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How does CBD fight cancer?

I have been getting a lot of questions about this subject. At present, there are 9 ways that cannabinoids have been found to combat cancer.(1)

Cannbinoids:
1) Increase apoptosis of cancer (ca) cells (decreases the lifespan of ca cells).
2) Increase autophagy of ca cells (ca cells eating up themselves).
3) Inhibit metastasis (stops ca cells from breaking off a tumor and migrating to another area to start growing there).
4) Inhibit cancer cell proliferation (growing and dividing of ca cells)
5) Increase tumor immunity surveillance (improves the immune system’s ability to recognize ca cells as “foreign” and kill them).
6) Inhibit epithelial-to-mesenchymal transition (changing from a normal cell to a less developed cell).
7) Inhibit tumor cell invasion (ability of a tumor to grow into the normal tissue).
8) Cause cell cycle arrest (keeps the cancer cells from dividing and making more cancer cells).
9) Reduce drug resistance (keeps the cancer cells from becoming resistant to the effects of chemo and radiation therapy.

Notice that I did not say CBD or hemp oil but cannabinoids. However, CBD by itself has been shown to have all of the mechanisms of fighting cancer listed above. Other cannabinoids have been shown to induce some, if not all, of these mechanisms in cancer cells also. Little to no research has been done using CBD-enhanced hemp oil which contains a multiplicity of cannabinoids, terpenes, and flavonoids. It seems logical that, due to the entourage effect, all the components in CBD-enriched hemp oil would work together to produce a better clinical result that the individual cannabinoids when used alone.

More information on Cancer and Cannabinoid research will be coming soon in my disease list.
I hope the above information is helpful.

Note: At this time, hemp oil, CBD, or medical marijuana have not been approved by the FDA in the treatment of cancer nor for any of its complications nor for any side effects associated with cancer therapy.

References
1) Velasco G, etal. Anticancer mechanisms of cannabinoids. Curr Oncol 2016;23(S2):S23-S32.

Cannabinoids and Breast Feeding

All the substances in cannabis (cannabinoids, terpenes, and flavonoids) are excreted in breast milk. Just like in pregnancy, we need to weigh the risks of exposure of the drug to the infant against the risks/benefits of the mother taking the drug. When it comes to compounds containing THC, almost always the potential risks to the infant outweigh, by a significant margin, the benefits for the mother. THC exposure in the developing brain changes the structure and function of the brain adversely and these effects almost always carry over into adulthood. When it comes to the other cannabinoids, we don’t have much data on the possible adverse effects to the infant. This is not because there are none, but because very little research has been done in this area. Therefore, we have to make decisions based on what we know at this point.

Presently, we know that CBD has effects on the immune and neural systems in normal human adults, but these effects don’t seem to harm them. In adults and children that have certain diseases, CBD can significantly change the function of both systems in extremely beneficial ways. We suspect that CBD can change the structure and function of both the immune and neural systems of breastfeeding infants, but we do not if this change will be for good, for bad, or of no consequence.

I do not recommend breastfeeding women take CBD-enhanced hemp oil if they don’t have to. If they have a certain disease for which they need to take CBD-enhanced hemp oil, they should talk it over with their doctor and their baby’s doctor before they take it. If the decision is made to take CBD-enhanced hemp oil, take some that has no THC in it, if at all possible. If some THC is required, take the minimal amount required to control the disease.
In regards to giving cannabis products to a mother to treat a breastfeeding infant that has a problem, there is no information I can find where this has ever been done. There are some theoretical situations where I can imagine trying it, but to my knowledge, no one ever has.

Bottom line

All the products in cannabis (cannabinoids, terpenes, and flavonoids) are found in breast milk and seem to have effects on the developing child. Some of these effects can be detrimental, specifically THC effects. Whether the other compounds cause detrimental, beneficial, or no effects to the infant is unknown at this time, however, there is potential for negative effects. My recommendation is not to take any cannabis products while breastfeeding, but if some are needed, the least amount of THC required to control the mother’s problems should be used.

Disclaimer: The above are my opinions only and any woman who is concerned about taking cannabis products while breastfeeding should consult with their doctor and their child’s pediatrician about this before proceeding.

Cannabinoids and Pregnancy

Recently, I have received numerous requests for my opinion of the use of CBD-enhanced hemp oil use and pregnancy. Having been a practicing Maternal/Fetal Medicine specialist, I have seen the devastating effects on the fetus of maternal of drug use during pregnancy, both illicit and prescribed drugs. However, I have seen the effects of not taking needed drugs on the mother, because of a debilitating medical condition, and the ensuing adverse effects on the fetus, also. In obstetrics, we are always having to determine the risks versus benefits of taking, or not taking, a drug for both the mother and the fetus.

What do we know?

