Welcome back to another episode of Your Mom on Drugs with me, the son.
And me, the mom.
My name is Josh Klaus and this is Jennifer Seltzer, Farm D, and I'm just a guy.
And we're bringing you our actually our 10th episode today, which is crazy to think.
And we're going to do it on a compound called CBD.
Now this compound was brought to us. Mom, you want to tell the story of why we chose to do this?
I would love to. So I had several people telling me, I mean, you know, older people,
my age, telling me that they want 21. That's right. Forever 21. And using CBD and or cannabidiol is the
actual what CBD stands for. And also just extra noticing how many dispensaries of CBD are around
in our cities and towns. And so it just made me think, I want to know more about this. And so
Josh and I talked about it and we thought this sounds like an absolutely perfect podcast. And
so here we are. Yeah, there's a ubiquitous use of it. So we should probably go into what it is and
how it's made and all the distinguish distinguishments behind that. So mom, what is CBD or cannabidiol?
OK, so cannabidiol is actually a part of the whole broader term of cannabis. And cannabis
describes products or compounds that are derived from two types of plants, either the cannabis
sativa or cannabis in indica plants. If you saw these plants, a picture of them, you would say,
oh, that looks like marijuana, because that's actually where marijuana comes from.
The cannabiniol, the cannabinoids are the biologically active naturally occurring
products from cannabis plants. The chemical structure was first determined in the 1960s.
And the most there are several most common forms of the cannabinoids. The first is tetra hydro
cannabinoid cannabinoid. I'm sorry, tetra hydro cannabinol, which is THC, or it's the main
intoxicating component of marijuana. And it's shown also to have analgesic and anti ametic effects.
The next one is cannabidiol or CBD. And it is considered traditionally to be non intoxicating
and not to have the psychoactive effects like marijuana, but it may have some anxiolytic
properties, which means anti anxiety. Can you remind me what any ametic means?
Oh, yes. Anti ametic means to help you not throw up. Okay. So it's against like nausea,
nausea and vomiting. Primarily it's used for cancer patients. Okay. So, and then hemp is,
I'm sure people have heard of that as well too is primarily you'll see hemp and textiles,
but which is like cloths, you know, woven fabric shirt with some hemp in it. Yes. So,
and it's predominantly CBD with a very low concentration of THC. So that's the definition
of hemp. Gotcha. Okay. So the, and these are specifically the cannabinoids,
the most frequently noted cannabinoids that we have available that we're familiar with.
Yeah. I remember reading too, that in each of these plant varieties, there's like 70 different
compounds, but these seem to be the ones that are the most studied or the ones of interest just
because they have the most, well, at least especially with THC, they have the most noticeable effects.
Right. Right. So just a little bit of how did the availability of CBD increase so
rapidly in the last several years? Yeah. Cause I'd never heard of it until recently. I did,
I always thought that it was just marijuana had THC in it. That was basically it.
Right. And so it actually came, I became familiar with it right before I retired from teaching in
2020. I also had a role on what is called the pharmacy and therapeutics committee for a hospital.
All hospitals have that committee and that committee is in place to help determine what
drugs are used in the hospital. And the issue of CBD came up because it's not a drug. We'll get
into this in just a minute, but it was patients were bringing it into the hospital and they didn't
know how to manage it. So, so basically in 2018, there was something called the agricultural
agriculture improvement act, which was also called the farm bill that came into play.
And this bill defined hemp as cannabis and cannabis derivatives that contained little to no
THC. It had to be less than 0.3% THC in those. Cause I think for the longest time,
marijuana is an illegal drug federally. Absolutely. And I think a lot, it was just kind of banned
outright. And I think this was probably a way to say, well, it's not, there's other chemicals
inside of these, you know, the Indica or Sativa variety that might not be as psychotropic as
something like THC. Right. And there are some derivatives of THC that actually have been FDA
approved as medications to be used primarily for nausea and vomiting in cancer patients that is
available. So, but, so when, when this farm bill came out, then hemp and those derivatives that
have very little THC in them became no longer illegal to sell or to market in the United States.
But they are still under the food and drug administration regulatory authority,
primarily subject to under the food, drug and cosmetic act because CBD is not considered a drug,
but it's considered a cosmetic. And I'll get to that in just a minute. Cool. In Texas, CBD, CBD
became legal to purchase in June of 2019. Governor Abbott signed that bill into practice here in
Texas. So let me just tell you a little bit about the food, drug and cosmetic act. The food, drug
and cosmetic act came into play in 1938. And it was due to the fact that there was a drug that was
being used. It was called sulfonylamide and it caused poisoning. It had contained a toxic ingredient
called diethylene glycol and it caused deaths. And so at that point, then the government decided to
create the food, drug and cosmetic act. And in this there's regulations for food, drugs and
cosmetics with the drug part of it. That's when it was just determined that all drugs had to have
safety and effectiveness data with them in order to be able to be approved as an actual drug.
