CBD for Fibromyalgia with Dr. Ginevra Liptan
Is It Helpful?, Is It Legal?, and What are the Differences Between CBD Products?
- Is there any difference between CBD, hemp, marijuana and cannabis?
- What are the differences between the effects of CBD and THC in your body?
- I live in a state where marijuana is not legal, or I work at a job where I can’t have THC in my system. What can I do?
- How can you make sure you are getting access to the right types of CBD for you?
- There is a huge amount of money being poured into researching both cannabis and cannabis-derived medications.
- I do encourage people to talk about it with their doctor, even though it’s uncomfortable.
CBD stands for cannabidiol, which is one of the active ingredients found in the cannabis plant. As a non-psychoactive component, CBD will not alter your brain or make you feel “high”. It does, however, affect your body. In this episode, we’ll talk about those effects specific to the fibromyalgia body. Should you talk to your doctor about using CBD? Dr. Ginevra Liptan will offer insight from a medical standpoint and provide resources to help further your own research.
About Dr. Liptan
Ginevra Liptan, M.D. is a graduate of Tufts University School of Medicine, board-certified in internal medicine, and trained in functional medicine, a holistic approach that blends both western and alternative medicine. After developing fibromyalgia as a medical student, Dr. Liptan spent many years using herself as guinea pig to find successful treatments, and has fine-tuned her approach by treating thousands of patients. She is one of the few clinical specialists in the world to focus solely on fibromyalgia, and directs The Frida Center for Fibromyalgia in Portland, Oregon.
Dr. Ginevra Liptan is the author of several books:
- The FibroManual: A Complete Fibromyalgia Treatment Guide for You and Your Doctor
- The Fibro Food Formula: A Real-Life Approach to Fibromyalgia Relief
- Figuring out Fibromyalgia: Current Science and the Most Effective Treatments (out of print)
To hear more from Dr. Ginevra:
Links & Resources
- Get free copies of Tami’s books here
- CBD: Dr. Liptan has many articles and videos on CBD on her blog and YouTube channel. She also has her own line of doctor-formulated CBD products at FridaBotanicals.com.
- Finally! Real Science on Cannabis for Fibromyalgia, Dr.Ginevra.com
- [Giveaway has ended] Enter to Win a very special giveaway of the Frida Botanicals CBD Tincture and Muscle Balm mentioned in this episode. Dr. Liptan and Tami are also throwing in signed copies of their books for you. This bundle is a value of $146 and you can win it absolutely free.
- Sagy, Iftach, et al. “Safety and Efficacy of Medical Cannabis in Fibromyalgia.” Journal of clinical medicine 8.6 (2019): 807.
- van de Donk, Tine, et al. “An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia.” Pain 160.4 (2019): 860.
- Bergamaschi, Mateus M., et al. “Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naive social phobia patients.” Neuropsychopharmacology 36.6 (2011): 1219.
- Bonn-Miller, Marcel O., et al. “Labeling accuracy of cannabidiol extracts sold online.” Jama 318.17 (2017): 1708-1709.
- Note: Additional studies on cannabis and cannabidiol can be found by visiting Google Scholar. In fact, searching for those two terms brought up over 600,000 results!
You are listening to the Fibromyalgia Podcast with Tami Stackelhouse, Episode 18.
Welcome to the Fibromyalgia Podcast! I’m your Coach, Tami Stackehouse.
In today’s episode, we are going to be answering the questions you have been sending in about the use of CBD for fibromyalgia.
Now, before we dive into today’s episode, I have another listener shout out for you. This one is from Elizabeth, who is actually in Italy.
She says, “Dear Tami, Thank you for this inspiring podcast series. This is life-changing for me, after having just discovered that I have a diagnosis of fibromyalgia. Thank you very much for all of your information and offering hope to people all over the world.”
Thank you so much, Elizabeth. I love this, and I love that I’m hearing from somebody on the other side of the world. It’s so amazing to me that the world is getting so much smaller, and that I am able to help someone that, not that long ago, I wouldn’t have been able to [help] because you were clear over there. So, thank you, again, so much.
Now, for those of you who are curious like I was, I actually just took a look, and so far this podcast has been heard in 56 countries around the world. That just boggles my mind. I would love to hear from more of you who are outside the US with what you think of the podcast and what you would like for me to talk about in future episodes. You can reach out on Facebook. You can leave us a review or comments on Apple Podcasts or reach us through the website at FibromyalgiaPodcast.com.
[02:40] Now, on to today’s episode. I have been getting a lot of questions through our Ask The Coach page about using CBD for fibromyalgia. A lot of people are wondering if it’s helpful, if it’s legal and what the differences are between the CBD products that you might see at your local drug store and medical marijuana or cannabis.
We’re going to cover all of that here today. Instead of trying to do this all by myself on an Ask The Coach episode, I decided that a better option would actually be to ask the experts. I have someone who is a fibromyalgia specialist. I have a fibromyalgia patient and a doctor who has created her own line of hemp-based CBD products. And that’s not a panel of three different people, that is one person — my very good friend, Dr. Ginevra Liptan.
For those of you who don’t know her, Dr. Liptan is a graduate of Tufts University School of Medicine and is board certified in internal medicine. She also trained as a functional medicine doctor, which is a holistic approach that blends both western and alternative medicine. You can hear more from her in Episode 5.
