Chances are really good you’ve heard about CBD oil. It’s been making rounds through social media and is seemingly everywhere touting benefits for everything from pain to sleep to anxiety to epilepsy. It has become a huge industry with analysts predicting the market in the United States will reach $1 billion by 2020.(1) But, what is it, is it legal, how is it taken, what are the risks and does it work for IC? Those are the pressing questions!

What is CBD?

CBD is short for cannabidiol, which is the second most common active ingredient of cannabis (marijuana).(2) CBD is in medical marijuana, but it also comes from the hemp plant. Unlike THC, CBD by itself doesn’t cause a “high.” The World Health Organization reports that CBD doesn’t show any evidence of dependence to date and is generally tolerated well.(3)

Is it legal?

Legality is a big question since CBD can come from marijuana, which isn’t legal in all states. Its legality isn’t super clear-cut, but at the end of 2015, the FDA lessened its requirements to allow researchers to be able to do more research on CBD.(2) Its legality can also be impacted by whether the CBD comes from the hemp plant or the marijuana plant. Hemp plant derivatives are legal, but marijuana plant derivatives aren’t legal everywhere. Each of the 50 states in the United States now has some sort of law legalizing CBD.(2)

The other factor for legality, including whether it can legally be bought online and shipped, is how much THC (tetrahydrocannabinol) is in the CBD.(4) THC is the component of marijuana that causes a “high.” Some CBD contains trace amounts of it. It is legal to buy online and ship only if it contains less than 0.03 percent THC.(4)

How is it taken?

Oil is a common way to take CBD and is dropped under the tongue, held for a couple of minutes and swallowed. Knowing the exact dosage to take gets a bit murky. The FDA doesn’t regulate CBD for most conditions. In June 2018, the FDA approved CBD in a drug as a treatment for people with specific types of epilepsy, but that is the only medical condition for which CBD has been approved by the FDA.(5)

CBD Oil Review, a website that compiles information about CBD oil, reports that after analyzing hundreds of products, the serving suggestion they’ve come up with is 25mg of CBD twice a day.(6) The site also says that people should wait three to four weeks before increasing their dose in order to be safe. All of that said, you need to talk to your doctor before taking CBD or any other supplement.

While oil seems to be the most common form in which to ingest CBD, other options exist as well including edibles, vapor, capsules and topical creams.

What are the risks?

Though CBD can have a few side effects like nausea, fatigue and irritability, the biggest concern is that it is a supplement and not regulated by the FDA.(2) A study released in 2017 found that only about 31 percent of CBD products bought online were labeled accurately, 43 percent were under-labeled (meaning they had more CBD than the packaging said) and 26 percent were over-labeled (meaning they had less CBD than the packaging said).(7) The same study found that THC was detected in 21 percent of them. The most mislabeled CBD product was vaporization liquid (nearly 88 percent were mislabeled) and oil was the least mislabeled CBD (only 21 percent were mislabeled).(7)

Clearly label alone can’t always be trusted in this unregulated industry. And that means consumers need to be incredibly cautious and knowledgeable before they make a purchase. As a supplement, CBD isn’t covered by medical insurance. So, if you decide to try it, you need to know what to look for.

Unless they have a lab or take their CBD oil to a lab, consumers can’t know for sure the label on their CBD oil is accurate. But there are a few precautions that can help make sure you’re getting a decent product. First, find out where the hemp was grown and whether it was organically grown. Hemp grown organically in the United States is best because the stringent regulations to be considered organic are in place.(8) Organically grown hemp is important because the hemp plant gathers minerals from the soil and stores them in its tissues, so if it’s grown with pesticides and harmful chemicals then those same pesticides and harmful chemicals are going to be in the CBD produced from that plant.(8)

Next, look for a company that grows and extracts its own hemp as well as provides test results from a state-certified testing facility either openly or upon request.(8) You also want to find out how the CBD is extracted. CBD extracted through an organic ethanol wash is preferred, but CO2 extractions are also OK.(8) Check the inactive ingredients as well. CBD is best digested if it’s in an oil that contains Medium Chain Triglycerides like coconut oil.(8)

