The explanation of the functioning of our bodies in relation to our endocannabinoid system (ECS) given here is summarized from the book Hanf Medizin by dr. Tanja Bagar, assistant professor. She has PhD in biomedicine and is a renowned expert on cannabinoids. The book is written in a simple language and explains science behind therapeutic value of CBD in illnesses that modern medical science is struggling with:
Endocannabinoid system (ECS) is a delicate system permeating our bodies. Cannabinology is a new realm of the medical science and most practicing medical doctors have no formal education on the topic. They will find this introductory book equally valuable as it also explains how cannabinoids can be used as an add-on therapy to existing accepted therapies.
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An average human body is built of 37 trillion cells and ten times more microorganisms. In every single cell in every single moment there are 10-15.000 chemical reactions taking place that are coordinated and strongly regulated.
A blood cell and a liver cell perform different tasks and have different form and structure but in their underlying biochemistry they are very similar and they function as a part of a larger whole. Therefore, a lot of coordination is required. Cells make great effort to “listen” to other cells and respond to their signals. Not all cells can “hear” all biochemical information. To recognize the signaling molecule (chemical news) a cell needs an appropriate receiver – a cell receptor built into the cell membrane.
When a signaling molecule binds to a receptor this leads the cell to adapt to the “news”. It is like taking umbrella with you in the morning when hearing the news, it will rain during the day.
Biochemical processes are very optimized and there is no single molecule or chemical reaction that is not absolutely necessary. When cannabinoids receptors were discovered in 1988 it was of course assumed, they exist to receive our own signaling molecules (endocannabinoids as they were later named) and not phytocannabinoids from hemp.
Cells only have necessary receptors and only as many as needed for their functioning. Many receptors of a certain type indicate that a certain signaling molecule is important for the functioning of this particular cell.
Receptors that respond to endocannabinoids are found almost everywhere in our bodies and crucially influence and steer our:
It was a difficult task for the researchers to understand the role and function of this complex system. Father of endocannabinoid research professor Raphael Mechoulam explains it in five words: eating, sleeping, relaxing, forgetting and protecting.
According to this explanation an easy way to self-evaluate the functioning of your own ECS is by asking yourself five questions:
In case you can answer with yes to all five questions your ECS is functioning well. Because of the hectic modern lifestyle ECS is overwhelmed which may lead to its malfunctioning. This means our first defense line is turned off and in turn can lead to many illnesses.
They are signaling molecules meaning they are conveying information between cells. Basic message they are bringing to the cells is: Take your foot of the pedal! Their basic role can be described as protective. They are excreted every time a dangerous situation occurs:
In all these situations endocannabinoids are excreted and consequently trigger many different physiological processes that try to re-establish balance (homeostasis).
All stimuli that challenge our cellular balance are perceived as stressors by our bodies. It is quite the same if they are toxins, pathogens, work stress, light contamination, electro smog or emotional challenges. They all put our ECS under stress. It is required to turn on and off all the time in order to keep our metabolism in balance. This can lead the ECS to produce endocannabinoids when they are not needed and vice versa. As a rule, malfunctioning of the ECS is the first step in the cascade of events that lead to development of all kinds of chronic diseases. Most scientist today agree that most if not all chronic diseases have an element of stress in their development.
ECS is tightly connected to our reaction to stress:
ECS is especially important in the phase of stress perception when it induces production of neurotransmitters and hormones (such as cortisol).
Neuronal reaction that follows stress can be appropriately modulated by a well-functioning ECS. Endocannabinoids act as retrograde signaling messengers and can modulate intensity of neuronal signal. This means they protect us from the unnecessary neuronal “noise”. This noise, for example, prevents us to fall asleep after a hectic day.
CBD dosing against stress: It is recommendable to take CBD in the morning if we expect to have a stressful day. Dosing should correspond to the stress level expected.
Immune system and ECS have a lot in common. They are both very complex and they both have protective role. The immune system is specialized for protecting us against viruses, bacteria and parasites. ECS on the other hand protects us from anything that could disturb our biochemistry. These two systems are tightly interconnected. Various types of immune cells are known to have very high density of CB2 cannabinoid receptors on their surface which is a clear indicator of strong connection between the two systems. It is however difficult to research connection between the two because complexity of both systems is not easily simulated in the laboratory conditions.
There are more than 200 different rheumatic conditions known and common denominator of most of them is that immune system is not working well. It does not recognize our own cells and attacks them as intruders. Usually our joints, ties and connective tissues are severed. Within this group of illnesses rheumatoid arthritis is the most common one and causes inflammation that results in pain, swellings and stiffness in joints. Since cannabinoid receptors and endocannabinoids are present in damaged joints it is obviously sensible to treat these joints with phytocannabinoids. They are well absorbed also when applied topically on damaged joints.
HIV positive patients have symptoms and persistent side-effects that are result of the illness and medicaments (depression, anxiety, nausea and weight loss). HIV virus needs to attach itself to the immune cells to penetrate them. Immune cells have CB1 and CB2 cannabinoid receptors and a study has revealed that when a cannabinoid is attached to an immune cell it restricts the ability of HIV virus to attach itself to the cell. A certain level of cannabinoids attached led to a 40 % decrease in number of infected immune cells.