[04:10] Part of her story is she developed fibromyalgia as a medical student. She spent many years using herself as a guinea pig, trying to find successful treatments and ways that she could first help herself, but also be helping her patients in turn. She has now fine-tuned her approach by treating thousands of patients. She is one of the few clinical specialists in the world who focuses only on fibromyalgia. She is the medical director of The Frida Center for Fibromyalgia in Portland, Oregon. She’s the author of The Fibro Manual, The Fibro Food Formula and Figuring out Fibromyalgia. (affiliate links)
Watching her patients try CBD products with mixed success has led her to develop her own line of CBD products, Frida Botanicals. You can find her on Youtube, Facebook and on her blog at [updated web address is DrGinevra.com]. And, as always, you will find all of the links, all of the products mentioned in this episode, at FibromyalgiaPodcast.com/18, for Episode 18.
[05:28] I’m also super excited to announce that we are doing a giveaway during this episode. We are going to be giving away a bundle of the Frida Botanicals products that we mentioned on this episode. Stay tuned until the end of the episode after my interview with Dr. Liptan, and I will tell you how you can enter to win. And now, on to our interview.
[05:57] All right, Welcome! Thank you so much for being here with me this week.
GL — Thanks for having me, Tami. It’s good to be here.
[06:03] TS — Awesome. I’ve gotten a lot of questions… I think I told you this when I asked you to be here, but I’ve had a lot of questions that have been sent into the Ask The Coach about CBDs for fibromyalgia. And, I thought, what better person to ask about this than a fibromyalgia specialist who has fibromyalgia and also happens to have her own line of CBD products? So, here you are.
[06:32] GL — Cute! So, thank you. I get a lot of questions about CBD, also. That’s actually how I got into the CBD business — because I got so many questions. And, I was wondering, “How can I make sure people are getting good access to good types of CBD?” So, yeah, I think it’s definitely something that people are wondering about: “Could it help me? And if so, how should I do it?”
[06:56] TS — Absolutely.
I think a great place for us to start with all of this is with some definitions and defining the terms. So, let’s just talk a little bit about what CBD even is. What do those letters even stand for? And, then, talk a little bit about medical marijuana, about cannabis, because I see a lot of people either thinking that they’re the same thing or thinking that they’re two totally separate things, and neither case is quite right. Why don’t you start with that?
[07:33] GL — Okay. I agree. It is something that people seem to be very confused about, and not just lay people. Sometimes, I hear doctors referring to CBD and cannabis as the same thing, and that is definitely not accurate. So, it is really important to just start with definitions first.
[07:52] GL — CBD stands for cannabidiol, which is one of the active ingredients in marijuana or cannabis. The main active ingredient we think about is THC, which is the psychoactive component. That’s the part that makes you feel high, gives you mood altering effects. That’s what recreational users of marijuana are seeking, is that brain effect. CBD is a non-psychoactive component of cannabis. So, it doesn’t affect your brain. It doesn’t make you feel high. It does affect your body and we’ll talk about the effects that it can have, but it doesn’t alter your thinking.
[08:36] GL — And. so, because of that, CBD is not considered a “drug of abuse” or something that can be [abused]. It’s not addictive. CBD on its own is considered very safe and the challenge comes when people mislabel. They say cannabis equals CBD, and that’s not the case.
CBD is something that is derived from the cannabis plant, but it can also be manufactured in the laboratory. It’s a molecule that can be made or extracted. It’s something that naturally occurs in cannabis plants.
[09:21] GL — The big distinction where things get really confusing for folks is the difference between hemp and cannabis. So, cannabis—marijuana—is a legal gray zone, because it’s federally still considered illegal, a drug of abuse, but in many states, it’s legal. So, if you’re getting CBD that’s derived from the cannabis plant—from the marijuana plant—it potentially, depending on where you live, could be illegal.
[09:57] GL — Now, if you’ve got CBD that’s from the hemp plant, which is a type of cannabis, but it is a different breed…
So, here’s the best analogy:
You know how when you look at dogs, they’re all the same species, but there are different breeds, and you recognize that a poodle looks different from a Chihuahua.
Well, hemp and marijuana are two different breeds of the same species of cannabis. Hemp has been bred to have very low or no THC and high CBD. And, because of that distinction, if you get CBD that is sourced from hemp, it is considered legal in all 50 states because hemp is legal in all 50 states.
[11:17] GL — I think, also, there’s not a lot of education on this, either. It’s something that a lot of people don’t even want to talk about. Doctors feel uncomfortable. A lot of doctors feel uncomfortable, so they don’t know much about it. In fact, I was at a conference recently where there was a pretty large company that does CBD. One of their representatives was at the FDA advisory hearings. There were recently some hearings about CBD in front of the FDA, and they said that even some doctors when they were to call the FDA, were using the wrong word, saying cannabis when they meant CBD and vice versa. So, it was completely confusing the discussion, because CBD is legal in all 50 states.
Cannabis is not legal in all 50 states, but yet they were throwing around the terms incorrectly. And these were doctors. I mean it was just like, no, no, no.
I think there’s just not enough good scientific understanding. To me, it seems really clear. I’m not quite sure where the confusion is, but that’s why I keep talking about it in different ways and writing blog posts and things. I’m trying to educate doctors, if they have some confusion about it, and also patients because we really have to become self-educated.
