Contents of this Article
CBD User’s Guide
CBD — you have probably heard about it and maybe even tried it. But — how much do you know about it?
Do you know enough to get the most benefit? Are you using it at the best dose? The best delivery method?
There’s a lot to learn about CBD — and many mainstream physicians do not really know a lot about CBD yet and often are still hesitant to recommend it.
There are lots of ways to get CBD and lots of websites that promote CBD as a “miracle cure”. But…Is it truly a “miracle” substance… or not?
If you want to know more about it, read this user‘s guide for the most accurate and up to date information available.
If you’re already up to speed and just looking for a product to buy, then check out my list of the best CBD oil products.
What is CBD?
CBD is short for cannabidiol. It is one of many phytocannabinoids (cannabinoids derived from plants) found in all species of Cannabis — and for the most part, only from Cannabis.
The CBD that is sold today is nearly exclusively derived from hemp — a plant that is genetically and chemically different than marijuana plants.
Hemp and marijuana are cousins — they are also legally distinct plants and are now being treated as distinct plants by the Drug Enforcement Administration (DEA) and the U.S. Department of Agriculture (USDA).
The phytocannabinoids — which includes both CBD and the “high”-producing THC (Tetrahydrocannabinol) – are plant substances which are believed to be a natural plant defense against stress caused by infections and damage caused by insects, bacteria, viruses and fungi and as a defense against the sun’s UV radiation and to dehydration.
Essentially, the phytocannabinoids protect the plant against biologic and environmental stress (1, 2). The phytocannabinoids are produced and stored in plant structures called glandular trichomes found mainly on the leaves of the plants (3).
Evidence that this biochemical system is important lies in the fact that it evolved over 500 million years ago and is present in all vertebrate organisms — ie. those with a backbone.
CBD — and other phytocannabinoids — bind to receptors of the endocannabinoid system to produce various effects.
Think of receptors as locks and phytocannabinoids like CBD as the keys. Not every key fits every lock — and if the key (or ligand as it is technically known) doesn’t fit, the lock (the receptor) won’t get unlocked — and in this case, not getting unlocked means that the receptor won’t be activated.
On the other hand, if the key does fit, then the lock is opened, and the receptor is activated to do what it is supposed to do.
To understand what CBD does — and what it doesn’t do, let’s take a look at the human endocannabinoid system.
The Endocannabinoid System in Humans
By 1988, it was known that the human brain has receptors for phytocannabinoids — in fact, these receptors are the most common type of receptor found in the human brain. The endocannabinoid system was discovered in 1992 by Drs. Hanus and Devane when they found the natural ligand — anandamide – for the receptor (4).
This was followed by the discovery of other natural ligands including 2-arachidonoylglycerol (2-AG), homo-gamma-lineleoul ethanolamide, docosatetraenoul ethanolamide (DEA), and noladin ether (2-AGE).
Around the same time, two sets of receptors for the endocannabinoid system were described — these are known as CB1 and CB2. There may be more receptors — there have been hints that more exist, but for now, these are the best understood.
The endocannabinoid system in humans plays an important role in modulating several different physiological processes including appetite regulation, pain perception, the immune system, mood, memory, sleep, inflammation, sensitivity to the effects of insulin and both fat and energy metabolism.
Overall, the endocannabinoid system helps maintain physiological balance known as homeostasis.
This list can give some clues as to the effects of both the endocannabinoids and the phytocannabinoids like CBD (5).
CB1 and CB2 have distinct locations in the body and distinct functions.
CB1 Receptors and Function
CB1 receptors are found mainly in the brain and the spinal cord — the central nervous system (CNS) (6).
The CB1 receptors are associated with cognitive and behavioral effects including effects on:
- Control of the muscles
- Pain perception
- Mediates the brain’s “reward” system
The main endocannabinoid that binds to CB1 receptors is anandamide — which is often called the “bliss” molecule. THC also binds to CB1 as well, producing the “high” and psychotropic effects.
CB2 Receptors and Function
The CB2 receptors are found outside the CNS, primarily on peripheral nerves, skin cells and on cells of the immune system. These receptors are associated with the immune system, inflammation, wound healing, and muscular and joint pain relief.
CBD binds primarily to CB2 receptors, though new research indicates that CBD may also bind to other receptors including serotonin receptors — this binding may also explain some of the effects of CBD.
