. As with all topical products, the key is to review the supporting cast of ingredients to ensure your patient is using a full spectrum natural and plant-based topical CBD product.
Next Steps for CBD
Legislation is expected before the end of 2018 which will decouple hemp and marijuana on the Controlled Substances Act and make hemp farming more attractive. This legislation is included in the 2018 Farm Bill and known as the Hemp Farm Act of 2018.
Once this happens, there will be a huge increase in CBD products on the market, and I strongly suspect more and more retailers will start carrying CBD products. CBD products will enter a new phase of consciousness for many Americans.
I urge all medical practitioners to feel comfortable discussing CBD with their patients, as this product has been and will continue to be driven by consumer demand. Ready or not, here comes CBD. The ECS, and our understanding of it will revolutionize medicine in the next century.
4 Redox Biology 11 (2017) 577–585; http://dx.doi.org/10.1016/j.redox.2016.12.029.
7 Cannabidiol induced apoptosis in human monocytes through mitochondrial permeability transition pore-mediated ROS production. Free Radic Biol Med. 2018 Jun 22. doi: 10.1016/j.freeradbiomed.2018.06.023
8 Cell Death and Disease (2013) 4, e949; doi:10.1038/cddis.2013.471.
9 CBD activates the nuclear peroxisome proliferator-activated receptor-γ and the transient receptor potential of vanilloid type 1 (TRPV1) and 2 (TRPV2) channels while also inhibiting cellular uptake and fatty acid amide hydrolase–catalyzed degradation of anandamide (FAAH). Cannabidiol: Pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia. 2014 Jun; 55(6): 791–802. doi: 10.1111/epi.12631
Colonel Philip Blair, MD, is a family physician and consultant in disease management. He graduated from West Point in 1972, attended the University of Miami School of Medicine, trained as an Army family physician and served as a combat physician in the first Gulf War. After medical assignments on three continents and 29 years in uniform, he retired from the Army and has since been consulting on complex disease management since 2000 with patients around the globe. Since 2013, Dr. Blair has been studying, treating and lecturing about the body’s natural endocannabinoid system (ECS), including pre-clinical trials with PTSD (post-traumatic stress disorder) sufferers. ECS disorders appear to be the root cause of many chronic medical conditions. Dr. Blair serves as medical director of Pro Health Advisor, Inc., and Elixinol, LLC. His current goal is to restore health and wellbeing by restoring his patient’s ECS through diet, exercise, appropriate medications and non-psychoactive herbs, including hemp.