Of course, also use common sense for finding a trustworthy company. Look for a company with easy-to-find contact information that lists where its hemp is sourced and how it’s grown. Try calling and see if you get through or, at the very least, send an email and see if you can interact with a real person.(8)

Make sure to determine the level of THC in the product. It shouldn’t have more than trace amount of THC, but you can find CBD oil certified to have low or zero levels of THC in them.(4) Paying attention to the concentration levels will also help you decide which product is best and the best value. According to the National Pain Report, quality CBD products have between 250 to 1,000 mg of CBD per fluid ounce.(4)

A few other concerns come up with CBD as well. There are not many studies just yet on how it helps with most medical problems and there aren’t many studies on any of its long-term effects. It can also interact with other prescriptions so you shouldn’t take it without first talking to your doctor. During the studies of CBD for treating epilepsy, researchers found that CBD increased the amount of anti-epileptic drugs in the blood. Those patients had to change their dosing on their other medications when taking CBD.(9)

Also during the epilepsy treatment studies, there was some indication that CBD can harm the liver. About 10 percent of the people in the study had increased liver enzymes with 2 to 3 percent having to be pulled from the study because researchers were so concerned about the high level of their enzymes.(9) Even if your doctor can’t prescribe it, he or she needs to know if you’re taking it and may want to monitor your health more closely to make sure the CBD isn’t interacting adversely with your other prescriptions or body.

Does CBD help IC symptoms?

No studies have been released examining whether CBD helps IC symptoms. Some patients say it helps them; others say it helps other chronic pain conditions they have but it doesn’t help their bladder symptoms. Very minimal research has been done about CBD oil and chronic pain.

Some research has shown that topically-applied CBD can potentially help arthritis pain; other research has shown that it can potentially help with muscle spasms of multiple sclerosis.(5) Another study found that CBD can reduce pain and inflammation without patients building up a tolerance to its effectiveness and having to increase their dose, unlike with pain medications.(5)

As far as helping with anxiety and insomnia, the answer is the same. Minimal research has been done, but anecdotal reports seem positive.

The bottom line

CBD isn’t a cure-all. It isn’t a magical supplement that will take away your pain and alleviate all your woes. Such a miracle elixir would be nice! But it does show some promise for treating some conditions. However, a LOT more research is still needed before making those claims. And being an unregulated industry brings along significant additional risks. If you decide that trying CBD is right for you, first make an appointment and talk with your doctor. He or she can give you additional insight and address any concerns about CBD interacting with your other medications. Learn as much as you can to make the best decision for your health.

 

References

  1. Doheny K. As CBD Oil Flirts with the Mainstream, Questions about Its Effectiveness, Safety Mount. WebMD. June 5, 2018.
  2. Grinspoon P. Cannabidiol (CBD) – What we Know and What we Don’t. Harvard Health Blog. Aug. 24, 2018.
  3. Expert Committee on Drug Dependence. Cannabidiol (CBD) Pre-Preview Report. World Health Organization. Nov. 6-10, 2017.
  4. Havens A. 10 Things you Need to Know Before you Buy CBD Oil. National Pain Report.
  5. Johnson J. Does CBD Oil Work for Chronic Pain Management?. Medical News Today. Updated March 16, 2018.
  6. CBD Oil Review. 10 Strategies to Fine-Tune Your CBD Oil Dosage.
  7. Bonn-Miller MO, et. al. Labeling Accuracy of Cannabidiol Extracts Sold Online. JAMA Nov. 7, 2017.
  8. Key to Cannibis. CBD Buyer’s Guide – How and Where to Buy Legal, Organic CBD Oil.
  9. Thompson D. CBD Oil: All the Rage, but is it Safe and Effective?. WebMD. May 7, 2018.