Potential Therapeutic Effects of Full Spectrum CBD Oil

Full-spectrum cannabidiol (CBD) oil is a hemp extract that contains a myriad of cannabinoids, terpenes, and flavonoids found naturally in whole cannabis and hemp plants. As opposed to pure CBD isolate, a single-molecule extract made from hemp plants, full-spectrum CBD oil contains a wide range of phytochemicals that work in concert to modulate the endocannabinoid system and potentiate therapeutic effects. This paper will provide an overview of the physiological actions, uses, dosing, and safety considerations of full-spectrum CBD oil.

The Endocannabinoid System


The endocannabinoid system is a complex physiological system for maintaining homeostasis that is composed of cannabinoid receptors, endocannabinoids, and enzymes.1,2,3 Cannabinoids are naturally occurring molecules found in hemp and cannabis plants that modulate endocannabinoid function. Over 100 cannabinoids have been isolated from cannabis plants, including CBD, a nonintoxicating cannabinoid, and tetrahydrocannabinol (THC), the compound responsible for the intoxicating effects of cannabis. Other cannabinoids of interest to researchers for potential therapeuticeffects include cannabigerol (CBG), cannabichromene (CBC), and cannabinol (CBN). In raw or unheated cannabis, precursor cannabinoids in their acidic form can be isolated, including cannabidiolic acid (CBDA) and tetrahydrocannabinolic acid (THCA).

Terpenes are naturally occurring aromatic molecules responsible for botanical aromas and flavors present in hemp and cannabis plants, as well as fruits, vegetables, trees, herbs, and flowers. Terpenes are Generally Recognized as Safe (GRAS) by the Food and Drug Administration (FDA) and other regulatory agencies.4

Organisms use terpenes in innumerable natural processes to communicate with their environment and serve in functions such as protection and reproduction. Terpenes are essential to the entourage effect, which is the synergistic effect of cannabinoids, terpenes, and flavonoids on physiological processes. Terpenes have varying physiological effects that likely contribute to the therapeutic effects of full-spectrum CBD oil.

For example, myrcene may have anxiolytic, antioxidant, anti-aging, anti-inflammatory, and analgesic properties.5 Beta-caryophyllene may modulate inflammation by reducing pro-inflammatory modulators.6 Alpha-bisabolol has been studied for potential benefits, including neuroprotective and antimicrobial effects.7

Flavonoids are a class of naturally occurring molecules that provide pigmentation and protect plants against damage from ultraviolet radiation, pests, and disease. They are of emerging interest to researchers in their potential synergistic action on the endocannabinoid system in concert with cannabinoids and terpenes.8

 

Potential Therapeutic Uses

The U.S. Drug Enforcement Administration (DEA) classifies cannabis as a federally illegal Schedule 1 controlled substance, a designation that strictly limits research on the potential therapeutic uses. An analysis of research funding between 2000 and 2018 in the United States, Canada, and the United Kingdom found that of the $1.56 billion that was directed to cannabis and cannabinoid research, about half of the money was spent on understanding the potential harms and misuse, rather than the therapeutic benefits.9 As a result of regulatory constraints, the body of research is limited on the possible therapeutic benefits of cannabinoids and hemp- and cannabis-derived products.

Although more rigorously conducted controlled trials are needed to assess the benefits of full-spectrum hemp and cannabinoids, preliminary evidence shows potential for various therapeutic areas of interest. Preliminary studies on full-spectrum hemp and CBD have included investigation of a wide range of therapeutic areas, including but not limited to: addiction,10 anxiety,11 autoimmune diseases,12 cardiovascular disease,13 diabetic complications,14,15 epilepsy,16 gastrointestinal disorders,17 inflammatory bowel disease,18 migraine,19 nausea,20 neurodegenerative diseases,21 pain,22 posttraumatic stress disorder (PTSD),23 psychosis,24 and sleep disorders.25

The following is a brief review of the evidence for selected therapeutic areas of interest.

