The Newsletter You've Been Waiting For
(Tuesday, July 24th)
This is NOT the newsletter where I announce that it’s the last one ever and that I will be retiring to Cabo San Lucas, although that indeed may be the newsletter that you’ve been waiting for. (I know it's the one that I'M waiting for.) This one is on CBD, which right now is beating the pants off raw water as the latest wellness craze. (Yes, “raw water” is a Thing. On the subject of raw water, I have nothing else to say right now, so let us press on.)
For anyone who somehow still doesn't know what that is, “CBD” is shorthand for “cannabidiol” and it’s a compound derived from hemp. It has suddenly become available in supplement and cream forms pretty much everywhere (since, as the ads announce, it is now legal in all 50 states). It is non-intoxicating and therefore people don’t have to worry about it making them feel good, which is some kind of Puritan issue that I’ve never understood. And for those who are under surveillance by The Man, it won’t mess you up on a drug test. So! What's not to love about it, right?
Everyone seems to be excited about CBD, each for their own reasons. Your nephew is excited because now he has something new to vape. Your grandma is excited because nothing has helped her knee and she is sure she is too old to go through surgery and all that post-surgical therapy. (And maybe she is right about that.) And your average person is excited because CBD is just so COOL.
Doctors aren’t terribly excited, though. And despite the notorious dislike of doctors for anything that looks like it might knock them/us off their Health Authority pedestals, there are some genuinely good reasons for that. And that is despite the fact that most of us believe that pain is one of the worst problems out there. I happen to believe that it is THE worst, but I’m still not excited about CBD.
(I know that many of you would dispute that pain is the worst health problem that there is. So here’s my reasoning. To me, the degree to which you can live your life the way that YOU want to is the degree to which you are healthy. And nothing interferes with THAT like pain.
(I hate pain. Hate, hate, hate. And so does everyone who has it. You can tough it out through a life with chronic pain, but it takes all the joy out of it. Plus you may THINK you’re doing everything in a normal fashion, but usually you are not. When you are in pain, depending on your circumstances and your personality, the stuff that gets left out of your life tends to be either the fun stuff or the important stuff. In both cases, you really aren’t living.
(You can have no end of horrid diseases, or even be dying, but as long as you can do what you want every day, you really don’t feel so bad. Without pain, you can live. Thus, effective pain relief is crucial for anyone who has pain that doesn’t want to just curl up and die.)
We aren't excited about it because although that is what it is being mostly touted for, CBD doesn’t have a whole lot of evidence yet for pain relief. In fact, it pretty much has none at all. Now, on the other hand, marijuana has quite a lot of evidence suggesting that it relieves pain of many types. But CBD is most emphatically NOT marijuana. If it was, it would be illegal in Tennessee. Only stuff that doesn’t help people is legal in Tennessee.
So if there's no evidence that it works, why is it everywhere? First of all, unrelieved pain is a huge problem. Second of all, both marijuana and CBD are in a particularly annoying phase that comes in pretty much every health/medical breakthrough. It is the period when something seems to have almost unlimited potential for helping with an important problem, but practically nothing about it is actually known for sure.
Anyone old enough to not want to talk about it can remember how antioxidants were going to cure everything. Well, they are handy in some regards, but most of that early promise totally fizzled. The problem is that there can be an awfully long time between the initial “this is it!” and the final “oh, no it's not" for any product or discovery. And THAT interval, the one that we are in now with CBD, is the time when American hucksterism absolutely shines.
That is the final reason CBD is everywhere. It is hugely profitable. Tiny amounts of the stuff without any guarantees of purity are being sold at hefty prices. Larger amounts (in doses that might actually have an effect of some kind) cost enough to make anyone sit up and say howdy. And its vendors will promise you the moon the entire time you are laying out your hard-earned cash for the stuff -- and they will promise it shamelessly and continuously.
That is why I blab about “evidence” here all the time. Evidence may not be a perfect guide to all things, but it’s a heckuva lot better than whatever is in second place. Which I suppose would be "wishful thinking".
There is no real evidence to speak of suggesting that CBD is any good for pain relief. There IS evidence suggesting that it may help with some types of seizures, and also with some mental/emotional conditions like anxiety and even schizophrenia. But there isn’t ANY evidence for it relieving pain. Right now.
Furthermore, the conditions that it IS good for -- well, CBD in dosages known to actually create a desired effect is very expensive. The studies that have shown it to work in both seizure and mental/emotional conditions have used dosages of several hundred milligrams per day. Out there in the American marketplace, a small bottle of CBD oil with a couple hundred milligrams of CBD in it will set you back $50 or so.
That’s not to say that small doses of CBD do NOT work. There just isn’t any evidence for it yet. And, here’s the thing. I don’t think that people should spend a lot of money on stuff that we don’t know whether or not it works WHEN THERE ARE THINGS AROUND THAT WE KNOW DO WORK.
In other words, if there was nothing else for your arthritic knee but rubbing a hundred bucks worth of CBD oil into it every day, be my guest. But there are a lot of drugless treatments out there for pain conditions with far more evidence for efficacy (and which are far cheaper) than CBD oil right now.
If you’re already using CBD and it’s working for you, great. If you aren’t and you wonder whether it will help you, don’t spend your money on it just yet. There are many good alternatives to drugs and surgery for pain issues. So if you have decided not to go the conventional route, take the time to consult a good map and don’t choose a road at random – first find out what might actually take you where you want to go.
--dr. diane holmes
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