A new approach to treat cancer was awarded a Nobel prize for physiology and medicine in 2018. It is based on stimulation of defense response of the immune system and is designated as “immunotherapy”. Cancer can be considered as a sort of inflammatory disease where immune cells penetrate tumor site and produce factors that cause tumor proliferation, angiogenesis and metastasis. There is still a wide debate open among oncological experts about the use of cannabinoids as an add-on therapy to the immunotherapy. There is however a lot of positive clinical experience especially from Israel. In any case these therapies need to be tailored to each patient individually.
Pain is transported to our brain by a special type of neurons called nociceptors (or pain receptors) through spinal cord into brain. We normally learn by using certain neuronal pathways. It is very similar with chronic pain: when in chronic pain certain neuronal pathways are used all the time we “learn” to feel pain easily. This results in perceiving a lot of pain even with a small pain stimulus coming to the brain from nociceptors. Chronic pain is modulated in our brain and it seems that glial cells play an important role in this modulation. They produce molecules that sensitize neurons. With chronic pain there is an overflow of these molecules in the brain and neurons are over sensitive all the time. At the same time these molecules are causing inflammatory reactions. And the inflammation is the last thing we want – especially in our brain. So, what can we do?
Cannabis was prescribed against pain longer than written history. Luckily, we can find elements of the ECS in all three levels of pain sensation: in the peripheral nociceptors, in the spinal cord and finally in the brain. With stress stimulus endocannabinoids are produced on demand to reduce pain. They have been researched and it is generally accepted that they provide:
CBD is known as a strong anti-inflammatory agent and regulates neuronal function. CBD also modulates endocannabinoid system; it especially reduces breakdown of the major endocannabinoid anandamide and its reuptake. This results in higher levels of our natural endocannabinoids which has many profound effects on our body. We cannot always expect quick results from CBD regarding pain modulation. It sometimes takes several months for the pain relief to take place.
Phytocannabinoids work best when ingested in their most natural form. CBD is best absorbed when it is accompanied by other phytocannabinoids such as CBG (cannabigerol), CBC (cannabichromene), CBN (cannabinol), CBDV (cannabidivarin), THC (tetrahidrocannabinol) to name just a few that are most abundant. All these cannabinoids come in acid forms in raw hemp resin as well (e.g. CBDa – cannabidiolic acid). When preserved during CBD extraction process, they significantly improve absorption as well. CBD oil that includes cannabinoids also in their acid form are called full spectrum CBD oils and have highest absorption.
Additionally, natural therapeutic compounds such as terpenes and flavonoids help absorption and improve therapeutic value of CBD oil. Hemp is composed of 1064 constituents, of which 144 cannabinoids, and many dozen terpenes and flavonoids with therapeutic value in their own right.
Generally oral absorption of CBD is very low. Only about 3-10 % of ingested CBD reaches blood. Two factors influence CBD dosing significantly: metabolism variability in each individual and type of CBD oil (see topic about Entourage effect).
Every individual has different metabolism and needs to assess their appropriate oral dose of CBD oil. One needs to start slowly with as little as 2-3 mg (1-2 drops) and work their way up every day by a drop or two. Patients with severe problems need doses as high as 100 mg daily. A typical daily dose is between 15-30 mg. CBD drops should be taken sublingually and kept under tongue for a minute or so. A portion of CBD absorbed through capillaries under the tongue will offer relief after just 15 minutes. After CBD oil is swallowed it will need approximately one hour and a half to reach its maximum blood level. The CBD effect will typically wear off slowly in 4-8 hours after ingestion.
Absorption of cannabinoids can be improved significantly when taken after a meal, especially one rich in fats.
Important: cannabinoids inhibit (slow down) functioning of liver enzyme group CYP450 that metabolizes many medicinal drugs. Generally, this results in higher blood levels of those medicines. You need to consider this and discuss it with your medical doctor to adjust (probably lower) the dosing of your medicine.
Sometimes there is a challenge in adding cannabinoids to existing therapies, because CBD can influence metabolism of some drugs. There are no severe counter indications known for cannabinoids as they are often known for pharmaceutical drugs. Cannabinoids are metabolised in the liver, more precisely on cytochrome P450. Cytochromes are a family of hemoproteins that transfer electrons on many metabolic pathways especially cell breathing. CBD has shown to be a powerful inhbitor of this enzyme group. Even though CBD is recognized as a substance with very solid safety profile with great potential in medicine, due caution is needed when a patient is administered drugs that are metabolised through cytochrome P450.
The best approach in administering cannabinoids including CBD is to start with low doses and increase them gradually.
Projectcbd.org is globally recognized as the single most trusted source of independent scientific information on hemp and its derivatives. They have conducted first global survey on use of CBD. It reveals a lot about how and for which conditions CBD is used. Here you can access the Project CBD survey.