How does CBD work? CBD’s medicinal properties and uses
This article explores how CBD works within our bodies and the role of the endocannabinoid system (ECS). It also covers the proven medicinal properties of CBD, as outlined by the World Health Organisation (WHO) and potential uses of CBD.
How is cannabidiol (CBD) processed by the body?
CBD is one of many cannabinoids found in the cannabis plant. Cannabinoids are chemicals that interact with cannabinoid receptors in the human body.
We have different receptors in our bodies that respond to certain classes of chemicals, for instance insulin, testosterone and estrogen each have their own receptors. The system of receptors that interacts with cannabinoids is the endocannabinoid system (ECS).
Understanding the endocannabinoid system, its functions and how it interacts with cannabinoids is at the core of understanding how CBD and other cannabinoids work in the body.
The endocannabinoid system (ECS)
The endocannabinoid system (ECS) is a complex biological system of neurons, neural pathways, neurotransmitters and cannabinoid receptors in the central nervous system (brain and spine) and the peripheral nervous system (limbs and organs).
The ECS is present in the lungs, liver, intestine, kidney, spleen, lymphatic and nerve tissue, and is involved in regulating a variety of cognitive and physiological processes, including:
- Pain sensation
- Immune function and response
- Stress response
- Cycles of cellular life and death
- Physical exercise (it’s responsible for the exercise-induced euphoria know as runners high)
- Fertility, pregnancy and both pre- and postnatal development
Cannabinoids – like CBD, THC and endocannabinoids – are naturally produced by our bodies and interact with the ECS through two key receptors. Type 1 receptors (CB1), are predominantly in the brain and interact with THC. CBD interacts with the type 2 receptors (CB2) that are found in the immune system, brain, gastrointestinal system and peripheral nervous system.
THC produces its mind-altering high by affecting the CB1 receptors in the brain. CBD, on the other hand, influences both the body’s use of its own naturally occurring endocannabinoids as well as acting on other chemicals in the ECS.
The broad influence of the endocannabinoid system within our bodies and the proven interaction between it and cannabinoids is the basis for the extensive list of possible applications and benefits of supplementing CBD.
Does CBD get you high?
CBD is one of the most prominent compounds in the cannabis plant, second to tetrahydrocannabinol (THC), the chemical responsible for the feeling of being high that is commonly associated with marijuana.
Even though it occurs naturally in the cannabis plant, CBD is non-psychoactive, meaning it does not produce a high or any mind-altering effects. In fact, CBD has antipsychotic properties and counteracts the psychoactivity of THC.
Medicinal properties of CBD oil:
In a 2017 assessment of CBD, the World Health Organisation (WHO) reported on CBD’s medicinal properties:
“The range of conditions for which CBD has been assessed is diverse, consistent with its neuroprotective, antiepileptic, hypoxia-ischemia, anxiolytic, antipsychotic, analgesic, anti-inflammatory, anti-asthmatic, and antitumor properties.”
WHO – November 2017
This assessment by the WHO is consistent with the British Journal of Clinical Pharmacology’s findings on CBD, published in 2013:
- Antiemetic – reduces nausea and vomiting
- anticonvulsant – suppresses seizure activity
- Antipsychotic – combats psychosis disorders
- Anti-inflammatory – combats inflammatory disorders
- Antioxidant – combats neurodegenerative disorders
- Anti-tumoral and anti-cancer – combats tumor and cancer cells
- Anxiolytic and antidepressant – combats anxiety and depression
– British Journal of Clinical Pharmacology ( 2013 review)
The following section is a breakdown and explanation of the medicinal properties reported by the WHO.
CBD as a neuroprotective agent:
Neuroprotection refers to the conservation of neurons and nerve cells. This means that CBD slows the rate of neuron loss, reducing the damage to the brain and nervous system. Central nervous system disorders that are treated with neuroprotection include neurodegenerative diseases, stroke, traumatic brain injury, spinal cord injury and neurotoxin consumption i.e. methamphetamine overdoses.
