June 2018 Issue

Ask the Expert: Spotlight on Cannabidiol
By Toby Amidor, MS, RD
Today's Dietitian
Vol. 20, No. 6, P. 8

Q: My clients are inquiring about cannabidiol (CBD) added to food and sold as supplements. What is CBD, what are its benefits, and how is it consumed?

A: CBD is one of the cannabinoids—chemical compounds that act on corresponding receptors in the brain—in the cannabis plant. Unlike its better-known counterpart tetrahydrocannabinol (THC), which is responsible for the "high" from marijuana, CBD is nonintoxicating with many potential health and wellness benefits. Some health professionals prescribe CBD to treat a wide range of conditions, including chronic pain, nausea, seizures, muscle spasms, insomnia, and inflammation, as well as for neuroprotection and appetite stimulation. It's also being studied for cancerous tumor suppression, blood sugar management, and bone growth.1-3 CBD is available in a variety of forms, including foods, capsules, tinctures, and more.

Historically, in response to demand for THC's intoxicating effects, producers largely bred marijuana strains higher in THC and lower in CBD. However, in 2009, a handful of CBD-rich strains (defined as 4% CBD or more per dry weight) were discovered in Northern California, making CBD more available.

CBD is fat soluble and is extracted from the cannabis plant using carbon dioxide, oils, dry ice, or solvents such as ethanol, butane, and hexane. CBD oil can be found as tinctures, capsules, edibles (such as candy and baked goods), creams and salves, and suppositories. It's also added to teas, bars, and other foods.

Whether in food or as supplements, "The benefits can be similar," says holistic cannabis practitioner and culinary nutritionist Janice Newell Bissex, MS, RDN. "The best way to reap the benefits is to find the mode that fits your [clients'] lifestyle." For example, taking a CBD capsule before bed for pain management is a common method since it can provide up to eight hours of relief.4 Some clients, however, prefer to take a tincture under the tongue, which enables them to increase the dose for any issues that arise with pain, anxiety, or insomnia. "Dosing with edibles and capsules can be tricky since metabolism via the [gastrointestinal] tract and liver is variable in each individual," Bissex warns. She recommends starting with a small dose (5 to 10 mg) and increasing in 5-mg increments until symptoms are relieved. It's important to work with a health care professional who has experience with medical cannabis.

Both hemp- and cannabis-derived CBD are available. Both plants are derived from the same plant species, Cannabis sativa, and provide the same medicinal benefits. The main difference between hemp- and cannabis-derived CBD is the amount of THC. Hemp contains less than 0.3% THC, while cannabis can have more than 0.3% THC. Hemp-based CBD oil is legal in every state as long as there's no THC in the product. Price and quality can vary, so Bissex recommends looking at where the cannabis plants are grown, whether pesticides are used, the extraction process (she avoids the solvents butane and hexane), and what the cannabinoid and terpene (another health-enhancing component of the cannabis plant) profile is. Medical marijuana patients can go to a dispensary to buy CBD products. Bissex sells high-CBD, organically grown, phytocannabinoid-rich hemp oil products on her website, JannabisWellness.com.

Recommendations for Clients
Although CBD use is controversial, it's important for RDs to understand it given its rising popularity. According to Bissex, "More than 55 million adults use cannabis, and the fastest-growing demographic is the over-65 age group, which has seen a 10-fold increase in cannabis use over the past decade." Because of this, Bissex recommends learning as much as possible about this blossoming industry. Many health professionals perceive cannabis users as "stoners," which can prevent learning and speaking up about the health and wellness benefits of cannabis.

There are many opportunities for RDs to learn about the science and use of medical marijuana. A well-attended talk at last year's Food & Nutrition Conference & Expo™ titled "Going Green: Use of Medical Cannabis in Medical Nutrition Therapy" discussed research on the benefits, risks, and applications of cannabis in various conditions as part of an integrative nutrition therapy plan.5 Handouts, including commonly asked questions, and other educational materials from this presentation are available online at https://bit.ly/2HnHoVb. In addition, the Holistic Cannabis Academy (http://holisticcannabisacademy.com) provides a comprehensive training program for health professionals who want to become holistic cannabis practitioners.

— Toby Amidor, MS, RD, CDN, is the founder of Toby Amidor Nutrition (http://tobyamidornutrition.com) and a Wall Street Journal best-selling author. Her three cookbooks include The Easy 5-Ingredient Healthy Cookbook, The Healthy Meal Prep Cookbook, and The Greek Yogurt Kitchen. She's a nutrition expert for FoodNetwork.com and a contributor to US News Eat + Run, MuscleandFitness.com, and MensJournal.com.

1. Welty TE, Luebke A, Gidal BE. Cannabidiol: promise and pitfalls. Epilepsy Curr. 2014;14(5):250-252.

2. Blessing EM, Steenkamp MM, Manzanares J, Marmar CR. Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics. 2015;12(4):825-836.

3. Penner EA, Buettner H, Mittleman MA. The impact of marijuana use on glucose, insulin, and insulin resistance among US adults. Am J Med. 2013;126(7):583-589.

4. Russo EB. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag. 2008;4(1):245-259.

5. Breeding Z, Borgelt L. Going green: use of medical cannabis in medical nutrition therapy. Paper presented at: Food & Nutrition Conference & Expo; October 22, 2017; Chicago, Illinois.