[12:45] TS — Right, right. I love your dog species analogy. I think we can carry that through a little bit further…
Let’s say you live in an apartment complex. Some apartment complexes might not allow you to have a dog such as a Pit Bull or a Doberman. Right now, those of us who are dog lovers know it’s the training, not so much the dog. But follow me with this analogy for a moment. So, you know these dogs are a little bit more dangerous, but your apartment complex is probably going to let you have your tiny teacup poodle that’s smaller than my cat.
[06:58] GL — Exactly. So, hemp is the little teacup poodle, which is legal. And then you have the Rottweiler as the marijuana, which may or may not be allowed or legal, and which you have to be careful with.
That’s the thing about psychoactive medications like that — they certainly can have a role in managing pain. THC, the active ingredient can be really, really helpful, but it can give you mind alterations. I had a patient that told me, “You know, when I use THC, I feel great! My pain is much better, but I just lay on the couch all day feeling high and that’s not really what I’m going for. I want to be able to lower my pain so that I can work, not so that I can just vegetate on the couch.”
[14:17] GL — I think that’s the perfect challenge with THC. How do you get it so it’s not so mind altering for you and you can still be functional? The drug companies, believe me, are trying to find THC derivatives that might have less of a psychoactive effect because it’s a really good pain medication. It does lower pain levels for sure, but we have to find a way to do it that doesn’t alter your thinking as much. And, interestingly, CBD, when it’s taken along with THC, in a kind of equal ratio cannabis, the CBD kind of counteracts some of the psychoactivity of THC so people don’t get as high or as altered from it but still get the pain relief.
15:03] TS — Yeah, that’s interesting. And, you know, if we’re being fair here, the opium poppy is another good analogy. Our drug companies have been able to figure out how to give us some things, like tramadol and Vicodin, which are a derivative of those opiates. And, in some of those, you get into heavier doses of those and you have the same thing where you have trouble thinking and you’re tired and you’re sitting on the couch. So, I personally am looking forward to the day where we start seeing this in a similar light, because there’s a great area here where we can find some pain relief for patients, but we’ve got to figure it out a little.
[15:55] GL — We do. And with this kind of shift in thinking around opioid medications, there is a huge amount of money being poured into researching both cannabis and cannabis-derived medications that maybe do it better or with less psychoactivity. And, also, looking at better opioids that maybe have less addiction or respiratory suppression. Less dangerous opioids — because opioids are really good pain medications, they’re just imperfect. They’re not perfect tools. They have some issues. So, I am hopeful that in the next decade or so, the drug companies will figure some better options out.
But, in the meantime, patients are kind of left in this vacuum… “Well, okay, what do I do? How do I manage my pain? My doctor doesn’t want to prescribe opioids or tramadol for me anymore. I live in a state where marijuana is not legal, or I work at a job where I can’t have THC in my system. So what do I do?”
And this is why I think so many questions come up about CBD. I also get a lot of questions about Kratom. You probably get a lot of questions about Kratom also, because people are looking for alternatives they can access because they don’t have good options — which is really infuriating to me that we just have… I mean it’s frightening. How do we not have better options?
[17:21] TS — Right. Oh my gosh. So true. So true.
So, would you say then that, when people are looking at all of the CBD products that are starting to pop up out there, are they are mostly hemp-based then? Or is it a combination?
[17:41] GL — It’s a combination. If you go into a dispensary in Oregon; I live in Oregon, you used to live in Oregon before you deserted us. Now you’re in Washington where they also have dispensaries. You go into a medical marijuana dispensary, and any CBD that you purchase from there is going to be derived from the marijuana—from that Rottweiler plant. That is more likely to have THC in it, and for some people, that’s what they’re looking for. They’re looking for, let’s say a tincture that has, you know, thirty milligrams of CBD and five milligrams of THC. And if you’re looking for anything that has THC in it, you’re going to find it in a dispensary, and it’s going to be marijuana-derived.
[18:27] GL — If you’re looking for hemp-based CBD, you’re going to find that sold over the counter. So, not in the dispensaries. It’s sold now in the New Seasons and other health food stores. I think some pharmacies are starting to carry it, like Walgreens, CVS, and others. The hemp-derived — meaning it comes from the variety of marijuana plant that has been bred into a new species called hemp with little to no THC. And that’s how you can sell it legally over the counter at a drugstore. Where you can’t go into your Walgreens and say, “Yes, I’d like some of that marijuana.”
The hemp-based CBD, I feel like, is a good place for people to start, because you know that you’re not going to have any effects of THC. There might be microscopic amounts of THC in it, sometimes. But to be sold as hemp-based CBD, it has to have less than 0.03% of THC. So, it’s basically zero, and you’re not going to have any psychoactive effect from it.
I think that’s a really good place for people to start because it’s kind of predictable. You can kind of know how you’re gonna react to it. It’s easier to access because you can get it online. You can get it in a retail store. You don’t have to go into a dispensary. You don’t have to have a card — and it tends to be cheaper.
Anything derived from marijuana tends to be more expensive, and a lot of dispensaries don’t accept credit cards. It’s all cash-based, and it can make people feel a little uncomfortable sometimes having to go into that environment. So, I think hemp-based CBD is easier. It’s more predictable. It’s safer and a good place to start.