However, the binding of CBD to the CB receptors is not quite direct — it appears to bind in such a way as to modify how it binds to endocannabinoids — it can act as a sort of molecular “dimmer” switch — in some circumstances it enhances the effect of the endocannabinoid or other natural “key” while in other circumstances it may diminish the effect. It is a subtler form of action than just turning on or turning off the function of a receptor (7).
What Are the Effects of CBD?
Research is really in the earliest stages, but CBD has been found to have a variety of effects including (8):
- Pain relief
- Neuroprotective substance
Many of these studies have used synthetic forms of cannabinoids and CBD (eg. Sativex, Epidolex, Marinol, Cesamet) rather than the natural hemp-derived CBD. Since these are synthetic drugs and differ structurally from CBD the results can’t always be considered equivalent.
The pain-relieving effects of CBD appear to be related to the anti-inflammatory and anti-arthritic properties of CBD and are also likely to be due to effects on the immune response — the inflammatory response is a major contributor to pain and is a part of the immune response.
CBD has been most commonly studied for its effects on treating pain in cancer patients. Again, the research is in early stages and is still complicated by political, legal and ideological problems.
Overall, the consensus that CBD can be effective in treating certain types of chronic pain is growing (9). There is also a growing consensus that CBD is promising — and that more studies need to be done (10).
The anti-inflammatory properties of CBD may be important for its pain-relieving effects. As an anti-inflammatory substance, it appears to function via CB2 receptors — but also via other receptors involved in inflammation, reducing the production of inflammatory cytokines (substances that signal the immune system to increase the inflammatory response) (11).
The antispasmodic effects are seen in the effectiveness of CBD in treating certain types of epilepsy, especially childhood epilepsy and disorders like Dravet syndrome (and Lennox-Gastaut syndrome (LGS) (12, 13, 14).
In fact, the Cannabis strain used in Charlotte’s Web CBD oil — one of the first on the market — was developed with a specific goal of treating a child — Charlotte Figi — who had Dravet Syndrome, a form of epilepsy that was not treatable with medication.
Charlotte’s parents heard about children with this disorder being treated with medical marijuana but did not like the idea of exposing her to THC – they found the Stanley brothers in Colorado who had developed a high-CBD/low-THC strain and were producing CBD oil.
Her parents decided to try it — and found that Charlotte’s seizures – up to 300 seizures a week — were controlled so that she currently has less than 3 seizures a month.
Charlotte began to develop and grow normally — and CBD oils began to gather people’s interest, not only for its anti-seizure properties but because at about the same time, many states were looking at legalizing medical and recreational Cannabis — and the current boom in CBD began.
Sleep and Insomnia
While the anecdotal evidence for CBD as a sleep aid, there are relatively few scientific reports — any sleep benefits are often reported almost as an afterthought.
Sleepiness is often considered an “adverse effect” of CBD rather than a therapeutic effect, though it appears that the interest in CBD as a sleep aid is increasing.
CBD appears to hold the greatest promise in helping those with REM (Rapid Eye Movement) sleep disorders, though other sleep disorders such as insomnia appear to benefit with most studies reporting improvement in sleep quality, falling asleep more quickly, staying asleep longer and decreased sleep disturbances (15, 16).
Anxiety and Depression
A recent study following 72 adults with anxiety and sleep disruption found that anxiety scores decreased in 79% of patients and sleep scores improved in almost 67% of patients (17).
A review on the effects of CBD on anxiety stated that “Overall, current evidence indicates CBD has considerable potential as a treatment for multiple anxiety disorders, with need for further study of chronic and therapeutic effects in relevant clinical populations (18).”
One recent study indicated that “Prolonged CBD treatment appears to have promising therapeutic effects for improving psychological symptoms and cognition in regular cannabis users (21).” This study had some limitations, but it used natural sources of CBD with participants reporting fewer depressive and psychotic-like symptoms after CBD use.
CBD in Psychiatric Disorders
While THC is the cannabinoid best known for its psychoactive effects, CBD has been studied to some extent as a treatment for psychiatric disorders including substance abuse, psychosis, anxiety, mood disturbances, cognitive impairment, and for personality, eating, obsessive-compulsive, post-traumatic stress/PTSD, dissociative and somatic disorders.
