You’ve probably heard of CBD, and maybe you have questions: Should I try CBD oil? What are the benefits of CBD? Are there any side effects of CBD? Being a Rheumatologist and having many of my clients inform me that they’ve either tried CBD or are on it, I thought I’d spend some time getting more familiar with it and share what I’ve learned.

Quite frankly, with all the different paths of medical care available, be it traditional, naturopathic, holistic, functional, or integrative, etc., it’s hard for many of us providers to branch out. But clearly CBD oil is getting a lot of attention and is something I feel every health care provider needs to be aware of. So here’s my take on it.

First, I’d like to start with the drawbacks. I know, we’re all excited to hear the good stuff and, trust me, it’s coming (and some of it is rather interesting), but first, what’s the downside?

So, the downsides to the latest supplemental craze, CBD. . .

1. Little research:

The primary concern for CBD use is the shortage of scientific pre-clinical, research-based evidence. The first CBD-based medication came out in June 2018 and was FDA approved for a rare seizure disorder. There have not been many of these medications since and, consequently, as far as clinical research data, that’s about all we have right now, although there are many studies currently being conducted.

But such things as long term impact on the body and drug interactions and well as the mechanism by which CBD works is still not clearly understood.

2. Poor regulation in the USA / quality of product:

As of right now, there are no CBD-based supplements that have FDA approval for therapeutic use. What this means is that the actual ingredients of the products available can vary and, therefore, finding a quality product can be difficult.

The current recommendations are as follow:

A. Preferably, we should use products from Europe at this time secondary to the more stringent CBD regulations that they already have in place.
B. CBD products we use should be extracted by carbon dioxide and not solvents.
C. The product should be certified by the Department of Agriculture to be organic and devoid of pesticides and herbicides.
D. We should ensure that the product is not merely hemp seed oil.

Third-party lab tests are important to determine the cannabinoid content of a product. A Dutch study found that only 7 out of 46 tested brands contained any traces of cannabinoid at all.

3. Cost:

Unlike available traditional treatment options, CBD products are not covered by insurance.

CBD oil prices can vary tremendously. Perhaps the best way to know if you are spending the ‘average’ is to calculate the price per milligram. According to what I found, the average price from six popular trusted brands was $0.15/mg of CBD oil.

4. Side effects:

Thankfully, side effects are minimal. From the one CBD product that was FDA approved, the most common adverse effects reported were somnolence (feeling tired), decreased appetite, and diarrhea. Additionally, some peeps in the study had an increase in their liver enzymes.

So, if you’re on a CBD supplement, it may not be a bad idea to have your liver enzymes checked every now and again. Current recommendation is before you start, one month after you start, and again three months later. At this time, we still aren’t certain if there are any long term adverse effects on the body.


Okay, now for the good stuff. . . 

CBD is one of many compounds, known as cannabinoids, in the cannabis plant. What you may not have known is that we actually have our own cannabinoids already, most notably anandamide and 2-arachidonylglycerol. Our own cannabinoid system is known as the Endocannabinoid (Endo-can-a-binoid) System, or ECS for short. The ECS has been implicated in many disease processes and is primarily involved with regulating inflammation and a healthy gut.

So, what is CBD then?

Well, CBD is one of many Phytocannabinoids (Fight-o-can-a-binoids) – these are cannabinoids that come from plants, and the two most notable are THC and CBD.

I’ll be focusing on CBD in this series, and now that we got the downside out of the way, we can chat about the upside.

Check out:

Part 2: Is it Worth Trying?


Part 3: Dosing and 5 Questions to Ask to Ensure Quality

(The primary sources for my CBD series include an article by VanDolah, et. al, from Mayo Clinic Proc. 2019 Sept. 94, from another in Curr Opin Rheumatol, May 2019, and from information on CBD oil provided to me by Ludlow Pharmacy.)



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