I find hemp-based CBD to be really good for sleep, for relaxation, for muscle relaxation, for nerve pain, for anxiety. It’s not a strong analgesic, meaning pain blocker. If you’re looking for pain blocking effects, you’re going to want one that has more of the THC. But, if you’re looking for something to help you sleep, help you feel less anxious, help you feel less tight, you know that fibromyalgia kind of tightness, the fight or flight nervous system, muscle relaxation, or nerve pain. If you have that burning kind of nerve pain, that’s where I think CBD really shines — and by that I mean the hemp-based CBD, simply because it’s easiest to access.
[21:11] TS — And, for people who might be thinking, “Hemp… we’re only seeing this in these things.” I want you to know that you probably have products in your house that have hemp in them. It is used in cosmetics. It is used in textiles. You can buy clothes made out of hemp. It’s used in paper and stationary.
[21:36] GL —They make hemp milk now. Instead of almond milk, they have hemp seed milk, which has no THC, but it comes from the hemp plant. Yes.
[21:45] TS — Yes. I even bought some hemp seeds, roasted hemp seeds at Costco, ones to sprinkle on your yogurt or cereal. By the way, they taste a little like pumpkin seeds, in case anyone’s wondering. That’s a good taste.
[22:00] GL — Yeah. I think I’ve had those, as well, and they’re a good source of your omega-3 and -6 fatty acids. Yeah. We use hemp in a lot of things—and that, my friend, is why hemp is legal in all 50 states. Because it’s grown for industrial purposes and food purposes. It’s really the same base plant, but it’s been bred into a form that can be used more for industrial uses. It has more of the ropey, fibrous material and as part of that, they bred out the THC and boosted the CBD.
[22:38] TS — So, maybe instead of our little teacup poodle, maybe it’s a shepherd or some kind of a farm dog.
[22:55] GL — Gentle.
[22:59] TS — Yes. Yes, exactly.
So, I know that another thing people are confused about, or have questions about, is that they hear CBD, and they think vaping. But that is just a tiny piece of how you can use it. And, honestly, not my favorite. I have asthma, so vaping is a no-go, but I love salves. Why don’t you talk a little bit about those and how they’re used and what gives people what kind of effects.
[23:30] GL — Sure. There’s actually a lot of different ways that people can use CBD as a medicine. Vaping is one, and I agree with you. As a doctor, I have a really hard time recommending that people put anything in their lungs because even if you don’t have asthma, inhaling foreign substances into your lungs is generally inflammatory. But, some people find it works really well for them, and that’s okay, as long as you don’t have asthma, emphysema, or something. So, you can vape CBD, which is basically inhaling it at a high temperature. That is, it’s vaporized. So, it’s not a smoke that you’re inhaling, it’s a vapor, and that’s safer on the lungs. The benefit to this method is that it’s quick-acting and it’s fairly predictable as far as your effect, but it’s also going to be in and out of your system fairly quickly. It’s not very long lasting.
You can take it orally. So, you can take CBD in gel caps or little tablets. You can do sublingual oils, things under the tongue. You can do water-based things under the tongue or sprays in the mouth — and I’ll talk a little bit about the pros and cons of each in a second. But, then, you can also rub it on topically. The great thing about that is you get zero brain effects, no psychoactive at all, but you can get localized pain relief.
So, I was honestly really surprised the first time. It was probably five or six years ago that I learned you could apply cannabis topically and get pain relief. Both THC and CBD have good topical pain-relieving effects. I remember just being like, “What? I’ve never heard of this.” But it actually absorbs really well into our fatty tissue and then right down into the fascia, that kind of painful muscle and nerve area that tends to bother us, from fibromyalgia. It is by far my favorite method of administration because you can localize it. You can really control it. There’s zero potential for any medication interactions, side effects, systemic or brain effects because you’re only going to get it locally. You have to make sure you get one that smells good.
[26:01] TS — Yes!
[26:04] GL — I’ve had ones that smell a lot like marijuana. I had a patient that was like, “I smell like I’ve been bathing in bong water,” and I was like, “Oh, that’s not good.” That’s not how you want to go to work, smelling like marijuana.
Most of the hemp-based CBD topical salves have other herbs or scents in them, essential oils — so it’ll be minty or lavendery — and some of those other herbs actually have additional benefits as well. The CBD muscle balm in Frida Botanicals, my line, has eight different herbs in it along with the CBD, and there’s really a synergistic effect when they mix. The arnica that’s in it also helps the CBD to work. So you get this really nice cumulative effect. You get a lot more benefit from it, and it smells good.
[27:01] TS — It smells awesome. The smell of your Muscle Balm is like… I could just sit and smell it. Most people wouldn’t say that about any kind of CBD product, that I just want to sit there and smell it just for the fun of it.
[27:14] GL — It’s aromatherapy.
[27:16] TS — Yes, exactly. Yours also has a really nice slippage. So, if you’re using it to work on yourself and actually doing some self-massage or somebody else is doing it for you, it’s got just a nice feel for being able to do that.
[27:33] GL — Yes, I agree, and that’s super important. I’ve had ones that are like chunky or runny. You would not believe! I’ve done so much CBD experimentation, all legal, all hemp-based, for anybody who’s listening from the DEA.
[27:49] TS — Right! Exactly. Oh my goodness.
[27:52] GL — So, the other question that you asked was for the kind of administration routes. I want to just quickly say about the sublingual administration of CBD…. It’s not absorbed very well from our GI tract. We don’t have very efficient absorption. So, let’s say you take a capsule that’s 30 milligrams of CBD. If you just swallow it into your stomach, you’re going to get a very small portion of that, usually less than 20% is absorbed into the system.