All of these disorders should be treated by a professional, as there is currently only limited data. A recent review of available studies indicated that there was a therapeutic potential for CBD use particularly for substance abuse, anxiety, PTSD and some forms of psychoses (22, 23, 24, 25).
CBD has been studied for the treatment of schizophrenia. In one recent study, patients given CBD (at 1000 mg/day in addition to their regular antipsychotic medications) had less severe symptoms and were rated as “improved” in their symptoms as compared to a group that did not receive CBD.
At these high doses, the authors did not see significant adverse effects (26).
CBD may also be useful for autism spectrum disorder (ASD) though there have been no significant studies to date (27).
Antioxidant and Neuroprotective Effects
CBD has important antioxidant effects — effects that may make CBD an effective agent to protect the nervous system, especially the brain, from the damaging effects of oxidizing agents such as excess free radicals (28).
Free radicals, highly reactive substances, are normally produced by the mitochondria in nearly every cell of the body and there are natural antioxidants such as Vitamin C, Vitamin E, glutathione and plant flavonoids and phenols which can “soak up” these free radicals.
If the levels of free radicals are too high, they bind to proteins and DNA in the cells and can damage them, leading to cellular and organ dysfunction. It is believed that several neurologic and other disorders are caused by high levels of free radicals in the cells, tissues, and organs of the body.
These include the dementias, cancer, asthma, diabetes, degenerative eye diseases (eg. macular degeneration) and cardiovascular disorders. Any substance with significant antioxidant activity should, at least in theory, protect against these diseases.
This antioxidant activity may make CBD useful in the treatment of Alzheimer’s disease, other dementias and diseases such as Huntington’s chorea and Parkinson’s disease — though it should be noted that in some cases of Parkinson’s disease, people have experienced a worsening of symptoms with CBD use (29, 30, 31, 32, 33).
Potential Cancer Benefits
It bears repeating — the studies done to date are very preliminary and limited. These studies have been done in cell cultures (in vitro) and some animal models.
There appear to be some apoptotic effects on tumor cells — in other words, CBD may kill off some tumor cells by a process known as apoptosis (34). CBD may also be protective against cancer by its antioxidant activity.
You should also know, however, that the history of cancer research is littered with stories about how something worked well in a lab or an animal model but had no positive effects on human cancer. So — we are still waiting for more evidence.
At this time, there can be no rational recommendation to use CBD to combat any form of cancer (35).
Is CBD Safe?
In nearly every study, CBD has demonstrated a very positive safety profile. However — if you are on any other medication you need to talk to your doctor or pharmacist about any potential interactions.
CBD is metabolized by the same sets of liver enzymes many other drugs are metabolized by and may inhibit or enhance the actions of these medications. To be as safe as possible, check with both your doctor and pharmacist before taking CBD.
Most of the studies done regarding safety center around CBD’s use in seizure disorders partly because CBD has been used to treat certain seizure disorders for several years and these have the largest amount of data collected.
In a recently released study on the safety of CBD in children and adults with either Lennox-Gastaut or Dravet syndromes (both of which are seizure disorders), the authors found that CBD was effective and safe for long-term use (36).
Another recent study also found that CBD was safe and effective in treatment-resistant epilepsy (37).
An extension of an earlier comprehensive survey on the safety of CBD confirmed the favorable safety profile of CBD and reported the most common side effects of CBD use as (38):
- Increased tiredness
- Changes in appetite
- Changes in weight
- Dry mouth
- Change in mood
- Slightly lowered blood pressure
Most of these reported side effects were relatively mild.
Who should not take CBD?
There are however some people for whom CBD is not recommended. These include pregnant or breastfeeding women and those with Parkinson’s disease.
People with severe liver, heart or kidney disease should not use CBD unless under the direction of a trained and knowledgeable physician.
In some patients with Parkinson’s disease, CBD can worsen muscle tremors. This may be because some disorders, including Parkinson’s, seem to benefit from a combination of CBD+ THC.
Children should not use CBD unless under the direction of a trained and knowledgeable physician.
Most studies on safety are relatively short-term, but CBD has been safe when taken at 300 mg daily for up to 6 months and 1200-1500 mg (daily) for up to 4 weeks.
According to the World Health Organization (WHO), CBD is safe and effective, showing a low dependence and abuse potential. Tolerance can develop after long-term use(months-years) (39).
