The inflammatory process is designed to initially help us with function and repair of injury. While short-term inflammation may be actually beneficial, long term inflammation can lead to chronic diseases such as cancer, diabetes, arthritis, inflammatory bowel disease and Alzheimers. And, acute inflammation can be downright painful. Typically, inflammation is treated with anti-inflammatories, both non-steroidal and steroidal drugs.
What is Inflammation?
Inflammation is the body’s response to injury. It is the body’s way of telling the immune system that it needs to heal itself, to repair damaged tissue and defend against pathological invaders such as bacteria and viruses. Five classic signs of inflammation include heat, pain, redness, swelling and loss of function.
Inflammation is a complex signaling process that uses molecules called eicosanoids to begin the inflammatory process. One mechanism CBD uses to reduce inflammation is by inhibiting one of the eicosanoid enzymes, the COX-2 enzyme. Inflammation is treated by anti-inflammatory
COX-2 inhibitor drugs such as the over the counter drug Advil, or the prescription drug diclofenac sodium.
For example, in acute injury inflammation is usually short and treatment is designed to remove the injurious agent. This is a positive inflammatory response. Our role is to prevent the inflammation from getting out of control by taking anti-inflammatory measures. Short-term measures for acute inflammation might include rest, ice, compression, elevation, and topical CBD. When inflammation is prolonged past the acute stage and becomes chronic tissue damage can occur and pain can become relentless. This is where CBD may also prove useful.
What happens when inflammation sets in? Your body increases its production of white blood cells and cytokines to help fight infection. Cytokines are small messenger proteins that can stimulate inflammation. Cytokines can be proinflammatory and will cause swelling and heat in the tissues as an inflammatory response. Cytokines are also involved in the sensation of pain. CBD has been shown to downregulate cytokines.
The primary problem with inflammation is the increased production of free radicals causing oxidative stress. Oxidative stress is the balance between production of free radicals and the presence of antioxidants. When there are more free radicals than antioxidants the body becomes stressed and out of balance and tissue damage occurs in general. When oxidative stress operates full speed damage occurs to proteins, fats, and genetic material, specifically. CBD has been shown to have powerful antioxidant activity.
Signs of inflammation include:
- Fatigue
- Mouth sores
- Chest pain
- Abdominal pain
- Fever
- Rash
- Joint pain
- Back pain
Acute vs. Chronic Inflammation
If inflammation is necessary for our body to heal, what types of inflammation do we need to control for our body to feel well and still be in balance and healthy? What is CBD’s role in each type of inflammation?
Acute Inflammation
Inflammation can be divided into acute and chronic. In acute inflammation, there is” local vasodilation, increased capillary perfusion, accumulation of fluid and pain from increased cytokine production.” If these processes are not halted, such as by the use of CBD or medication, and whatever caused the inflammation is not removed, progression to chronic inflammation may occur which is manifested by a maladaptive immune system and the overexpression of pro-inflammatory genes, the dysregulation of cellular signaling and the loss of barrier function.
Examples of acute inflammation:
- Joint dislocation
- Sports injury in general
- Bronchitis
- Surgery
A reaction to an acute injury will begin within two hours of the injury and anti-inflammatory measures are generally begun to prevent the inflammation from causing tissue damage or pain from the resulting swelling. Acute inflammation can serve a positive role if it stops an infection from causing tissue damage or cushions an injured joint from further harm.
Chronic Inflammation
Chronic inflammation is a maladapted immune system response of the immune, nervous, endocrine, and reproductive systems to a perceived threat or injury. This maladaptation leads to such diseases as:
- Rheumatoid Arthritis
- Systemic Lupus Erythematosus
- Multiple Sclerosis
- Psoriasis
- Inflammatory bowel disease
- Obesity
CBD in Obesity Related Inflammation
Obesity is a disease of inflammation. Pro-inflammatory cytokines secreted from the fat cells in obesity increase the risk for diabetes. Altered action in the endocannabinoid system causes impairment in fatty acid metabolism.
CB receptors are responsible for the browning of white fat cells thus being responsible for an increase in the metabolic rate that comes with brown fat. Overactivation of the CB1 receptors contributes to obesity and metabolic problems. CBD helps block CB1 receptors. And, stimulation of CB2 receptors have anti-obesity activity. These effects can be achieved best through use of a full spectrum product utilizing the full benefits of the cannabinoid spectrum. Again, more studies are needed, particularly in humans.
