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Health

Most CBD benefits hold promise, but not proof

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CBD, or cannabidiol, is suddenly everywhere. In oils, creams, bath products -- even food and pet treats. But what is it? And will it end up being a big medical breakthrough or just the latest fad?

CBD is the most abundant non-psychoactive compound found in marijuana and hemp. It’s different from THC, the compound that gives pot users a “high.”

Epidiolex, the first drug containing CBD, was recently approved by the Food and Drug Administration to treat specific rare and severe forms of epilepsy.

Dr. Orrin Devinsky, neurologist and director of NYU Langone's Comprehensive Epilepsy Center, spearheaded the studies of CBD that led to Epidiolex. He joined us on "Take Care" to talk about the benefits of cannabidiol.

He says that various studies in the past five to 10 years have identified several receptors in the brain that CBD effects. In addition to the receptor that is involved in the rare forms of epilepsy, CBD also appears to have an impact on one of the serotonin receptors. Devinsky says that may be why CBDs have shown to have some anti-anxiety effects.

But proponents of CBD claim the compound can help many other conditions -- everything from inflammation to acne to cancer.

Devinsky says so far the scientific evidence just isn’t there.

“It’s important to say right now in 2019 as we talk, the only disorder for which we have strong scientific evidence that CBD is effective is in these rare, childhood onset epilepsies.”

And Devinsky notes that CBD isn’t even proven to help all seizure disorders.

“In other forms of epilepsy, some studies have actually been negative, as in the focal epilepsy study. And many other epilepsies have not been studied,” said Devinsky.

“As far as other areas, there’s supportive evidence in anxiety disorders, in schizophrenia, in behavioral disorders associated with autism, in insomnia and in a variety of inflammatory disorders from gastrointestinal to arthritis. So the potential for CBD and the hope for CBD is enormous and very wide, but the scientific data right now is fairly limited.”

There are many studies in progress about the impacts of CBD, including using CBD for pain. Some researchers hope CBD could help the ongoing opioid drug crisis.

Devinsky says the studies have not been promising to date for cancer pain. But pain from arthritis and multiple sclerosis is different. Anecdotally, many patients say the CBD creams have helped pain caused by those disorders.

CBD is on the market in a variety of forms, from oils to pills to lotions. Devinsky says if you’re going to try CBD, it’s important to know how the body absorbs it.

CBD is a very fat-soluble compound. Devinsky points out that most medications people are used to taking are water soluble and very well absorbed by the gastrointestinal track. But CBD is poorly absorbed that way, according to Devinsky, which means the dose you get when you take CBD could literally vary four-fold. That’s a different the doctor calls “enormous.”

“If you take CBD on an empty stomach or in association with a high-carbohydrate meal, you may only absorb 4-6% of it. If you consume it with a high-fat meal, which could be a ribeye steak or avocado, then you may absorb up to 16 to 20%,” Devinsky said.

At low doses, Devinsky says he believes CBD is a fairly safe drug. And he has treated hundreds of people with it. But, he warns that the long-term effects have not been studied.

“It is natural and it comes from a plant, but it is a drug,” said Devinsky. “Whenever you take 100 pounds or 500 pounds of leaves from a plant, and extract a single chemical or compound of the 400 or more compounds that are in that plant, in medicine, that is absolutely a drug. And you are not using it in a natural dose, you’re using at a pharmacological dose.”

Some people take 100-600 mg of CBD a day. That compares to the 5 mg you get when smoking the plant.

On the positive side, CBD does have fewer side effects than many other drugs used for neurological and psychiatric diseases, according to Devinsky.

But with many people using CBD for conditions it’s not proven to work for, Devinsky said “perhaps the most dangerous part of that is if they forego effective treatment with another drug.”

The regulation of CBD is confusing because different states have different laws, as does the federal government. Devinsky said in addition to that causing confusion for consumers, it’s making it harder to do research on the compound.

And what about using CBD on animals? Devinsky said he’s not making recommendations, but it’s not unreasonable to try it at a low dose on your family pet.

Whether it’s you or a furry friend using CBD, Devinsky’s advice seems like common sense. Observe the patient carefully to monitor its effects and do your due diligence to try to get a reliable producer.