All the substances in cannabis (cannabinoids, terpenes, and flavonoids) readily cross the placenta and can (and do) affect the fetus. Therefore, we need to weigh the risks of fetal exposure to the risks/benefits of maternal use of the drug. When it comes to compounds containing THC , almost always the risk for the developing fetus outweighs, by a significant margin, the benefits for the mother. This is because we have good evidence that THC exposure in the developing brain changes the structure and function of the brain adversely and these effects seem always to carry over into adulthood. When it comes to the other cannabinoids, we don’t have much data on the possible adverse effects. This is not because there are none, but because very little research has been done in this area. Therefore, we have to make decisions based on what we know at this point.

Presently, we know that CBD has effects on the immune and neural systems in normal human adults, but these effects don’t seem to harm them. In adults and children that have certain diseases, CBD can significantly change the function of both systems in extremely beneficial ways. We suspect that CBD can change the structure and function of both the immune and neural systems of fetuses, but we do not if this change will be for good, for bad, or of no consequence.

Recommendations

At this time, I do not recommend pregnant women take CBD-enhanced hemp oil if they don’t have to. If they have a certain disease for which they need to take CBD-enhanced hemp oil, they should talk it over with their obstetrician before they take it. Many diseases improve during pregnancy and patients often can reduce or eliminate their medicines for these diseases. If the decision is made to take CBD-enhanced hemp oil, take some that has no THC in it, if at all possible. If some THC is required, take the minimal amount of THC required to control the disease. Only in rare circumstances will one ever have to take significant amounts of THC during pregnancy.
In regards to giving cannabis products to a mother to treat a fetus that has a problem, there is no information I can find where this has ever been done. There are some theoretical situations where I can imagine trying it, but to my knowledge, no one ever has.

Bottom line

All the products in cannabis (cannabinoids, terpenes, and flavonoids) cross the placenta and seem to have effects on the developing fetus. Some of these effects can be detrimental, specifically THC effects. Whether the other compounds cause detrimental, beneficial, or no effects to the fetus is unknown at this time. My recommendation is not to take any cannabis products during pregnancy, but if some are needed, the least amount of THC required to control the maternal problems should be used.

Disclaimer: The above are my opinions only and any woman who is concerned about taking cannabis products during pregnancy should consult with their doctor about this before proceeding. Note: hopefully their doctor is a board-certified OB/GYN, or better yet a board-certified MFM, Maternal/Fetal Medicine, specialist.

Where should I buy my CBD?

CBD seems to be available everywhere—in vape and shops, convenience stores and gas stations, specialty CBD/Hemp Stores, and the internet, just to mention a few.  However, not all CBD products have CBD.  Independent testing has found that many products that are labeled as having CBD actually have no CBD and, if they do have CBD, the level may be very different from that on the bottle, either higher or lower. 

What am I suppose to do?

After reviewing multiple sites and companies that provide CBD products to the public, I have found that the reputable companies seem to agree on the following severn criteria to determine where to buy CBD.

1) CBD-enriched Hemp Oil

Get CBD-enriched hemp oil.  Not CBD by itself nor hemp seed oil, but hemp oil made from the plant, not the flowers.  Hemp oil will contain multiple cannabinoids, terpenes, and flavonoids, all of which are beneficial and needed to produce the entourage effects seen when hemp oil is taken instead of plain CBD. (See Blog: The Entourage Effect for reasons why to only use CBD-enriched hemp oil)  CBD-enriched hemp oil is more costly to produce than plain CBD.  Good companies don’t scrimp but provide the best quality product.

2) Purity of the product

Is the CBD organic and GMO free?  Is it free of pesticides, heavy metals, and toxins?  Does the company test for these things and publish the results?  Good companies want their product to be safe.

3) Product production

Where does the product come from?  How is the hemp oil extracted from the plant?  High pressure CO2 extraction is the best and it is even better if high pressure CO2 is combined with ethanol extraction.  Beware of other solvent extractions as they may remain in the product.  Ethanol is easily removed from the product.  Good companies want to produce good product.

4) Laboratory testing

Is the product tested for consistency in its contents from one batch to other?  The companies will test each batch in their own lab and will send occasional samples to outside labs for independent testing (to make sure that their in-house testing is correct).  In-house testing of every batch ensures that the concentration of the cannabinoids, terpenes, and flavonoids is consistent from one batch to another.  Good companies want to produce consistent product.

5) Transparency

Does the company publish the results of their testing and/or the independent results of the outside testing of their product?  This is like being able to read the ingredients in a food product.  Does the company publish the testing of their products for pesticides, heavy metals, and toxins?  Good companies want you to have this information. 

6) Return policy

Does the company let you return their product for any reason within 60 days after obtaining it?  Less than sixty days doesn’t give one time to adequately try the product and return it if it is not working.  Do they offer a refund or just a credit?  Do they pay for the return shipping?  Good companies stand behind their product.

