The popular complementary therapy is rising in popularity. Here’s what you require to know before utilizing it to control type 2 diabetes.
You probably don’t have to look farther than your local drugstore or beauty product supplier to know cannabidiol (CBD) has taken a starring role in everything from sparkling water and gummies to tincture oils and lotions. Some may even say that cannabidiol (CBD) is the “it” ingredient of this day and age.
You’ve probably also heard that cannabidiol (CBD) — which is an abbreviation for cannabidiol — can help with pain, stress, and anxiety. “When people are in pain, they have a stress response, which causes an increase in cortisol and an increase in blood sugar,” says Veronica J. Brady, PhD, CDE, a registered nurse and an assistant professor at the Cizik School of Nursing at the University of Texas in Houston. Relieving pain can help alleviate the stress response and improve blood sugar levels, as well as improve sleep, she adds.
If you’re managing type 2 diabetes, it’s natural to be curious about whether cannabidiol (CBD) might help you manage those symptoms, too, to help stabilize your blood sugar. Some healthcare professionals say cannabidiol (CBD) may play a role in treating diabetes, but it’s important to understand that the only health condition cannabidiol (CBD) has proved effective for is epilepsy in kids. The jury is unfortunately still out, because of a lack of comprehensive research on cannabidiol (CBD) and type 2 diabetes.
“We don’t know that THC or cannabidiol (CBD) exerts an effect on diabetes itself, and that means control of blood sugars,” says Cory Toth, MD, a neurologist at Fraser Health at Burnaby Hospital in British Columbia. He adds that pain relief is the number one reason people with diabetes use cannabidiol (CBD) and tetrahydrocannabinol (THC), another compound found in cannabis, in Canada. It’s worth noting that cannabidiol (CBD) does not cause psychoactive effects like THC, its chemical cousin.
Why People With Type 2 Diabetes Are Considering Cannabidiol (CBD).
One thing is for sure about cannabidiol (CBD): People with type 2 diabetes are taking an interest in the ingredient as a management tool.
In Nevada, where Dr. Brady used to work as a certified diabetes educator, her patients with type 2 diabetes used cannabidiol (CBD) for nerve pain. She says patients would use cannabidiol (CBD) in a tincture or in oils that they rubbed on painful areas, including their feet. Patients could buy cannabidiol (CBD) at medical marijuana dispensaries, which would offer dosing instructions. “They worried about the impact on their blood sugars,” says Brady.
Ultimately, though, Brady says that her patients reported that cannabidiol (CBD) reduced their nerve pain and improved their blood sugar. She adds that those people who used cannabidiol (CBD) oils for nerve pain also reported sleeping better.
Heather Jackson, the founder and board president of Realm of Caring in Colorado Springs, Colorado, a nonprofit that focuses on cannabis research and education, also senses an interest in cannabidiol (CBD) within the diabetes community. “In general, especially if they’re not well controlled, people are looking at cannabinoid therapy as an alternative, and usually as an adjunct option,” says Jackson, adding that callers have questions about cannabidiol (CBD) for both blood glucose control and neuropathy pain.
Realm of Caring receives an average of 7,000 inquiries about cannabis a month, Jackson says. The organization keeps a registry of these callers, where they live, and their health conditions. Jackson says that people with type 2 diabetes are not a large percentage of the callers, but they currently have 330 people with diabetes in their database.
Jackson says that the Realm of Caring does not offer medical advice, and it does not grow or sell cannabis. Instead, it offers education for clients and doctors about cannabis, based on its ever-growing registry of cannabidiol (CBD) users, their conditions, side effects, and administration regimen. “We are basically educating,” says Jackson. “We want you to talk to your doctor about the information you receive.”
Scientific Studies on Cannabidiol (CBD) and Type 2 Diabetes, and Barriers to Research.
Despite interest among people with type 2 diabetes, large, rigorous studies showing how Cannabidiol (CBD) may affect type 2 diabetes are lacking, says Y. Tony Yang, MPH, a doctor of science in health policy and management and a professor at George Washington University in Washington, DC. Specifically absent are randomized controlled trials, which are the gold standard of medical research, per a June 2016 article in the New England Journal of Medicine.
But early research may suggest the two are worth studying further. For example, a small study published in October 2016 in Diabetes Care in the United Kingdom of 62 people with type 2 diabetes found that Cannabidiol (CBD) did not lower blood glucose. Participants were not on insulin, nor were they on any diabetes drugs, and they were randomly assigned to five different treatment groups for 15 weeks: 100 milligrams (mg) of cannabidiol (CBD) twice daily; 5 mg of THCV (another chemical in cannabis) twice daily; 5 mg Cannabidiol (CBD) and 5 mg THCV together twice daily; 100 mg Cannabidiol (CBD) and 5 mg of THCV together twice daily; or placebo. According to the authors, THCV (but not Cannabidiol (CBD)) significantly improved blood glucose control.
A Canadian study published in Pain of 37 people with diabetes found that a synthetic cannabinoid called nabilone improved nerve pain. “We also found patients had better sleep measures, so their sleep was more complete. Anxiety levels improved to a smaller amount,” says Dr. Toth, who led the study.
“Pain has a lot of neighbors,” Toth says. “If you have chronic pain, you typically have sleep issues, raised levels of anxiety, and depression. So, we thought nabilone could target some of those important features in those patients [with diabetic nerve pain].” He adds that nabilone is commonly prescribed for pain in Canada.
