SMOKE WITHOUT FIRE?
It’s the niche cannabis compound that’s become a wellness panacea, popping up in face creams, food supplements and bath bombs. What’s less apparent is whether there’s any scientific basis to the buzz. WH tries to see through the haze of CBD
The hype around the cannabis compound CBD is real – but does the science back it up?
Agust of wind whips through the field and the crops sway like synchronised swimmers. Overhead, a drone buzzes in and out of earshot, capturing every inch of this plot of land as effectively as a disgraced datamining company. There’s nothing remarkable about this field other than the idyllic Irish landscape, hidden away in County Louth, some 50 miles north of Dublin, and the only clues that point to its purpose are of the sensory kind; when the breeze blows, it delivers an olfactory overwhelm that smells suspiciously like Camden Market. The plant is hemp and the field belongs to a company called Celtic Wind Crops. Its co-founder, Paul Mccourt, started growing hemp in 2011, but pivoted his business model two years later when he began to hear whispers of the healthenhancing powers of a compound contained within the plant. The compound is CBD.
And it’s a decision so steeped in foresight that you might be tempted to ask him for next week’s lottery numbers.
These three letters have infiltrated the wellness market as effectively as a product backed by Paltrow. It’s in your cocktails, face cream and chocolate and, across the pond, you can top off #selfcaresunday with a CBD bath bomb or give a CBD treat to your dog. Claims of its transformative powers range from easing symptoms of anxiety and reducing chronic pain to stopping seizures and shrinking tumours; claims that, if proven, would surely take this niche ingredient from wellness wonder compound to healthcare panacea, the likes of which we haven’t seen since the discovery of penicillin.
There’s just one problem. No one seems to get it. Between a regulatory framework that makes War And Peace look like a beach read and science that requires a chemistry degree, collective confusion ensues. But there’s more at stake than looking stupid.
COMPOUND DIVISION
While cannabis has become inextricably linked with getting stoned, it’s actually a family of plants. For our purposes, we’re interested in two members: marijuana and hemp. Both contain compounds called cannabinoids, the most prolific being tetrahydrocannabidiol, or THC. It’s THC that renders knock-knock jokes hilarious and gives beige food Michelin qualities, and the marijuana plant is packed with the stuff. That’s why it’s illegal to grow marijuana in the UK and being caught with it is an offence under the Misuse of Drugs Act 1971. Hemp, however, contains only trace amounts of THC – so delivers no high. Instead, it’s abundant in the compound cannabidiol, or CBD. It’s this non-psychoactive and legal sister of THC that you’ll find in the innumerable CBD oils and capsules on the web and your local high street. Because such products are sold as food supplements and cosmetic products in the UK, the companies behind them aren’t permitted to make medicinal claims, but a word-of-mouth campaign has created the next big thing in wellness regardless.
CBD has broken the internet in a way that a Kardashian could only dream about; forum after forum is filled with accounts of how this compound has cured chronic pain when nothing else worked, stopped seizures and eased anxiety. Could a littleknown plant compound really have such a transformative effect on the human body? The answer, if there is one, will lie in the endocannabinoid system. ‘It’s a signalling system in the body that helps to regulate things like temperature, sleep, mood and appetite,’ explains Dr Amir Englund. A researcher at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, he’s currently studying the role of CBD in psychiatric disorders. ‘The goal is homeostasis [the physiological answer to #balance], meaning that the endocannabinoid system usually remains dormant until something goes awry.’ It was discovered in the 80s in the quest to uncover the mechanism by which THC makes you high, but scientists are still trying to understand exactly how the endocannabinoid system works. It’s so complex that researchers suspect it could be as influential to your body’s functioning as the dawn of Whatsapp was for the planning of hen dos.
