an introduction to cannabinoids€¦ · disclosures: •i completely & wholeheartedly believe...

CBD 101An Introduction to Cannabinoids

By Meredith Warner MD, FAAOS

Well Theory

www.thewelltheory.com

An Introduction to Cannabidiols

Meredith Warner MD, FAAOSOrthopedic Surgeon

Founder, Well Theory & The Healing Sole

Disclosures:• I completely & wholeheartedly believe in the power of natural medicine, to include

herbal remedies such as Cannabis sativa; specifically I really believe in the power of

cannabinoids and terpenes found in that plant. Because of this, I have developed a

hemp-based line of products under my name.

• In addition to this; I am a design surgeon and consultant for some western medical

surgical companies as well – and believe that utilizing the best from both worlds

(western medicine and natural medicine) is often in the best interests of my patients.

Demystifying CBD:

• Why is CBD suddenly everywhere?

• What is CBD?

• How does it work for so many different health problems?

• How much should I take?

• When to consider taking CBD

• Is it legal?

• Is it safe?

• Special Offer

Is CBD a Miracle or Merely Hype?

• Skeptics Believe CBD is Just Another Wellness “Trend:”

• Leeches

• Blood-letting

• Hypnosis

• Crystals

• Thigh master

• Master cleanse

• Waist trainers

Is CBD a Miracle or Merely Hype?

• While Trendy, CBD Does Have Proven Benefits

• Been around thousands of years

• Proven a powerful anti-oxidant

• Demonstrated to be neuroprotective

• Known to be a strong anti-inflammatory

• I Believe CBD Is Here To Stay

Cannabidiol: “CBD”

• CBD is a non-intoxicating and non-

psychoactive part of the Cannabis

sativa plant

• It has no euphoric effect

• It will not get anyone ”high”

• A large component of the ‘Industrial Hemp’

Cannabidiol: “CBD”

• Many say that CBD gives them a “body high”

• People just feel better, looser, happier and generally

healthier

CBD: A Long History of Use

• Medicinal benefits have been

known for thousands of years

• Ancient Chinese

• Russians

• Native Americans

• Ayurvedic Medicine

CBD’s Journey to Legalization in USA

• 2014 - THC made legal for medicinal purposes in 11 states

• 2018 - Epidiolex approved by the FDA (GW Pharmaceuticals)

• 2018 - CBD decriminalized and no longer a scheduled drug; hemp placed under

regulation of USDA and FDA

With Legalization, CBD Skyrocketed

• Since the decriminalization of this non-psychoactive herbal remedy, growth has

been rapid and strong

• Many products

• Many celebrities branding white-labelled products

However…

With Legalization, CBD Skyrocketed

• Many products on the market are not what they say they are

• Gas stations – often counterfeit from China

• Much CBD is an oil byproduct of hemp biomass used for industry; hemp is a ‘bio-

accumulator’ and the CBD could have pesticides and toxins in it (especially from other

countries)

• JAMA 2017: 70% of products are falsely labelled; mostly vape products

Caveat Emptor• Journal of American Medical Association 2017:

• 84 CBD products bought online

• Sent to an independent lab for testing

• 43% under-labeled (usually vaping products)

• 26% over-labeled

• 31% accurate (usually oils)

• THC detected in 18:84 products

• 75% mislabeled

Is CBD Safe to Take?• To date it has been noted that there is no organ damage with CBD even if taken in doses

of up to 5000mg daily

• This does not include contaminated products or mislabeled products

• 2019 study in Epilepsy Research showed in those using

large amounts of CBD (along with seizure drugs) for 5

years had few side-effects

• Somnolence and diarrhea were the worse

Is CBD Safe to Take?

• In a 2019 Epilepsia study of CBD treatment for severe seizure

disorder

elevated liver enzymes in 10% of participants

• That is 37 of the patients

• 29 of them were also on Valproic Acid

Can CBD Cause Liver Damage?• Recent guidance from FDA warns of this adverse event with use of CBD

• From the Epidiolex trial

• Really was elevated transaminase levels

• Seen with concomitant use of a drug known to do so

• Elevated at high doses

• 8% at 10mg/kg/day

• 16% at 20mg/kg/day

• 3% in placebo group

Can CBD Cause Liver Damage?

• If you weigh 62.5Kg (150#) @ 10-20mg/kg/day

• You would have to take either 625mg a day or 1250mg a day

• I have never and will never recommend this amount

• Many studies are looking at the liver protection offered by

Vaping: Especially Risky ‘Source’ of CBD

• 4 out of 9 vaping products tested in another study

contained ‘Spice’

• SPICE = SYNTHETIC MARIJUANA

• Virginia Commonwealth University Study 2019

Use Caution When Selecting CBD Products

• Should be made in USA

• Should be made at FDA-Registered Facility

• Should be tested by FDA-certified 3rd party independent testing facility

• COA should be available

• Should probably not be purchased at a gas station

Testing process: GC, HPLC, MS

When To Consider Trying CBD

Proper Dosing

Start Low and Go Slow

General Rule of thumb: Safe at 0.5mg /kg/day to 25

mg/kg/day

Wellness Support From The Inside

Does CBD Work?

• Due to Federal Government bans and regulations human studies have not been

allowed

• Finally these are starting in this country

• NIH has 150 registered studies

• 1000s more in the works at Universities

• 10000s published

• Mostly animal and lab

Does CBD Work?

