S03E62 CBD or Cannabidiol - Magic Medicine or Snake Oil

Ever wondered about the buzz behind CBD? In our latest episode, we get up close and personal with this much-hyped compound, exploring everything from its potential benefits to its rather complicated legal status.

With my interest piqued after looking into help with my sleep sleep struggles, CBD oil started to look like a potential magic medicine. Let's take a deep look into what CBD actually is and how it differs from its infamous cousin, THC.

What is CBD? Is it legal? Where can you get it safely? Brace yourself for a fascinating dive. Remember, it's not just about getting on the bandwagon, it's about understanding what you're getting into. So tune in and get ready to bust some myths about CBD!

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#cannabidiol

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S03E62 CBD or Cannabidiol - Magic Medicine or Snake Oil

Sam Rhee: CBD or cannabidiol has been all the rage for the past couple years. I first heard about CBD when I did a podcast episode in 2021 with my two plastic surgery colleagues, Drs. Sal Pacella and Sam Jejurikar about using CBD for postoperative pain management. There were lots of anecdotes in the news at the time about how CBD was supposed to relieve pain, have neuroprotective effects, and even have cardiac benefits by reducing blood pressure by improving arterial function.

The hype grew even greater when all the celebrities jumped on board. Joe Rogan said he used it for his turf toe injury. Kim Kardashian said that she took CBD for her anxiety. Supposedly Tom Hanks uses CBD and even Martha Stewart's French bulldog was on the stuff.

After that, I started to hear a lot of athletes at the gym talk about using topical CBD for managing muscle soreness and to speed recovery. I also tried using a CBD cream for a [00:01:00] little bit, but I didn't like the smell. It was mixed with something menthol, so it reminded me of Ben Gay, and I wasn't sure, it wasn't doing much anyway for me.

But finally, about a month ago, I was talking to someone in my WHOOP group. I've mentioned on this podcast, this fitness tracker that I wear called a WHOOP, which measures HRV, heart rate variability and tracks all sorts of other things, such as exercise and calories burned.

But the main thing I use my WHOOP for is to track my sleep. I belong to an online group of about 30 athletes at my gym who use the WHOOP. We can see each other's sleep, fitness and recovery scores, and the WHOOP app ranks us according to these numbers.

It's a good way to incentivize us to try to keep staying healthy. There's nothing like gamifying something to add extra incentive to see if you can get a higher recovery or fitness score than someone else, but consistently, I am at the bottom or near bottom of the group every week when it comes to the amount of sleep I get. And my WHOOP friends know this and like teasing me about it, about how [00:02:00] bad my sleep scores are.

Out of the big four: nutrition, exercise, stress, and sleep, the one thing I still struggle with the most has definitely been sleep.

It's probably been a lifetime issue, but I have worked mightily for the past month or two to improve my sleep scores with mixed results. Nearly all of my sleep issues are self-inflicted. The main issue I know is that I just go to bed too late most nights. But some of the other factors contributing to my poor sleep are poor sleep hygiene. I often use my phone just before going to bed, and I frequently don't engage in a good wind down routine that helps me prepare for sleep.

But even with addressing these issues, some nights I just have problems falling asleep. I've tried other sleep aids such as melatonin without much success, and this is where my friend mentioned CBD oil as a game changer in terms of helping to fall asleep faster. I know some of my other friends use marijuana edibles to help fall asleep, but I've always been reluctant to use something that powerfully psychoactive [00:03:00] plus marijuana is technically still illegal under federal law, even if it is now legal in the state of New Jersey.

So to use it just to help me sleep seemed like overkill. But from what I was hearing about CBD, it sounded like an ideal compound to help me fall asleep. So I wanted to try it. But I had a bunch of questions. What is CBD in the first place? Where could I get it? Would it be legal? So let's talk about my quest for this magic miracle drug, CBD.

So the first question I had was, what is CBD? Is it weed? Is it illegal? Is it safe? So first of all, just remember, although I am a physician, the information in this podcast is my own anecdotal experience.

So as always, the quick legal disclaimer when talking about medical issues, this show is not a substitute for professional medical advice, diagnosis, or treatment. My show is strictly for informational purposes only, and always seek the advice of your surgeon or other qualified healthcare provider with any questions you may have regarding medical care and never disregard professional medical advice or delay seeking advice [00:04:00] because of something you hear on my podcast.

