An Introduction to CBD: By practitioners, for practitioners By Claudia le Feuvre Dip BCNH and Rory Batt MSc Personalised Nutrition www.mightygreen.co.uk June 2020
Agenda • Who are Mighty Green? • What is CBD? • Is CBD Safe? • What is the Endocannabinoid System? • CBD and… sleep/ addiction/ anxiety/ depression/ pain • Rory’s MSc Findings • Claudia’s Clinical Findings
Who are Mighty Green?
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What is CBD? CBD (cannabidiol) is one of over 100 plant chemicals called cannabinoids that come from the plant genus Cannabis. CBD is one of the cannabinoids that is largely non-psychoactive. That means no nasty surprises when its used.
Is CBD Safe? “CBD does not produce the effects that are typically seen with cannabinoids such as THC. It also failed to produce significant effects in a human study of abuse potential discussed below. Across a number of controlled and open label trials CBD of the potential therapeutic effects of CBD it is generally well tolerated, with a good safety profile”
WADA - World Anti-Doping Agency
NICE approved CBD product
Types of CBD There are different types of CBD extract. CBD is CBD - there’s no changing that……. But, there’s more to an extract than just CBD. There are other compounds which are important. cbdoilusers.com Some extracts contain other cannabinoids, in addition to compounds called Terpenes.
Other Cannabinoids are Valuable, Too There are added benefits to having other cannabinoids in the extract. 1) Other cannabinoids have their own unique therapeutic effects. 2) They also have shared therapeutic effects with CBD. What this means……. 1) There is a greater diversity of therapeutic effects. 2) The effects of CBD are compounded by other cannabinoids.
The Entourage Effect This is where the compounds of hemp extracts work together in synergy. Together they produce a greater therapeutic effect than they would when given alone. In other words, the whole is greater than the sum of its parts. Were not just talking about cannabinoids, but Terpenes and Flavonoids as well.
What is the Endocannabinoid System (ECS)? Basically, the bodies own cannabinoid system. We make our own cannabinoids, known as Endo cannabinoids. These communicate as chemical messengers via a network of special (cannabinoid) receptors. The ECS is a collective term for cannabinoid receptors, endocannabinoids and the metabolic enzymes which make and degrade them.
The ECS It was only discovered in the 1990’s Known as ‘the super computer that regulates homeostasis in all mammals’ for many functions including: - Mood - Appetite - Sleep - Memory - Hormone production - Pain - Stress - Inflammation & Immunity
Our bodies are designed to utilise cannabinoids.
Phyto & endocannabinoids control neuronal activity VanDolah, H. J., Bauer, B. A. and Mauck, K. F. (2019) ‘Clinicians’ Guide to Cannabidiol and Hemp Oils’, Mayo Clinic Proceedings . Elsevier Ltd, pp. 1840 – 1851. doi: 10.1016/j.mayocp.2019.01.003.
Endocannabinoids influence neuroinflammation Nakagawa, Y. and Chiba, K. (2014) ‘Role of microglial M1/M2 polarization in relapse and remission of psychiatric disorders an d d iseases’, Pharmaceuticals . MDPI AG, pp. 1028 – 1048. doi: 10.3390/ph7121028.
Endocannabinoids influence inflammation Endocannabinoids regulate both the innate and adaptive immune systems (*). AEA is the most potent anti- inflammatory endocannabinoid, acting on most cell subsets (*). 2-AG exerts both pro- and anti- inflammatory effects - its effects are strictly dependent on cell type (*). Pacher, P., Bátkai, S. and Kunos, G. (2006) ‘The endocannabinoid system as an emerging target of pharmacotherapy’, Pharmacological Reviews , pp. 389 – 462. doi: 10.1124/pr.58.3.2.
Omega Fatty Acids, Endocannabinoids & Inflammation EC’s are synthesised from Omega - Fatty Acids. Since EC’s are also inflammatory regulators, their levels influence inflammatory tone. This is another way dietary n-6 influences levels of inflammation. Bosch- Bouju, C. and Layé, S. (2016) ‘Dietary Omega -6/Omega-3 and Endocannabinoids: Implications for Brain Health and Diseases’, in Cannabinoids in Health and Disease . InTech. doi: 10.5772/62498.