[28:26] TS — So, you have to take more than what you actually want.
[28:30] GL — Exactly, and it’s expensive, right? If you’re taking 30 milligrams, but you’re actually only absorbing about 5 milligrams of that… I mean, it’s okay — and some people prefer that method just because they don’t like the taste of the oil or caps are easier to travel with, that kind of thing — but you get a lot more absorption if you do it under the tongue. I have people hold whatever they’re using, whether it’s oil- or water-based, hold it under your tongue for 60 to 90 seconds and you get a lot of absorption there, and then you swallow it and you get further absorption in your stomach. So, you get a rapid-acting effect and then a longer lasting effect. That’s typically my preferred method: CBD oil under the tongue.
[29:20] GL — But everybody’s different. Everybody has different preferences as far as what they like. There are some folks that really feel that water-soluble CBD is what they like better. I’m not a big fan. CBD is actually a fat, right? So, it actually lives and likes fat much more than water. And, you know how when you put olive oil and vinegar together and the oil separates out of the water, right? That’s what happens when you put CBD in water. It’ll make these clumps that are hard to absorb. What they have to do to make it water-soluble is to add chemicals that alter it so it will stay dissolved in the water. I don’t like that additional chemical alteration. It’s just one more thing that…. Now, [with CBD oil] you can avoid that extra chemical step.
I do prefer that [CBD oil], but some people really prefer the water-soluble. It tends to be like a spray. Some people really like that. So, it’s not that it’s bad, it’s just that I feel like simple is better, and if you can limit that additional chemical step… Sometimes, the chemicals kind of burn. I don’t know, for me it burns my tongue a little bit. Whatever they use to make it water-soluble sometimes can be irritating to the sensitive fibromyalgia person. But, again, everybody’s a little different and what works, works for them.
So, I think number one, the best way is topically. That’s the easiest, least hassle, less to worry about. Then, the next best option, number two, would be sublingual oils under the tongue.
[31:07] TS — What about things like gummies? I hear a lot of people talking about CBD gummies lately.
[31:13] GL — So, the gummies are basically the same as taking a capsule. It’s just a little bit better absorption because you’re chewing it up a little bit. So, you’re getting a little bit of absorption in your mouth, but then it is just absorbing in your stomach the same way a capsule does. I think people like them because they’re yummy.
TS — Well, you know, it’s like Mary Poppins with a spoonful of sugar.
GL — That’s cool. That totally works. So, I think of it as the equivalent of picking a capsule.
TS — Right. But in a form like your children’s chewable vitamins.
[31:52] GL — There are some issues though with kids around gummies. You have to be really careful if you’ve got CBD gummies at home because kids will be like, “Oh great, gummy bears!” You know they make marijuana-infused gummies that have both THC and CBD, and you read these horror stories of kids that got into their parent’s medicine. CBD is reasonably safe for kids. They’re just going to feel really relaxed if they get into your CBD gummies, but it could cause them some distress. The THC gummies can actually be dangerous. So, that’s another reason I’m not a huge fan of the gummies, I guess. It just seems like you’re asking for trouble, maybe.
[32:41] TS — Yeah. I totally could see that. Especially if you have kids at home. Right. Yeah.
So, tell us a little bit about… I know we were talking before I started recording about the fact that there hasn’t been CBD research done specifically on fibromyalgia, but we have had some research done on cannabis, looking at the different percentages of CBD and THC and things like that. Tell us a little bit about that.
[33:12] GL — Well, I’m happy that we’re doing this. It is perfect timing because I just did a blog post about the recent cannabis research that’s been done. Up until 2019, just a few months ago, there had been very little done on looking at cannabis for fibromyalgia. Back in 2011, they did some kind of survey-type studies where they asked people at a pain clinic if they had fibromyalgia. If so, have you taken cannabis?, and was it helpful? You know, they’ve done that kind of study. But up until this year, there hadn’t been any where they looked at people as they went along and looked at people over a period of time.
There was just a study that came out of Israel where they had people that were coming to a medical cannabis clinic with fibromyalgia, and then they were started on cannabis. They followed [the patients] over six months to see how they were doing. 80% of the patients reported a clinical improvement. So, at least a moderate improvement of their symptoms, which is huge. I mean, to give you a sense of perspective, the studies on Cymbalta or Lyrica, it was like 30% of people reported improvement. So, we’ve got 80%. It’s really significant. And their average pain levels dropped from 8 out of 10 to 5 out of 10. So, a drop of three points is pretty good.
[34:44] TS — It’s also huge.
[34:46] GL — It is. I mean, that’s so much better than what we see in studies. What they did is just let people use whichever strain of cannabis they felt was right for them. So, there’s 14 different strains people had access to, and they had all sorts of different ratios. Some were really high in THC and low CBD, some were high CBD, low THC, some were in the middle.
What we don’t know, based on this study done in Israel, is there a right ratio that is the best? In my experience, clinically, for pain relief, that equal ratio of THC/CBD tends to be best, but a lot of people can’t tolerate it. So, then, maybe a high CBD, low THC would be better.
That’s going to be kind of the next step in trying to figure out within cannabis: are there good ratios, maybe different ratios for different illnesses? Maybe what somebody with fibromyalgia needs is different than, let’s say, rheumatoid arthritis. Okay.