But for our purposes, because CBD is considered a cosmetic, the things in this act that are
relative or that are relevant for CBD are the fact that manufacturing facilities can be inspected
where CBD is manufactured and that it can be that you can do quality standards for a cosmetic,
but it's not going to be like a drug because it's not a drug. So there are a little bit of
regulatory authority, but not like medications. So it's going to be more kind of the lines of like
sunscreen or certain lotions. I don't know if sunscreen maybe considered a...
There are certain types of sunscreens that are FDA approved, but not all of them and stuff.
Okay. Yeah, we should also kind of come into play as like, remember this is the FDA, so it's the
food and drugs. So we're talking about drugs, but also around food. And it's just a funny little
side note. I don't know if it's funny, but it's like there was a time, I think we take for granted
how consistent food has become in terms of shipment and quality. Like back, I believe it's in the 19th
century. There was a time when coffee just kind of became a very predominant beverage in the United
States. And so there was a massive demand for it across the United States. And a lot of suppliers
were saying, well, I only have about 25% of the bean to meet the demand. Basically, I don't have
enough supply. So what they would do is that they would stuff it full of stuff that kind of look
like ground coffee or coffee beans and put it in the mix. So you thought that you were getting
a whole coffee bean or a whole bag of coffee, but really you were only getting 25% with a lot of
other stuff in between. And if suppliers are not required to list the ingredients that they have
out, they will stuff it with other things. We're also seeing this too, currently with the fentanyl
crisis, there's a lot of recreational drugs, things like MDMA or other pill forms that are
actually being laced with fentanyl because fentanyl is really cheap to make. And then they can just
put it in there and it's actually leading to deaths. MDMA or also known as ecstasy is actually not
lethal. It's actually the fentanyl inside of it that actually causes the lethal dose. Anyway,
it's a side tangent to the importance of having when a supplier actually says what is inside of
their product. And so the FDA was created as mom pointed out as a response to say, hey, if you're
selling these products, you have to actually put out what is inside of it. And also we have to
determine if this is actually claiming to do what you say it's doing. And so the FDA is almost kind
of like the police department. They're enforcing the laws that have been set by the government to
actually say, hey, you're actually doing what it's actually doing. Right. And nowadays, I can't
remember now how far back it was when food labels got put on food, but before those labels were not
on food. So you did not know what the content was actually included in your bread or your cereal or
whatever and stuff. And now you do. Right. We still don't even know the dosages of that too,
other than just like the carbohydrates and fats, because they don't want to give away the recipe.
It's competitive edge. Right. But then we have to remember the dose makes the poison. So just like
in, you know, CBD, like it, the THC content is 0.3%. So yes, there is a bit of THC, but you would
have to consume a whole lot of CBD to get that high and probably not enough to actually be cost
effective. Yeah, right. And there's other adverse effects, which we'll get to it momentarily.
So again, as I said, CBD is sold only as a cosmetic except for one medication, which is called
Epidiolex. And it is FDA approved to treat some treatment resistant seizures that are
primarily seen in young infants and small children. And so, like I said, it used to be a
scheduled drug, but it is now no longer a scheduled drug in the in the controlled substance scheduling
system. But anything that has any THC in it that's greater than 0.3%, any cannabis derivatives,
is still considered what is considered a schedule one drug and is illegal things like heroin,
you know, that the marijuana that other than the ones that have been modified and regulated by the
FDA as a drug, you know, they are still considered illegal. And as Josh mentioned, because CBD is a
cosmetic, then there's no regulation as to the quantity in each individual drop gummy tablet.
Yeah, because CBD comes in a lot of different forms. It comes in oils, it comes in gummies,
it comes in a lot of different ways. Right. So there was no standard market manufacturing
process for it. So there was one survey that found that only 30% of products had accurately
labeled content. That's crazy. So like you have a three in 10 chance of a product that you're buying
actually meaning what it says. Right. Having enough CBD in it. So yeah, that you're thinking
it's going to be so anyway, so a couple of fun statistics about CBD. I just found this topic just
really fascinating. I think I don't know why because it's just it's because so many people
are using it. And I'm not sure that it has the effects that people think that does. So anyway,
there was a survey of 2000 United States adults, it found that 60% of respondents had tried CBD,
and they believed in its medicinal benefits. 65% of these US adults pulled believed that CBD was
safer than alcohol. Although only 44% of these people thought that CBD should be legal.