Inflammatory Skin Disorders
Cannabinoids seem to exert their cutaneous effects through direct and indirect receptor mechanisms. Despite a low mortality, diseases such as acne or scleroderma frequently take a toll on the individual’s self-esteem and sense of self-worth. When itching and pain are involved, the misery becomes even more evident. In 2019 a psoriasis patient was successfully treated with a CBD topical which showed a dose dependent effectiveness. In another study, 20 patients were instructed to use a topical ointment on their psoriasis for 3 months demonstrating a positive reduction in inflammation and an increase in quality of life. A synthetic cannabinoid high in CB2 receptor affinity is showing success in treating an inflammatory skin condition called dermatomyositis. Clearly cannabinoids are having a positive effect on inflammatory skin disorders in the studies to date.
Can CBD be Used for Inflammation?
Some of these chronic conditions do not have acceptable treatments for the pain associated with them such as osteoarthritis. Opioids and non-steroidal anti-inflammatories (NSAIDs) often do not adequately control the pain and/or are not acceptable as a treatment option. In a landscape of opioid addiction, other viable pain relievers must be found. This is where CBD can be safely used topically or orally to control the pain from the inflammatory process.
Several studies have supported the use of CBD in inflammation. A 2016 study on pancreatic inflammation in mice treated with 10 weeks of CBD developed Type 1 diabetes later in life than the control group. A 2017 study on rats with osteoarthritis showed a reduction in inflammation and a decrease in nerve injury after topical CBD was applied.
CBD as a Safe Alternative Anti-inflammatory
Current therapies for inflammation involve pharmaceutical drugs with well-known and mostly adverse side-effect risk profiles not only on the cardiovascular system but on the gastrointestinal tract as well. Drugs such as diclofenac sodium or ibuprofen are common pharmaceutical answers to inflammation, but they come at a price that may put your heart or gut at risk.
CBD has few to no adverse side effects making it a perfect alternative to more dangerous therapies.
Does CBD Help with Inflammation?
CBD is well known for its anti-inflammatory effects. CBD limits formation of free radicals and modulates the function of the immune system. How does it do this?
CBD Does the Following:
- Increase cellular apoptosis (cellular death)
Cell death refers to a leakage of cell contents into the adjacent tissues, resulting in the transfer of white blood cells to the injured tissue. The accumulation of white blood cells and release of enzymes and oxygen radicals enhances the inflammatory reaction. Apoptosis removes virus infected cells and pre-cancerous cells. Apoptosis maintains the balance of cells in the immune system.
- Inhibit cell proliferation
Cellular division increases rapidly during the inflammatory process and CBD slows down the growth of unruly cells.
- Inhibit cytokine production
Cytokines are signaling molecules released from immune cells that cause inflammation
- Stimulates induction of T-regulatory cells
T-regulatory cells prevent auto-immune disease, are immunosuppressive and promote wound healing
IL-6 has pro-inflammatory characteristics and plays a pathological role in autoimmunity and chronic inflammation.
CBD amplifies CB2 receptor signaling which in turn, regulates inflammation and immune cell activity. It does this without actually binding to the CB2 receptor. CBD can down-regulate the CB1 receptor while up-regulating the CB2 receptor. It does this through a myriad of parallel metabolic pathways involving other receptor sites and enzymatic actions. Its actions are often termed the “entourage effect” since CBD works in concert with terpenes, flavonoids, and other synergistic molecules to achieve its anti-inflammatory effect.
CBD is also known to inhibit a specific enzyme (FAAH) that breaks down the body’s own endocannabinoid, anandamide, causing these levels to be elevated exerting another synergistic anti-inflammatory effect.
CBD Dosage for Inflammation
Clinical trials are fervently underway to try to answer the myriad of questions the new legal status of CBD has ushered in. With CBD status now mostly legal in the US and Europe and the rest of the world taking a renewed interest in it pharmacologically, studies that can accurately answer CBD dosage questions are underway. For now, we have a plethora of animal studies that cannot be extrapolated to humans and small, poorly designed human trials from which to glean some information on dosages for inflammation.
Full Spectrum CBD or Isolate, which is More Effective?
Clinicians tend to agree that THC and CBD work together quite well as an anti-inflammatory combination. THC has direct action on the cannabinoid receptors that control inflammation. A full spectrum oil would give that added THC that an isolate does not have. THC has 20 times the anti-inflammatory activity of aspirin and twice that of cortisone. Sublingual isolate tinctures, however, work fast, the dose can easily be adjusted, and they last for 6 hours.