[35:53] GL — They did say that the CBDs — the strains that were high in CBD — helped. People also reported to benefit from them, but they didn’t have that data. They didn’t record this person had this much benefit and they were on a high CBD. This person had this much benefit and they were on a high THC. They just kind of lumped it all together. So, I think that’ll be the next step, is to figure out: are there specific strains or ratios that are ideal for fibromyalgia? So, that’s one thing.
The other thing is, earlier this year in the Netherlands, they did a study where they had people vaporize a high THC/low CBD, a medium range, and then a high CBD/low THC. So, three different kinds of ratios, high THC, low THC, middle, and they had them vaporize that, and then they tried to gauge how their pressure sensitivity was. So, how much pressure it took for them to say, “ouch”, basically. What they found is that, actually, the higher THC ones worked best.
When they gave people with fibromyalgia — had them vaporize a high THC/low CBD strain — they found that really impeded the pain signals going to the brain. Interestingly, the high CBD version didn’t have that same effect. So, it does seem to be the THC that has the analgesic component, the pain blocking component, whereas it’s the CBD that has some of the other effects, like the more anti-inflammatory, muscle relaxation, sleep improvement, anxiety.
[37:41] GL — What I would love to do, if Lady Gaga can come fund a study, I would love to look at the effects of CBD on sleep. How does CBD affect the sleep of people with fibromyalgia? Does it improve their sleep quality? Do they get more deep sleep? Does it help them to fall asleep more quickly? Does it overall reduce their fatigue? Getting that sleep improvement, that is where it would be really interesting to look at.
Because, clinically, that’s what I see. I mean, people report that CBD helps with our sleep. I’d love to actually really study that and kind of figure out: is there an optimal dose? I mean, right now, people just kind of titrate to their effect, but maybe there’s a dose that would be pretty consistent for most people. But, managing that could be something that maybe down the road…
Even doctors don’t understand much about cannabis. They might feel comfortable if there had been a study about hemp and CBD, for example, looking at that for sleep and fibromyalgia. Maybe doctors might actually bring it up or feel more comfortable recommending it. So, that’s kind of my hope. I think research would help to improve the comfort level of doctors with it, and maybe patients, also. I mean, people like to know if things have been studied.
[39:01] TS — Absolutely — and if we can get more precise on the amounts to take for different things, then it’ll be a little bit more like the butterbur studies for migraines. Right? Like, taking this much, this many times a day, you know?
[39:18] GL — Yes, exactly. Like, it would be more medicinal.
[39:22] TS — For sure. Have there been studies on CBD only, or have they all just been cannabis? Looking at the plant that has it all.
[39:33] GL — There have been studies looking at CBD only, but not for fibromyalgia. They’ve looked at other conditions like diabetic neuropathy. They’ve done a lot of studies on anxiety, PTSD. So there definitely are CBD only studies, but there hasn’t been CBD only and fibromyalgia.
[39:54] TS — What did they do? Do you know offhand what they found in some of those studies? Because I was thinking about the anxiety one, that’s definitely something that affects us with fibromyalgia.
[40:04] GL — Absolutely. Yeah. They found it to be very helpful for anxiety. They did one that was really interesting. You know, people tend to get a lot of anxiety about public speaking. So, they did a study where they split people into two groups. Half of them, they gave CBD before they had to do their public speaking and the other half [they] didn’t. The half that got CBD not only reported feeling less anxious, but their actual biomarkers of anxiety — like heart rate, sweating, things like that — also were down. So, it actually does calm down that fight or flight nervous system, which, you know, in fibromyalgia just kind of goes haywire. So, yes, the studies on anxiety are good. The studies on PTSD are good… insomnia… It’s all shown positive effects, and that’s why I think CBD has really gone viral, so to speak, because it does work.
[41:01] GL — Now, it’s not just a panacea — and where I get a little worried is… if, sometimes…. It seems like on social media it’s now “CBD cures cancer” and “it did this” and you know “made me grow a foot taller” and “I lost 20 pounds” and I’m like, you have to have realistic expectations for it. But for anxiety, it’s really impressive. I mean it’s my kind of go-to now for anxiety. Before I give somebody a prescription for an antidepressant or benzodiazepine, I start them on CBD, because if I can get them the benefit they need, great. That’s so much better than starting yet another medication. You know what I mean?
[41:44] TS — Absolutely. And this is a good time for me to remind everybody who’s listening, I’m going to try to track down all these studies that she’s talking about and we will have links to them. We’ll definitely link to that blog post that you just wrote.
[41:58] GL — Yeah, and there’s two blog posts about CBD and all the links are there. So if you type DrLiptan.com [new website is DrGinevra.com], all the blogs have my heavily linked to research for your reading.
[42:10] TS — Excellent. So, anybody who’s interested in that, this is Episode 18. Just go to FibromyalgiaPodcast.com/18 and I will have the links to those specific blog posts. But of course you can also go to DrLiptan.com [new website is DrGinevra.com] and you’ll find them there, too.
So, what have you seen with your patients as you’re working with them? How have you seen their lives changed as they start using some of these products to help with sleep or anxiety or whatever?
