IF IT’S BEING PROMOTED DOES THAT MEAN IT’S VERIFIED?
Lets play a game of Jeopardy! This health trend has the internet buzzing with over 8 million tags on Instagram and over 500,000 published Google Scholar articles. If you answered “WHAT IS CBD?”, you’re right on the money. With this much advertising on social media, it makes me wonder - is this product actually worth all the hype?
Let’s start with the content. Cannabidiol (CBD) is one of the many cannabinoid compounds found in cannabis that doesn’t contain the psychoactive ingredient tetrahydrocannabinol (THC) that produces that “high” normally experienced with marijuana. (1) This highly publicized health fad claims to address a myriad of medical conditions such as reducing anxiety and skin inflammation.
With COVID-19 adding an extra dimension of unanticipated apprehension, it has come to my attention that Insta bloggers are promoting the use of CBD to help alleviate any anxiety and stress in their lives. I’m sure we’ve all seen those IGTV recipes adding drops of CBD oil into morning smoothies/protein shakes. But, before we start implementing these measures into our daily routine, I thought we should see if these claims are in fact verified by scientific research.
CBD & Anxiety:
According to a large retrospective case series published in The Permanente Journal in 2019, patients showed a rapid decrease in anxiety scores with minimal side effects after CBD administration (results consistent with available preclinical and clinical data). (1) However, before concluding that CBD should be the gold-standard in anxiety-related disorders, controlled clinical studies are still needed to establish the credibility of these findings. (1,2) Another concern with CBD supplements is not only the lack of evidence in human studies (2,3), but also the lack of knowledge in terms of appropriate dosing. (2) Researchers have observed an inverted bell-shaped dose-response curve which indicates that the correct dosing of CBD differs for individual patients and their symptoms and cautions that more is not always better. (2) The figure below helps to illustrate this dose-response amongst study participants who were given either a placebo or various doses of CBD prior to inducing anxiety by asking the participants to perform a public speaking test. The resulting anxiety scores from this experiment are not linear, which means higher doses of CBD are not necessarily more effective in reducing anxiety. The ‘Goldilocks’ spot for this study was at 300 mg of CBD, where the anxiety score showed a statistically significant difference in reported anxiety levels compared to those who received the placebo (PLAC). (4)
CBD & Cosmetics:
Being a makeup fiend, I’ve also noticed the ever increasing supply of CBD infused makeup and skincare products hitting the shelves. Globally, the CBD cosmetics industry is currently valued at over $580 million, and is projected to reach about $1.7 billion by 2025. (5) CBD cosmetic companies claim that their products can do everything from being anti-inflammatory and moisturizing agents to having antioxidant and anti-wrinkle properties. (6) However, with the lack of science in this field, a lot of the “hype” generated with CBD cosmetics and skincare ultimately comes down to marketing. There has, however, been some evidence that link CBD products to acne reduction. In a study published by The Journal of Clinical Investigation, CBD administered on cultured human sebocytes normalized the “pro-acne agent” in a dose dependent response, which essentially means it can mitigate acne breakouts due to excessive face oiliness. (7)
So back to the question, is all this hype actually worth it? The answer is maybe (for some things)! The effects of CBD in acne treatment do seem promising, but once again, with the lack of double-blind, randomized placebo-controlled trials, this is a gray area of research that still needs further exploration. (8,9) Before you ditch your derm prescribed products for the latest CBD infused topical, do some research. The claims of CBD skincare and cosmetic products have some potential, but consult a professional before including them in your routine.
Regulation of CBD Products:
So how safe is it to purchase CBD in the marketplace? Because both CBD and THC are derived from the same plant, it is natural for CBD products on the market to contain trace amounts of THC.The FDA regulates products via their THC content and products containing less than 0.3% THC are deemed legal. Based on this they are not further regulated for their potential safety or efficacy. (10) Let’s look to the FDA who, since 2015, have been issuing warning letters to firms marketing unauthorized CBD containing drugs. As part of its investigation, the FDA tested these compounds and found that many of them did not contain the levels of CBD that they claimed to.(10) Further, the FDA stresses that CBD products like these are not approved by the FDA for cures, treatments, or prevention of any disease. Interestingly enough, the only FDA approved CBD product is Epidiolex to treat epilepsy. (11) So before you buy any products, check for FDA warning letters. The full list can be seen here. In addition, on November 25, 2019, the FDA released a warning for 15 companies marketing CBD products in a manner that violates the FD&C Act. Read more here.
If a product hasn’t been flagged by the FDA, does that make it safe to use? Well, another pro tip is to check the manufacturer’s website for a Certificate of Analysis or a COA. If a company has a COA, that means that the product has been tested by a third-party laboratory for quality assurance, meaning you can be more confident that the product actually contains what is listed on the bottle. On a more positive note, The World Health Organization (WHO) states that “to date, there is no evidence of recreational use of CBD or any public health-related problems with the use of pure CBD”. (12) Based on our research, current knowledge, and scientific research on CBD products, it is possible that CBD products could have benefits for various health concerns. With this being said, if you believe that you have a condition that could be alleviated with CBD, talk to your doctor to see if CBD can benefit you.
Drop us a comment below to give us your take on CBD products! Interested in uncovering more research behind the latest health trends? Subscribe to our blog, follow us on Instagram @thepineperspective, tweet us @PinePOV, and like us on Facebook for more!
Primary Authors:
Arushi Krishnan
MPH Candidate | Dartmouth College
Divya Chawla
MPH Candidate | Dartmouth College
Contributors:
Shruthi Patchava, Monica Nguyen, Minda Liu
MPH Candidates | Dartmouth College
References:
1. Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. Perm J. 2019. doi:10.7812/TPP/18-041
2. Cannabidiol (CBD) — what we know and what we don’t - Harvard Health Blog - Harvard Health Publishing. https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476. Accessed May 8, 2020.
3. CBD risks and the chance to rein in supplements – Harvard Gazette. https://news.harvard.edu/gazette/story/2019/08/cbd-risks-and-the-chance-to-rein-in-supplements/. Accessed May 8, 2020.
4. Crippa JA, Guimarães FS, Campos AC, Zuardi AW. Translational investigation of the therapeutic potential of cannabidiol (CBD): Toward a new age. Front Immunol. 2018;9(SEP). doi:10.3389/fimmu.2018.02009
5. Everything You Need To Know About CBD Skincare. https://www.forbes.com/sites/nomanazish/2020/12/30/everything-you-need-to-know-about-cbd-skincare/#cf5733a3abf4. Accessed May 8, 2020.
6. Jhawar N, Schoenberg E, Wang J V., Saedi N. The growing trend of cannabidiol in skincare products. Clin Dermatol. 2019;37(3):279-281. doi:10.1016/j.clindermatol.2018.11.002
7. Makrantonaki E, Ganceviciene R, Zouboulis C. An update on the role of the sebaceous gland in the pathogenesis of acne. Dermatoendocrinol. 2011;3(1):41-49. doi:10.4161/derm.3.1.13900
8. CBD Cosmetics: Are They Worth the Hype? https://thegoodfaceproject.com/articles/CBD-oil-cosmetics. Accessed May 8, 2020.
9. Eisenstein M. The reality behind cannabidiol’s medical hype. Nature. 2019;572(7771). doi:10.1038/d41586-019-02524-5
10. FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD) | FDA. https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd. Accessed May 8, 2020.
11. CBD: Safe and effective? - Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/is-cbd-safe-and-effective/faq-20446700. Accessed May 8, 2020.
12. Hazekamp A. The Trouble with CBD Oil. Med Cannabis Cannabinoids. 2018;1(1):65-72. doi:10.1159/000489287