2020 has been a year where America’s nightly news reports consist of the number of COVID-19 cases and resulting deaths from the virus. Although the number of fatalities is large, growing and causes fear about disease contact, there is another widespread condition that is associated with more than 800,000 deaths annually: metabolic syndrome.1
While there are several medications and dietary supplements to address various aspects of metabolic syndrome, there is currently no single cure. Recent research into industrial hemp extracts and various cannabinoids suggest that this natural CBD hemp oil may be able to help patients and physicians deal with many symptoms of this prevalent condition, according to Golden, Colorado-based Panacea Life Sciences.
What is metabolic syndrome?
Metabolic syndrome is a cluster of symptoms that include increased blood pressure, high blood sugar, excess body fat around the waist and abnormal cholesterol or triglyceride levels.2 These conditions are correlated with additional comorbidities (as shown in figure one) increasing the risk of heart disease, stroke and type 2 diabetes. The prevalence of this condition is rather high, with an estimated 37 percent of Americans having metabolic syndrome – a number that increases each year. One of the causes for this high degree of incidence is the western diet (high in sugars and fats) coupled with an increasingly sedentary lifestyle.
First line therapy to treat metabolic syndrome and reduce comorbidities is to diet and exercise. Losing 10 pounds is a great start to reducing symptoms of this syndrome, however, additional medications may be needed to control blood pressure, cholesterol or blood sugar. Anyone who has tried diets, fad diets or lifestyle changes may find losing weight or keeping the weight off is not an easy task. Multiple pathways help determine how much we eat and even steer us toward specific food types such as those with high sugar content when a sweet tooth kicks in. The body even has a complex regulatory system that keeps body weight at a steady-state or set point through communication between the brain, liver, adipose tissue and digestive system.
Over the past quarter century, pharmaceutical companies have worked to discover potential treatments for metabolic syndrome to decrease appetite and food intake as well as other specific treatments for each of the comorbidities listed in Figure 1. The key to minimizing health issues due to metabolic syndrome is to address the four main symptoms: reduce body weight, reduce blood pressure and control blood levels of sugar and fats (triglycerides and cholesterol)2.
How do cannabinoids come into the picture?
Just as the body has its own weight regulation system, it also has another recently discovered complex physiological system called the endocannabinoid system (ECS), which mediates balance, or homeostasis, for a wide range of processes including mood, inflammation and metabolism.3,4,5,6 The ECS is a collection of more than 70 receptors and enzymes throughout the body that help boost underactive pathways or dampen others. Taking cannabis or hemp oil extracts (e.g. hemp oil rich in cannabidiol) can stimulate the ECS to provide health benefits in multiple areas, including some aspects of metabolism.
Although scientific and medical understanding of the ECS is in its infancy, it is clear that the ECS and cannabidiol therapy may provide benefit directly to metabolic syndrome and comorbidities.
The cannabis paradox and weight loss
Studies have shown that natural cannabis extracts have beneficial effects that can potentially help diabetic patients with improved glycemic control through increased insulin sensitivity, inducing weight loss in diet-induced obese rates and protective effects on hyperglycemia in vivo.7,8 A paradox seems to exist where it is well known that using cannabis creates the munchies, increased appetite and higher calorie consumption, but cannabis users show lower incidence of obesity and diabetes.9,10,11
These observations led researchers in the late ’90s to develop a drug called Rimonobant, a blocker of the THC response through the cannabinoid 1 receptor (CB1R).12 While this drug was shown to be effective in Europe for causing the desired appetite suppression and weight loss13, Rimonobant was never approved in the U.S. and was actually removed from the market as it was associated with depression and suicidal tendencies in a portion of patients taking the drug.14
While Rimonobant demonstrated that the ECS does have an effect on metabolic syndrome, it also negatively affects mood. Instead, researchers are now focused on looking into other cannabinoids that may have positive effects on both mood and appetite.
Cannabidiol and THC-V
The industrial hemp plant, Cannabis sativa L., expresses as many as 113 different cannabinoids, the most well known being Tetrahydrocannabinol (THC) and Cannabidiol (CBD). Each of these cannabinoids have different chemical structures and are anticipated to have distinct effects in the body. Two of these cannabinoids, CBD and tetrahydrocannabidivarin (THCV), have shown promise in modulating various aspects of metabolic syndrome.