This was very interesting to CBD use broken down by age, 18 to 25 year olds, 32% usage incidents,
there was a 62% incidents and people 26 to 41 years old, 42 to 47 year, I'm sorry,
42 to 57 year olds had a 59% usage, 58 to 76 year olds had a 49% usage, but over 77 year old,
they had an 89% usage. I was like, wow, that's interesting. We'll get to that. Primarily people
who are over 77 years old are using it for sleep for insomnia and for sleep and stuff. So younger
people are using it for that, but they also have a greater usage of it for anxiety and relieving
stress. And this is a mate. I mean, this was a study, or this is a survey that was done by Forbes
in 2024. And they did, I think, with like 2000 participants from people 18 plus and over.
If you go, I went to another survey in 2019 and the attitudes amongst people older than 55 or 65
was vastly different. It was very negative. So it is amazing how in five years, like the perceptions
of CBD have vastly changed to going from like, we think this is kind of like marijuana, we don't
really want to touch it, which is, it is a little bit more hesitant amongst older people to now have
like, oh, this is just an alternative in the non THC version of marijuana and it's safe and it's
natural and it's cheap. So I think the pandemic might've helped out with that. Just people being
at home and probably just going online. I'm like, I'm feeling anxious. I need to help with sleep.
What can I do to do something about it? But I was amazed at looking at a 2019 survey versus a 2024
survey and just seeing how the attitudes, and it's just amazing how information travels so quickly.
Oh, I know. It can change people's perceptions. Oh here, this'll blow your mind. So in 2014,
the sales from CBD was $108 million in 2022. So eight years later, it was $1.9 billion
Oh my gosh. in the United States. That is incredible. Isn't that crazy? That's crazy.
And again, like Josh said, the most common forms are gummies, capsules, oils, and lotions. There
are some other forms that we'll mention in as well, in a little bit as well.
And then I looked too at consumer spending per month on CBD. 29% of the population, this is still
from that same Forbes survey, spent $50 a month. 23% spent 20 to $49 a month. And the 34 to 44 year
old age group spent the highest. They were the highest spenders of buying CBD. So, and then 60%
felt like CBD was safe to consume. Only 45% felt it was socially acceptable. And then there was
also 46% that believed that CBDs would result in a positive drug test. Yeah. Thinking very similar,
it's like, because THC will pop up in the blood. And it will, because there's that small percentage
of THC in it. So it very well can show up on a positive drug test. Yeah. Another thing I want to
mention too is that there was a study done by a branding group. I think they were trying to
actually, they noticed that there were negative associations between consumer usage and marijuana.
And they noticed that people were giving this attribution to CBD as well. And they measured
that four out of 10 people that they surveyed thought that CBD was just another version of
marijuana. They're like, oh, this is just a different variety. Very much like the Indica
versus the Sativa are different varieties. They were thinking it was the same thing. So there's
also this belief that these chemicals will provide similar benefits, but as you know,
the mom on drugs is going to let you know, just because they come from the same plant,
their mechanism of action might be a little bit different. That is a great segue into the next
section, because we are now going to talk about that, that as far as like how CBD works. So,
so like we said, that CBD is derived from the cannabis Sativa plant. And it is distinct from
over 100 other different types of cannabinoid compounds. And I'm going to turn this back over
to Josh, because one of the things that I learned as we were putting this information together was
that we have a system in our body called the endocannabinoid system, which is responsible for,
it's a signaling system that contributes, it's throughout our body, and it contributes to things
like stress response, anxiety, memory, pain, behavior, and it also is important in the
neurosynaptic development of teenagers, adolescents and stuff. And so we're going to see how CBD and
or other cannabinoids affect this system. So Josh, take it away.
Oh, thank you. Yeah, I, my undergrad degree was in neurobiology. So I have a little bit of understanding
of the system upon my reading. So, and as you, if anybody's listened to the show a lot, I love to
give analogies just to modern day life, because, you know, we're made of stuff and other stuff is
also stuff. So I think it's really helpful to really think about, especially your brain
as a collection of musical instruments. And a lot of times you want to figure out how is that symphony
playing. So when I'm talking right now, there's a certain amount of musical instruments playing so
that the muscles in my throat are going at the proper rate. So I'm producing sound that my mom
and y'all listeners will hear and interpret. And when you're interpreting those, your brain is doing
the same thing. If I all of a sudden got hungry or thirsty, there'd be different instruments that
would turn on and would amplify in certain parts of my brain and let me know, oh, you're thirsty,
you're hungry. So in that way, your cannabinoid system or endocannabinoid system
responds to two types of endogenous cannabinoids that you have inside of your body.