It’s All About Balance Balancing The ECS is the Key It can go either way: An underactive ECS has its issues. So does an overactive ECS Pharmacological manipulation is tricky, as the ECS is diverse and plays countless roles in human physiology. A great example is what happened with Rimonabant…….. Pacher, P. and Kunos, G. (2013) ‘Modulating the endocannabinoid system in human health and disease - successes and failures’, FEBS Journal . John Wiley & Sons, Ltd, 280(9), pp. 1918 – 1943. doi: 10.1111/febs.12260.
Not everyone’s ECS is fully functioning… Lifestyle factors that influence how the ECS works: • Emotional stress & Childhood ECS imbalance in disease: Trauma ↓ CB1 receptors • Obesity & Diabetes ↑ ECS • Poor diet (Fructose, High n-6 intake) • Fibromyalgia, Migraine, IBS, PTSD ↓ ECS ↑ EC’s • Depression ↓ ECS • Sedentary Lifestyle • Schizophrenia ↑ ECS (*) • Poor Sleep ↑ EC’s • Genetic SNP’s ↑ / ↓ EC’s, CB1 and CB2 Receptors
CBD to the Rescue The good news is, we can use CBD to help regulate the ECS. CBD can both enhance or reduce the activity of the ECS, to restore homeostasis based on individual requirements. How…..? By acting as an adaptogen: “A plant extract that is held to increase the body's ability to resist the damaging effects of stress and promote or restore normal physiological functioning” Scharf, E. L. (2017) ‘Translating Endocannabinoid Biology into Clinical Practice: Cannabidiol for Stroke Prevention’, Cannabis and Cannabinoid Research . Mary Ann Liebert Inc., pp. 259 – 264.
Don’t Forget About Other Plants Other plants besides cannabis (CBD) can also modulate the ECS, by enhancing levels of endocannabinoids and interacting directly with cannabinoid receptors. ● Chilli’s ● Ginger ● Green Tea ● Black Pepper ● Echinacea ● Maca ● Cacao ● Rhodiola Rosea
CBD & Sleep Better sleep quality overall.
CBD & Addiction Short term - using CBD for greater duration may prove useful in staving off relapse.
CBD & Anxiety Acute trial, but results encouraging - need long term follow up.
CBD & Depression No studies looking directly at depression yet, but some secondary effects of CBD were found to influence depression. “Participants reported significantly fewer depressive and psychotic -like symptoms post treatment compared to baseline” Solowij, N. et al. (2018) ‘Therapeutic Effects of Prolonged Cannabidiol Treatment on Psychological Symptoms and Cognitive Function in Regular Cannabis Users: A Pragmatic Open- Label Clinical Trial’, Cannabis and Cannabinoid Research . Mary Ann Liebert Inc., 3(1), pp. 21 – 34. Case report: Patient presented with pain, depression and anxiety. Following 3 months use of CBD; “ She reported being less emotional and feeling calmer. She said that her anxiety dropped from 9/10 down to 3 to 4/10 and that her mood had stabilized” Hegazy, O. and Platnick, H. (2019) ‘Cannabidiol (CBD) for Treatment of Neurofibromatosis -related Pain and Concomitant Mood Disorder: A Case Report’, Cureus . Cureus, Inc., 11(12).
CBD & Pain management Studies with CBD have also found it to be effective for managing pain. CBD (2.5mg per actuation) have been shown to significantly reduce neuropathic pain compared to placebo
Rory’s MSc Findings That the ECS is involved in the pathophysiology of Metabolic Disease: • Insulin resistance • Hyperglycemia • Hyperinsulinemia • Adiposity ( ↑ Lipogenesis ↓ Fat Oxidation) • Increased Appetite • Hyperlipidemia • Pancreatic β cell destruction • Inflammation • Oxidative stress Lipina, C. et al. (2012) ‘New vistas for treatment of obesity and diabetes? Endocannabinoid signalling and metabolism in the modulation of ener gy balance’, BioEssays , pp. 681 – 691. doi: 10.1002/bies.201200031.
Rory’s MSc Findings Western diet is high in Fructose and n-6, which drives increased production of EC’s. EC’s activate CB1 to promote energy storage, and discourage energy utilisation. Theoretically, CBD may help mitigate some pro-obesogenic/diabetic effects at the level of the CB1R, because it can block its activation. Although, this has yet to be proven clinically. Another cannabinoid THCV has been clinically proven to arrest Type 2 Diabetes progression. Clark, T. M. et al. (2018) ‘ Theoretical Explanation for Reduced Body Mass Index and Obesity Rates in Cannabis Users ’, Cannabis and Cannabinoid Research . Mary Ann Liebert Inc, 3(1), pp. 259 – 271.
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