• US Government owns one of the first patents on CBD as a medicinal product

• So, does it work? Yes

• Patent for neurodegenerative and anti-inflammatory support/treatment properties

Research on Effectiveness

• Brazilian study demonstrated it works for social anxiety

• Benefits seen for anxiety and PTSD

• Currently being studied heavily for TBI and concussion syndromes

• Benefits for pain have been proven

• Differences in spinal fluid cannabidiol levels seen in Migraine patients

2018 Journal Cannabis and Cannabinoid Research

• Survey of 2400 people that take CBD

• Conditions = arthritis pain, chronic pain, MS,

Insomnia, PTSD, anxiety, depression, Parkinson’s

2018 Journal Cannabis and Cannabinoid Research

• 62% of the participants take CBD for such a condition

• 38% take it for wellness

• 35% participants said it worked ‘very well’

• 4% said it did not work

• No discussion of type, dose, frequency or

product-testing

The Method of CBD Effectiveness -Only Recently Discovered

• Endocannabinoid System

• Discovered in 1980s

• Heavily researched since

• Unifying system

• ECS is Taught in Less Than 10%

of Medical Schools

• Nutrition, herbals, lifestyle medicine

• Only recently has ‘Integrative Medicine’

even existed

The Endocannabinoid System

• "Eat, Sleep, & Relax" System

• Balance

• Homeostasis

• Optimal Function

• Optimization of all other

systems

The Endocannabinoid System

• Endocannabinoids are fundamental to regulating pleasure, memory,

thinking, concentration, body movement, awareness of time, appetite,

pain, and sensory processing; even brain development.

ECS • GPR55 Receptors– G-protein receptor 55

• Facilitation of neurotransmitter release

• PPAR – Peroxisome proliferator-activated

receptors

• PEA and other fatty-acids are potent agonists

• PEA is also increased by decreased levels of FAAH

(action of CBD)

• This receptor is important in inflammation

Some Known Benefits of CBD

• Anti-inflammatory

• Delays adenosine uptake in cell and limits inflammation

• Regulates cytokine release of WBCs

• Anti-angiogenic

• PPAR receptor action

• Prevents vessel migration into a region

• Modulates reactive oxygen species pathways

• Anti-oxidant

• Inhibits autophagy and apoptosis

• Interacts with Transient Receptor Potential

Vannilloid type 1

• Found in synovial lining of arthritic joints

• Reduces pain

• Inhibits neurotransmitter release via CB2 receptors

• Reduces pain

• Inhibits serotonin action by the G-protein receptors

• Less pain, insomnia and anxiety

• Anti-psychotic effects by way of mu and delta opioid

receptor interactions

Benefits of CBD

• Because of actions on CB2, TRPV1, GPR55, PPARs

• Reduced inflammation

• Reduced pain

• Better immunity

• Better endothelial, muscle and cardiac function

• Neuroprotection

• Liver protection

Who Uses CBD: Dispelling Myths• CBD users include everyone

• 52% female, 38% male

• CBD users are mature

• 43% older than 55 years

• CBD users are educated

• 71% of users have a college degree or more

• CBD users are looking for better medicines

• 62% have a known condition

Safety of CBD, a Phytocannabinoid

• In general, CBD is very safe (in my opinion, based on my research)

• CBD metabolized in liver, endocannabinoids are hydrolyzed at the cell site itself

• Phytocannabinoids are metabolized by CYP450 enzymes

• Same as most prescription drugs

Safety of CBD, a Phytocannabinoid

• Liver works by way of a large group of enzymes that metabolize toxins, drugs and

other damaging substances

• Amazing detox center in our bodies

• Make sure that your important prescription drugs are not metabolized by the

same CYP450

• Discuss with your personal physician

CYP450 Interactions• CYP3A4 – CBD inhibits

• CYP2C19 – CBD inhibits

• CYP1A2, 5 – CBD inhibits

• CYP2B6 – CBD inhibits

• If your prescription inhibits one of the CBD CYP450s, you will have effectively more CBD in system

• If your prescription activates it, you will have less CBD in the system

• CBD acts like grapefruit: Do the ‘grapefruit test’

• https://www.drugs.com/drug_interactions.html

WARNING• If you are on important medications metabolized in the liver, talk with a doctor that understands

CBD and make sure the prescribing doctor is OK with your current dosing

• Check BP when on CBD

• Check blood sugar, etc.

• Use common sense

• Do not take massive doses

• Do not eat 1500mg gummy bears please

Interactions between your drugsModerate ibuprofen + cannabidiolApplies to: ibuprofen, cannabidiol

Cannabidiol may cause liver problems, and using it with other medications that can also affect the liver such as ibuprofen may increase that risk. You should avoid or limit the use of alcohol while being treated with these medications.

Call your doctor immediately if you have fever, chills, joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, abdominal pain, dark urine, pale stools, and/or yellowing of the skin or eyes, as these may be signs and symptoms of liver damage.

Talk to your doctor or pharmacist if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Drug Interaction: Ibuprofen

A Special Offer For Attending

Introducing 1-1 CBD Consultation

https://www.thewelltheory.com/consultation/

CBD: Great Herbal Enhancement for Life + Wellness

• Hemp is amazing and the whole-plant entourage of full or broad spectrum is changing the game

• There are massive wellness benefits to the phytochemicals in hemp

• There are many fraudulent and contaminated products on the market

• Be careful - Caveat Emptor

• The phytochemicals in hemp interact with liver enzymes at high doses

• Check for drug-drug interactions and discuss with your prescribing physician

Be well.

• Keep in mind, I’m unable to answer any specific medical questions. I cannot give diagnoses

or treatment advice online. Please make an appointment to see me if you live in the Baton

Rouge metropolitan area or seek out a physician in your area.

Well Theorywww.thewelltheory.com

an introduction to cannabinoids€¦ · disclosures: •i completely & wholeheartedly believe...

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