 

Addiction

A limited number of preclinical studies suggest that CBD may have therapeutic properties on opioid, cocaine, and psychostimulant addiction.10 Some preliminary data suggest that it may be beneficial in reducing tobacco addiction.26

Preliminary studies show CBD could potentially be useful for alcohol addiction.27 In animal studies, CBD reduces alcohol intake and motivation to drink. Preliminary evidence suggests that CBD may have therapeutic potential for alcohol-related liver and brain damage.28

Some research shows that CBD may be a potential treatment for opioid use disorder by craving and relapse and through its anxiolytic properties.29,30,31,32 A review of preclinical and clinical reports regarding the effects of CBD as a therapeutic intervention for substance use disorder found that CBD may reduce the consumption, motivation, or relapse of alcohol, opioids, and stimulants. The review also found that CBD may also reduce withdrawal signs of morphine and cocaine.29

 

Anxiety

According to the National Institute of Mental Health (NIMH), an estimated 19.1% of U.S. adults had any anxiety disorder in the past year.33 Females had a higher past year prevalence for anxiety disorder (23.4%) than males (14.3%). Researchers are investigating the endocannabinoid system as a therapeutic target for new anxiolytic drug development.34 CBD interacts with the cannabinoid type 1 receptor (CB1R), the serotonin 5-HT1A receptor, and other receptors in the brain that regulate fear and anxiety-induced behaviors.11

Studies have found that CBD inhibits the fear of public speaking, one of the main symptoms in patients with generalized social anxiety disorder.35,36 Patients treated with CBD had significantly reduced anxiety, cognitive impairment, and discomfort compared to placebo. In an open-label 4-week trial in 14 patients with moderate-to-severe anxiety, treatment with a full-spectrum high CBD product showed significantly reduced anxiety as well as improvements in mood, sleep, and quality of life.37 Additionally, CBD can offset the common side effect of anxiety caused by THC in cannabis or cannabis products.38

 

Diabetes

A growing body of evidence shows that endocannabinoid system imbalances are related to metabolic regulation, obesity, and hyperglycemia, leading to an interest in the endocannabinoid system as a pharmaceutical drug development target for the treatment of diabetes.14 The endocannabinoid system plays an important role in pathophysiological processes related to diabetic complications, such as vascular inflammation, oxidative stress, diabetic nephropathy, atherosclerosis, and neuropathy. It is possible that the antioxidant and anti-inflammatory properties of CBD and other cannabinoids may be beneficial in the treatment of cardiovascular and other complications associated with hyperglycemia.15

 

Epilepsy

Various ancient cultures have historically used cannabis to treat epileptic convulsions. CBD has been most thoroughly studied in the treatment of epilepsy compared to other conditions. Several randomized clinical trials have shown the effectiveness of CBD in epilepsy.39,40,41 In June 2018, the FDA approved the first CBD product, Epidiolex®, to treat Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex in patients 1 year of age or older.42

 

Gastrointestinal Disorders

Gastrointestinal tract function and homeostasis is thought to be modulated by the endocannabinoid system, including control of motility, secretion, and epithelial barrier function. Cannabinoids have shown potential for therapeutic uses in gastrointestinal disorders including inflammatory conditions, disorders of motility, abdominal pain, and the prevention of nausea and vomiting.17,20

 

Migraine

The endocannabinoid system is known to modulate the formation of migraine headaches through a variety of mechanisms, including glutamine, inflammatory, opiate, and serotonin. A review of studies on cannabinoids for migraine and headaches found several beneficial long-term and short-term effects, including decreased daily analgesic intake, dependence, and level of pain intensity.19

 

Neurodegenerative Diseases

Alzheimer’s disease is the most common neurodegenerative disease, characterized by a progressive decline in memory and cognitive and behavioral functions. Current therapies are limited in effectiveness. The neuroprotective, antioxidant, and anti-inflammatory properties of CBD are of interest to researchers in the treatment of Alzheimer’s disease.43

The endocannabinoid system is also increasing interest to researchers as a potential therapeutic target for Parkinson’s disease, a progressive disorder of the central nervous system that affects movement and the second-most common neurodegenerative disease after Alzheimer's disease.44 CBD has been studied for its potential neuromodulatory and neuroprotective effects in Parkinson’s disease.45

 

Pain and Inflammation

In the context of the opioid crisis, there is increasing interest in studying the endocannabinoid system as a drug target for pain. Neuronal and immune cell functions play a role in pain, and the endocannabinoid system modulates both cell types. Preclinical evidence suggests the potential for cannabinoids in the treatment of neuropathic pain and acute and chronic inflammatory pain.46

 

Full-spectrum hemp oil has shown therapeutic potential in chronic neuropathic pain studies in mice.47 Study results are mixed on the potential of CBD to alleviate acute and chronic pain in older adults.48 Cannabinoid receptors are present in immune cells, suggesting that the endocannabinoid system plays an important role in modulating immune function. Therefore, CBD is of increasing interest to researchers due to its potential anti-inflammatory properties.49,50,51

 

