CBD: What’s all the fuss?

It seems like you can’t turn around these days without seeing something related to CBD, or cannabidiol, products. A neighbor recently asked me what, if anything, I knew about the health benefits of CBD oil. I had recently read an article in Consumer Reports, which provided a little bit of insight, but her query made me want to delve a little deeper – for my own knowledge and to field potential questions from my coaching clients. I’ve tried to simplify what I have learned into a few key questions and answers below:

What is CBD?

Cannabidiol, or CBD, is a compound extracted from both the marijuana plant as well as its close relative the hemp plant. One of the most important things to know upfront is that CBD does not get users high. It is another compound in marijuana – THC or tetrahydrocannabinol – that produces its psychoactive properties.

 

What do people use it for?

A growing body of preliminary research suggests some of CBD’s properties may improve health. Early studies suggest that CBD affects the endocannabinoid system (ECS), which is a series of receptors found throughout the body that are involved in regulating many of our critical biological processes. These processes include sleep, memory, mood, and metabolism. Because CBD stimulates the endocannabinoid system, it is believed to help promote homeostasis in the body, reducing the sensation of pain and inhibiting inflammation.

Due to its purported anti-inflammatory properties, many individuals use CBD products to relieve pain from things like arthritis as well as general muscle soreness. Another popular reason cited for its use is to reduce stress and anxiety. Others report that it improves sleep.

 

Does it work?

The jury is still out, primarily due to a lack of sound, scientific research (e.g., randomized controlled trials, which are the gold standard when it comes to research). Many experts point out that most CBD product claims are based on anecdotal evidence, as it is still an unregulated industry at this time. The strongest scientific evidence is for CBD’s effectiveness in treating two rare but devastating forms of childhood epilepsy. In July 2018, the FDA approved the first prescription medicine (Epidiolex) with CBD as its active ingredient to help those patients manage seizures.

Scientists admit though that one of the key reasons for the lack of scientific evidence is due to government rules that have prevented federal money from being used to research CBD’s possible health benefits (more on that in the next section). The good news is some of those regulations are being lifted and just last year, the National Institutes of Health awarded $140 million toward cannabis research, with $15 million dedicated to CBD studies.

 

Is it legal?

Unfortunately, there is no simple answer to this question as there are different laws and regulations at the state and federal levels. It starts with the fact that for decades, federal law did not differentiate hemp from other cannabis plants. The 1970 Controlled Substances Act banned cannabis of any kind. This recently changed with successful passage of the Agriculture Improvement Act of 2018, which essentially allows farmers to grow hemp and legalizes hemp derivatives like CBD. It also removes CBD extracted from hemp from the DEA’s list of “Schedule 1 drugs” (whereas marijuana and THC remain on the list). These changes should allow for more research, BUT now that the FDA has approved a CBD-based prescription drug, it is recommending that any product that markets CBD for health purposes should go through its rigorous official drug approval process. And we know that that can mean years of research and scrutiny before products make it to market.

In addition, the FDA has indicated that when CBD is added to food, it is then considered a “food additive” – and the FDA has not yet approved CBD for that purpose. Unfortunately, this has left health officials in many states in the position where they feel the need to crack down on food and drinks with CBD. The good news in all of this is that it is pushing the FDA to determine how to regulate CBD and clarify the current confusion over its legal and regulatory status. So, stay tuned for a more definitive answer regarding the legality of CBD products.

 

Bottom line

I am glad that my neighbor’s inquiry prompted me to learn more about CBD and its potential health benefits. I think I am more open to trying it to see if it helps with either stress relief and possibly joint pain (my knees and hips are starting to show their age). However, I plan to discuss it with my physician at my annual physical this fall, just to get her professional opinion about it and to make sure there are no reasons I should not take it.

Below are some general recommendations to consider before you try CBD:

  • It is always a good idea to talk with your healthcare provider before taking any kind of supplements that are not regulated by the FDA. You want to ensure that CBD products will not interfere with any other medications (prescription or over the counter) you are taking. You also want to be sure CBD products will not aggravate any existing medical conditions.

 

  • Do your research on the quality of the products and pay particular attention to the actual contents of the product. Many online products that were tested had less CBD than advertised and some had no CBD at all. You can ask to see the Certificates of Analysis (COAs), which provide results of tests related to the actual contents of the products. Any reputable company should be willing to share those results.