The National Cancer Institute (NCI) recently reported that “Because cannabinoid receptors, unlike opioid receptors, are not located in the brainstem areas controlling respiration, lethal overdoses from Cannabis and cannabinoids do not occur (40).”
And according to US government agencies researching cancer: “Although cannabinoids are considered by some to be addictive drugs, their addictive potential is considerably lower than that of other prescribed agents or substances of abuse. The brain develops a tolerance to cannabinoids (41).”
Is CBD Legal?
The Farm Bills of 2014 and 2018 removed industrial hemp from the DEA’s Schedule I list — and changed the law to state that if a product is derived from hemp and follows all the procedures dictated in these Farm Bills, then hemp-derived products were considered legal under Federal Law.
There are some states where restrictions still apply, so check with your own state and local ordinances and laws to be certain.
If you are outside the US, the laws are constantly changing.
Technically, in the EU, CBD is legal if it contains ≤0.2% THC. But, as in the US, different member nations have different laws, so check to make certain.
As of this writing, the only country in Africa where CBD is legal is South Africa.
Again, there are many countries where laws addressing CBD are in the “pipeline” so check to learn the applicable laws where you live.
Here is a useful map of where CBD is legal if you live in the USA
Figure 2: Map with legal status of CBD in the US as of 6/2019.Lokal_Profil/Creative Commons license
Let’s Take a Look at The History of Cannabis Legality
Cannabis has been used for food, its fibers, as fuel and for medicine for at least 5000 years (probably longer) but essentially throughout recorded history. It has been “controversial” for a significant part of that time — but the controversies have often been more political, cultural and ideological than medical or scientific (42).
Phytocannabinoids are unique to Cannabis species. Most (but not all) botanists recognize three species of Cannabis — C. indica, C. sativa, and C. ruderales. There are male, female and hermaphroditic plants.
There are numerous strains of Cannabis, some, like industrial hemp, hybridized and selected for the strength of the fibers. (The high CBD content of industrial hemp was not originally planned — it was just a fortuitous outcome).
Other strains have been selected for high THC production, nutritional value, balance of effects, disease resistance, plant stabilization or specific forms of trichomes — the plant glands which contain a high concentration of cannabinoids.
Besides hundreds of different cannabinoids, Cannabis plants also produce or contain a variety of terpenes (substances that give off the characteristic odor), flavonoids (which can act as antioxidants), fatty acids, amino acids, and other nutrients and minerals.
There are three main Cannabis preparations:
- Bhang or grass: contains a mixture of seeds, flowers, leaves, and stems
- Ganja or sinsemilla: contains unfertilized (seedless) female flowering tops
- Charas or hashish: Cannabis resins which can be produced by hand or other extraction methods
In ancient Egypt, Cannabis was known as “shemshemet”. Other ancient cultures including the Sumerian, Akkadian, Chinese, Indian, Persian, Greek and Hebrew cultures used Cannabis for pain, migraines, infections from parasites, for glaucoma, for obstetric complaints, fertility issues, to reduce fevers, for nausea, diarrhea and other digestive complaints, muscle spasms and for mood disorders (43).
Early US History
The history of Cannabis in the US is complex, confused and often, well, just bizarre.
Hemp was an important agricultural product in the early American colonies — Virginia, in 1619 passed a law that required hemp to be grown on every farm (44).
Hemp was used as currency in Virginia, Pennsylvania, and Maryland and for clothing, rope, paper and as a grain. Even the Declaration of Independence is written on paper made with hemp.
But, by the mid-1800s, it started being replaced by cotton, at least for clothing.
Hemp and its cousin marijuana were used as a medicine in the colonies, through the Revolutionary War and throughout the early decades of the 1900’s.
Physicians in the Eclectic Movement, naturopaths, chiropractors, homeopaths as well as others used marijuana primarily as a sedative, a pain reliever and to improve digestive and cardiac function. However, that was soon to change.
The quality of medical schools during the early 20th century was often questionable and in 1910, The Flexner Report recommended that the number of medical schools be reduced, the requirements for entry be increased, that medical licensure is regulated and that physicians should be trained as scientists (45).
This was all well and good — except that it limited the number of alternative, osteopathic and African American training facilities and turned medicine into somewhat of a monopoly for white men of some degree of wealth.
One of the “side effects” of these changes –along with sometimes overt racism — was the progressive criminalization of Cannabis.