Cannabinoids are very well tolerated with side effects only observed at very high levels of dosage (>10 mg/kg) in a majority of patients.15 For the average CBD consumer this would be close to a gram of CBD, whereas dosing recommendations are less than 100 mg (note that the Food Standards Agency in the UK recommends a maximum serving size of 75 mg).16
There are not many studies on THCV, but this cannabinoid has been shown to decrease appetite through a mechanism different than through CB1, which may allow appetite suppression without the side effects observed with Rimonobant.17 Preclinical studies demonstrate that THCV decreases food intake but also decreases fat uptake into adipocytes and hepatosteatosis (fatty liver, one comorbidity in metabolic syndrome patients).18 In one small human clinical trial, THCV showed effect in several glycemic and lipid parameters indicating that this cannabinoid should be pursued as a potential therapeutic agent for glycemic control.19Currently, THCV is a minor cannabinoid that will be present in very small amounts in CBD hemp oil. As plant genetics and other technologies evolve, THCV may become more prevalent in products.
Cannabidiol has been shown through multiple preclinical models and limited clinical studies to slightly lower blood pressure and help lower levels of blood sugar, cholesterol and fatty acids, including cholesterol.18,19 In a small human clinical study, CBD lowered blood pressure significantly by 5 mm Hg.20 While this is not a dramatic effect for those diagnosed with high blood pressure where lowering pressure more than 20 mm Hg may be needed, this is a small benefit added to the other properties of CBD, like its ability to improve cardiovascular health as shown by other studies.21
Although cannabinoids have multiple actions in the body, they would be best described as general anti-inflammatories or antioxidants.22 Aside from the effects on major aspects of the metabolic syndrome, cannabinoids also may help provide additional health benefits such as providing protection from oxidative tissue damage, lessening pain experienced by diabetics and potentially helping diabetic retinopathy.23-25
Starting a CBD regimen
While CBD hemp oil provides many health benefits, those on prescription medications should consult with their physician before starting a CBD or cannabinoid regimen. Although CBD is very well tolerated unless taken at a very high dose, it may interfere with the metabolism of certain prescription medications which could elevate the prescription medication in the body.25,26
Patients could experience side effects not from the CBD, but from having a higher concentration of the prescription medication in their blood than normal. Conversely, the addition of CBD may render the prescription medication inactive as some drugs require conversion by liver enzymes to be active.
There are no set guidelines for how much CBD to take to achieve health benefits, mostly because of the lack of prolonged research. When starting with CBD, it is best to begin with a low dose (such as 10 mg) to determine how well individuals tolerate the CBD oil, then increase as needed to achieve desired benefits. As mentioned above, the UK FSA recommends the maximum daily dose of 75 mg CBD per day.
On the path toward a healthier lifestyle
For those experiencing the metabolic syndrome and the numerous conditions that stem from this condition, there is a natural product that can help increase health. While the first line of therapy is almost always diet and exercise, a CBD hemp oil regimen may be able to help by potentially decreasing appetite, lowering blood sugar, increasing insulin sensitivity and lowering triglyceride levels. The overall antioxidant properties of the components in CBD hemp oil can potentially help those who are working to eliminate their metabolic syndrome while gaining multiple health benefits.
- C.I. Bih et al. Neurotherapeutics 2015 v12 p 699
- A. Ligresti et al. Physiol Rev 2016 v96 p1593
- Panacea Life Sciences, unpublished molecular pharmacology study
- Y. Simon and D. Cota Eur. J. Endocrinol. 2017 176, p. R309.
- S. Ramlugon et al. Phther. Res. 2018, 32, p. 1080.
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- O.A. Anthony Epidemiology 2015 26, p. 597.
- A.C. Adejumo et al. PLoS One 2017 12, e0176416
- D. Kim et al. PLo One 2017 12, e0186702.
- A. Porcu et al. Neuropharmacology 2018 133, p. 107.
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- A.H. Sam et al. J. Obes. 2011, e432607.
- G. Reidel et al. Br. J. Pharmacol. 2009 156, p. 1154
- C. Silvestri et al. J. Hepatol. 2015 62, p. 1382
- K.A. Jadoon et al. Diabetes Care 2016 39, p.1777.
- K.A. Jadoon et al. JCI Insight 2017 2 e93760.
- R. Jiang et al. Life Sci. 2011 89 p165.
- S. Atalay et al. Antioxidants 2019 9,p 21.
- S.Atalay et al. Redox Biol. 2020 36, e101613
- G. Gruden et al. Br. J. Pharmacol. 173, p. 1116.
- R. Jiang et al. Life Sci. 2011 v89 p165
- O. Zendulka et al. J. Curr. Drug Metab. 2016 v 17 p 206