They're naturally occurring. These are things that your nervous system actually uses and they
actually use them in really cool ways. You maybe have heard of things like neurotransmitters and
neuromodulators like dopamine, serotonin, GABA, glycine, but this is a, it essentially is a
post-synaptic neuromodulator. What that means most of the time, you're sending neurotransmitters
from one nerve cell to the next nerve cell to make a mechanism of action. So for example,
if you eat something like a cookie, your first neuron or the thing in the brain cell will
basically flood what we call the gap between two brain cells called a synapse with dopamine to
basically say, oh, that was good. This was really rewarding. We should do more of this. Your brain
really likes to reward you for eating food. So the post-synapse is receiving the signal. Now,
what an endocannabinoid is, it is a post-synaptic signal. So it actually sends a signal back to the
first neuron and says, hey, stop, basically stop making more dopamine. It actually is, it basically
is a dampener of these systems because you don't want dopamine just going on forever. You want to
kind of a, you want to close the feedback loop to let you know like, hey, we're good. We're good
here. So essentially you have this natural system inside. So when you take something like THC or
CBD, these molecules fit really, really well because they are cannabinoids. It's almost like
having a parking space that is a certain width. If you have another car that is just that width,
then it's going to fit right directly into that parking space and it's going to mimic that
mechanism of action. And actually in terms of things like THC, it actually out competes your
naturally occurring cannabinoids and it will basically override the system.
And as if anybody's ever smoked marijuana before, you know the feelings that you get
in the symphony that starts to play. And some people really like it depending on the concentrations
that you have. Some people really, they don't, it actually amplifies their anxiety or their paranoia.
Some people, it makes them very creative. It makes them have overarching ideas. It makes them
have overarching ideas because everybody's biology is so different. And so those chemicals are going
to essentially cause different things inside of their body, which makes it so variable. And
everybody's got a different experience. So it's really cool that we have this system and we've
basically found plants that have been able to activate these things. But what we're probably
going to do, do you have anything to add to that system? I would tell you that while THC amplifies
the system because there are cannabinoid receptors, there's a type one and a type two cannabinoid
receptor in that system, in that endocannabinoid system. But what they've found is CBD does not
activate those system, those receptors. It doesn't fit in with those receptors. In fact, what they've
found is that they may antagonize those receptors instead. So dampen down the effect. Not sure
there. They're not exactly sure how CBD works in that whole system. So it may have some effects on
serotonin. It may not. So again, it's just not necessarily the actual mechanism is not
absolutely known. So we just probably why THC will give you that quote unquote high CBD won't,
because it doesn't act on those receptors. Remember these receptors are in your brain.
So anytime that you consume something like THC, it's going to go through your lungs and then it's
going to get into your bloodstream, cross the blood brain barrier because it's very lipophilic,
meaning that it likes fatty things. And if you didn't know, your brain is primarily fat. It's
all fat. So it basically goes in there and then it binds to these receptors. CBD is also lipophilic
as well. But like mom said, it doesn't have the affinity for these receptors. So it's going to
have a different mechanism of action. Right. Like I said, there are some thoughts that maybe the
reason that CBD might have some effect on anxiety would be because it activates serotonin receptors
that has not necessarily been proven, but that's just a thought. And it's anti-seizure activity
is not well known, but it may be that one of our naturally occurring endocannabinoid,
endocannabinoids or cannabinoids inside our body, it may keep it from breaking down,
which may give it some anti-seizure activity. So again, there's just some, these are kind of some
thoughts as far as it's concerned. So one of the, so in addition to being effective for blocking or
reducing seizure activity, that has been proven in some studies in infants and young children,
there are some other potential uses for CBD that have been touted, not with a lot of data
and not with a lot of positive data. That doesn't necessarily mean that maybe in some of these areas,
it might not be effective, but it means that we need larger, more well controlled trials.
So it's randomized controlled trials that Josh and I have talked about. And they're, they're,
they cost a lot of money. And so with something like CBD, you think who's going to fund a study
to show CBD's safety and efficacy in pain, you know, for example, or whatever. So,
yeah, maybe we should take a little bit of a moment to talk about the benefit of why a randomized,
you know, potentially maybe even ideally a double blind randomized control trial would be
a good mechanism for this. Especially just as we highlighted earlier, there's a lot of beliefs
around CBD and its effectiveness and its correlation with something like THC or like
a traditional smoking marijuana. And if anyone's ever done a recreational drug like marijuana,
you do feel something. And sometimes the idea when you feel something, you feel like something's
happening inside of you. And if you take something similar to that, you might think that that thing
is also happening. And that's kind of my guess of why I think a lot of these, a lot of these
treatments or a lot of these symptoms, they feel like will be treated by CBD. But I want to
transition over to you to say like, so why is belief not enough? Why do you need to test and do
a randomized control trial? What's the benefit of that? So that double blind randomized control
trial is the gold standard for a trial. And so basically when you have a randomized double blind
placebo control trial, or even an active control trial, meaning that you're comparing a drug to
another already known established medication, you're, what you're trying to do is eliminate any,
what we call confounding variables. That means any noise that could quote unquote noise that could
make it look like the drug is better than it actually is. So that's why it's very good to have
a placebo arm, as well as the active medication that you're studying compared to one another.
