Victor Melgan
Victor Melgar (Instagram @victhealchemist, Twitter @thevictormelgar)

Cannabidiol (CBD) is in the news and on the internet, but what is it, and how can it help you?

Fight Colorectal Cancer (Fight CRC) spoke with two experts about CBD and the Food and Drug Administration (FDA) approved uses.

Victor Melgar, Chief Operations Officer of NALA Health, covered CBD for general human use, while Ashley Glode, PharmD, BCOP, Associate Professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Science, provides Fight CRC with a medical perspective for CBD and medical cannabis.

CBD for General Use

Victor Melgar, Chief Operations Officer of NALA Health tells us that NALA was started with the simple idea that CBD could pave the way for all natural healing and remedies through the power of cannabis. However, CBD is only part of the equation. In fact there are over 100 active and inactive cannabinoids found in the cannabis plant. 

What is CBD?

CBD is one of over 100 different Cannabinoids that are extracted from agricultural hemp and cannabis. This cannabinoid does not contain the same psychoactive compounds that give the “high” effect that is in THC, which is why CBD is known as the "medicinal compound" of the plant. 

Studies have shown that CBD treats pains, aches, anxiety, and stress and was originally praised by renowned herbalist Nicholas Culpeper for treating gout, skin inflammations, and muscular/joint pain in 1625. According to the US National Library of Medicine, cannabidiol has been shown to treat seizures and syndromes.

How is this all possible? The human body contains an endocannabinoid system (ECS) and already produces cannabinoids daily, which are regulated by two receptors, CB1 and CB2. These receptors are found in our immune and nervous systems, in which they assist in moderating inflammation, our immune response to pathogens, motor control, appetite stimulation, and perception of pain.

There are also non-cannabinoid receptors that are activated by CBD such as serotonin, orphan, vanilloid, and nuclear receptors. These activations are the cause of anti-anxiety and anti-inflammatory relief!

What are the benefits of taking CBD? 

Many studies have shown the benefits of taking CBD to reduce seizures in adults and children with various conditions. More studies conducted have shown CBD helps alleviate inflammation-based symptoms, anxiety, stress, insomnia, pain, and seizures. CBD helps alleviate cancer-related symptoms at high doses.

Will CBD make me high?

CBD has no psychoactive effect and therefore, you won't feel "high." However, depending on how many milligrams you ingest, you can feel sleepy, very relaxed, and possibly a bodily "floating" sensation. 

Will I fail a drug test?

CBD by itself will not show up on an employer's drug test. The FDA states that CBD products must be at least 99.7% pure CBD and allows only 0.3% THC to make it legally consumer ready. CBD may stay in your system anywhere from 24 hours to a few weeks. That timeframe can change depending on a variety of factors, including metabolism, consumption method, frequency of use, and dosage. Therefore, if a large amount of THC is found in the CBD you are using, it may show on a drug test. Make sure you read the label of the product you are using and that it meets these regulations and guidelines. 

Purchasing CBD from a reputable company is a must, and you can read more about CBD regulations below.  

Can CBD help me? 

Each cannabinoid helps in ways big or small, depending on the combination, ratio, and dosage you are taking.

First, determine what symptom or problem you are experiencing. For example, CBD + CBN would be more effective for sleep-related problems. CBD + CBN + CBG might be more effective for inflammation-based problems. Even though you can take CBD and CBG by themselves, it is more effective to take cannabinoids in pairs or groups because when you combine cannabinoids, you create something known as the "entourage effect," which allows each cannabinoid to be boosted by the other or a counterpart. By working backward, you can find the right combination for you. 

How do I choose a CBD?

Key terms you should look out for are broad spectrum, full spectrum, and CBD isolate. Broad spectrum CBD products contain many cannabinoids in varying amounts such as CBD, CBN, CBC, CBG, to name a few, with no trace amounts of THC.

Full-spectrum products may contain all cannabinoids, including THC. Some full-spectrum products may have CBD isolate, pure CBD with no trace amounts of the other cannabinoids. While CBD works great on its own, due to the entourage effect, it is best to combine CBD with other cannabinoids. 

How do I take CBD? 

CBD can be taken sublingually (under the tongue), via inhalation or ingestion, or applied topically.

Products exist for each route of consumption. For example, sublingual products include CBD oils of all types taken underneath the tongue. Inhalation products include CBD flower and CBD concentrates, such as shatter and wax. Ingestion products are CBD edibles, such as CBD honey or CBD-infused food. Topical products are absorbed through the skin, so products can include CBD lotion, massage oils, salves, creams, and transdermal patches.

Typically, inhalation is the fastest route to absorb CBD and ingestion is the slowest. However, all four ways are effective depending on your symptom and dosage. 

Where does CBD come from?

CBD is manufactured in a variety of ways. It typically goes through an extraction process.

There are three main ways to extract CBD from the cannabis plant: 

  1. Carbon dioxide (CO2) extraction: This method uses CO2 to separate CBD oil from the cannabis plant. It is a popular extraction method for CBD products and is capable of successfully producing a high concentration of CBD. 
  2. Steam distillation: With this method, steam helps separate the oil from the plant material. It is a popular method for extracting essential plant oils, but it is not as effective as the CO2 method. 
  3. Solvent extraction: Although this method is effective if solvents are left behind, the process does pose a potential health risk. Solvent extraction can also affect the flavor of the extract. 
  4. Lipid extraction: This process is gaining popularity, as some companies are now trying to avoid CO2 and solvents. After extraction, the resulting CBD oil is considered full-spectrum. Hemp-sourced CBD has a THC concentration of 0.3% or less. The extract must go through a cooling and purification process to obtain a CBD isolate product. Further processing leaves behind a crystalline isolate, or CBD crystals.