 

Sources:

Consumer Reports article October 2018 issue – “New Hope for Pain Relief?”

Consumer Reports article May 2019 issue – “CBD Goes Mainstream”

Harvard Medical School Health Blog: https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476

Green Compass Global: https://greencompassglobal.com/The-Science/?mitem=28279

Brookings Institution: https://www.brookings.edu/blog/fixgov/2018/12/14/the-farm-bill-hemp-and-cbd-explainer/

Complementary Approaches to Health

As I mentioned in a recent post, the outer ring of the Wheel of Health focuses on Professional Care, which may include both conventional and complementary approaches to healthcare. A primary goal of integrative medicine is to erase the distinction between conventional and complementary approaches and instead encourage the use of the most effective, evidence-based modalities across the continuum.

 As a public health professional, I absolutely believe in the importance of prevention and primary care services that are typically obtained through more traditional or “Western medicine” practices. However, I also believe in, and have experienced firsthand, the benefits of more complementary approaches, many of which are grounded in more “Eastern medicine” traditions. I have had conversations with many individuals who are skeptical about the effectiveness of complementary approaches. My belief is that if you are open to these approaches and believe they can help you, they will. Whereas if you are skeptical and doubtful of their effectiveness, they likely won’t work for you. I feel fortunate that we all have a choice when it comes to deciding what treatments we seek to help us achieve and maintain our health and wellbeing.

Firsthand experience

I’d like to share my experience with some complementary approaches I have used to help manage anxiety. I have dealt with anxiety since I was a young child. One of the ways my anxiety manifested itself was through a nervous habit of biting the inside of my cheeks. I would chew away as I ruminated on my many worries about school, family, fitting in and all the other concerns of an adolescent trying to find her place in the world. I didn’t think much of it as a kid, but I became more self-conscious about it as I matured. I imagine I looked pretty silly with my mouth contorted to one side or the other. When my husband gently inquired about this habit, it made me realize it was noticeable to others and not something I could keep hidden.

I knew I wanted to break this habit but felt powerless to do so. As anyone who has tried to stop a long-standing habit knows, it can be incredibly difficult to change the behavior. I tried chewing gum to keep my mouth occupied. I tried that bitter tasting chemical that is supposed to help you stop biting your finger nails. I decided to try therapy, to address the underlying issue of anxiety. It helped manage the anxiety to some degree but didn’t break the habit. I eventually decided to see a psychiatrist and try anti-anxiety medication, which to me was a last resort. I try to avoid prescription medications unless absolutely necessary. I started taking a relatively low dose of an SSRI (selective serotonin reuptake inhibitor, a class of drugs commonly used to treat depression and generalized anxiety disorder). I would say it took the edge off a little, but it wasn’t solving the problem I wanted to fix which was the cheek biting. I weaned off the medication after about two years, as it wasn’t doing enough, and I did not feel like trying different medications.

At that point, I felt stuck and resigned myself to living with this habit. Then one day my husband came back from a weekend of camping with some friends and shared some interesting news. A couple of the guys had shared that they were working with a local shaman to help resolve some physical and mental health issues – and that this shaman was essentially a miracle worker, curing their ills. I was somewhat taken aback as these gentlemen are well-educated, highly respected professionals…and the first image conjured up in my mind when I heard the word shaman was “witch doctor.” My curiosity was piqued. My husband gently suggested that perhaps this shaman could help with my cheek biting. I was skeptical at first but willing to try anything to get some relief.

I went for my first visit with the shaman and left feeling like a new person. I had not really experienced energy work before, but I felt like he literally wiped away all negative energy that had been present in my body. It took about three or four sessions to kick the habit, but I did stop biting my cheeks. It felt like a huge weight had been lifted from my shoulders. I did experience an occasional relapse, but I would go in for a booster session and be good as new. The only downside to the experience was the cost – it was several hundred dollars per session and not covered by insurance. For me, it was worth every penny, but I realize I was fortunate that I could afford to seek his services.

I stayed free from my nervous habit for a couple of years but then started to experience more relapses. At this point, our financial situation had changed and we did not have as much disposable income to spend on these services. I sought some less expensive opportunities involving energy work, but they were not as effective at stopping the cheek biting. I felt resigned again to just live with it but knowing that it was possible to break the habit made me continue to seek other options. One day I was doing some internet research about cheek biting and stumbled upon individuals who had success with hypnosis. I was intrigued but skeptical again, as all I knew about hypnosis was the Vegas-style shows where some volunteer from the audience gets hypnotized and does silly things on stage to entertain the crowd. As I read more, I realized that hypnosis was different than that and many people have used it to help stop smoking or to lose weight.

