By Karen Lee Richards
As anyone who has ME/CFS (myalgic encephalomyelitis / chronic fatigue syndrome) will attest, finding an ME/CFS treatment that helps with any of its many symptoms can be challenging. Since as yet there are still no FDA-approved drugs for the treatment of ME/CFS, patients often turn to natural remedies to try to find relief from a variety of ME/CFS symptoms. CBD oil is one of those natural remedies that is becoming increasingly popular.
What Patients Say About CBD for ME/CFS
As the use of CBD oil becomes more common, ME/CFS patients who have experienced significant improvement are beginning to tell their stories.
- One of the best-known stories may be that of Tom Bethell reported in the UK publication the Daily Mail. At the age of 15, Tom was bed-bound and hadn't been to school for almost eight years. He had stopped growing and was so weak, it was difficult to even breathe. At that point, he told his mother that he “didn't want to live anymore.” However, after he began taking CBD oil, he made a remarkable turnaround. His mother said his symptoms were alleviated and he began growing again — 11 inches in nine months and two shoe sizes in eight weeks. He was soon able to return to living the life of a normal 15-year-old.
- In 2018, Pinetree told her recovery story to Cort Johnson on his blog, HealthRising. Prior to trying CBD oil, Pinetree was bedridden and needed help with pretty much everything. She had found a few supplements that helped some, but she still had some fairly severe symptoms. She credits CBD oil with making the difference for her. Since she began using CBD oil, Cort reports, "Now her bed is for sleeping at night, she is able to care for herself, and is starting to look for a job. The brain fog, the headaches, the severe pain, the overwhelming post-exertional malaise, the depression are gone!"
- Kristin Kollinger also told her ME/CFS healing story on HealthRising. Kristin went from being a hard-charging executive to being bed-bound, too weak to take a shower or even lift a glass of water from her bedside table. When traditional medicine didn't help her, she turned to natural healing methods, including nutrition and meditation. While those things helped, it was adding CBD oil and low-dose naltrexone that really made the difference for her. Kristin said, “CBD oil has reduced my exercise intolerance, decreased nerve pain, reduced inflammation, increased my immunity, and helped with sleep.” Although she still has some symptoms, they are significantly less. She says she feels the best she has in eight years and is now able to work part-time.
5 ME/CFS Symptoms CBD Oil May Help – The Research
Since much of the research into CBD oil is relatively recent, you probably won't be surprised to learn that so far there has been no published research on CBD for ME/CFS specifically. But there is research on the use of CBD oil for several ME/CFS symptoms that can give us insights into its effectiveness.
1. Pain and Inflammation
CBD oil may be best known for its pain relieving qualities. Several studies have supported the effectiveness of CBD in reducing pain and inflammation, including these:
One report reviewed the results of several systematic reviews, which covered dozens of studies on CBD for pain. Their research concluded, "In adults with chronic pain, patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms."
- A 2012 study published in the Journal of Experimental Medicine found that the use of CBD can reduce pain and inflammation. They concluded, “These cannabinoids may represent a novel class of therapeutic agents for the treatment of chronic pain...” They also noted that CBD apparently does not cause analgesic tolerance, requiring ever-increasing dosages, as usually happens with opioid medications.
- A 2017 paper published in Expert Opinion on Therapeutic Targets listed CBD oil as a possible option for reducing the activity of glia — the brain cells thought to be involved in sensitization of the central nervous system and a feature of ME/CFS as well as other central sensitivity syndromes like fibromyalgia, migraines, and IBS.
Extreme fatigue is the symptom most often identified with ME/CFS. Although CBD may not restore normal energy levels, it does have properties that can give energy levels a boost.
Several studies, including a 2014 study, published in the journal Current Neuropharmacology, reported on the potential of CBD to promote wakefulness. Exactly how it works is still being studied, but some experts believe CBD helps to strengthen the cells that are involved in making you sluggish and sleepy, as well as improving focus and mental clarity.
One very interesting thing about CBD is that it is biphasic. That means it can have very different — sometimes even opposite — effects at different concentrations. At low concentrations, it can promote wakefulness and energy, while at higher concentrations, it can help with another ME/CFS symptom: insomnia.
3. Sleep DifficultiesAnother symptom commonly reported by ME/CFS patients is their inability to get quality, deep sleep. We know there are CBD receptors in the area of the brain responsible for maintaining sleep/wake cycles, and a study done on animal models have shown that activating these receptors with CBD can induce sleep.
Several human trials have demonstrated the benefits of CBD on both the quality and quantity of sleep:
- CBD was shown to improve complex REM sleep disorders in Parkinson's disease patients in a 2014 study published in the Journal of Clinical Pharmacy and Therapeutics.
- A 1993 study done with healthy volunteers confirmed the sedative effects of CBD.
