It has been years since I started thinking about writing this column; I have held off awaiting a convincing level of confirming research and clinical evidence. There is still an amazing amount we don’t know, but there is now a satisfactory amount of evidence and personal experience that I feel OK in writing.

CBD, cannabidiol, seems in some ways to be the latest equivalent of what century-ago hucksters sold as snake oil. It can cure any ill, modulate any pain, fix broken relationships and make your life all that it could possibly be. The interesting thing about CBD is that it comes remarkably close to actually doing many of those things, especially modulating pain, body temperature and inflammation.

CBD is one of several compounds found in the cannabis plant; they are called cannabinoids.

Marijuana and CBD have been used therapeutically for 10,000 years or more; hemp, a strain of cannabis and a major source of CBD, may have been the first crop ever cultivated. It was only in the 1930s that those paranoid legislators who make the regulations that run our lives decided the benefits were outweighed by what they perceived as the downsides. In fact, there are hardly any downsides, and at last, we are being allowed to use these ages-old compounds to our benefit.

I am now comfortable enough with CBD that I am making it available to my patients as an adjunct to my own pain management treatments.

What your brain does

Did you know that your brain produces its own cannabinoids? It also produces its own opioids. Thankfully, your built-in drug manufacturer is smart enough to do this at just the right time, and in just the right quantities to deal with specific situations.

You have an elaborate array of biochemical processes called the endocannabinoid system that was discovered first in 1992; its name implies the creation of cannabinoids within your body. Its role is primarily to be involved in regulating things both physiological and cognitive: fertility, pregnancy, prenatal and postnatal development, appetite, pain sensation, mood, and memory. It plays a major role in physical exercise, as well, including the euphoria we call runner’s high.

Cannabinoids work by interacting with two specific receptor proteins in your brain and body. The CB1 receptor is found in various parts of your brain and nervous system, as well as your organs and tissues. The high that you get from marijuana, THC, results from its activating your CB1 receptors. The CB2 receptor occurs throughout your immune system and regulates appetite, pain and others. The growing evidence is that CBD acts primarily on CB2. These actions contribute to its therapeutic effects.

Do you need CBD, and how much?

The indications for CBD are becoming known. For example, CDB has been used successfully to treat epilepsy in children, and there is a growing list of conditions that benefit from CBD.

The National Institutes of Health suggests the following as being, or having the potential to be, treated with CBD: anorexia, emesis, pain, inflammation, multiple sclerosis, Parkinson’s disease, Huntington’s disease, Tourette’s syndrome, Alzheimer’s disease, epilepsy, glaucoma, osteoporosis, schizophrenia, cardiovascular disorders, cancer and obesity. In addition, there are migraines, anxiety and depression, and PTSD, not to mention an assortment of pain conditions.

How much you should take seems to be the least well-understood aspect of CBD. Dosage is almost a guessing game related to many factors, and different for each individual. In view of the very low toxicity and benign side effects of CBD, however, you can probably afford to experiment with your dosage. At this time, the best advice is to start low, be patient and increase dosage slowly over time. And, as always, it’s never a mistake to consult with your doctor before engaging a new approach to your health.

One NIH study of the effect of CBD on anxiety showed 25 mg per day to be the ideal for all of the participants. It discovered also that not only was too little CBD ineffective, but also that too much CBD was ineffective. That is, there seems to be what they call a “Goldilocks Zone” in which CBD works for anxiety, and there are probably such zones for other conditions, as well.

How do you take it?

There are some common ways of taking CBD, and the right way depends on the reason you’re taking it.

Swallowing. The slowest but longest-acting way is to swallow your CBD oil in the form of capsule, powder or even in food. It’s slowest because it has to get some way through your digestive system to get into your bloodstream. When taking CBD this way, be sure to consume a good portion of fat, like coconut oil, as CBD is soluble only in fats, not water.

Under your tongue. A faster way is to use drops of a tincture under your tongue. The underside of your tongue and your cheeks have plenty of capillaries, so the CBD gets directly into your bloodstream.

Topical. If your hip hurts from arthritis, say, the most direct way to get CBD to your inflammation is to rub it on. Very little of it gets to your bloodstream. The main effect is to reduce the inflammation where you hurt. In addition to creams and lotions, suppositories and sprays are available.

Vaping. It’s possible also to smoke CBD. This is the fastest way to get CBD through your system, but the shortest duration; the peak effect is 10 minutes or so.

Where can you get it?

Many outlets, like drugstores and markets, are starting to offer CBD. Amazon has a variety of CBD products, and there are other online sources.

CBD is generally extracted from hemp, but there are a variety of ways to do this, some good, some not-so-good. So have a care in that generally, you can’t know the extraction method used, the concentration or the purity of the product.

In my practice, I buy CBD from a local source that I know goes to great lengths to ensure the quality of the product it sells.

Cautions and side effects

CBD seems to be well-tolerated by almost everyone, and so the risk of using CBD in any form seems to be low. That said, there are some cautions.

Dry mouth, fatigue, reduced appetite, drowsiness and diarrhea, while not common, are possible side effects of CBD. Further, CBD may interact with some of your medications.

Grapefruit has the same interaction with medications as CBD does. So, you may see on your prescription not to have grapefruit while taking this medication; the warning also applies to CBD. For a list of grapefruit-prohibited medications, go to www.drugs.com/article/grapefruit-drug-interactions.html

Despite these cautions, the benefits of CBD usage generally far outweigh the possible downsides.

Bob Keller maintains a holistic practice in Newburyport. He offers medical massage therapy for pain relief and advice on muscular balance and diet, as well as psychological counseling, dream work and spiritual direction. Many patients call him Dr. Bob, but he is not a medical doctor. He can be reached at 978-465-5111 or bob@myokineast.com.