CBD
and Chiropractic
Emerging from the shadow of its controversial - and sexier - sibling tetrahydrocannabinol (THC), cannabidiol (CBD) is close to being a panacea. Judging from the amount of research conducted in the last 10 years on this phytochemical, and by a wide range of claims concerning its therapeutic benefit, CBD may be a health-care game-changer.
A non-psychoactive supporter of the
human endocannabinoid system, CBD appears to be useful in relieving
seizures, pain, anxiety, insomnia, depression, and more, and
theoretically replacing painkillers, anxiolytics, sleeping pills,
antidepressants and other dangerous prescription drugs. CBD has no
unwanted side-effects.
In contrast to medical and recreational
cannabis products containing THC, CBD oil, an extract of the
low-to-no THC industrial hemp plant, is legal for sale and
consumption in all states of the U.S. in spite of the December 2016
Drug Enforcement Administration's (DEA) creation of a new "Code
Number" for "Marihuana Extract". CBD oil is legal for
consumption in all states.
Background
The hemp plant from which CBD is
extracted has been used for thousands of years and across a variety
of cultures in dozens of applications including paper, clothing,
rope, fuel, plastics, and building materials. In 17th century
America, farmers were ordered by law to grow hemp. According to an
1850 census there were 8400 hemp plantations in the U.S. In the early
20th century, the Ford Motor Company produced hemp fuel.
But in 1937 Congress put an end to hemp
farming by passing the Marijuana Tax Act, spearheaded by
Federal Bureau of Narcotics chief Harry Anslinger. The Marihuana
Tax Act made it illegal to grow cannabis of any kind including
hemp - and for anyone to possess cannabis - without a tax stamp. The
catch-22 here is that the government never issued the tax stamps.
A strict alcohol prohibitionist,
Anslinger - as the story goes - looked for another prohibition about
which to evangelize when alcohol prohibition ended in 1933. Some say
that Anslinger chose this new prohibition to justify the continuation
of his job at the Federal Bureau of Narcotics. In any case, growing
cannabis of any kind, including industrial hemp, in the U.S. became
illegal as it still is today. (The 2015 Industrial Hemp Farming
Act, a federal bill that would legalize hemp cultivation in the
U.S., would change that.)
Ironically, the U.S. is the largest
importer and consumer of hemp and hemp products, and it's the only
industrialized nation that can't grow it. (The U.S. imports most of
its hemp from China.) On top of that irony is another: CBD oil
extracted from industrial hemp is legal to sell and consume in all
fifty states.
Biochemistry
CBD was discovered in the cannabis
plant in 1940 but its structure wasn't described until 1963. When THC
was isolated from hashish in 1964 by Yehiel Gaoni and Raphael
Mechoulam at Hebrew University, and subsequently identified as the
major active component in cannabis, CBD was considered inactive and
it faded from view.
Cell receptors in the human body for
the cannabinoids were discovered in the 1980's by Raphael Mechoulam.
In the 1990's Mechoulam identified cannabinoids made in the human
body (called endocannabinoids) one of which he and his
associates called "anandamide", from the Sanskrit "ananda"
meaning joy or bliss. With the discovery of anandamide, the
cannabinoid receptors, and related enzymes, the "endocannabinoid
system" (ECS) emerged.
The human body makes the fatty acid
endocannabinoids from arachidonic acid and cell-membrane
phospholipids. These fat-related molecules, such as anandamide, have
cell receptors identified as CB1 and CB2. Anandamide and THC are
"ligands" with respect to the endogenous cannabinoid
receptors, especially CB1, which is present mostly in the brain and
nervous system. ("Ligands" are molecules, inside or outside
of the body, that are alike in their ability to bind to the same
receptor.) Another important endocannabinoid derived from arachidonic
acid is identified simply as 2-AG.
CBD is an exogenous cannabinoid that
has a weak affinity for endogenous receptors CB1 and CB2. However,
CBD inhibits the enzyme that breaks down the endogenous anandamide,
thus increasing the presence of anandamide. Some researchers
speculate that its inhibition of this enzyme accounts for some of
CBD's effects on the nervous, immune, and other systems.
Some physiological functions of the
endocannabinoid system include homeostasis, neuroprotection, memory
processing, heart rate and blood pressure regulation, and lung
function.
