Should CBD become a part of your wellness routine in these troubling times? – CNN

"After I finished a round of anti-seizure medications, there weren't any other pharmaceuticals available to help me with my brain injury," Frankel said. "All of the neurosurgeons [who] I consulted said I needed bed rest until the inflammation goes down."

As a mother and wife who needed to function, Frankel became restless as she struggled with pain due to the swelling in her brain. Then her husband stumbled upon CBD, a natural anti-inflammatory derived from the cannabis plant that could, perhaps, offer some hope.

"The idea of finding relief through plant-based therapy was extremely appealing at the time. I knew about cannabis, but I wasn't educated about all of the plant's therapeutic components."

While THC is the compound that has psychoactive properties and gives the euphoria or high that people experience, CBD -- its nonpsychoactive sister, so to speak -- has emerged as a shining star -- without the mind-altering potential of THC.

In 2019, the Farm Bill made it legal to grow hemp in the United States and legal to sell hemp-derived CBD products grown in the US as well as abroad, as long as the hemp plants and hemp-derived products contain less than 0.3 percent of THC per dry weight. However, the bill does not cover CBD derived from marijuana, even if THC is removed.

Unlike hemp-derived CBD, which is sold over the counter, CBD derived from marijuana requires a doctor's prescription and is sold at regulated, licensed dispensaries (depending on your state laws) and used for specific conditions, according to Chin.

Potential therapeutic benefits of CBD, both hemp- and marijuana-derived, include reducing pain and inflammation, decreasing anxiety and aiding sleep, according to Chin, who has extensive experience in the application of CBD and cannabis across a spectrum of pathologies.

CBD calms the nervous system by working on the neurotransmitters regulating nerve cells in our brain, called GABA receptors, Chin explained. "It tells your body it's time to power down -- so there is a relaxation component." This can be extremely helpful during stressful times when someone might experience heightened anxiety levels, like during the coronavirus pandemic, Chin added.

People living with coronavirus-related anxiety due to fear of one's health or the health of loved ones, isolation, entrapment from quarantining, a disrupted routine, or simply uncertainty of the future might turn to CBD as a useful tool to get them through this difficult time. Of course, the trauma of health care workers on the front lines is another aspect of the pandemic calling for anxiety and pain relief, where CBD may be a welcome lifestyle intervention.

"Health-care workers [who] are working long shifts are finding CBD helpful for restorative sleep and on their days off using it for pain and inflammation -- from being on their feet all day, [and having] low back pain and neck pain," Chin said in an email.

"CBD can also help with panic attacks and insomnia as the prevalence of depression and PTSD mounts in response to this pandemic," Chin added.

Dr. Elizabeth Thiele, director of the pediatric epilepsy program at Massachusetts General Hospital and professor of neurology at Harvard Medical School, who was a part of the team of doctors involved in the drug's safety and efficacy trials, said that one patient was experiencing more than 100 seizures per day, but "a week later after CBD had four seizures in one day."

Though at first it may seem strange, the CBD formulated for the development of Epidiolex comes from marijuana -- the drug we often associate with adult recreational use.

Perhaps that's why hemp-derived CBD has become ubiquitous. You can find CBD at local drug stores, airports, and online markets, and it's found in forms ranging from brownies to beauty creams. "The maker of Budweiser is developing a CBD-infused beer ... and at your neighborhood cafe, you might find an option to add a shot of CBD to your morning latte. And that's not even talking about the CBD beauty industry where you can find everything from CBD bath bombs to toothpaste to face masks," Chin said.

But just because CBD is popping up everywhere, as a wellness booster that doesn't necessarily mean it should be.

"I think there is a huge amount of interest in the patient community regarding what [over-the-counter] CBD can do and what it can't do," Thiele said. "But I don't think until we have the data, we can say 'Yes, it's good for this' and 'No, it's not good for that.' "

While CBD creams, for example, may help ease pain according to anecdotal reports, "we need a lot more science on a clinical level ... not only with CBD but with the other [cannabis] compounds," Thiele said.