So that all of that noise will hopefully get kind of blocked out or kind of just covered by looking
at that placebo arm. Yeah. What's some of the noise that you would want to remove? I think,
I mean, common ones are like gender or race. It's like you kind of want all of those even
between the two groups. So you, you know, cause if you had like 60 year olds in one group and 20
year olds in the other group, you could say, well, maybe it was due to age, right? Right.
And also the other thing too, with a randomized control trial is that you pick usually one,
maybe two things that you're looking at to look at statistically that you're going to measure data
and show with an objective measurement that something's better than something else. So you,
so if we're looking at CBD versus placebo in pain, for example, we want to look at some pain
measurement score and show that it wasn't just suggestive that CBD was better, but because we've
got that covered with that placebo arm, but that we actually can show by measuring with these tests
that actually it could be better. We don't have that kind of study, but it could be that kind of
study. Right. Cause if a study was also, if it's a, if it's, if it's blinded, meaning that the person
received, let's say we have a person in group A and group and a person in group B, the person is
unaware of which one they're getting. Right. So that's very important. And you tell them like,
Hey, we're actually going to give you some CBD. And then one person, you're actually giving them
the CBD and the other one you're not. So both of them quote unquote believe that they're getting it.
And so you essentially are also controlling for belief. You like, you also, you have belief in
both categories and then one gets the drug and versus the other. And you're seeing if that's,
if that difference is statistically significant to see like this drug actually does something.
Right. Okay. Right. And it'd be great if it was double blinded because then even the researchers
wouldn't know. That's triple blinded. Oh, no, no, you're right. I'm sorry. I've been out of,
yeah, it's double blinded. Yes. I didn't even know there was a triple. There is a triple blind.
That's when the data analysts are also. Wow. Yeah. So, yeah. So yes, if the researchers and
the participants are blinded, there's all, there will always be somebody that knows what medication
somebody's getting in case they had an adverse effect. But yeah. So, but yeah. So that, that
gives you cleaner data. Because everyone has like a bias and an incentive for the study to go a
certain way. And you're just trying to remove as many biases, biases as possible. Yeah. Cause as,
as much as we want to be pure scientists, we have thoughts and opinions about something, you know?
Right. So, so CBD has been looked at in a variety of different areas, including pain, schizophrenia,
social anxiety disorder, anxiety disorder, diabetes, cancer, inflammatory bowel disease,
multiple sclerosis and anti-inflammatory effects. And, and, and it really hasn't been shown to be
statistically better or proven to be effective in any of those areas. Because again, we don't
have large trials. There have been some trials done in anxiety, small ones, the data are not great.
Open label trials. What that means is that people know what they're getting. There's no control
group. There's no placebo group. So they, they, they can say they're better, but you don't know
whether or not that's just like Josh said, their belief, you know, or just they think it's due to
the drug rather than maybe they're having a better day, you know, or whatever, you know, or, you know,
you just don't know that and stuff. So, and we're so good at attributing, you know, whatever we're
feeling to something that we did rather than like, well, maybe it's just cause I'm feeling better.
Right. There were some small studies that showed that CBD might be better, help people be better
at, or feel better with test anxiety or speak public speaking anxiety. But that doesn't, that
doesn't, you can't generalize that to anxiety disorder. There aren't data for that. So it's
more better for short term where there might be some data to suggest like for short term anxiety
versus just generalize anxiety. Like if you're an anxious person, maybe, but again, those studies
were not great, you know, either and stuff. So, and there've been the data are all over the board,
you know, and stuff as far as that's concerned. So we really do need more data. And this makes
a lot of sense because this seems like this industry has, you know, blossomed over the past
decade. So it just seems like that we're playing catch up with the public's opinion and their
consumption of CBD. Right. And remember, because it's a cosmetic and not a drug, so there's
no real regulation over how it gets used. I mean, well, there's, there's some regulation as far as
some of the, like maybe it's manufacturing or processes, but it's not like a drug, a medication
where you have studies that should, that, you know, it has to be safe and effective. And like
you said, it's like if someone says they took CBD and felt better compared to somebody else, as you
said earlier, only 30% of the CBD that gets sold is actually saying how much is in it. So even if
you compared two different people, you don't know how much CBD is actually if two people self
reporting, so they could be taking very different doses. Absolutely. Like when, when, if I told you,
I drank coffee today versus somebody else, their dose is probably much weaker than mine. So it's