[42:43] GL — I have done a little, mini… You know, human memory’s somewhat faulty, especially, foggy memory. So I did a study where I actually looked at twenty of my patients I had given CBD, and I looked at the outcome of what they had reported to me. So, doing a chart review, basically. And what I found is about two thirds of the folks that I recommended CBD to and were taking it reported some benefit. Some people reported benefit for anxiety, some for sleep, some for pain, some for all three. So, two thirds found some benefit. One third — maybe a little bit under one third — one third didn’t report any benefit but also didn’t have any side effects. So, I feel, definitely, the benefit-risk ratio is pretty good.
At that point I had not specified, you know, I didn’t break it down, to what brand of CBD people were taking. Was it a water-soluble? Were they vaping it? I didn’t break it down like that, and going forward, I’m trying to do that in my documentation so I can really see if topical CBD is giving people all the benefits they need, or does it have to be sublingual? Does it have to be vaped? You know, trying to look at it from a scientific perspective of what’s working for folks. It’s pretty interesting because it doesn’t work for everybody, but when it works, it’s really pretty impressive. So, I think it’s worth a try for something that helps two thirds of the folks that I give it to. I think it’s worth a try.
[44:30] GL — I see the biggest benefit for anxiety and insomnia and a more mild pain-relieving effect. If you’re looking to CBD to replace a strong analgesic medication like an opioid, you’re going to be disappointed because it is not a strong analgesic. If analgesic is what you’re going for, you probably would be better served by going to a dispensary and getting something that has a little bit of THC in it because that’s your strong painkiller. In general, I’m moving away from opioids to manage pain and I am trying to encourage people to explore the cannabis derivatives, simply because they are safer. They are less addictive than opioids, and honestly they’re becoming more accessible because it’s getting so hard to be prescribed or access opioids. So, I think for most folks, it’s absolutely worth a try.
I do encourage people to talk about it with their doctor, even though it’s uncomfortable. I think, just like any medication, there can be interactions with other medicines. So, for the most part, CBD — hemp-based CBD — is safe to take with almost every medication. But, if you are on a medication like a blood thinner, where it’s really important that you have a very narrow window of blood levels, CBD can affect the blood levels of other medications. So, if you’re on chemotherapy, if you’re on a blood thinner, if you’re on something where you get your levels measured and it’s really important that it be in this precise range, then you absolutely have to get tested before you start CBD and be monitored as you take it. Other than that, I have people take CBD along with basically all their other typical fibromyalgia medications.
It plays pretty nicely with other medications, but just to be on the side of caution, I definitely recommend people run it by their doctor to see if there could be an interaction with any medication [they are] taking. Unfortunately, your doctor might not have that much information, but maybe your question will prompt them to do some research about it. And, then, for the next patient they’ll be like, “Oh CBD, I’ve heard of that and I’ve done this study.” You know, or, “I read the study about it.” So, a piece of it is, we are having to educate our doctors and bring them along into the next century, 2019.
[47:16] TS — That’s right. You know, I have to say that what I’ve seen with my clients is very similar to what you just described. And it’s interesting, us doing this interview, because one of the things that I’m realizing as we’re talking is that my clients who really didn’t see any effect from trying CBDs, were all taking capsules.
[47:41] GL — Yeah. The capsules are unfortunately not a great test. Yeah. I’ve actually had people I’ve switched from the capsule to the oil, and people get totally different results, because you’re just getting so much more of the medication. Right. Absolutely, not great. Not a great way. I mean, it’s okay…
[48:03] TS — Right, right, exactly. You just have to be aware of that difference between what you take and what you are actually getting in your body. So. Awesome.
[48:13] TS — I know we’re getting close to the end of our time, and there’s one last question I have for you, which is for that person who has been listening to this episode and hearing some of these benefits. If they want to maybe try some CBDs, obviously Frida Botanicals is a great place to go, but would you give us some guidelines on: how do you know if you’re getting the right thing? Because I’ve also heard lots of stories from people where the plants may have even had mold on them or…
[48:48] GL — Or maybe the product doesn’t even have any CBD in it.
[48:51] TS — Yes. I’ve also heard that also. Be careful of what you buy, just like anything, right? Like the story that came out a while back about the supplements they bought at Walgreens or wherever, that didn’t actually contain what they said they were supposed to contain. This is no different.
[49:09] GL — Exactly. And that’s such a fear of mine. I mean that.
So, here’s the thing, they did a study a few years ago. Some researchers ordered about a hundred different CBD products online and had them third-party tested — so a separate lab looking at them — and about half of the products that they ordered were mislabeled. Either:
- They didn’t have any CBD in them when they said they did
- Or they had a lot more CBD than they said they did
- They were contaminated with something else
- Or they had high levels of THC.
- Or there were products that they ordered online that said they were hemp-based CBD and they had really high THC.
So, can you imagine how awful it would be to take something, like, “I’m going to work, taking my hemp, taking my… Oh, oh. There was something in there that I was not anticipating.”
[50:01] GL — So, what I recommend across the board is: make sure that the product you’re buying is third-party tested — and the company should display on their website the results of the third-party lab testing. They should be looking at how much CBD is in there, how much THC is in there. They should be testing for pesticides. Okay? And making sure that there’s no impurities, nothing like mold. So many fibromyalgia patients are chemically sensitive, and the last thing you want is to get something where you’re putting in, you know, something that’s laden with pesticides or otherwise contained.