Posttraumatic Stress Disorder

The endocannabinoid system is likely to be involved in posttraumatic disorder (PTSD) symptomology, a mental health disorder that is developed after experiencing traumatic events.23 PTSD can include somatic, cognitive, affective, and behavioral symptoms. Considerable overlap exists between PTSD and other psychiatric conditions, such as anxiety disorders and depression. CBD has been shown to facilitate fear extinction through its action at CB1 receptors. CBD may affect PTSD through action at the amygdala and the hippocampus in the brain.52

 

Sleep Disorders

According to the Centers for Disease Control and Prevention, an estimated 70 million adults in the U.S. live with chronic sleep disorders.53 Preliminary research suggests that CBD may help regulate sleep, and it may be of potential therapeutic benefit for a number of sleep disorders,25 including insomnia,54 REM sleep behavior disorder,55 and excessive daytime sleepiness.56

 

Dosing

Appropriate dosing of full spectrum CBD oil can be difficult to determine because of limited studies, the variable nature of hemp plant composition, and a wide range of results from extraction methods. Inconsistencies in product formulations and labeling accuracy in full-spectrum CBD oil on the market present additional challenges in determining the proper dosage. Optimal doses may depend on individual factors, such as body weight, age, the condition being targeted, and individual physiological differences.

A systematic review of 35 CBD studies found that doses studied spanned a wide range, between less than 1 mg/kg/day to 50 mg/kg/day.57 The review found that studies that used higher doses tended to have better therapeutic outcomes compared to lower doses overall; however, more studies are needed to determine the therapeutic dosing range. Lower cannabinoid doses are less likely to cause drug interactions or side effects.

The most rigorous CBD dosing information available comes from studies on Epidiolex® (CBD oral solution), the only FDA-approved CBD product for the treatment of seizures associated with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex in patients 1 year of age and older.42 The recommended dosing of Epidiolex® is calculated by the weight.

However, clinicians and patients should be aware that Epidiolex® dosing recommendations cannot be extrapolated to dose full spectrum CBD oil because Epidiolex® is purified CBD and lacks other natural components such as terpenes and cannabinoids. There are currently no FDA guidelines for full-spectrum CBD oil dosing. In the absence of official guidelines or recommendations, experts often recommend a “start low, go slow” approach for cannabinoid dosing, meaning to start at a low dose and then titrate up as tolerated based on individual symptoms and response.58

 

Safety

CBD is generally well tolerated with mild side effects.60,61 The World Health Organization Expert Committee on Drug Dependence found in 2017 that CBD “exhibits no effects indicative of any abuse or dependence potential.”62

 

The following are some of the potential side effects and risks of CBD:61

  • Liver damage
  • Sedation
  • Diarrhea
  • Changes in appetite
  • Mood changes

 

In large studies of CBD treatment for epileptic patients, adverse effects of CBD included drowsiness, decreased appetite, and diarrhea.63,64,65 Elevated liver function was observed in some patients. Therefore, the FDA recommends liver function tests before beginning Epidiolex® treatment, and at 1 month and 3 months after beginning treatment. Caution should be exercised in prescribing full-spectrum hemp oil or CBD to patients with decreased hepatic function.

Consumers should look for reputable sources of full-spectrum CBD oil with quality control measures including laboratory testing for contaminants, such as heavy metals and phthalates.66 The FDA has issued warnings that CBD products on the market that do not contain the amount of CBD claimed on the label.67

Drug-Drug Interactions

CBD has known drug-drug interactions with many medications, especially those metabolized by cytochrome P450 (CYP450) enzymes in the liver, including but not limited to:68,69,70

  • Acetaminophen
  • Alcohol
  • Amiodarone
  • Anti-epileptic drugs
  • Antidepressants
  • Cyclosporine
  • Levothyroxine
  • Warfarin

 

Sedative effects can be compounded when combining CBD with other sedating drugs, such as benzodiazepines or antihistamines.

Conclusion

While preliminary research shows potential benefits, more rigorous studies are needed to determine clinical efficacy, dosing, and safety. Consumers should select full-spectrum CBD oil products from reputable sources with verifiable lab testing and rigorous quality control practices.

Disclaimer

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. We encourage you to speak with your medical provider to determine if a full-spectrum CBD oil is right for you.

 

About Blue Gem Hemp

Blue Gem® Hemp proudly makes premium Full-Spectrum CBD Oil. Two simple ingredients: organic, American-grown hemp and medium-chain triglyceride (MCT) oil, designed to elevate your self-care. Your Wellness. Our Passion.

 

By Simi Burn, PharmD

November 14, 2022

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