like, you have to really measure out the milligrams of caffeine and control that of what's actually
going on. Absolutely. So yeah. So we mentioned earlier that, that CBD comes in a lot of different
form, formulations. So again, we talked about the fact that it was, it became available in Texas in
2019. As long as it has THC concentrations less than 0.3%. I mean, it is available. The only FDA
approved indication is for seizures and a drug called a pidelex. This was so interesting because
CBD comes from a plant that the, the formulation of CBD that you take could be contaminated with
pesticides, heavy metals, or household chemicals because it comes from the ground and stuff. So,
so you again, because it's not standardized and that stuff doesn't get filtered out, you don't
know exactly what you're taking, you know, so that's, that's concerning as well. It does come with a
lot of different doses forms. It's got an oral solution, soft gels, gummies, an oral oil, an oral
tincture spray, a lotion, and it can be vaped as well. So I actually looked up this as well as like,
if you're concerned, if you want to take CBD, it is really good to look up companies that have been
third party tested to actually confirm and do the chemical analysis inside of their batch. Like there
are some people who know, even though they know that the FDA doesn't requirement, they actually do
the FDA analysis or their, their regimen of analysis and, and you can do, you can go to a lab
that will essentially do this analysis and they actually put that on their labels. So, but you
have to do the due diligence of look up where, who these companies are and what they're doing so that
you know what you're getting. So there are some companies out there who are honest, but if you're
just going to the grocery store or your local pharmacy and you get the first thing that you grab,
it might be a good idea to do some research to see what's actually going in there and if they're a
reputable company. Right. So we have to remember that anything we ingest, a alternative medicine
like melatonin, a prescription drug or CBD, they're going to have adverse events associated with it,
or adverse effects associated with them. Everything does. So I wanted to give you the most common
adverse effects or side effects that are associated with CBD. They're mostly dose dependent so that
what that means is the more you take, the more likely you will have that particular side effect
or adverse effect. Somnolence, somnolence, which means like you have a lot of excess of drowsiness,
it can occur in up to 30% of patients and that was determined primarily with the Epidiolex,
which is the FDA approved agent. But because it has CBD in it, we can assume that that will happen in
the non-FDA approved formulations as well too. You can have diarrhea in up to 24% of patients.
You can also have insomnia or difficulty sleeping in about up to 10% of patients. You can have
irritability and agitation, aggression and anger in lower percentages, maybe 5% or so of patients.
You can have a decreased appetite, drowsiness and fatigue, just that as well. A dry mouth,
you could have an increase in body temperature or like a slight fever, nausea and vomiting,
weight loss, anorexia, which means that you've lost your appetite, and hypersensitivity reactions,
such as a rash or itching, especially with the topical formulations.
Did you notice in this study that those percentages that you're noticing, were they compared to people
that didn't take it or was it just a percentage of people like self-reported was in an observational
study? Some of them were compared to placebo and some weren't. I've got the decreased appetite
that I have was 16% in CBD patients versus 5% in placebo. It wasn't statistically,
analyzed, but there were different, that was definitely higher in the CBD patients.
Yes. Also, just like we can't really make claims about its benefits, it might also be good to
notice in people with its side effects, it's like, could have been a bad day, it could have been
something that they've eaten. Also another need to do the randomized control trials, also figure out
the long-term or even short-term side effects as well, and what is actually attributable to CBD.
Probably the most serious side effect or adverse effect that's been associated with CBD is that it
can increase your liver enzymes. Our liver enzymes can go up and the measurements, or the percentages
I saw were eight to 25%. That's like one in four. Elevated liver enzymes is not necessarily bad,
but you just have to watch the person to make sure that they then don't develop liver injury
and things that you would notice in a patient if they had liver injury would be things like
unexplained nausea and vomiting, or if they have some upper right quadrant abdominal pain, fatigue,
they could look kind of yellow and they have dark urine. So that's just things to watch for.
This happens when you take, it's usually when you take higher doses of medications. I know alcohol,
you obviously you get things like cirrhosis of the liver. I don't know if that's because
increased liver enzymes. I also know with acetaminophen, if you take north of certain dose.
You can have liver toxicity. Yeah. You can die from Tylenol overdose. Yeah.
Right. I can't remember how many milligrams you can take.
Yeah. It depends and stuff. So yeah, overdoses for sure. And other prescription medications,
you can have elevated liver enzymes with a variety of medications, but it's just that
watching to see whether there's liver enzymes go really high.
