CBD for Diabetes?
Many people with chronic conditions like diabetes are turning to CBD because they believe that it can help restore balance and well-being — and there is an increasing amount of research to back it up.
With Junella Chin MD
As we learn more about the benefits of holistic wellness and alternative therapies, it becomes ever clearer that hemp products like CBD — scientifically known as cannabidiol — cannot be ignored. But what is CBD, and how can it possibly help people with chronic diseases like diabetes?
For a lot of people, CBD’s association with marijuana is enough to scare patients away from considering it. This can certainly cause anxiety if you are concerned about getting high, feeling cognitively impaired, or using an illegal product. CBD — as helpful as it’s shown to be — is still misunderstood. So, let’s dive into some of the facts around what CBD is and what it isn’t.
What is CBD?
First things first: CBD is a natural compound that is extracted from the Cannabis sativa plant. Yes, this is the same plant that tetrahydrocannabinol (aka THC, or marijuana) comes from — but CBD by itself is not marijuana and it cannot get you high.
Now, CBD can be extracted from both hemp and cannabis. Hemp is a non-psychoactive cannabinoid, meaning it can’t get you high like marijuana does. It carries almost no THC content (less than 0.3 percent, the legal limit) and it is not a controlled substance in the US. It is also not illegal.
Marijuana, on the other hand, contains much more THC and is a controlled substance. It is what produces a high or euphoric feeling.
When you use CBD, it’s the ratio between THC and CBD that makes the difference. Hemp-derived CBD contains less than 0.3 percent THC while marijuana-derived CBD contains 5 to 30 percent THC.
People who want the health benefits without the high (which includes many patients with chronic diseases and pain) will purchase hemp CBD oil that contains less than 0.3 percent THC or is entirely THC-free.
CBD is generally sold in the form of tinctures or oils, supplements, extracts, and gummies. It is also found in pain-relieving and calming gels, lotions, and bath salts. It’s not usually smoked.
Most of the CBD oils on the market are labeled “full-spectrum,” which means that they’re rich with almost all of the health-friendly compounds within the cannabis plant that are also not psychoactive. These include flavonoids (which are polyphenols and antioxidants), other cannabinoids, and terpenes (therapeutic compounds that have anti-inflammatory and antidiabetic effects). In other words, “full-spectrum” CBD contains natural compounds that can help boost your overall health and support your diabetes management regimen.
What does the research say about CBD?
To understand why CBD works, it’s best to understand how. First, CBD works with your endocannabinoid system, which is designed to promote homeostasis — or harmony — within your body. In fact, endocannabinoids are actually cannabis-like molecules made naturally within your body. When you use CBD, it influences or activates these receptors. It has also been found to influence non-cannabinoid receptors as well.
According to UCLA Health, “We now know the endocannabinoid system is involved in a wide variety of processes, including pain, memory, mood, appetite, stress, sleep, metabolism, immune function, and reproductive function. Endocannabinoids are arguably one of the most widespread and versatile signaling molecules known to man.”
One of the main reasons people turn to CBD is for chronic pain. The National Library of Medicine states that CBD oil has been found to provide relief for a variety of conditions, including chronic pain.
CBD has even influenced the creation of certain drugs. In fact, in June 2018, the first CBD-based drug was approved by the US Food and Drug Administration to help treat severe epilepsy.
Other studies have found that well-sourced CBD oils are found to have a host of benefits — many of which can be of help to diabetics. Beyond pain and epilepsy, CBD is used as a holistic remedy for:
- feelings of anxiety and obsessive behavior
- inflammation and oxidative stress
What does CBD do to help diabetes?
Perhaps most importantly, CBD has been shown to improve inflammation levels and oxidative stress (effects from free radicals within the body), says Dr. Junella Chin, Integrative MD and chief medical expert for Yesterday Wellness. “Cannabinoids work on nerve endings, reducing pain and inflammation. It can get to the heart of the problem versus taking a pain reliever, which is temporary.”
This can be a big deal, as diabetes is an inflammatory condition. Rampant inflammation can also cause insulin resistance.
The American Journal of Pathology found, “CBD was able to reduce oxidative stress, inflammation, cell death, and vascular hyperpermeability associated with diabetes,” noting that “oxidative stress and inflammation play critical roles in the development of diabetes and its complications.”
CBD may also improve insulin resistance and pancreas health. In a study on animal subjects with non insulin-treated type 2 diabetes, it was found that subjects who received CBD at 100 mg twice daily (as well as other treatments like tetrahydrocannabivarin, a phytocannabinoid), saw significantly decreased fasting plasma glucose and improved pancreatic health.
According to Rory Batt MSc, who studies the connection between the endocannabinoid system, CBD and type 2 diabetes, CBD may help boost pancreatic health in humans as well. “CBD can also help to protect the pancreas from becoming destroyed by overactive immune cells. Effectively, this means someone may be able to keep producing insulin themselves for longer. However, unless they ultimately change their diet as well, they will inevitably end up with a pancreas that cannot produce insulin—but CBD could significantly extend the time until that happens.”