Additionally, there is anecdotal data showing that CBD oil is useful for a variety of inflammatory skin diseases including eczema and psoriasis, Zeichner said.

"The skin has a large amount of CBD receptors, so there is great potential. But we need to separate the beauty hype with the reality," Frankel said.

And then there are athletes, who take CBD in anticipation of a tough workout in order to minimize soreness -- something Frankel calls "a newer part of the trend."

"People are pushing their bodies -- with triathalons; CrossFit; boot camp -- these are extremely challenging physical experiences -- and so they are taking CBD topically and internally to protect against inflammation ... hoping that CBD will alleviate it."

If you suffer from back pain and do a lot of yoga or SoulCycle, you could consider using [over-the-counter] CBD as a preventative three to four times per week to prevent chronic-use injury," Chin said. But fully understanding the range of CBD's therapeutic effects and its optimal application requires more extensive research. "We know that CBD is a potent anti-inflammatory. The limited studies that exist debate exactly when athletes should try to damper inflammation and when they should just let the body recover on its own. There is lack of research regarding CBD and exercise, and it is mostly anecdotal information," Chin added.

Experts say it's critical to check with your doctor before trying any form of cannabis, particularly if you are on other medications. For example, if you are currently on an SSRI antidepressant, interactions with cannabanoids can occur.

"It is important to check with your health professional, whether your CBD is derived from hemp or your CBD is derived from marijuana. While research on CBD is promising, it is still a compound with potentially wide effects in our body and can interact with the medications that you are taking ... and can make their effects more powerful." Chin said.

Though hemp-derived CBD is legal, it remains unregulated. That means you should question health claims that may appear on labels.

"Selling unapproved products with unsubstantiated therapeutic claims -- such as claims that CBD products can treat serious diseases and conditions -- can put patients and consumers at risk by leading them to put off important medical care. Additionally, there are many unanswered questions about the science, safety, effectiveness and quality of unapproved products containing CBD," said Dr. Ned Sharpless, acting FDA commissioner.

Because of these issues, in addition to checking with your doctor first about whether or not to consider taking CBD, it's important to check a company's website for product testing, indicated by a Certificate of Analysis, or COA.

Additionally, it should reveal that there are no pesticides, molds or heavy metals. "So everything on the label is in there -- and everything you don't want is not in there," Frankel said.

Chin also advises looking at the extraction method used in the production of hemp-derived CBD. "Extraction methods using propane, hexane, pentane and butane are cheaper but can leave toxic residue. Ethanol extraction is considered a safer method for extracting CBD from plant matter as is 'supercritical CO2 extraction,' which uses carbon dioxide under high pressure with cold temperatures," Chin said.

Lastly, read the label. "If it says hemp oil -- that's not CBD oil," Frankel said. Unlike CBD oil, which contains a high concentration of CBD, hemp oil is a nutrient-rich oil from hemp seeds but contains no cannabinoids.

Cannabis is such a personalized and customized therapeutic plant, and dosing is very individualized. A brownie containing 10 milligrams of CBD may be fine for one person but too much for someone else -- and you may not feel its effects until 45 minutes after ingesting it. "There is a reason why we say 'start low and go slow,' " said Chin, who prefers oils and tinctures to edibles because you can measure the dose.

Also, cannabis is metabolized differently by women and men. "Because of the female hormone, estrogen, women are more sensitive to the effects of the chemical compounds within cannabis -- cannabinoids and terpenes," Chin said, though she added that this is more pronounced with psychoactive THC than CBD.

And even within your own body, you can build up a tolerance level, which may mean taking a break every once in a while. "I suggest women take periodic cannabis fasts to allow the endocannabinoid system to reset," Chin said.

"It's a complex relationship with a plant that can provide incredible well-being and wellness -- but you have to be willing to put in the work," Frankel added.

Lisa Drayer is a nutritionist, an author and a CNN health and nutrition contributor.

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Should CBD become a part of your wellness routine in these troubling times? - CNN