During the early 20th century, Cannabis was used most often in the African American and Mexican communities.
By 1931, 29 states outlawed marijuana and in 1937, the Marijuana Tax Act made growing any species or strain of Cannabis illegal (46).
Cannabis was removed from the list of allowed drugs in 1941.
During World War 2, the ban on Cannabis growing was lifted to allow the production of rope and other materials to benefit the war effort.
Figure 3: Hemp for Victory was a film released in 1942 encouraging farmers to grow hemp for the war effort.
In 1970, the federal Controlled Substances Act (CSA) classified Cannabis as a Schedule I drug meaning that it had a “high potential for abuse” and “no currently accepted medical use”. Other drugs listed as Schedule I included heroin, lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote (47).
Now, to the current legal status of Cannabis and industrial hemp.
The 2014 Farm Bill allowed “institutions of higher education” and state agriculture departments to grow hemp under a pilot program as long as state law permitted it (48).
Additionally, the 2014 bill established a definition of industrial hemp, officially setting the THC threshold in the U.S. at 0.3 percent on a dry weight basis.”
The 2018 Farm Bill legalized hemp production AND removed industrial hemp from the list of controlled substances (49). This is the point at which it gets more shadowy.
Technically, the 2018 Farm Bill created some exceptions to the federal legality of CBD and other hemp products. One section (Section 12619) provided that CBD (and other cannabinoids) derived from hemp would be legal as long as the hemp production met all federal, state and other guidelines consistent with the Farm Bill (50).
Functionally, this means that the CBD is legal if the industrial hemp is grown by a licensed cultivar at an approved facility and the derived products contain less than 0.3% (by weight) of THC.
However, the FDA has still not determined if CBD can be marketed or sold as a dietary supplement OR if it can be sold across state lines. The FDA just recently completed a process of public hearings and comments but has not yet made any statements or policy decisions.
CBD is approved as a prescription drug (as Epidolex) so in theory (!) the FDA should not have many issues with CBD as essentially an over-the-counter drug…but, that is not yet official.
In addition, there are state and local laws to take into consideration.
In some states (Idaho, South Dakota) CBD is not legal for any use. In Kansas, CBD is not legal but decriminalized.
How to find approved CBD products
So, it is still pretty murky. There are ways however to find approved CBD products.
- Check the laws in your state and local area. For example, in the state of Washington, medical and recreational Cannabis has been legal for some years — but there are counties in Washington state that have local ordinances regulating the sale of Cannabis and hemp products.
- Look for products derived from hemp grown in the US from a licensed cultivar (grower). Your best bet is to find a product where the hemp is grown in states where Cannabis is legal (Blue in Figure 3)
- For safety and quality control, you should get a product that has been 3rd party tested by a reputable lab and has a Certificate of Analysis (COA) available for your specific lot or batch number.
- Reputable labs should be using ISO standards and have been validated by one of the following:
- Association of Official Agricultural Chemists
- The American Herbal Pharmacopoeia
- The U.S. Pharmacopeia
- This information should be available either on the COA, on the lab’s website or by calling the lab
- The COA is a good way to make certain that the label is accurate and that you are actually getting the amount of CBD that the label says you are getting.
- Reputable labs should be using ISO standards and have been validated by one of the following:
Types of CBD Oils
You have probably heard about “full spectrum”, “broad spectrum” and “isolates” when reading about CBD.
What are these and why is it important for you to know?
CBD is one of hundreds of phytocannabinoids along with terpenes (which give a distinctive odor), flavonoids (antioxidants), chlorophyll and other substances found in the hemp plant.
By law, the industrial hemp plant producing the CBD needs to contain less than 0.3% THC for it to be sold as hemp-based CBD. So, once the plant has been harvested the plant substances have to be extracted from the dried plant.
There are two main extraction methods used:
- Ethanol (or other solvent) extraction
- The traditional methods for herbal extraction used ethanol. The dried plant is soaked in ethanol and the phytocannabinoids and other substances (including chlorophyll) dissolve in the ethanol (or other solvent) and can then be separated from the plant’s fibers.
- This is a less expensive method but is less selective. Chlorophyll, for example, is extracted with ethanol and can give CBD oil a somewhat funky (at least to some) taste.