Yeah. I think this is such a good point. I think a lot of times people will see risks like this
and they'll, and not even just with things like CBD, but even medications that have made it through
FDA approval. And I think it's really key to reinforce that the dose makes the poison. So
our- Sometimes, not always, but sometimes. Well, I mean,
I can't think off the top of my head, but it's there. Talk away while I think. So, but it's like,
there are some medications, there are some medications that it doesn't, it's not dose
related. It just may be that your body, for whatever reason is going to be a photosensitive
or there you're sensitive to sunlight. Maybe things like anaphylactic shock when you take-
Right. Or yeah, that, or that you're, if you and I both took tetracycline for acne
or clindamycin for acne that you might get, I might get sunburned, but you might not because
you're, you're just less sensitive or whatever. So-
I guess what I'm asking is like, but if you, let's say you took half the amount,
would you- It might not matter. That might not matter.
Okay. So there are certain drugs that it doesn't matter regardless of the dose. It's just the
mechanism. I guess that would- Okay. This is a good discussion to have. So it's like,
so it's like, so okay. And places like that, it seems to be more of your body's own immune
response to- So it's like-
Or mechanistic response to whatever is going on.
It's a cascade that essentially happens. It's almost kind of like a domino effect.
Right. I guess when I'm talking about with things,
let's just use alcohol as an example, right? Like, so there's an acceptable dose of alcohol,
you're called your blood alcohol content. But if you go over that, obviously more of the functions
inside of your body are going to start becoming impaired. So there's an obviously dose response
to what's happening inside of your body. So maybe I should clarify that. You're right.
So if you take something that essentially triggers biological cascades, things like an allergen or
certain medications, I mean, you can just take a tiny little dose and it's going to put that into
gear, but something where it just is dose dependent, something like alcohol, it's going
to be a different way. Right.
Okay. That's good to distinguish. Yeah.
So whenever I say dose makes the poison, think of the latter. Think of things like alcohol or
things like acetaminophen or Tylenol and the more you take the worse response, aspirin.
And yeah, so to close the loop on that, why I was bringing that up, that's so important to do
the trials because if you get any sense of harm, I think there's kind of this thing in the public
where they think of the pharmaceutical commercial and they hear all of the side effects.
Yes.
And I don't think people really understand it's like, yeah, those side effects are there.
I actually would love to ask you when you see the side effects, are those side effects from
a pharmaceutical commercial from one of the phases of the controlled trial? Because they're
determining toxicity, right? And phase two.
It's not toxicity that they have to, that they are by law when they put those commercials on TV,
they have to cite the most, they have to cite adverse effects associated with that medication.
Now, mostly it, you know how, when you get a prescription drug, sometimes they'll give
you that what they call the package inserts that goes along with the medication. And there is a
adverse effect section in the package insert. And you'll see that usually most package inserts
now have the particular adverse effect of the medication compared to placebo or maybe another
active drug or whatever. So you can see them compared. Sometimes they do the statistics on
adverse effects in drugs and sometimes they don't. And the reason that they don't do the statistics
is because the number of patients that have that particular adverse effects is not high enough to
be able to do legitimate statistics on. So, but you'll get the percentages as far as, and sometimes
they don't do the statistics for whatever reason. I couldn't answer that question.
But they will note those adverse effects, but it could be that it's only happening in 1% of patients,
you know, instead of 25%, but they still list it as part of the adverse effects on that commercial
because that's the top 10 or 20 adverse effects associated with that medication.
And they just have to note it by law. So regardless of the percentage or the relative risk or the risk
that you're associated with it. Right. Yeah. So yeah, a lot of times, yeah, that's a really
good point. So I think it's probably better safe than sorry, just to say, you know, this is the
risk that you might be accruing by taking this thing. Right. Okay. Yeah. And then you and your
healthcare provider can make a decision as to whether or not you take it or not. So yeah,
whether the juice is worth the squeeze and, but so if only like 1% of people get acne from taking
a medication, you're like, okay, I'm going to take that risk. Yeah. I'm going to take the risk
if it's going to help me prevent cancer. Right. Right. Absolutely. Yeah. So we'll move on to
what are some of those common myths or myths under myths. Boy, I'm having a hard time with
words today. Maybe comedy myth, comment. Yeah. It'll like, chill me out. Uh, common myths or
myths, understandings about CBD. First of all, the first one might be that research is researchers
are not studying CBD and they actually are. Um, there are data, there are some trials in progress,
but we just don't have the data yet. So we can just stay tuned as we see whether or not there can be
some more definitive, um, uh, uh, uses identified for CBD. Um, the next one is that it's a proven
treatment for many health conditions. And this is not the case. It's, it's only proven for one
particular indication, but it's used for a lot of stuff that there aren't data to support at this
current time. Uh, the third misunderstanding is that CBD is illegal. It's not illegal. Um, uh,
it is, it was approved or it was made legal to purchase in 2019 in Texas. Uh, different states
have different regulations. I believe what, with what I read was that I think all 50 states allow
CBD to be sold. Now, uh, the fourth myth is that CBD will make you high, high. Um, you say hi,
hi, you gotta pay homage to your Southern roots. That's right. Um, but that is not correct because
remember it does not act, uh, it doesn't, um, uh, amplify or increase the action at those CBD
receptors. Like, uh, like marijuana. Right. Uh, all CBD is the same is not true. We talked about the
fact that it's because it's not regulated, you can have different quantities and different materials
and every CBD, uh, gummy CBD tincture drop because again of that lack of regulation, uh, medical,
uh, medications that are FDA approved are regulated. And while they're not exact milligram
amounts in each one, they've got this small 10% window, uh, plus or minus that. So it makes sure
that you've got the maximum amount. And that's not the case with CBD. Again, CBD and marijuana
are not the same. Uh, so you can't conclude that they are. Um, and that CBD is safe. CBD is, um,
um, it's not without adverse effects. So just remember that, uh, safe and that we can't call
it safe because studies haven't been done. Yeah. It's like safe relative to what? Right.