This 1998 study was one of the first to publish the antioxidant properties of CBD and its potential as a neuroprotective agent:
“The antioxidative properties of cannabinoids suggest a therapeutic use as neuroprotective agents, and the particular properties of cannabidiol make it a good candidate for such development”
CBD as an antiepileptic
Antiepileptic or antiseizure drugs are anticonvulsants, which are used in the treatment of epileptic seizures. Anticonvulsants subdue the rapid firing of neurons during seizures. Interestingly, anticonvulsant medications can be used to treat neuropathic pain, further evidence that CBD has neuroprotective qualities.
Additionally, anticonvulsants can act as mood stabilisers, potentially making them useful for the treatment of bipolar and personality disorders.
The study ‘Cannabidiol: Pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders’ noted that:
“CBD bears investigation in epilepsy and other neuropsychiatric disorders, including anxiety, schizophrenia, addiction and neonatal hypoxic-ischemic encephalopathy”
CBD and hypoxia-ischemia recovery
Hypoxic-ischemic brain injury is a diagnosis covering an array of brain injuries resulting from insufficient blood or oxygen to the brain. Typical causes of hypoxic-ischemic brain injury include: cardiac arrest, respiratory arrest, suffocation, carbon monoxide and other gas exposures.
Hypoxic-ischemic brain injury can cause an array of cognitive, emotional and behavioural problems, including: seizures, movement and motor function disorders and cognitive impairment. CBD has been shown to lead to functional, biochemical, and neurobehavioral improvements following Hypoxic-ischemic brain injury:
“Cannabidiol (CBD) demonstrated short-term neuroprotective effects in the immature brain following hypoxia-ischemia”
“These results emphasize the interest in CBD as a neuroprotective agent”
CBD as an anxiolytic:
Anxiolytics are drugs used to reduce anxiety and treat symptoms of anxiety disorders. Commonly prescribed anxiolytics are in the benzodiazepine family and include: Alprazolam (Xanax), Diazepam (Valium), Lorazepam (Ativan), Chlordiazepoxide (Librium), Clonazepam (Klonopin).
Anxiolytics like the benzodiazepines above have notable side effects and warnings:
- Addiction: if taken for long periods they are habit forming and addictive.
- Tolerance: Taking anxiolytics for an extended period can result in a tolerance
- Withdrawal potential: If users stop taking anxiolytics suddenly, withdrawal symptoms are possible
- Overdose potential: dangerous overdoses are possible
In a stark comparison, CBD does not come with side effects and warnings as serious as the benzodiazepines mentioned. CBD can be safely taken at high doses, is non-addictive, has no dependence potential and has shown no withdrawal symptoms:
“No studies assessing the dependence potential (withdrawal and tolerance) of CBD in humans could be identified”
Expert Peer Review for Cannabidiol (CBD)
World Health Organisation
Geneva, 6-10 November 2017
CBD as an Antipsychotic:
Antipsychotics (neuroleptics or major tranquilizers) are psychiatric medications used to manage psychosis and psychotic symptoms, including: schizophrenia, bipolar disorder, delusions, hallucinations, paranoia and severe anxiety.
Clinical research into CBD’s antipsychotic properties is still underway, however early trials and studies have had very promising results. Particularly with regard to its side effect profile being much safer than current antipsychotic medications:
“Cannabidiol exerts antipsychotic properties comparable to the antipsychotic drug amisulpride while being accompanied by a superior, placebo-like side effect profile.”
“CBD prevented human experimental psychosis and was effective in open case reports and clinical trials in patients with schizophrenia with a remarkable safety profile” “These results support the idea that CBD may be a future therapeutic option in psychosis, in general and in schizophrenia, in particular.”
CBD as an analgesic (painkiller):
Analgesics are any drugs which are used for pain relief (analgesia). There are many forms of analgesic which act differently on the peripheral and central nervous system. Most analgesics work by reducing inflammation or swelling as anti-inflammatory drugs, others work by blocking pain signalling to the brain by affecting the central nervous system.