- Ethanol is a safe solvent to use, but others, such as naphtha, petroleum, butane, or propane can be a hazard, especially when they are not evaporated off efficiently. The result of ethanol or other solvent extraction is a lower concentration of CBD as compared to CO2
- CO2 extraction
- This method uses supercritical CO2 to “pull out” CBD, other cannabinoids and constituents from the dried hemp plant. Supercritical CO2 is CO2 that possesses both fluid and gas properties and allows for the oils (which contain cannabinoids and the other substances) to separate from the fiber and other plant material.
- CO2 extraction is a safe and efficient way to purify CBD, but it is expensive. It is also a “clean” way of producing CBD because it doesn’t add anything to the mixture — the CO2 used to separate the plant constituents can easily be evaporated off once the separation process is complete.
- The CO2 extraction method can be very selective — the process can be adjusted so that up to 92% of the substance extracted is CBD.
Steam distillation is occasionally still used but is overall less efficient — it also requires larger numbers of plants to get the same amount of CBD.
Full Spectrum CBD Oil
After either process of extraction, the resulting oil is called “full spectrum” because it contains CBD, other cannabinoids (including THC), terpenes, flavonoids, fatty acids, amino acids, and other plant substances.
Traditional herbal medicine nearly always used “full spectrum” extracts because it was believed that the other plant substances derived from the extraction were necessary to produce a balanced effect — the other plant substances worked cooperatively or synergistically to produce an effect.
This is now called the “entourage effect”. The entourage effect is not (quite) a scientifically proven concept but it does have a history in traditional herbal medicine (51).
However, for some, having THC in a product is a significant problem (see the section “Is CBD Legal?”). Some people have valid concerns about the psychoactive effects of THC, others are more concerned about having a positive drug test.
This has led to the development of “Broad spectrum” CBD products.
Broad Spectrum CBD Oils
Broad spectrum CBD is full spectrum CBD without the THC — an extra extraction step has been taken to remove any THC — or at least remove most of it so that it contains less than 0.3% THC, essentially only trace amounts if at all.
Broad spectrum CBD still contains all the other cannabinoids except the THC. It also contains the terpenes, flavonoids, fatty acids, and amino acids as well as other plant constituents — it is only missing the THC.
It also still exhibits an entourage effect — but without any risk of a positive drug test or any potential psychoactive effects — in other words, no possibility of a high.
You should know that both full and broad spectrum CBD oils contain other cannabinoids which may also have health benefits — the research on these is just beginning. AND — both the full and broad-spectrum CBD oils contain other phytochemicals that may have health benefits (52).
- Terpenes provide both odor and flavor to CBD oils. As a group, they also have anti-cancer, anti-inflammatory, anti-anxiety, analgesic, and immune-stimulating properties. They may also help with cognition and memory.
- Phenols including flavonoids are antioxidants and anti-inflammatory agents. Some of the phenols found in both full and broad spectrum CBD oils include apigenin, luteolin, kaempferol, quercetin, and cannflavins A and B.
Finally, some companies are producing CBD isolates — this is highly purified CBD, usually to 99.9% purity. CBD isolate is a crystal or powdered form of CBD with no flavor or odor.
The CBD isolate can be used orally (dissolved under the tongue, for example), added to liquids such as oils and teas or added to foods. CBD isolates can also be used to customize vapes, topicals such as creams, lotions or balms.
How to Determine the Right Dose of CBD for You
The mantra in CBD dosing is to “Start Low and Go Slow”.
It can take quite a bit of trial and error, but it is the safest and most effective way to find the ideal dose for you.
Everyone is different and there is still a lot we don’t know about how CBD might interact with other medications, so if you have a health professional you can trust and can consult with, that is generally best.
Many, however, don’t have a trusted health professional they can turn to. There are some basic guidelines you can follow, beyond the Start Low and Go Slow concept.
The mg amounts referred to in the recommendations given below apply to the total amounts of CBD that should be daily — at least to start with.
CBD has what is known as a wide therapeutic window — what this means is that there is a broad range (in mg) of the total amount of CBD that appears to be safe — AND different people need different amounts for different needs.
Functionally, this means that finding your ideal dose is a process of trial and error. If you follow the Start Low and Go Slow approach, you will find the best dose for you without taking more than you need OR paying more than you need.
The smaller a person you are, the less CBD you should need. The maximum amount of CBD you should start with is about 18mg per dose.