All well and good. But if this system exists naturally within the human body, what do CBD and THC have to do with it? It’s all down to receptors in the body called CB1 and CB2, which can be activated by cannabinoids naturally produced by the endocannabinoid system. THC from the cannabis plant interacts with these receptors in much the same way as your own cannabinoids; binding to CB1 and CB2 receptors to do its thing. CBD, however, interacts with different receptors. ‘There are about 20 different molecular targets for CBD in the body,’ adds Dr Saoirse O’sullivan, associate professor in the faculty of Medicine and Health Sciences at the University of Nottingham. ‘Some of those targets are beneficial for pain, others for inflammation. One of the main targets is the serotonin receptor, which is largely responsible for things like reducing anxiety.’
It’s these interactions that explain why the list of conditions being studied in conjunction with CBD reads like a medical dictionary. A recent review from the University of Salerno, Italy, suggested diseases on which CBD may have therapeutic benefits include degenerative brain conditions such as Alzheimer’s and Parkinson’s, and inflammatory conditions, such as rheumatoid arthritis and Crohn’s, as well as pain, psychosis, depression and cancer. Are we looking at the holy grail of health? ‘People ask me how one drug can do so much because, unlike other medicines – which only act at one site – CBD has many different targets,’ says Dr O’sullivan. ‘The fact that CBD is anti-inflammatory explains why it’s beneficial in treating such a range of different conditions (like inflammatory bowel disease, neuroinflammation and arthritis, as well as skin conditions) where inflammation is part of the problem.’
CBD has broken the internet in a way that a Kardashian could only dream about
But, right now, the optimism around CBD is just that. A drug can only be said to work if it’s been granted a medical licence. At the moment, there’s only one licensed CBD drug, Epidiolex, for the treatment of two kinds of rare childhood epilepsy. And while promising research exists, much of it is based on cell and animal studies, leaving scientists unwilling to say for certain that CBD will live up to its potential in humans.
MIXED FEELINGS
While the scientific community is diligently building an evidence base for CBD, it’s being touted across the mainstream market already. Your average health-food shop is likely to throw up a 30ml bottle of CBD oil retailing at £79.99 alongside a tea for £1.99, with little to help you discern the difference between the two. ‘The biggest issue we have now is a lack of education around what CBD products are and what they’re supposed to be doing,’ says Paul North, director of external affairs at Volteface, a think tank for drugs policy. ‘There’s a clear need for consumers to differentiate the high-quality CBD oil – the likes of which tends to be used in scientific studies – from the extracted products, such as vegetable oil containing CBD extract, and Cbd-containing teas and cocktails.’ It’s confusion that Mccourt is keen to clear up, too. Celtic Wind CBD oil is produced by pressing the whole hemp plant, a method he claims delivers a range of health benefits that make his products superior to those produced by extracting just the seed oil.
Plus, like trying to get pissed on chocolate liqueurs, the dose of CBD in your average consumer product is nowhere near the quantities used by scientists to investigate the effects of the compound. Dr Englund cites a recent epilepsy study where the dose given to participants was 10 to 20mg per kilogram of body weight, per day. For someone who weighs 70kg, that’s 700 to 1,400mg. As for anxiety, he points out that the lowest dose that’s been found to have an effect in experimental studies of anxiety is
‘The more you hear about something’s benefits, the more you believe it’ll work’
300mg. ‘The doses used in studies are significant because CBD isn’t well absorbed in the body. The exact bioavailability depends on the form in which you take it – ingested orally it’s around 6% and inhaled it’s around 35%. So you need a high dose to get any biological effect,’ he adds.
As for CBD creams, a 2017 study into the anti-inflammatory properties of cannabinoids found them to be useful in treating a wide range of skin conditions, such as eczema, psoriasis and dermatitis, with the study author commenting that ‘perhaps the most promising role for cannabinoids is in the treatment of itch’. ‘As far as I’m aware, there is no published literature on the absorption of CBD transdermally,’ Dr O’sullivan adds. ‘However, for a skin condition, you are at least applying the CBD directly to the problem area, so it’s a question of tissue penetration and how well it reaches the dermis.’ Though, she adds: ‘I have started using a CBD cream on rosacea myself.’