Is CBD legal?

Regulation for CBD depends on the state; however, many states follow the federal guidelines. Due to the Farm Bill that was passed in 2018, CBD oil that follows the 2018 Farm Bill’s established regulations can be bought, sold, and used within all 50 states.

However, it’s important to note this is only true when CBD oil contains no more than 0.3% THC content. Anything above this number is deemed illegal and will not be recognized by the FDA as a legitimate CBD product. To ensure quality and precision a company must have the following verification processes in place:

  1. Source of CBD product
  2. Adherence to FDA guidelines 
  3. General quality control protocols 
  4. Third-party tested certificates of analysis

The source of the CBD products is very important. Is the source marijuana- or hemp-based? Does it adhere to FDA guidelines for CBD product development, which include having a facility, consistent measuring, and testing metrics? Is there quality control to ensure sanitizing equipment and to make sure no contaminants are found in the batches created? A third-party tested certificate of analysis is a very important verification if a third-party is testing each product to make sure that each product meets regulations and to ensure no contaminants are found. 

CBD for Medical Use

Ashley Glode, PharmD, BCOP, Associate Professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Science provided Fight CRC with a medical perspective for CBD and medical cannabis. 

Dr. Glode’s clinical practice site is the Phase I/GI/Head and Neck/Sarcoma Multidisciplinary Clinic at the University of Colorado Cancer Center, Colorado’s only National Cancer Institute designated cancer center.

Her clinical, research, and scholarship interests include supportive care interventions to maximize treatment dose intensity while minimizing toxicities and improve patient quality of life, and evaluate the use of integrative therapies, dietary supplements, and cannabis in cancer patients.

Is CBD or Medical Cannabis approved by the FDA as a treatment for cancer patients?

Not at this time. CBD, or Epidiolex, was FDA approved July 31, 2020 for the treatment of certain types of seizure disorders. The THC-based product of dronabinol (Marinol) is FDA approved for anorexia in patients with AIDS and chemotherapy-induced nausea and vomiting.

How can someone keep track of important considerations, such as dosage and potency, when there are so many cannabis products available now?

It is very important for patients to understand the label on their specific product and know the dosage of the product they are ingesting. It is important for patients to review this information with the staff at the store where the product is being purchased.

The components we know most about are THC and CBD. Products may be more predominantly THC or CBD, or be more of a 1:1 blend. THC and CBD exert different effects in the body; therefore, a patient may want a predominantly CBD- or THC-based product based on the indication. I recommend patients keep a journal of what they took and when, what their goal was (such as a decrease in pain from a 7 to a 4, resolution of nausea so they may eat a meal, etc.), if they achieved that goal, and any side effects they may have experienced. This helps guide any adjustments that need to be made to products or dosage that is used.

How can a patient effectively prepare to discuss therapeutic cannabis use with their care team?

A patient should be open and honest about what they have tried, if anything at all; what research they have done; and what their goal(s) of use are. It is important for their providers to understand where they are in their cannabis journey to make the best recommendation.

We try to weigh the risks and benefits with the limited information we have on potential drug interactions and safety concerns to do what is best for each patient. Each cannabinoid product is different in what it contains and patients may experience different effects. 

Ultimately, we as the patient’s care team are learning too since there are limited studies with the products patients are using. Patients should bring us with them on their journeys and share their experiences with us.

What Patients are Saying

“I use CBD or delta 8 (another cannabis compound) daily since North Carolina has legalized medical marijuana.”  

JJ Singleton, stage IV CRC survivor

“I use a dermal patch after chemo to help with nausea and appetite. I have some cream that I use on my temples to help with sleep. Both are CBD and THC 1:1”  

Tim McDonald, stage IV CRC survivor

“After my 6 1/2 hour surgery I couldn't sleep for days. I finally got some vape CBD and it really was helpful! FYI, vaping in the hospital is frowned upon!”  

Jay Overy, stage II rectal cancer survivor

“I use CBD for anxiety.” 

Mandi Griffin, stage III CRC survivor

“I did use it for anxiety but my body got too used to it, so now I’m on anxiety meds. So my experience wasn’t as good.” 

Courtney Maurer, stage III CRC survivor 

Additional Resources

Check out the additional resources and community stories we have around the use of cannabis and other alternative medicines. Remember to talk to your doctor about the complementary or alternative therapies you are considering before trying them so you can discuss how they may interact with your current treatment course. When you have all of the information, you can make an informed decision about what’s right for you!

Complementary and Alternative Medicine for Colon Cancer

Medical Marijuana and Cancer: What’s the hype?

Using Alternative Medicine Alone Has Major Risks

Cannabis Podcast

Medical Marijuana w/ Paul Rawat

2 thoughts on “CBD: Is it Right for You?

  1. THC + CBD has helped me with mFOLFOX6 side effects. Taking this plus alpha loipoic acid has anecdotally reduced peripheral neuropathy symptoms.

    Additionally the cannabinoids reduce my symptoms of nausea which typically occur days 4-7 of each treatment cycle. I take THC+CBD sublingual lay and typically get nausea relief within 10 minutes that lasts for 8 hours or so. I no longer take Ondansetron which causes me constipation because of this.

    Finally, my appetite improves with the cannibinoids, and my insomnia from muscle recovery (restless legs) is reduced.

    So I’d recommend considering cannibinoids (after talking with oncologist) to those in chemotherapy. I do note that it takes a little while to learn how to dose the THC to achieve positive effects while not getting “high”.

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