A medium-sized person (between 130-230 pounds) should start at between 8-25 mg of total CBD per dose. A larger person (over 230 pounds) should be looking at between 15-40 mg of total CBD per dose.
You can do 3-4 doses a day, depending on what you are trying to relieve.
What are you using CBD for?
For example, if you are dealing with anxiety, depression or pain you can dose throughout the day, taking the recommended amounts 3-4 times daily.
If you are dealing with sleep issues, you are likely best-off dosing once, about an hour before bedtime.
Always check with your healthcare professional before starting CBD — none of these recommendations can replace the advice of a healthcare professional who knows you and knows what you are dealing with.
Working solo in self-medication is never a good idea.
Why you need to be diligent in CBD dosage
You can also start even lower than these recommendations but ask a knowledgeable health care professional before going much higher unless it is recommended by a healthcare professional.
Because first of all, more is not always better.
Second, CBD may not work well for you, or for the condition you are looking to benefit. It’s a fact of life that not everything works for everyone, so why waste the time, energy and money if it doesn’t seem to be right for you?
Third, we just don’t have enough information to know how CBD may affect a person at these higher doses. The safety profiles described use some higher doses, but the studies used a variety of sources for CBD and it is not clear that they are referring to CBD only — they are sometimes referring to the total amount of phytocannabinoids and the CBD content was only a part of the total.
There is just too much right now that we do not know. For example, we don’t know what interactions CBD may have with other medications, and we do not have a lot of information on how CBD is metabolized by the liver.
The labeling of many CBD products often lacks enough clear information about the actual amount of CBD in every dose — with many CBD oils, the amount of CBD in the entire bottle is listed, but it is often not clear how much CBD is in every dose. You should avoid those types of products and go with products that tell you how much CBD is in every dose and how to determine that dose.
What Forms Does CBD Oil Come In?
The CBD delivery method is another thing to take into consideration. Is it an oil, a vape, a topical (skin) product or an edible?
Here are some points you should consider:
- Vaping has the fastest effect but is difficult to recommend because even though the product is vaporized and not burned, it can still produce contaminants that can have unknown effects. Vaping also has the shortest-lived effects.
- Tinctures (often in alcohol) or oils can be taken under the tongue for 30-60 seconds and then swallowed and have an effect within (usually) 20-30 minutes, but anything taken orally goes through what pharmacologists call “First Pass Metabolism” which means that the liver gets the first “shot” at the CBD — and some of the CBD will be metabolized and less than 100% of it will enter your bloodstream. The CBD in edibles and capsules also go through first-pass metabolism. Any oral delivery gives relatively rapid effects and lasts longer than vaping.
- Capsules: CBD oil can also be “packaged” in capsules or gelcaps. For these, full or broad-spectrum extracts can be used—and they can be as oils or as dried extracts. CBD isolate capsules are available as well. These capsules or gelcap preparations have all the same actions (and potential side effects, though these are few and relatively mild) as would the oils taken under the tongue and by mouth. The bioavailability may be somewhat less in the capsule/gelcap form—but we really don’t know. It may come down to personal preferences—some people prefer the oils while others prefer the capsules or gelcaps. In addition—you can always bite down or otherwise break open the capsules or gelcaps and still get the oils.
- Topicals avoid first-pass metabolism, are relatively rapid and last for a relatively long time. Topicals may come as a cream, lotion or balm, but CBD oil can also be directly applied to the skin.
- Edibles are very much like the tinctures and oils in the sense that they are delivered by mouth. First pass metabolism applies. Edibles take a bit longer to work (1-2 hours) and the effects often seem to last about 2-4 hours. Edibles are particularly useful if you don’t like any of the natural or added flavors of the tinctures or oils.
AN IMPORTANT NOTE ABOUT VAPING
As a physician, I don’t recommend vaping very often if at all. While there are reasonably valid arguments that vaping heats up the oil rather than burns it, and is therefore less risky than smoking a joint, you have probably heard about a number of illnesses and death that have been associated with vaping. The best current advice is to avoid vaping completely until we understand what is happening in those that have gotten ill or who have died.
Also, bioavailability is important to take into account when you are determining your best dose.
Bioavailability is an indication of how much CBD can enter the body. In general, vaping has the highest bioavailability, followed by oils and tinctures.
Capsules and edibles have the lowest bioavailability.