I was hesitant to take the leap until I found a local practitioner who also happened to be a fellow graduate of the Duke health coaching program I attended. This connection gave me the courage to reach out and make an appointment. Once again, it took a few appointments to completely kick the habit. However, in the past year or so since I first underwent hypnosis, I have only had a couple of minor relapses that were easily fixed with a one-time booster session. The cost of hypnosis is much more reasonable and since I sought the services to help address a health issue (anxiety), I have been able to use our Health Savings Account to cover the cost.

I will readily admit that I don’t know exactly how the energy work and the hypnosis helped me break this habit. When I questioned the shaman about how his therapy works, he really couldn’t explain it. His response was basically “if it fixed your problem, does it really matter how it works?” He’s got a point. From what I have read about hypnosis, it is a way to access a person’s subconscious mind to help implement the desired change. The hypnotist serves as a guide, using suggestions that can help you modify your behavior and achieve your goals. Regardless of how these approaches work, I am grateful that they have helped me when conventional healthcare couldn’t. I encourage you to consider exploring complementary approaches if you are not achieving the results you desire through more traditional means.

A little bit about me

It all started with being a fat kid. I know that’s not PC in today’s world, but it’s the truth. From a pretty young age, I used food for comfort – to deal with stress at home or in school, to celebrate happy events and to block out sadness and avoid other “icky” emotions. I was a classic emotional eater (and it was oh-so-easy with an Italian grandmother who loved to cook). I also wasn’t very active and so naturally, the pounds started piling on. As you can imagine, being overweight as an adolescent is NOT fun. I was teased and nagged about my weight, struggled to find clothes that fit, and judged myself for how I looked and felt, inside and out. Good times!

Fast forward a couple years to junior high. I made a friend who accepted me for who I was and helped me learn to love myself. She encouraged me to try out for school sports, and not surprisingly, once I became more active, the weight gradually started coming off. This was about the same time that Oprah had her first public victory with weight loss. Remember the episode where she pulled out the wagon loaded with fat equivalent to the pounds she had lost? I was glued to the set and wrote in my journal that day that if Oprah could do it, so could I. I did succeed at losing weight and getting fit – and that experience sparked a lifelong interest in wanting to help others be healthy too. Hence, my current role as a health coach.

Unfortunately, like Oprah, I have struggled most of my life to maintain a healthy weight – mostly because I love to eat! In college, I gained and lost the “freshmen 15” at least once or twice (those Ben and Jerry’s® pints were my kryptonite). When I finally entered the working world after finishing grad school, I had the time, money and energy to eat healthy, join a gym and get back in shape.  I lost weight for my wedding, then gained more than I needed to with my pregnancy a few years later. I turned to a weight loss support group to lose the baby weight and for the most part, kept it off as I entered my forties. For the past few years I have gained and lost the same 5-10 lbs, so I finally decided to break this vicious cycle by adopting a mindful approach to weight management. I’ll be writing about that in some future posts, but more and more evidence is showing that traditional “dieting” does not work. In fact, it works against you.  Weight management is as much about how you eat as what you eat.

Weight management has probably been my biggest challenge health-wise, but I have also struggled with anxiety and stress management (which definitely contributed to that emotional eating habit I mentioned previously). I have read self-help books and pursued counseling in the past, but the best thing I have done for myself in this arena is adopt a daily mindfulness meditation practice. I’ll be blogging about that too! I was first exposed to the Mindfulness Based Stress Reduction (MBSR) program in 2010. For the first several years, my practice was a bit erratic – I’d keep at it for months at a time and then fall off the wagon, so to speak. It is in the last year really, that I found the right tools and resources for me that have helped solidify my practice. If I could give only one piece of health advice to anyone who asks, it would be to adopt a daily meditation practice. To me, it is the closest thing we have to a “magic pill” as it can have a beneficial impact on so many areas of your health and life.

The reason I share my story is twofold – it gives you a little insight into my own journey toward optimal health and demonstrates that we all have the power to own our health and make choices every day that lead us to a healthy, happy life.