Products for inflammation may be found here.
Topical Doses of CBD for Inflammation
Animal studies have revealed that lower doses of topical CBD ointments do not have the same anti-inflammatory effect as higher doses. This could be possible since CBD will interact with the cannabinoid receptors located on the epidermis but not actually enter the endocannabinoid system. The epidermis has cannabinoid receptors, but the effect is local, not systemic which is why topicals can be used without the CBD getting into the bloodstream and thus, the entire endocannabinoid system.
Transdermal applications have shown a dose-dependent response as well with the higher doses giving the greater relief of pain. Animal studies showed a wide range of effective doses from 6.2 – 62 mg/day. Transdermal applications enter the endocannabinoid system.
Oral Doses of CBD for Inflammation
Oral bioavailability is quite low – about 13-19% of intake. Suggested oral amounts are 5-25 mg/kg/day according to one study. To get an idea how much CBD oil this would be for anti-inflammation for this woman calculate: for a 60 kg woman take 60 kg and multiply by 5mg -300 mg of CBD.
The low oral bioavailability is due to the excretion of metabolites via the kidneys and the multiple metabolic pathways CBD undergoes in the transition from the gastrointestinal tract through the liver and then undergoing elimination.
Oral CBD bioavailability can be increased if taken sublingually and held under the tongue putting the oil in direct contact with the blood vessel located on the underside of the tongue. Hold the oil there for 60-90 seconds. Sublingual distillates for inflammation may be found here.
CBD Doses Based on Weight
Other resources based on body weight suggest a dose range of 1-6 mg of CBD per 10 lbs. of body weight. The weight guideline is not clear on whether these dosage recommendations are for inhaled or oil-based products. For example, starting at the lowest dose of 1 mg per 10 lbs., a 100 lb. woman would need 100 lbs. divided by 10 = 10 x 1 mg = 10 mg to start. Dosages will vary according to several variables including sex, genetics, environment, presence of food, form of CBD, age and others. A scientific basis for the weight guidelines is not to be found and varies from website to website. CBD doses as high as 300 mg/kg have been evaluated with no significant side-effects.
What about CBD Vaping for Inflammation?
Doses by inhalation would theoretically be lower as you do not have to deal with the first pass metabolism associated with digestion and the CBD would pass into the bloodstream within minutes. Clinical data on doses on inhalation for inflammation are currently lacking although a proposal for an aerosol delivery system of 4 mg -200 mg of CBD has been proposed.
It has recently been suggested that cannabinoids may be therapeutic as an adjunctive anti-inflammatory therapy in SARS-CoV2 infection through aerosol inhalation. CBD has shown a decrease in inflammatory activity after administration to an animal model and it has been suggested as an adjunct therapy with Remdesivir, a treatment effective at reducing COVID-19’s severity but leaving the lungs in an inflamed state subject to further fibrosis.
Can Athletes take CBD Legally?
All cannabinoids except for CBD are prohibited from the World Anti-Doping Agency (WADA) so CBD is in the clear for using topically or orally to treat inflammatory conditions resulting from sports trauma or injuries.
Topical ointments and creams packed with CBD are widely available in doses up to 3500 mg for application on injured areas to subdue pain and reduce swelling in the injured athlete. These may be used in conjunction with CBD oils for a synergistic effect without worry of an athletic penalty.
What About Combining Tumeric with CBD for Inflammation?
Tumeric, derived from the spice curcurmin, has been used medicinally for centuries. Herbalists and functional medicine practitioners use it today for a variety of ailments, inflammation being one of them. Tumeric combined with CBD enhances the effect of CBD’s anti-inflammatory effects in a synergism characteristic of the entourage effect.
Application
We know CBD works for inflammation. It definitely offers a safer alternative than opioids or NSAIDs. Many products for CBD treatment exist and more are being put on the patent market every day. The literature supports using both topical and oral CBD for inflammation with dosages yet to be determined.
Topical use of a cream would be beneficial for a few days then you might want to consider moving to a higher bioavailability product. For more chronic conditions you might want to consider oral or aerosol/inhalation devices for use every day to prevent unrelenting discomfort and pain that often accompany inflammatory conditions. Be sure to coordinate with your primary clinician for guidance with potential drug interactions or questionable dosages.
