Page 23 - Today's Dietitian (March 2020)

P roducts containing cannabidiol (CBD) were measured several times during the public speak-

ing exercise. Patients who were pretreated with CBD
seem to be everywhere, from corner
showed significantly less anxiety, cognitive impair-
stores to mail-order giants. Consum-
ers can pick from supplements and
ment, and discomfort during the simulation.
Janice Newell Bissex, MS, RDN, FAND, a holis-
sprays to balms and brownies as they
seek the serenity promised by this
cannabis derivative. Cannabis bever- tic cannabis practitioner, culinary nutritionist, and
owner of Jannabis Wellness in Melrose, Massachusetts,
ages are particularly appealing to consumers. Accord- says, “We are beginning to learn about the variety of
ing to a survey by High Yield Insights, 17% of current health benefits of CBD to help alleviate pain, anxi-
CBD respondents, led by men aged 21–34, reported con- ety, insomnia, muscle spasms, inflammation, depres-
suming CBD beverages, and 30% of nonusers reported sion, and possibly autism. It isn’t a cure-all, but it can
interest. With a projected average annual growth in improve or relieve a lot of conditions in a more natu-
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the United States of 75%, from 2018 to 2023, the emerg- ral way. Some of my clients have been able to decrease
ing category of CBD beverages is hard to ignore. their use of antianxiety and pain medications after
adding cannabis to their regimen.”
Overview of CBD Questions remain, however, regarding the safety of
Of the Cannabis sativa plant, marijuana and hemp are CBD, including the effects of long-term use and using
the best-known strains; CBD and tetrahydrocannabi- multiple CBD-containing products simultaneously. CBD
nol (THC) are the best-known bioactive compounds. use has been associated with liver toxicity, extreme
More than 80 phytocannabinoid compounds have been sleepiness, interaction with certain medications, and
identified in the Cannabis sativa plant alone. CBD is the potential harm to a fetus or breast-fed baby. More
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nonintoxicating cannabinoid associated with health research is needed to better understand the benefits and
benefits, including analgesic properties. THC, the intoxi- drawbacks of CBD and to increase knowledge about the
cating compound, features prominently in marijuana endocannabinoid system, its potential modulators, and
but is present at less than 0.3% in hemp; therefore, hemp its impact on various conditions.
is the source of choice for CBD.
A quick scan of the available research demonstrates Regulatory Status in Flux
broad interest in the functions and health-supporting The 2018 Farm Bill removed hemp from the list of
roles of the body’s endocannabinoid system, includ- Schedule 1 narcotics (where it previously was catego-
ing mental and physical health, as well as disease treat- rized with marijuana) and legalized its cultivation,
ment and prevention. Plant-derived cannabinoids (ie, opening the door for production of topical and other
phytocannabinoids) have been researched as potential products containing CBD. The Farm Bill retains FDA’s
therapeutic options because of their modulation of the authority to regulate the sale and marketing of CBD-
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endocannabinoid system. containing foods. However, under the federal Food,
In her FNCE® 2019 presentation, “CBD is Every- Drug, and Cosmetic (FD&C) Act, because CBD is an
where! Navigating the MNT and Its Role in the Mar- active pharmaceutical ingredient in an approved drug,
ketplace,” Laura Lagano, MS, RDN, CDN, highlighted Epidiolex, food (or beverage) products containing CBD
more than two dozen conditions CBD usage can help can’t be introduced into interstate commerce, that is,
alleviate. She noted that CBD acts by impacting sero- manufactured in one state and sold in another, accord-
tonin, opioid, dopamine, and other receptors located ing to the FDA. 6
throughout the body. The FDA issued warning letters in late November
Studies suggest the effects of CBD on the activity of 2019 to companies regarding CBD in their food and
the endocannabinoid system have the potential to ben- beverage products and for higher amounts of THC
efit treatment for a broad range of conditions, including than are stated on labels or legally permitted. In a
neurodegenerative, cardiovascular, and inflammatory November 26, 2019, consumer notice, the FDA stated
disorders; obesity and metabolic syndrome; cachexia; that “under the FD&C Act, it’s illegal to introduce
chemotherapy-induced nausea and vomiting; and tissue into interstate commerce any human or animal food
injury and pain. Clinical trials, however, have focused to which certain drug ingredients, such as CBD, have
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primarily on THC and its targets, CB1 receptors. To date, been added. In addition, the FDA isn’t aware of any
CBD studies are limited to preclinical and pilot studies basis to conclude that CBD is GRAS [generally rec-
that elucidate its anti-inflammatory, antioxidative, and ognized as safe] among qualified experts for its use
neuroprotective effects. 4 in human or animal food. There also is no food addi-
One preliminary study published in 2011 com- tive regulation which authorizes the use of CBD as
pared the effects of simulated public speaking on an ingredient in human food or animal food, and the
healthy control patients, patients with diagnosed but agency is not aware of any other exemption from the
untreated social anxiety who received a single 600-mg food additive definition that would apply to CBD. CBD
dose of CBD, and patients with diagnosed speaker is therefore an unapproved food additive and its use
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anxiety who received a placebo. Subjective mood in human or animal food violates the FD&C Act for
and self-deprecation tests and physiological tests reasons that are independent of its status as a drug
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