To review, in the human body a very
important physiological system of lipid molecules, cell receptors,
and enzymes operates to help maintain homeostasis. This system, the
endocannabinoid system, responds to lipid chemicals called
phytocannabinoids and endogenously-produced cannabinoids such as
anandamide and 2-AG. The phytocannabinoids, especially CBD and THC,
are produced most abundantly in the cannabis plant. Though legal in
some states, at the federal level THC is illegal and still considered
a dangerous drug by DEA. However, CBD is legal and the oil can be
extracted, sold, and consumed everywhere in the U.S. and is viewed
increasingly as a nutritional and therapeutic agent with a wide
spectrum of beneficial effects.
Therapeutic effects
A partial list of CBD's pharmacologic
characteristics includes anti-inflammatory, anti-convulsant,
anti-biotic, anti-fungal, anti-spasmodic, anti-oxidant,
anti-psychotic, analgesic, and anxiolytic. CBD has been useful in the
treatment of multiple sclerosis, Parkinson's disease, Alzheimer's,
Crohn's disease, post-traumatic stress disorder, diabetes, arthritis,
and psychiatric disorders ("... cannabidiol may ameliorate
psychotic symptoms with a superior side-effect profile compared with
established antipsychotics." Leweke, F. Therapeutic Potential of
Cannabinoids in Psychosis. doi: dx.doi.org/
10.1016/j.biopsych.2015.11.018). CBD even can be used in treating
acute psychosis induced by THC.
Of the little research that was
performed on CBD prior to the 1990's, two studies, one in 1947 and
another in 1949, demonstrated CBD's anti-convulsant properties in
children, properties comparable to phenobarbitol but without the
latter's toxicity. Considering the harmful side-effects of
phenobarbitol, which include behavioral and cognitive function
issues, it is unfortunate for many families that leads from this
research were not followed. Interestingly, a 1924 book by a Dutch
neurologist listed Cannabis indica as a drug-adjunct in the
treatment of epilepsy. It seems that doctors' fascination with
synthetic chemical medicine in the early-to-mid 20th century in the
U.S. resulted in the obviation of valuable plant-based medicine and
in unnecessary suffering.
As mentioned, endo- and phyto-
cannabinoid research has exploded in the last few years. Much of the
purpose of this research, however, has been to identify "targets"
and "magic bullets" for drug research. There is a
compulsion among ECS researchers to isolate the active components of
the cannabis plant so that pharmaceutical analogs can be synthesized
and marketed for clinical use by doctor prescription. The phrase
"ripe for therapeutic exploitation" found in cannabis
research articles betrays the modus operandi. ("...the
ECS has become one of the main targets for the design of drugs that
could act as therapeutic agents in pathological processes."
Aizpurua-Olaizola, O et.al. Targeting the endocannabinoid system,
dx.doi.org/10.1016/j.drudis.2016.08.005). However, the many and
varied regulatory actions of the ECS and the wide effects of the
exogenous cannabinoid CBD may frustrate these efforts. There are
about 120 molecules identified as cannabinoids, one of which is CBD.
And there are cannabinoid receptors everywhere in the body, especially in the nervous and immune system cells, where CBD has
effects. CBD also has non-receptor effects. In a sense, these
discoveries about the endocannabinoid system and CBD are guiding us
to a new, more accurate perception of health and holism.
A recent paper by Ethan B. Russo, M.D.,
his third in support of his theory of a Clinical Endocannabinoid
Deficiency Syndrome (CED), illustrates overlapping relationships
between three chronic pain syndromes suffered by many people and
whose successful treatment has eluded conventional medical science.
These three syndromes - migraine, fibromyalgia, and irritable bowel -
have comorbidity and a "commonality of symptomatology",
Russo says, that point to a deficiency of endocannabinoids,
especially anadamide. Cannabidiol is known to raise anadamide levels
("Cannabidiol inhibits the degradation of anadamide" doi:
10.1038/tp.2012.15).
The identification of a CED was made
possible by research into the endocannabinoid system and its
cannabinoid ligands. In the conventional manner, we have named three
apparently different diseases and have attempted to develop specific
drugs to treat these diseases. In the case of CED, however, we see
that the three diseases are the same deficiency disease process with
symptoms that manifest differently. And we find that, possibly, one
plant, that is cannabis, with many synergistic components, is the
appropriate treatment. This latter approach is holistic.
Some success has been realized in the
"magic bullet/biological target" approach, however. For example,
Nabilone, developed by Eli Lilly and Company, is a synthetic THC
prescribed for nausea, pain management, fibromyalgia, and multiple
sclerosis. Nabilone does have unwanted side effects though.