[50:44] GL — So, the thing to look for is really the third-party testing, and that means that the company that’s making it can’t be the one that’s testing it. It has to be a separate company that has no financial relationship to them. I use a company locally called GreenLeaf Lab, which is really great. They do a lot of the cannabis testing for the whole Oregon area. So, I get every batch tested, and I post those results on the website. That is becoming more and more of the standard practice. I strongly encourage people, whatever product they’re buying, to make sure that information is available to them. And if a company doesn’t have that posted, I’d say steer clear and maybe go to a different source.
[51:32] TS —Excellent. Anything else you would recommend that people look for if they’re looking for a good CBD to try. Or is that third-party testing really the main thing?
[51:44] GL — I think the third-party testing, along with reading reviews. You know, I mean that’s pretty standard these days. You can get some useful information I think from that. Particularly around taste, you know. I’ve tried, in my market research, I tried a lot of different CBD oils and tinctures, and some of them, to me, tasted awful, like they used stevia or other artificial things. Stevia’s natural, but they use, like, artificial sweeteners or weird flavors, and I personally didn’t like that. So, you also want to make sure that it’s something that, the taste is amenable to you. The Frida Botanicals line is just unflavored. It’s just oil, coconut oil, and the hemp CBD. So, it’s unflavored and I prefer that, but everybody has their own preferences. I would say third-party testing, and then read reviews on tastes. You can make sure that it’s something that’s palatable for you.
[52:43] TS — And then I would also recommend that you listen back to the parts [of this episode] where we were talking about the different forms that you can get things in, like the water-soluble, oil-soluble, salves, and that kind of stuff, and really think about what it is that you’re needing it to do for you, and how it’s going to fit into your life, and some of that.
[53:08] GL — And how long you need it to last. Absolutely. On one of my blogs on DrLiptan.com [new website is DrGinevra.com], I go into the actual comparison of the different methods. So, that could be a good resource for folks as well.
[53:20] TS — Perfect. We will make sure we link to all those goodies. Awesome. And, of course, I will say it: If anybody is looking for a good brand, I do definitely recommend Frida Botanicals. I have the Muscle Balm, myself, like I said. I love it. It sits by my chair and I put it on when I need to.
[53:44] GL — It sits by my bed. I put it on every night before bed.
[53:48] TS — Yes, exactly, and, like I said, it smells really good, so you don’t have to walk around smelling like a skunk.
[53:54] GL — Yes, exactly. Thank you, my dear. Thank you for having me on.
[53:57] TS — Absolutely. Any last minute thoughts for us on the topic?
[52:43] GL — None on the topic, but I want to say… Tami, congratulations on a really awesome podcast and Episode 18. Woot!
[54:10] TS — Thank you, so much. And you guys know, I blame her for this whole thing.
[54:14] GL — Yeah, I totally take that blame, and I told you so.
[54:20] TS — Yes, it was that airplane ride back from the Sacramento Walk, where you pestered me for five hours straight…
[54:29] GL — “You have to do a podcast on fibromyalgia, Tami.”
[54:34] TS — Awesome. Well, thank you, again, so much, and everybody stay tuned. I’m going to do a quick recap at the end here and give you a bunch of links again. So, thanks so much.
[54:46] TS — Thank you, so much, for sticking with this until the end. Remember all of today’s resources, research studies and links can be found at FibromyalgiaPodcast.com/18 for Episode 18.
As I mentioned at the beginning of this episode, we are doing a very special giveaway of the Frida Botanicals CBD Tincture and Muscle Balm mentioned in this episode. You guys are going to love it. Dr. Liptan and I are also throwing in signed copies of our books for you. This bundle is worth well over $100 and you can win it absolutely free. There is no purchase necessary. All you have to do is visit FibromyalgiaPodcast.com/18 and look for the Enter Competition button. Just click on that, fill out the form, and you’re set. You can even earn extra entries by sharing the contest with your friends. This contest giveaway is going to run for a month after the episode airs, so be sure to enter right away. [Contest ended]
[55:57] Upcoming in future episodes of the Fibromyalgia Podcast:
We have our special “Ask The Coach” or “Dear Tami” episode, where we are going to be answering the question, “Is it common to gain weight with fibromyalgia?” The short answer to that question is, “Yes.” In our Ask The Coach episode, I’m going to dive in a whole lot deeper and talk about why it’s so easy to gain weight with fibromyalgia and why it’s not your fault. There’s so much going on in your body, and it’s kind of surprising if you run across somebody who doesn’t gain weight with fibromyalgia. And we’re actually gonna dive in to all of that.
We are also in the process of scheduling Dr. Jarred Younger to come talk about his fibromyalgia research. He has done a lot of research on inflammation in the brain in fibromyalgia. He was actually the person to discover that. And also on using low dose naltrexone for fibromyalgia, which those of you who are familiar are excited to hear his research. Those of you who aren’t familiar, we’re actually going to be talking about that in the episode with him.
[57:16] Now, remember, as always, you never have to stress about taking notes or worry about fibro fog. We’ve always got you covered with our full show notes and the resources at FibromyalgiaPodcast.com. Remember you can go grab copies of my books for free out there — of course, these are downloadable electronic copies. If you want that paperback, you’re going to want to go and enter to win our contest to grab that. You can also, of course, always find it on Amazon. You can also just let me know through the website any questions you have for our next Ask The Coach episode and also if you are interested in having a consultation with one of our coaches about ways that you can feel better faster. Is there something you’d like me to talk about on the show? If you’ve got any questions, you can let me know that through the website as well. See you next time.