So with that being said, the first question I had was, how is CBD different than say, the typical marijuana product that people use to get high?

So CBD or cannabidiol is about one of 113 compounds found in the cannabis plant. And all of these compounds are called cannabinoids. And the most well known cannabinoid is THC or tetrahydrocannabinoid, which is the primary psychoactive compound found in cannabis, or marijuana, and that is the THC that causes the well-known high that people get from taking marijuana. Most cannabis or marijuana, contains a combination of all of these 113 cannabinoid compounds in different proportions and strengths, which leads to the different brands and strains of marijuana having different reported effects with some strains having a more mellow effect, or others causing a more increased appetite, et cetera.

So all of these compounds, including THC and CBD, work by binding specific cannabinoid receptors in the brain.[00:05:00]

These receptors are common in many animals, including humans, and they're part of the brain's endocannabinoid system or ECS. This ECS helps regulate a variety of neurologic functions, including movement, learning, memory, emotion, and pain. Now, CBD has a different effect than THC in the brain because they bind these receptors differently than THC.

And research is still trying to characterize these neurologic pathways. For example, there is some evidence that THC alone can increase anxiety while CBD can reduce or mitigate some of THCs effects when taken together. THC is extremely psychoactive, but CBD appears not to be, or if it is, it has very minimal psychoactive effects.

So last year the FDA actually approved a medication, Epidiolex, a purified CBD extract to treat rare seizure disorders in patients two years and older after multiple double-blind and placebo controlled trials showed that CBD helped reduce [00:06:00] seizures. More trials are currently ongoing regarding the use of CBD and the reduction of social anxiety and also the treatment for PTSD.

Based on these studies, CBD itself appears to be safe in regards to side effects. The main side effects with Epidiolex included diarrhea, sleepiness, fatigue, and weakness among other relatively mild issues. And there does not appear to be a known toxic overdose of CBD.

There have also been some small studies that also seem to indicate that CBD either helped with anxiety reduction or sleep. So based on the current medical literature, I was ready to give CBD a try as a sleep aid.

So after knowing that CBD itself as a compound is different from THC and it appeared to be safe in its extract form, the second question I had was, is CBD legal or was it like marijuana?

So many states have decriminalized the use of the cannabis plant or marijuana, either for medical use or more recently for recreational use as well, including the state of New Jersey. However, cannabis is still illegal [00:07:00] according to federal law and in some states.

So right now, at the time of recording this podcast, the legality of CBD is somewhat complicated. But this is the simplest way to think about it as far as I can figure it out. And of course, I'm definitely not a lawyer, so take all of this with a grain of salt.

Right now, the federal government has divided the cannabis plant into two categories, cannabis and hemp. If the cannabis plant contains more than 0.3% THC, it is called cannabis and it is illegal under federal law. If the cannabis plant contains less than 0.3% THC, then it is called hemp and it is considered legal.

So if the CBD is extracted from a plant with more than 0.3% THC, even if that CBD extract contains no THC because the source plant was illegal, then the CBD derived from that plant is also illegal. But if the CBD is extracted from a hemp plant containing less than 0.3% THC, the CBD is considered legal.

[00:08:00] But it still gets slightly more complicated. Because CBD is the active ingredient in the medication Epidiolex, which is a prescription only medication, the FDA regulates CBD containing products federally because it is an active ingredient in a prescription medication. And the FDA has stated that no CBD containing products can be marketed as a medical supplement or as having any kind of health benefits.

Also, as an active ingredient in a prescription medication, CBD is not allowed to be added to food products according to the FDA. So what does this mean on a federal level about the legality of CBD? I'm not exactly sure. I think it's legal to take CBD if it's derived from the hemp plant. But actually selling CBD products or marketing them may actually be illegal, or at least marketing them as medical supplements is illegal?

It's hard to say. Each state has its own regulation about CBD as well, and in most states, CBD is fully legal, like in New Jersey. [00:09:00] Or in many states, it's conditionally legal, depending on the source, whether it's cannabis or hemp or it's total THC content. You'll obviously have to check your local regulations.