Another potential benefit of CBD for diabetics? It can help improve diabetic neuropathy, says Dr. Chin. Diabetic neuropathy is a painful type of nerve damage that is caused by high blood sugars damaging nerves through the body. Patients often feel this in their feet or legs, and CBD can help relieve some of that discomfort and pain.
How does CBD work?
But how does it all work? CBD targets something called G-protein coupled receptors (GPCRs). Dr. Chin says these are some of the largest receptors in our bodies, playing a diverse role in bodily functions.
In fact, more than a third of our prescription drugs, including those for diabetes, are made to bind to GPCRs. “That’s how important it is. The fact that cannabinoids are the largest GPCR is why CBD may affect insulin resistance.”
According to Dr. Chin, CBD should be used as a long-term tool, not something you take here and there. “It’s best for long-term use because of its relatively safe profile and cumulative effects. Day one will be different from day 30. If you give it time, you may be able to turn the volume down on your inflammation.”
Reducing inflammation and disease activity requires a holistic approach, of course. Beyond using CBD, you’ll want to ensure you’re using your prescribed medications correctly, managing your stress levels, eating a colorful, anti-inflammatory diet (think veggies, fruits, and healthy fats), and exercising very regularly. All of these behaviors work together to reduce inflammation and help establish more balanced hormone levels.
Dr. Chin believes that CBD helps to treat some of the core issues behind diabetes, and that it can help improve overall diabetes lifestyle management. It’s not that CBD magically corrects insulin sensitivity right away, but rather that it can be helpful as part of a larger holistic regimen.
What should I know before I try CBD?
While enthusiasts have incorrectly lauded CBD as a miracle drug, it is more of a subtle supplement that can work differently for every person. Here are some tips for diabetes patients who want to try CBD for the first time:
- Clear it with your doctor first. It’s smart to speak with your healthcare provider before starting a CBD regimen, especially if you’re using an array of medications, as CBD may interfere with drug metabolism in some instances.
- Do your research. Because CBD isn’t regulated, it’s always best to do your research and buy your CBD from trustworthy sellers. Batt recommends making sure your CBD supplier is transparent about testing. “Use brands that test for heavy metals, mycotoxins and pesticides, as these can all disrupt endocrine function,” he says. Lord Jones is a reputable brand.
- Consider “full-spectrum” CBD. Full-spectrum CBD, because of its cannabinoids, flavonoids, and terpenes, provides the ‘entourage effect’ that may be beneficial for inflammation and insulin resistance.
- Experiment with dosage. If you’re going to use CBD, try aiming for 2.5 – 20 mg per day — but you may need to experiment with dosage and brand before seeing positive results. You can always increase your dosage, but you can’t take it down again. So, start at the lowest dosage and go from there.
CBD helps to quell inflammation, making it a new holistic option for diabetics to add to their health regimens.
CBD for Type 2 Diabetes: What Are the Benefits and Risks?
The trendy complementary treatment is rising in popularity. Here’s what you need to know before you use CBD to manage type 2 diabetes.
You probably don’t have to look farther than your local drugstore or beauty product supplier to know 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) — which, like THC, is a component of the cannabis plant, but doesn’t contain its psychoactive effects — is the “it” ingredient of our age.
You’ve probably also heard that CBD can help lessen stress, anxiety, and pain. “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, CDCES, 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 aid sleep, she says.
If you’re managing type 2 diabetes, it’s natural to be curious about whether CBD might help you manage those symptoms, too, to help stabilize your blood sugar. In fact, the prevalence of cannabis use increased by 340 percent among people with diabetes from 2005 to 2018, according to a study published in Drug and Alcohol Dependence in July 2020, which surveyed people on their use of cannabis (CBD or THC, in any form) in the previous 30 days.
But does it work for treating diabetes? Some healthcare professionals say CBD may have a role to play, but it’s important to understand that the only health condition CBD has proved effective for is epilepsy in kids. The jury is unfortunately still out, owing to the lack of comprehensive research on CBD and type 2 diabetes.
Still, in the aforementioned survey, 78 percent of people used cannabis that was not prescribed by a doctor. “Diabetes patients might still use cannabis for medical reasons, but not have a prescription,” says Omayma Alshaarawy, MBBS, PhD, an assistant professor in the department of family medicine at Michigan State University in East Lansing, who led the study. Recreational use is another factor. She points to a separate study, published September 2019 in the Journal of the American Medical Association, that found that more than 50 percent of people with medical conditions such as diabetes or cancer use cannabis recreationally.
How People With Type 2 Diabetes Are Using CBD
In Nevada, where Dr. Brady used to work as a certified diabetes educator, her patients with type 2 diabetes used CBD for nerve pain. She says patients would use CBD in a tincture or in oils that they rubbed on painful areas, including their feet. Patients could buy 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 CBD reduced their nerve pain and improved their blood sugar. She adds that those people who used 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, senses an interest in 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. Callers have questions about CBD for neuropathy pain, joint pain, gastrointestinal issues, and occasionally blood glucose control, according to a spokesperson for Realm of Caring.