Whether or not a CBD product will work for you depends not only on what it is and how much you’re using, but why you’re using it. For some, the health hype around CBD is persuasion enough to buy a product with the vague hope of ‘feeling better’. And yet, to assume that the market is made up of bandwagon-jumpers is to ignore the people populating the forums; those who speak about CBD with pious devotion, for whom CBD has eased symptoms when nothing else has. With anecdotal evidence like this, how can CBD not work? According to Dr Englund, bioavailability isn’t the only issue at play here. ‘It’s not impossible that low doses are effective,’ he says. ‘But in a research scenario, CBD is only deemed successful if it has a greater effect than the placebo.’ The placebo effect is controversial when it comes to individual health – who is anyone to say that a person is ‘imagining’ symptoms improving. Indeed, so powerful is the effect thought to be in the context of drugs, that researchers are increasingly rejecting the term, referring instead to a ‘meaning response’ – the physiological response the body has to something that is meaningful. ‘The more you hear about something having a benefit and the more you learn about the mechanism, the more you believe it will work, and in some ways, the more likely it is to work,’ adds Dr Englund. ‘Every detail that feeds into the story will add to the placebo effect. CBD ticks all the boxes, so we have to be at least open to the idea that all these anecdotal stories are evidence of people believing that CBD works for them.’
HIGH SOCIETY
Whether or not a CBD product is actually working isn’t the only reason to be cautious. ‘If a product is regulated as a medicine, the processes and quality management behind that product are rigorous,’ explains Henry Fisher, co-founder of cannabis consultancy firm Hanway Associates. As for food supplements and cosmetic products, they’re regulated by a different rulebook.
So, to take CBD in the hope that it will ease a specific health symptom is to do so without the protection of the regulatory framework that would be applicable to a pharmaceutical product sold in the UK for the same condition. While the side effects of CBD appear to be limited to the gastrointestinal (read: toilet) variety, researchers have raised concerns over the way CBD interacts with other drugs. Dr Englund points to findings where high levels of anti-epileptic medication were observed in those who had taken CBD. ‘CBD seems to interfere with enzymes in the liver that help to break down certain drugs,’ he explains. ‘It means that people might unexpectedly end up with a higher dose of their prescription medication and they might experience side effects as a result.’
The absence of steadfast rules also creates an opportunity for rogue operators to move into the market, with every expert WH spoke to voicing concerns that the CBD and THC content included on product packaging is not representative of the contents within. The International Cannabis and Cannabinoids Institute recently published the results of a test on the quality of retail-available CBD products. Of the 35 tested, nine had a THC level that represented a risk to the user – the risk being, they didn’t know they were taking a psychoactive compound. It means that if you’re buying CBD products, you’d be wise to do your homework. ‘Find out which products make their lab tests freely available or put more effort into making sure that they have a reliable quality-assurance protocol that they use internally,’ adds Fisher. ‘Larger brands and well-known products are more likely to be made by companies who have good-quality management structures and so are producing reliable products – in that they contain the amount of CBD that they claim to.
Researching a company’s management structure. Not quite as ’grammable as that CBD cocktail, but it’s an approach that prioritises health over hashtags. Back in the field where Celtic Wind products begin their lives, Mccourt is a big proponent of such an approach – he did, after all, give WH an all-access pass to his hemp field. ‘You should absolutely research the company you’re buying the product from,’ he says. ‘Find out how they make it, where they get their raw materials from and how contactable they are. Traceability is so key with CBD. If you can’t find out that information, then ask yourself if it’s really worth spending your money on.’ While some are buying CBD -based products because they alleviate otherwise unbearable symptoms, others are sipping on CBD cocktails and waiting to feel something (probably, tipsy). If you fall into the latter camp, you might want to save your money until the science and legislation catches up. But you may not be waiting long. Multiple clinical trials are nearing completion and researchers are currently exploring the use of CBD for improving transplant acceptance, reducing symptoms of schizophrenia and even treating addictions to opioids, alcohol and, yes, cannabis. We can’t tell you next week’s lottery numbers, but we can say this: like the lingering smell from its psychoactive counterpart, CBD is going nowhere.