Okay, so after I knew that CBD might be able to help me sleep, and it was at least legal in New Jersey and possibly legal on a federal level, as long as I probably didn't market it or sell it to others. My third question was, where could I get CBD from a place that I really knew sold CBD? One study examining CBD products at Virginia Commonwealth University found that out of nine products advertised as a hundred percent natural CBD extract. One actually contained dextromethorphan, an over the counter cough medication. And four of the products actually had a synthetic cannabinoid compound known as Spice that has been known to have many negative side effects, such as anxiety and psychosis.

Another study found that more than two thirds of the CBD products had an incorrect amount of CBD listed on the label, and some of the products [00:10:00] actually had higher than allowed concentrations of THC.

So looking for a CBD extract, I did what any savvy consumer does when looking for a product. I looked on the internet and I read a bunch of reviews. And I started on Reddit, which has an active CBD forum.

And the first company that the forum moderators recommended was a place out of Colorado called CB Distillery. CB Distillery claims that they source their CBD from industrial hemp grown in the United States. They list a bunch of certifications, including from the US Hemp Authority, Colorado Department of Public Health and Environment, and more importantly, they have certificates of analysis for their products from accredited third party labs.

All of their reviews online appeared to be very positive, and they had been in business since 2016. I don't have any affiliation with CB Distillery, but it seemed like a reasonable place to try. They had a million different CBD products available, and I won't get into the nuances about the CBD products, including the differences between full spectrum versus broad spectrum [00:11:00] versus isolate CBD or even other cannabinoids such as CBN plus CBD. That rabbit hole starts to go pretty deep.

So you may be asking yourself right now, okay, so what did you actually get and did it work for you? So I did go ahead and get the full spectrum CBD oil tincture from CB Distillery about a month ago.

It contains fractionated coconut oil called MCT or medium chain triglycerides and full spectrum CBD hemp extract. It is listed as having less than 0.3% THC. The product comes as a 30 milliliter bottle with a dropper. I followed the instructions on the box, which is to take one milliliter, which is about 33 milligrams of CBD extract, supposedly a light to moderate dose, hold it under the tongue for 15 seconds, and then swallow just before going to bed.

The taste of this CBD extract was pretty bland, basically just tasted like oil, which is tasteless. Maybe there's a slight organicky tinge to the taste, but nothing bad.

And I've used it for a month and I [00:12:00] will say that I do feel like I fall asleep faster. There were some nights I used to lie there thinking about all the things I had to do or have other concerns or worries on my mind, which would delay sleep. The CBD effect is not a sledgehammer for me. It's more subtle, but I think it did help me consistently feel calmer as I fell asleep.

I think the other thing that the CBD did help was with my shoulder ache at night. I've been dealing with a shoulder issue for a while, and lying down does make it somewhat uncomfortable, and the CBD has helped that ache feel less noticeable at night so I wouldn't have to rely on Advil so much. I still have issues with waking up in the middle of the night, and I would say the CBD effect seems to last about three to four hours for me.

Increasing the dose to two ml's did not seem to make a huge difference for me, so I generally just stick to one. I think it's helped me enough that I've ordered a second bottle for a second month. It isn't the cheapest supplement. A one-time purchase from CB Distillery for this product was about $60, but if you subscribe, the cost drops to about $45.

[00:13:00] I'll stick with it for a while and see if it continues to help with my sleep while I continue to work on other issues that are plaguing my sleep hygiene.

Would I recommend CBD for sleep? I will say it seemed better than melatonin for sure, and my mental state does seem more positive when falling asleep on CBD. But again, the effect is more subtle than overpowering. But your mileage may vary.

Check it out for yourself and let me know what you think. And if you already use CBD regularly, let me know where you get it from and what it does for you.

My weekly thankful is the feedback I got this week for the podcast.

I'm never sure who listens to the show because my topics are generally whatever I feel is interesting to me, and I don't have a specific theme or topic group, so the topics vary widely, but I've gotten some great comments on YouTube and also in person about some of the shows and how some of these topics have resonated with people, including the flow state episode with athletes. Shout out to the strongman athletes out there, as well as for those who have started to notice the "H bomb" dropping out there, once you start to look for it.

Please let [00:14:00] me know your thoughts and suggestions. Thanks again for listening and sharing. DM me @BotoxAndBurpeesPodcast on Instagram, or leave a comment at youtube.com/@BotoxAndBurpees. Thank you very much.