The organization receives thousands of inquiries about cannabis therapies a month. It 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 540 people with diabetes in their database.
Jackson says that 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 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 CBD and Type 2 Diabetes, and Barriers to Research
Despite interest among people with type 2 diabetes, large, rigorous studies showing how 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 School of Nursing in Washington, DC. Specifically absent are randomized controlled trials, which are the gold standard of medical research.
Early research suggests CBD and diabetes are indeed worth further study. For example, a small study published in October 2016 in Diabetes Care in the United Kingdom looked at 62 people with type 2 diabetes and found that CBD did not lower blood glucose. Participants were not on insulin, but some took other diabetes drugs. They were randomly assigned to five different treatment groups for 13 weeks: 100 milligrams (mg) of CBD twice daily; 5 mg of THCV (another chemical in cannabis) twice daily; 5 mg CBD and 5 mg THCV together twice daily; 100 mg CBD and 5 mg of THCV together twice daily; or placebo. In their paper, the authors reported that THCV (but not CBD) significantly improved blood glucose control.
Other CBD research is still evolving. Some 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 CBD specifically.
That there are so few studies of CBD in people with type 2 diabetes has to do with a lack of focus on CBD as an individual component. Historically, cannabinoids (a group of chemicals in the cannabis plant) have been lumped together, including CBD, THC, and more than 100 others. The 1970 U.S. Controlled Substances Act classifies cannabis as a Schedule 1 drug with the highest restrictions. Currently, 33 states and the District of Columbia allow cannabis for medical use and 11 states allow cannabis for recreational use.
The 2018 Farm Bill removed industrial hemp from the controlled substances list, clearing the way for more production and research of CBD. Meanwhile, growers and manufacturers are better able to isolate CBD, mainly by cultivating industrial hemp that is high in CBD and very low in THC, says Jackson. So, perhaps in the coming years, more research on CBD and diabetes will emerge.
How the FDA Views and Regulates CBD for Disease Treatment
Yet, as evidenced by the July 2020 study in Drug and Alcohol Dependence, people with type 2 diabetes aren’t waiting for further study to hop on the trend. Brady says her patients have been open about using CBD, particularly the younger patients. She says one of her older patients was initially uncomfortable about buying CBD in the same shop that sold marijuana but eventually gave in. Brady adds that many people associate CBD with smoking marijuana, despite their distinctly different effects on the body.
The U.S. Food and Drug Administration (FDA) approved the first CBD medication in 2018, for treating childhood epilepsy. Currently, there is no other FDA-approved 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 CBD. In April 2019, the FDA stated that it would be 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 CBD products that make claims of curing or treating disease, leaving many CBD products for sale,” wrote Pieter Cohen, MD, and Joshua Sharfstein, MD, in a July 2019 perspective in the New England Journal of Medicine. Dr. Cohen is an assistant professor of medicine at Harvard Medical School in Boston, and Dr. Sharfstein oversees the office of public health practice and training at the Johns Hopkins Bloomberg School of Public Health in Baltimore.
Precautions for People With Diabetes Looking to Try CBD
For the CBD products already on the market, Jackson says it’s often difficult to know what’s inside. A study published November 2017 in the Journal of the American Medical Association found that only 30 percent of CBD products were accurately labeled, with under- and over-labeling of CBD content, and some products containing unlisted chemicals such as THC.
Vaping liquids were the most commonly mislabeled CBD products in the study. The International Research Center on Cannabis and Health in New York City warns that consumers should not purchase vape products from unregulated and illicit markets. A small investigation by the Associated Press in 2019 showed that some CBD vapes had synthetic marijuana.
Jackson points out that CBD may affect certain cholesterol and blood pressure drugs, and a study published in June 2017 in Cannabis and Cannabinoid Research detailed these interactions. Other side effects of 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 like diabetes. Jackson speaks from personal experience as a mom finding CBD treatments for her son’s epilepsy. She says consumers should ask manufacturers whether 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.
“There is little known about cannabis health effects, especially among patients with chronic conditions. Research is growing, but still solid evidence evolves,” says Dr. Alshaarawy. For these reasons, she recommends that patients talk to their doctors so they can discuss the benefits and potential harms of cannabis and monitor their health accordingly.
How to Talk to Your Healthcare Provider About Using CBD for Type 2 Diabetes
Jackson and Brady advise people who are considering CBD for diabetes to ask their providers about the complementary therapy before adding it to their treatment plan. Brady says it’s difficult to find research about CBD and type 2 diabetes, even in her capacity as a diabetes educator. Still, in 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.
There’s a lack of rigorous research on how CBD may affect type 2 diabetes, but early studies and anecdotal reports suggest it may help manage stress, anxiety, and pain. Learn more about using CBD to control your blood sugar.