Saying it could be one of those things where maybe there's just overarching epidemiological data,
you know, just a retro active study to see like, if you just, and you have to do a self report,
be like, how many, you know, milliliters of this tincture do you take a day? And then you just ask
multiple people and you see the dose response and you see how many adverse effects are associated
with that. Um, but I think what, yeah, what would be a lot better is to actually figure out, you
know, what those doses are that are safe. As long as people are going to continue to use it, you
know, it would be good to know whether or not their money that they're spending on this is,
is really worth, worth that, you know? So, so to conclude or to wrap up what we've been talking
about today, as far as CBD is that we have found today or, and Josh and I both looking through the
literature is that it's, it's, it's used as prevalent in the United States and it's got a
variety of reasons. There's a variety of reasons why people use CBD. It is legal to purchase in
Texas. Um, but this is something I didn't mention. If you're going to manufacture CBD, you have to
get a hemp growers license and, uh, there's an application for it. And if you're going to grow
hemp, then you can do that, but you have to be regulated. So, um, it is FDA approved to be
used to treat, uh, uh, treatment resistant epilepsy. Um, it does have some adverse effects
associated with its use and it's not considered a drug in the United States as safety and efficacy
studies haven't been conducted yet. So we do need additional data to determine its efficacy for the
conditions for which it's currently being used. So yeah, it's been really interesting to see a
chemical so widely accepted and not really have too many solid claims on what it's actually doing.
Yes. It just seems like a really interesting time to see, you know, is this just one big placebo
and that people are just getting benefits from it, just from having the agency of taking something
or is there truth in a lot of the claims or some of the claims that we're seeing out there?
And, you know, we talked about the fact at the beginning of this podcast that in 77 year olds,
a lot of the, of the people are using it for sleep. Well, because it has sedation, uh, you know,
or drowsiness associated with it, you know, is it really being used more for an adverse effect
associated with it? Really, really than an indication per se, or should we look at,
should we have clinical trials that actually look at its use in insomnia or sleep difficulties to
see whether or not it's really beneficial there instead of rather than using it for a supposed
adverse effect? That's a good point. I think, I think another comparable example is something
like alcohol, like alcohol can make you kind of drowsy. Right. If you have a couple of glasses of
wine. And if you do that every night to fall asleep, you might fall asleep, but long-term,
like what's it going to do to you? Right. And you might raise the risk of liver damage.
So I think very similar to this, like just because you take something and actually I'm kind of a big
fan of like, if it's not that harmful and you feel like you're getting a perceived benefit of it,
even if it doesn't quote unquote work or it has an evidence, just do it because just the belief that
it kind of works, especially for things like pain, you just want the pain to go away. And so if you
feel like it reduces your pain, that's great. But the big thing is like, what is that doing to you
long-term? Right. You know, smoking can make you, it can reduce your anxiety from your nicotine and
make you more focused, but it can, you know, increase your risk of lung and throat cancer.
So just asking yourself, is the juice worth the squeeze? And that's where something like,
you know, large clinical trials can come into play and do that. So we're just, we're in the middle of
one big natural experiment going on right now. There you go. So, well, thank you again for
a great topic and a good discussion. Oh yeah. This is really fine. I hope that y'all found this useful.
This was for me, it was not just about CBD, but just about manufacturing processes,
how we regulate things in the U S specifically. And, you know, the role of belief and what we
take and what we think is useful, which are all really important things too. I think sometimes we
forget that these things, even things like acetaminophen, when it's generic, has to get made
somewhere and it's getting made in some pharmacy. And sometimes that pharmacy isn't very good. And
you have to really make sure that the stuff that you're getting is actually pure so that it actually
has the effect that we're doing. So until next time, we really thank y'all for listening to this
episode. My name is Josh Klaus and I'm Jennifer Seltzer and we'll see you soon. Thank you. Bye.