The form of CBD you choose can also depend on the condition you are hoping to benefit.
If you are in chronic pain that covers a significant part of your body, vaping (remembering some of the concerns) or an oral form as an oil, tincture or edible is likely your best bet.
If you are trying to deal with anxiety or depression, an oral form is probably better.
If you are dealing with painful joints, the topical forms are likely to be better.
How, exactly, can you start low and go slow?
That depends on your delivery system.
Vapes can be pre-measured but if you are using a non-pre-measured oil, start with 10-15 drops at a time and increase by 5 drops as needed. And — believe it or not — most droppers used are standard.
In tinctures, there are 20 drops for every mL — and 10 drops for ½ mL droppers — you have to read the labels carefully to see what the CBD dosage is per mL to determine how much CBD you are getting.
As an example, if your bottle of CBD oil contains 3 mg/mL, every drop should contain 3/20= 0.15 mg and 5 drops will give you 0.75 mg (5×0.15). ½ an mL will give you 1.5 mg (3/10 drops).
Edibles can be cut into quarters or halves — sometimes smaller pieces if you can!
So, once you have the smallest dose you can measure, wait for a day using that smallest dose to determine how well it is working. Then increase it every day or every other day.
Be sure to wait at least one-two days before determining if that dose is working for you.
Example: On the first day, you take 1 drop of CBD oil that contains 3 mg CBD in every mL for back pain and you take it every 3-4 hours. It may be difficult but wait for at least a day.
If that amount doesn’t work, the next day take 2 drops every 3-4 hours. If that still is not effective, wait two days and try 4 drops then 6, 8, 10, 12 and so on, increasing the dose every other day.
Try to be as objective as possible — keep a journal.
With pain relief, determine how much pain you have the day you begin. Let’s say that is a 6/10. You should set a reasonable goal — let’s say you want pain relief so that you can function — and that is at 2/10. (Everyone is different, and you may very well get total relief, but these are guidelines).
Assess your pain every day as well as you can. You are quite likely to get some pain relief after the first or second dose change — but it may not be significant until the third or fourth. Try to be as patient as possible.
Another example would be using CBD oil to get better sleep. Let’s use the same oil with 3 mg of CBD in every mL.
Start your journal and start with 1 drop under the tongue on the first night and record how well you slept.
If you need to, try 2 drops the next night and the 3rd night. If you are not sleeping better, on the 4th night try 4 drops. Still not sleeping better? On the 5th night, try 6 drops, then 8 and 10.
How Long Should I Take CBD For?
As a general “rule of thumb”, any drug, medication or natural product should be taken only as long as there is a problem that is being addressed. This is, admittedly, a cautious approach, but overall in my experience, it has served people well.
First — why take something you don’t need? Second — and this may turn out to be very important — there are some indications that cannabinoids can induce tolerance, usually after being taken for an extended period.
In this context, tolerance means that your body has gotten used to a certain level of CBD and after some time, you may need more CBD to get the same effect. We know more about the development of tolerance to THC, but it is not unreasonable to think that tolerance can develop to CBD.
Also — while many don’t like to think of a natural product as a drug, the fact is that CBD is being used as a drug and the body reacts to it just as if it were a drug — the body is unaware of social or cultural niceties. This means that it may also produce effects such as rebound pain or hyperreactivity and other adaptive changes after being used long term.
We just don’t have the information to be certain.
If you are taking CBD for pain relief — stop using it when the pain is gone. If you are dealing with chronic pain, use the CBD for 2-4 weeks at your optimal pain-relief level and then see if you can comfortably back down by ~ 10-20%.
If you are using CBD to help you sleep better, use it for 2-4 weeks and then try to sleep without the CBD.
If you are using CBD to help you with occasional anxiety or depression, see how you feel once the triggering event or situation has been removed — and always also consider talking to a counselor or therapist.
If you are taking CBD for a seizure disorder, follow your physician’s instructions and take the CBD for as long (and how) they recommend.
CBD Oil FAQ
Stock Photos from ElRoi / Shutterstock
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About the Author
Dr. Zora DeGrandpre practices naturopathic medicine (home visits) in rural Washington and is a professional medical and scientific writer and editor, specializing in naturopathic, functional, botanical and integrative medicine. Dr. DeGrandpre has degrees in drug design, immunology, and natural medicine and has extensive research experience in cancer and molecular immunology.