- An early clinical trial gave 160 mg of CBD to people suffering from insomnia. After just a few days, the participants reported sleeping longer and waking less frequently during the night.
4. Anxiousness and Low Mood
Feelings of anxiousness and low mood are common symptoms reported by many ME/CFS patients. CBD may offer an effective natural alternative for those who don't want to take or who experience negative side effects from traditional mood-stabilizing medications.
Multiple studies have demonstrated CBD's ability to quell nervousness. A review published in the September 2015 issue of Neurotherapeutics looked at 49 preclinical, human experimental, clinical, and epidemiological studies. They found evidence that "strongly supports CBD as a treatment for generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder..."
Both a 2014 review and a 2018 review of multiple studies found that CBD appears to act as an antidepressant in animal models of depression. Another study, published in the February 2019 issue of Molecular Neurobiology, concluded, "The data support a promising therapeutic profile for CBD as a new fast-acting antidepressant drug."
5. Mitochondrial dysfunction
The mitochondria are the main source of energy for all of the cells in our body except red blood cells. Numerous studies have shown that the mitochondria in the cells of ME/CFS patients are unable to produce energy properly. One test demonstrated that ME/CFS cells, when pushed to their maximum capacity, were only able to increase their mitochondria output by 47%. That's less than half of the 98% increase achieved by the healthy control cells.
CBD has been shown to have a positive effect on mitochondria. A 2012 French study identified the presence of cannabinoid receptors on mitochondrial membranes. That opened the door for further investigations into how the endocannabinoid system (ECS) might be involved in regulating mitochondrial activity. A year later, a Brazilian study found that administration of CBD increased mitochondrial complex and creatine kinase activity in the brains of animal models.
What Form of CBD Oil Is Best?
When deciding what form and how much CBD oil to use, bioavailability is a very relevant issue. Bioavailability refers to how much CBD is ultimately absorbed into the bloodstream. Following are the approximate absorption rates for the four most common means of delivery of CBD oil:
- Oral: 4-20%
- Sublingual: 12-35%
- Vaporized: 34-60%
- Topical: 45%
But absorption rates don't tell the whole story. There are other things to be considered when choosing which CBD product is best for you.
Oral consumption refers to CBD that is swallowed, whether as an oil, in capsule form or in food. When taken orally, CBD has to first pass through your digestive system before circulating through your liver. This process means it will take a while for the CBD to reach your bloodstream and only a small portion of it will actually get there. However, on the positive side, what doesn't reach your bloodstream is stored in fatty cells and can be released over a period of days. Therefore, if oral CBD is consumed consistently and on a regular basis, it can provide a steady, long-lasting effect. This can be particularly helpful for chronic conditions like ME/CFS.
Sublingual consumption refers to CBD that is administered under the tongue, in the form of oils, tinctures, sprays or lozenges. This method bypasses the digestive system and is absorbed directly into the bloodstream. When using CBD sublingually, you should hold it under your tongue for at least a minute or two before swallowing to allow it to be absorbed by the mucous membranes. Sublingual delivery gets the CBD into your bloodstream much faster than oral consumption, but the effects won't last quite as long.
Vaporized consumption refers to CBD that is inhaled through the use of a vaporizer pen. This method, also referred to as “vaping,” has the highest bioavailability rate and is the fastest way to get the CBD into your bloodstream. The effects can be felt in as little as 15 minutes, but they do tend to wear off after just two or three hours. However, if you're in pain and looking for fast relief, vaporizers can be an excellent option.
Topical administration refers to CBD that is applied directly to the skin in the form of creams, lotions, balms or salves. While topical application doesn't really get a lot of CBD into the bloodstream, it does absorb into the skin and interact with the nearby cannabinoid receptors. This can be an effective method of delivery for localized pain relief. It can, however, take from one to 48 hours to be effective, depending on the dose and frequency of use. Many users find that regular topical application provides the best and longest lasting relief.
How Much CBD Should I Use?
There is no single or simple answer to how much CBD oil is right for you. Since people with ME/CFS are often very sensitive to many things, including foods, medications and supplements, the best rule of thumb to follow is always to “start low and go slow.” Start with the smallest dose possible for whichever delivery method you choose. If you're able to tolerate that without significant side effects, increase the dose very gradually until you find a dose that provides the symptom relief you're looking for without negative side effects.
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Karen Lee Richards is ProHealth’s Editor-in-Chief. A fibromyalgia patient herself, she co-founded the nonprofit organization now known as the National Fibromyalgia Association (NFA) in 1997 and served as its vice-president for eight years. She was also the executive editor of Fibromyalgia AWARE magazine. After leaving the NFA, Karen served as the Guide to Fibromyalgia and Chronic Fatigue Syndrome for the New York Times website About.com, then worked for eight years as the Chronic Pain Health Guide for The HealthCentral Network before coming to ProHealth.