CBD along with THC is already being used in the pharmaceutical product Nabiximols (sativex) to treat neuropathic pain as well as spasticity, overactive bladder, and other symptoms of multiple sclerosis. Its standardised in composition with each spray containing a dose of 2.7 mg THC and 2.5 mg CBD. interestingly a study on Sativex revealed that:
“The presence of CBD in the Sativex preparation was crucial to attain significant pain relief”
There is also promising potential for cannabinoids like CBD and THC to be used in conjunction with opioids for treating chronic pain with fewer or no side effects. The study: ‘Role of the Cannabinoid System in Pain Control and Therapeutic Implications for the Management of Acute and Chronic Pain Episodes’ found that when CBD was used in addition to opioids “the required dose of each agent could be reduced” significantly enough, to dramatically reduce or eliminate side effects.
CBD as an anti-inflammatory:
Anti-inflammatories are substances or treatments which reduce inflammation or swelling, they make up roughly half of painkillers. Non-steroidal anti-inflammatory drugs are commonly used and easily accessible, they include aspirin, ibuprofen, and naproxen etc. They work by counteracting / inhibiting the cyclooxygenase (COX) enzyme which is responsible for creating inflammation. Long term use of anti-inflammatory drugs like these can cause gastric erosions, stomach ulcers and in rare cases severe haemorrhage.
The study ‘Cannabinoids as novel anti-inflammatory drugs’ reported that: “Cannabinoids have exhibited significant potential to be used as novel anti-inflammatory agents” however “further evaluation of the mechanisms that account for their anti-inflammatory properties is necessary”.
A 2012 animal study by the National Institutes of Health found CBD to “significantly suppress chronic inflammatory and neuropathic pain without causing apparent analgesic tolerance”.
CBD as an anti-asthmatic:
Asthma is a disease causing inflammation of the airway passages in our respiratory system. Asthmatics can experience difficulty breathing, bronchospasms, coughing and shortness of breath.
Treatment for Asthma is categorised as either; instant relief medications used for acute asthma, or long-term preventative medications which reduce inflammation and airway resistance.
The 2010 study, ‘Cannabinoids as novel anti-inflammatory drugs’ reported that “cannabinoid-based compounds may represent a novel class of therapeutic agents for the treatment of allergic airway diseases”. This potential to treat airway diseases is consistent with its anti-inflammatory properties and possible use as an anti-asthmatic in the future.
CBD as an anti-tumoral:
Cannabinoids are currently used to treat pain and nausea caused by in cancer patients. The anti-tumoral properties of cannabinoids including CBD are promising:
“Scientists reported that THC and other cannabinoids such as CBD slow growth and/or cause death in certain types of cancer cells growing in lab dishes. Some animal studies also suggest certain cannabinoids may slow growth and reduce spread of some forms of cancer.” – American cancer society
However, CBD and cannabinoids as anti-cancer treatments are are still very much in the early stages of clinical trials.
Potential uses of CBD
The following list of potential uses of CBD was published in 2017 by the Department of Pharmacy, University of Salerno, Italy in the review: ‘Cannabidiol: State of the art and new challenges for therapeutic applications’. The potential uses they state are consistent with CBD’s medicinal properties outlined by the World Health Organisation above.
- Rheumatoid arthritis
- Alzheimer’s disease
- Parkinson’s disease
- Crohn’s disease
- Multiple sclerosis
- Cardiovascular diseases
- Huntington’s disease
- Diabetic complications
- Hypoxia-ischemia injury
- Inflammatory bowel disease
- Inflammatory diseases
Cannabidiol: State of the art and new challenges for therapeutic applications
– Pisanti et al (2017)
Limited CBD studies:
In the 1970s all types of cannabis, including hemp, were outlawed in the United States as part of president Nixon’s War on Drugs. For this reason, research into CBD is limited with many potential uses and applications having only limited supporting clinical evidence. The exception to this is epilepsy, where CBD has been demonstrated as an effective treatment in several clinical trials.
With medicinal, and in some cases recreational cannabis use becoming legalised and accepted, it will become more accessible for researchers to further investigate CBD, its medicinal properties and potential uses.