Pharmaceutical extract Sativex, containing about equal amounts of
isolated THC and CBD, is prescribed for multiple sclerosis and
neuropathic pain and has fewer unwanted side-effects. A CBD
pharmaceutical extract called Epidolex currently is the subject of 13
clinical trials in the U.S. alone. These trials are designed to test
CBD isolated extract for its effectiveness against epilepsy,
seizures, refractory childhood epilepsy, and schizophrenia.
In some research, subjects reported
preferring the whole plant to the isolated extract or synthetic form
of cannabinoid ("... the antiinflammatory and antinociceptive
activities of standardized CBD-enriched plant extracts increased with
dose, making whole-plant extracts superior to pure CBD for the
treatment of inflammatory conditions." Aizpurua-Olaizola, O
et.al. Targeting the endocannabinoid system,
dx.doi.org/10.1016/j.drudis.2016.08.005). Because there are 483
compounds unique to the cannabis plant there may exist what Raphael
Mechoulam calls the "entourage effect" as a way of
explaining the supporting or interacting role played by the plant's
less well-known molecules. Viewing the variety of beneficial effects
of the cannabinoids from the reductionistic "magic
bullet/biological target" perpective, conventional medical
scientists describe the action of the whole plant as a "synergistic
shotgun". The habitual use by the conventional medical system of
the ballistic projectile metaphor is revealing.
Descriptors such as "entourage
effect" and "synergistic shotgun" also suggest the
inherent holism of application of the cannabis plant in addition to a
melding of food, dietary supplement, and medicine concepts. Is a
full-spectrum CBD oil extract a medicine, food, or dietary
supplement? All of the above?
Still the conventional medical system
is behind the curve in developing the phytocannabinoid CBD (see
Sanjay Gupta's documentary Weed). As a general use extract, a
traditional medicine, or a dietary supplement, companies in Colorado,
California, and elsewhere, specializing in botanical extracts, are
developing and marketing CBD oil, and a doctor's prescription is not
needed to obtain these products. This grass-roots, small
private-company approach is likely to appeal to independent
chiropractors.
Chiropractic
Research published in 2005 in the
Journal of the American Osteopathic Association (JAOA)
purports to show that osteopathic manipulation increases the body's
production of anandamide. From the abstract of the article (J Am
Osteopath Assoc. 2005 Jun, 105(6):283-91), "The authors propose
that healing modalities popularly associated with changes in the
endorphin system, such as OMT [osteopathic manipulative technique],
may actually be mediated by the endocannabinoid system." They
found posttreatment anandamide levels had increased by 168% over
pretreatment levels. (Subsequent research on this subject was
inconclusive.)
A 2008 article published in the JAOA
(JAOA Vol. 108. ,No. 10, October 2008) provides a comprehensive
review of the ECS, and suggests that it "...may reflect OPP
[osteopathic principles and practice] on a molecular level."
Citing four tenets observed by the profession that represent
principles of patient care, the author shows how the ECS relates to
and supports these principles. The ECS's wide ranging homeostatic
effects as described resonate with osteopathy's more holistic
philosophy, according to the article.
Although the beneficial effects of the
chiropractic adjustment in the clinic are well-known, the biochemical
mechanisms that underlie it are not. It may be that the effect of the
adjustment is mediated by the endocannabinoid system, especially
anandamide: both spinal adjustments and the ECS produce a downward
modulation by "retrograde neurotransmission" at neural
synapses of long-term potentiation in spinal neurons caused by
persistent glutamate release. Since stretching, torsion, or
compression of a nerve or nerve root, as in subluxation, causes
damming of CB1 receptors proximal to the damming effect resulting in
persistent glutamate release downstream, the adjustment may
precipitate the "retrograde neurotransmission" phenomenon
and satisfy the feedback loop for pain relief. Thus in this way we
can understand at least the biochemical effects of the adjustment.
And we might recommend the use of a CBD herbal extract, orally or
topically, for increased pain relief. In addition, researchers have
discovered that cerebrospinal fluid contains abundant anandamides and
may play a role in the production of the cranial rhythmic impulse,
which is known to Sacro-Occipital Technique practitioners.
Another irony, this one comic/tragic,
is that the best medicine for the inflammation-based diseases that
lately affect so many Americans has been discovered in a plant that
has been officially villified, outlawed, and sanctioned as having no
value. There are similarities to chiropractic in this irony.
Possibly, we are emerging from the harmful effects of a deluding,
deceptive perception. In any case, for chiropractors who want to
provide patients with whole plant-based nutritional support to
potentiate the effects of the adjustment or as support against
fibromyalgia and other conditions of imbalance, CBD extract is ideal.