7) Unique Products

Does the company offer unique products that have special benefits?  However, beware of the claims and make sure that the claims are backed up by science.  An example is “water soluble CBD”.  CBD is an oil.  It is not water soluble unless it has special treatment like nanotechnology which makes the oil droplet size very, very small (4x smaller than a bacteria).  Even then the product will make the water it is suspended in a bit cloudy.  If the water is clear—It can’t contain much, if any, CBD and definitely not CBD-enriched hemp oil.  Good companies make unique products but good science supports the product’s uniqueness.

Bottom Line

 Buy your CBD from a company that uses quality produced CBD-enhanced hemp oil, produces a consistent, pure product and regularly tests for consistency of ingredients and purity from contaminants, regularly publishes those laboratory test results, stands behind their product with a great return policy, and, if it produces unique products, uses proven scientific methods that make these unique products worthwhile.  You are usually not going to find this information at a convenience store, etc. but only at CBD/Hemp specialty stores, medical offices, or on-line.  I am presently using these criteria to evaluate some of the biggest sellers of CBD and will present these results in a future blog.  

How much CBD-enriched hemp oil should I take?

 

The amount of CBD-enriched hemp oil that an individual needs is dependent on multiple factors:

  1. The weight of the individual (the volume of distribution of CBD within the body is greater than the total weight/size of the body, meaning it is distributed throughout all the body and concentrated in certain cells, including fat cells)
  2. The location of the symptom (if the symptoms are relatively superficial, a superficial application may be adequate; if the symptoms are deeper or systemic, then a systemic application would be needed)
  3. The location of the cause of the symptom (some symptoms are felt superficially but are due to injuries located deep inside the person, i.e., diabetic neuropathy: it is felt on the periphery but the cause is inflammation within the spinal cord.  In this disease, both superficial and systemic therapy is needed; superficial resolves discomfort quickly but the pain returns, only the systemic therapy will produce any long-term reduction in the pain and this takes some time)
  4. The status of the patient’s own endocannabinoid system
    • Some diseases seem to be caused by a breakdown or deficiency within the person’s endocannabinoid system, such as, fibromyalgia.  In this case micro dosing may be more effective than intermittent dosing.)
    • Different people need different amounts of CBD because of the way their body metabolizes, uses, and stores CBD and because of their own body’s ability (or lack thereof) to produce endocannabinoids.
  5. The biphasic nature of cannabinoids. In multiple animal studies and some human studies, cannabinoids (including CBD) has been shown to produce an effect at a low dose, then start to lose the effect at a higher dose, then re-produce the same effect at an even higher dose.  Sometimes the lower dose effect is greater than the highest and sometimes, vice-versa.  Often a higher dose produces other effects, some of which may desired and some which may be undesirable.  The actual amounts to produce this biphasic response varies from individual to individual and is probably influenced by #4, above.
  6. The desired outcome of the patient. Some patients only want to sleep better, some want pain relief, etc.  Once the patient’s outcomes are met there is no need for them to take more, unless they change their desired outcome.
  7. For some diseases, the starting doses for physician-prescribed,specific disease treatment of CBD and/or THC has been published, but this is for that particular drug and that drug alone. Whether this dosage is useful for CBD-enriched hemp oil products is not known.

In practice, I usually start someone out on a relatively low to moderate dose initially and gradually build up or down until they are getting the desired result.  I find that people who use topical CBD-enriched hemp oil and are helped, usually do even better when it is combined with a systemic administration (sublingual or oral).  I have found that the water soluble, full spectrum hemp oil from CBD American Shaman is excellent and recommend it first for almost everyone that has a need for systemic therapy because of its clinically seen fast rate of absorption and high blood levels.  A few individuals will have adverse side effects to the water soluble (usually headache, “hang-over”, mental disorientation, or fatigue) and I switch them to sublingual which just about everyone can tolerate.  When using sublingual, I have them take 2-3 drops several times a day.  Any more than 2-3 drops doesn’t help much more because no one can hold it under the tongue for long enough to get that much absorbed without swallowing.   Most of my patients end up on systemic therapy but that’s the nature of my practice (allergy and immunology).  If someone had a practice with lots of muscular/ligamentous/tendon injury (like a chiropractor), they may find that the topical is adequate for most of their patients.  However, I have found that those who like the topical, usually like their feeling of well-being they experience when they take a systemic form of CBD-enriched hemp oil, also.  

Bottom Line: 

The amount of CBD-enriched hemp oil that an individual needs and the method by which it is administered vary greatly and is influenced by a host of factors.  Most seem to start by taking a low to moderate amount and vary the amount up or down depending on how they are responding.  Micro dosing seems like it may be helpful in individuals with endocannabinoid deficiency diseases and/or systemic inflammatory disease.

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