Other cannabidiol (CBD) research is still evolving. Some cannabidiol (CBD) and diabetes studies have been done in rats, which leads to findings that don’t always apply to human health. Other studies have looked more generally at the body’s endocannabinoid system, which sends signals about pain, stress, sleep, and other important functions. Still other studies, including one published in the American Journal of Medicine, have looked at marijuana and diabetes, but not cannabidiol (CBD) specifically.
So why aren’t there more studies of cannabidiol (CBD) in people with type 2 diabetes? “One reason is definitely regulatory barriers,” says Dr. Yang. He points to the 1970 U.S. Controlled Substances Act, which classifies cannabis as a Schedule 1 drug with the highest restrictions.
Cannabis itself is difficult to acquire for research studies, says Yang. “It is only available through the National Institute on Drug Abuse,” he adds, which has limited supplies.
“Another issue is funding,” says Yang. “In order to do more research, the National Institutes of Health needs to be more open-minded. And other funders must be willing to spend money.” Currently, 33 states and the District of Columbia allow cannabis for medical use and 11 states allow cannabis for recreational use.
Historically, cannabinoids (a group of chemicals in the cannabis plant) have been lumped together, including cannabidiol (CBD), THC, and more than 100 others. In the past decade, growers and manufacturers have been able to isolate cannabidiol (CBD), mainly by cultivating industrial hemp that is high in cannabidiol (CBD) and very low in THC, says Jackson. The 2018 Farm Bill removed industrial hemp from the controlled substances list, clearing the way for more production and research of hemp and thus cannabidiol (CBD).
“There have not been a huge amount of clinical studies [of Cannabidiol (CBD)], but most of that relates to how the cannabinoids have been treated as a group,” says Toth. “They’ve been looked down upon. There is stigma around them,” he says.
“It’s tough for researchers to get access to the quality, quantity, and type of cannabis product required to address precise research questions on cannabis utilize,” states Yang.
Patient Use, the FDA, and the Quality and Quantity of Cannabidiol (CBD).
People with type 2 diabetes aren’t waiting for further study. Brady says her patients were open about using cannabidiol (CBD), particularly the younger patients. She says one of her older patients was initially uncomfortable about buying cannabidiol (CBD) in the same shop that sold marijuana but eventually gave in. Brady adds many people associate cannabidiol (CBD) with smoking marijuana, but she cautions that cannabidiol (CBD) and THC are very different chemicals in terms of the way they affect the body.
The FDA (U.S. Food and Drug Administration) approved the first cannabidiol (CBD) medication in 2018, for treating childhood epilepsy. Currently, there is no other FDA-approved cannabidiol (CBD) medication for diabetes or any other condition, according to the FDA. In December 2018, the FDA said it was unlawful under the Federal Food, Drug, and Cosmetic Act to sell food or dietary supplements containing cannabidiol (CBD). In April 2019, the FDA stated that it’s taking new steps to evaluate cannabis products, and it held a public hearing about cannabis products in May 2019.
“The FDA, for the time being, has focused its limited enforcement resources on removing cannabidiol (CBD) products that make claims of curing or treating disease, leaving many cannabidiol (CBD) products for sale,” wrote Dr. Cohen (is an assistant professor of medicine at Harvard Medical School in Boston), and Dr. Joshua Sharfstein (oversees the office of public health practice and training at the Johns Hopkins Bloomberg School of Public Health in Baltimore), in a July 2019 perspective in the New England Journal of Medicine.
Of cannabidiol (CBD) products on the market, Jackson says it’s often difficult to know what’s inside. A study published in November 2017 in the Journal of the American Medical Association found that only 30 percent of cannabidiol (CBD) products were accurately labeled, with under- and over-labeling of cannabidiol (CBD), and some products containing unlisted chemicals such as THC.
At the time this article was written, a spokesperson for the Joslin Diabetes Center in Boston, an affiliate of Harvard Medical School, said that the research center was unable to provide feedback about cannabidiol (CBD) and type 2 diabetes.
Jackson points out that cannabidiol (CBD) could affect certain blood pressure and cholesterol drugs, and a study published in June 2017 in Cannabis and Cannabinoid Research detailed these interactions. Other side effects of cannabidiol (CBD) include tiredness, diarrhea, and changes in weight or appetite, the researchers write.
“What you put in your body is really important,” says Jackson, adding that’s especially true for people with major health conditions including diabetes. Jackson speaks from personal experience as a mom finding cannabidiol (CBD) treatments for her son’s epilepsy. She says consumers should ask manufacturers whether cannabidiol (CBD) products are free of mold, pesticides, and other toxins.
Realm of Caring, Jackson’s nonprofit, created a reference sheet for evaluating products and manufacturers. It also endorses products that adhere to standards such as those from the American Herbal Products Association and the FDA’s Current Good Manufacturing Practice regulations.
How to Talk to Your Healthcare Provider About Using Cannabidiol (CBD) for Type 2 Diabetes.
Jackson and Brady advise that people considering cannabidiol (CBD) for diabetes ask their providers about complementary therapy before adding it to their treatment plan. Brady says it’s difficult to find research about cannabidiol (CBD) and type 2 diabetes, even in her capacity as a diabetes educator. Still, from her experience, if people are looking for a natural way to manage pain, it’s worth a conversation with their healthcare provider. “It’s something that should be talked about, especially if they’re having significant amounts of pain, or really any pain at all associated with their diabetes,” says Brady.
“It’s a reasonable alternative,” says Brady. “As it gains in popularity, there needs to be some information out there about it.