In the last few weeks the NHS approved two cannabis based drugs used to treat epilepsy and multiple sclerosis. (1) One of the drugs, Epidyolex, has shown to reduce the number of seizures in children by as much as 40%.(2) This particular drug is made up only of CBD…… but what is CBD?
What is CBD?
CBD stands for Cannabidiol, which is one of over 100 chemical compounds found in cannabis plants marijuana and hemp. CBD together which tetrahydrocannabinol (THC) are the two main cannabinoids within cannabis. (3) CBD, however, should not be confused with THC, as THC is the psychoactive component within cannabis and responsible for the ‘high’ experienced when using the whole cannabis plant.(3)
How does CBD effect the body?
CBD effects a system known as the endocannabanoid system (ECS), which is widespread within our bodies. The ECS effects areas such as the central nervous system (CNS), our brain synapses and how we respond to environmental input.(4)
What are the potential benefits of CBD?
Anti-anxiety and Sleep
CBD has shown to improve gamma-Aminobutyric acid (GABA) receptor signalling. GABA is our calming / relaxation neurotransmitter and the effect CBD has on this could be why it has shown to help relieve anxiety and improve sleep. (5,6)
CBD has also shown to reduce anxiety by connecting with specific CNS receptors which are known to manage our fear response and anxious behaviours. These include 5-HT1A a serotonin (so called ‘happy chemical’) receptor and CB1R (Cannabinoid receptor type 1). The former aiding with anxiety reduction and the latter reducing fear. (7)
Inflammation and Pain
Pain, in part, is dictated by our bodies inflammatory responses and one of the key players in this are molecules called pro inflammatory cytokines.(8) Animal studies have shown that CBD significantly decreases pro inflammatory cytokines, thus potentially supporting the use of CBD in inflammatory disorders.(9) Another animal study showed that the use of topical CBD reduced pain and inflammation caused by arthritis.(10)
Further human trials are needed to shed more light on this area, but the outlook is positive for CBD and pain.
Gastrointestinal health
CBD has shown to improve intestinal barrier integrity and function following damaged caused by Clostridium difficile infections.(11)
CBD may also have benefits for people with irritable bowel disease (IBD). A recent study found that CBD and palmitoylethanolamide (PEA) reduced intestinal permeability, otherwise know as leaky gut. (PEA is a fatty acid amide know to reduce inflammation).(12)
There is also more research in the pipeline as to whether CBD may be a option for people suffering from Crohn's disease. (13)
Where to buy quality, scientifically tested CBD?
The quality of CBD varies widely depending on where you get it. I have found that U.K company Provacan produce high standard products using organic hemp; as well as having their products independently tested by a 3rd party organisation. Check out their website for more information and recommendations - https://provacan.co.uk/
Who shouldn’t use CBD?
Pregnant and breastfeeding women are advised to avoid taking CBD.
CBD also interacts with the CYP450 enzyme and may effects prescription drugs metabolised through the CYP450 system. People taking these drugs should consult their doctor before using CBD.(14)
Angiotensin II blockers
Anesthetics
Antiarrhythmics
Antibiotics
Antidepressants
Anti-epileptics
Antihistamines
Antipsychotics
Benzodiazepines
Beta-blockers
Calcium channel blockers
HIV antivirals
HMG CoA reductase inhibitors (aka statins)
Immune modulators
NSAIDs
Oral hypoglycemic agents
PPIs
Prokinetics
Steroids
Sulfonylureas
Reference List:
1. Two cannabis medicines approved for NHS [Internet]. BBC News. 2019 [cited 26 November 2019]. Available from: https://www.bbc.co.uk/news/health-50351868
2. Sekar K, Pack A. Epidiolex as adjunct therapy for treatment of refractory epilepsy: a comprehensive review with a focus on adverse effects. F1000Research. 2019;8:234.
3. Genevieve Lafaye A. Cannabis, cannabinoids, and health [Internet]. PubMed Central (PMC). 2019 [cited 26 November 2019]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741114/
4. Lu H, Mackie K. An Introduction to the Endogenous Cannabinoid System. Biological Psychiatry. 2016;79(7):516-525.
5. Bakas T, van Nieuwenhuijzen P, Devenish S, McGregor I, Arnold J, Chebib M. The direct actions of cannabidiol and 2-arachidonoyl glycerol at GABA A receptors. Pharmacological Research. 2017;119:358-370.
6. Shannon S. Cannabidiol in Anxiety and Sleep: A Large Case Series. The Permanente Journal. 2019;.
7. Blessing E, Steenkamp M, Manzanares J, Marmar C. Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics. 2015;12(4):825-836.
8. Bruni N, Della Pepa C, Oliaro-Bosso S, Pessione E, Gastaldi D, Dosio F. Cannabinoid Delivery Systems for Pain and Inflammation Treatment. Molecules. 2018;23(10):2478.
9. Li H, Kong W, Chambers C, Yu D, Ganea D, Tuma R et al. The non-psychoactive phytocannabinoid cannabidiol (CBD) attenuates pro-inflammatory mediators, T cell infiltration, and thermal sensitivity following spinal cord injury in mice. Cellular Immunology. 2018;329:1-9.
10. Hammell D, Zhang L, Ma F, Abshire S, McIlwrath S, Stinchcomb A et al. Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. European Journal of Pain. 2015;20(6):936-948.
11. Gigli S, Seguella L, Pesce M, Bruzzese E, D’Alessandro A, Cuomo R et al. Cannabidiol restores intestinal barrier dysfunction and inhibits the apoptotic process induced by Clostridium difficile toxin A in Caco-2 cells. United European Gastroenterology Journal. 2017;5(8):1108-1115.
12. Couch D, Cook H, Ortori C, Barrett D, Lund J, O’Sullivan S. Palmitoylethanolamide and Cannabidiol Prevent Inflammation-induced Hyperpermeability of the Human Gut In Vitro and In Vivo—A Randomized, Placebo-controlled, Double-blind Controlled Trial. Inflammatory Bowel Diseases. 2019;25(6):1006-1018.
13. Cannabidiol Usage as an Adjunct Therapy for Crohn's Disease - Full Text View - ClinicalTrials.gov [Internet]. Clinicaltrials.gov. 2019 [cited 1 December 2019]. Available from: https://clinicaltrials.gov/ct2/show/NCT03467620
14. Iffland K, Grotenhermen F. An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis and Cannabinoid Research. 2017;2(1):139-154.