By Liz Sutherland, ND
Reviewed by Jen Palmer, ND
Using Ingestible and Topical CBD Together
One of the reasons you probably became a chiropractor in the first place is because you want to make more drug-free options available to people for their overall health and wellness. Offering both ingestible and topical forms of CBD in your practice is a wonderful way to expand your repertoire and provide your patients with more individualized choices. This article will explain why combining ingestible and topical forms of CBD may help enhance your patients’ experience of health and wellbeing. It will also provide tips on how to begin.
The key to understanding the rationale behind combining ingestible and topical CBD rests in the physiology of the endocannabinoid system (ECS) itself.
Review of the Endocannabinoid System (ECS)
The endocannabinoid system (ECS) is the master regulator behind homeostasis, or physiological balance, for a multitude of biological processes including endocrine, gastrointestinal, neurological, and immune functions. You can think of its basic mandate as: Relax, Sleep, Eat, Forget, and Protect! All humans, in fact all living creatures with the possible exception of insects, have an ECS. The ECS consists of cannabinoid receptor sites; endocannabinoids; and specialized enzymes for the biosynthesis and metabolism of these endocannabinoids.
ECS receptor sites, known as CB1 and CB2, are located throughout the body. CB1 receptors are found mostly in the brain and spinal cord, and CB2 receptors are mostly in the immune system, peripheral nervous system, and organs. Our bodies produce endogenous chemicals known as endocannabinoids on-demand to restore balance in response to both internal and external events that cause stress, pain, or anxiety. Phytocannabinoids, such as CBD, which are found in the hemp plant, resemble endocannabinoids and are able to interact with our CB receptors as well. Humans have more receptor sites for endocannabinoids in our brains than for ligands of all other biological systems combined, a testament to both the importance and reach of the ECS.1
Unfortunately, common factors such as pain, stress, aging, and environmental toxins can hamper the ability of the ECS to support homeostasis and resilience.2
The ECS and the Skin
Given that the skin is a neuroimmunoendocrine organ, it should come as no surprise that there is also a cutaneous endocannabinoid system. CB1 and CB2 receptors are found in dermal layers all the way to the subcutaneous tissue. In fact, our skin cells, including the cells of hair follicles and sebaceous glands, are able to synthesize endocannabinoids. The cutaneous ECS plays a major role in skin homeostasis including barrier formation; skin cell regeneration; and regulation of the inflammatory and immune responses. Its functions include supporting wound healing, as well as regulating sebaceous gland secretions (oil) and hair growth.3
In addition, the cutaneous ECS interacts with TRP receptors, which are involved in modulating sensations of pain and itching. As a side note, this system of TRP receptors is also where menthol and camphor, the active ingredients in CBD CLINICTM topical products, have their effects.
Topical CBD interacts with ECS skin receptors that are local to the site of application.
Evidence suggests that dysregulation of the cutaneous ECS may contribute to the development of acne vulgaris, atopic dermatitis, contact dermatitis, psoriasis, itching, pigmentation disorders, and abnormal hair growth.4,5,6 Some studies show that our endocannabinoids may also have an analgesic effect in the skin.7
Why Use Ingestible CBD and Topical CBD Together?
Ingestible and topical applications are the two most common ways CBD is administered. If you’re already using CBD CLINIC topicals with your patients, you may be starting to understand why you would want to add ingestible products. When CBD is applied topically, it interacts only with cannabinoid receptors local to the application site, making topicals an ideal way for you to tailor a focused approach for your patients. CBD CLINIC topicals provide a powerful option for pain relief, because of their active ingredients; they can also balance and revitalize the skin, because of their emollient content.8
When CBD is ingested, it can potentially interact with ECS receptors that are throughout the body. This means ingestible CBD may have more of a systemic balancing effect overall, which would complement the targeted focus of CBD CLINIC topicals. In addition, Charlotte’s Web ingestible products are created from whole-plant hemp extracts that contain a naturally occurring array of phytocannabinoids (in addition to CBD), and phytonutrients such as terpenes, flavonoids, phytosterols, and essential fatty acids. These plant constituents may work best in combination because they work together to optimize each other’s effects on the ECS, a phenomenon known as the entourage effect. A 2015 study that gave participants an extract containing only CBD (CBD isolate) found that the benefits on pain and inflammation stopped sooner than they did for participants who were given a whole-plant CBD extract. In addition, participants given the whole-plant extract were responsive to dose variations, and much less was needed to produce the same results.9
The following is a summary of some of the systemic balancing effects that studies indicate ingestible CBD might have.
Supporting Regular Sleep Cycles
A review of CBD clinical research suggests that cannabinoids may favorably impact sleep disturbance, with study participants often reporting a subjective improvement in their sleep quality.10
Supporting a Sense of Calm and Focus and Relief from Everyday Stresses
A randomized controlled study recreated a situation likely to induce anxiety in most people, namely public speaking. Participants’ anxiety levels were measured using subjective self-report and objective physiological measures (e.g., heart rate and blood pressure). The group pretreated with CBD showed significantly less anxiety, cognitive impairment, and discomfort in performing public speaking compared to the placebo group.11
The sense of relaxation reported by healthy participants who were given an oral CBD extract correlated with activity in the limbic and paralimbic areas of the brain. Participants also reported decreased symptoms of anxiety. Participants receiving placebo did not show the same effects on brain imaging and did not report significant changes in their anxiety.12
Supporting Recovery from Exercise Induced Inflammation
CBD has been shown to support normalization of systemic inflammation in a number of animal models.13
Tips for How to Include Ingestible CBD Products
Charlotte’s Web ingestible CBD extracts are crafted to work in harmony with the body’s endocannabinoid system. In addition to the potential overall systemic benefits, another advantage to using ingestible CBD is that you can advise your patient to gradually increase or decrease the amount they take each day, depending on the concentration of CBD they are using, their individual physiological profile including the health of their ECS, and their specific wellness goals.
Any patient who is benefitting from topical CBD is a great candidate for ingestible CBD.
Where to Start
Charlotte’s Web offers ingestible CBD in the form of tinctures, capsules, and gummies. Starting with tinctures will give you and your patients the most flexibility as it will allow you to titrate servings. If your patient is new to ingestible CBD, it’s recommended that you begin with no more than 20mg/day. The average amount many people ultimately take is 50mg/day.
For How Long?
CBD ingestible extracts may affect everyone a little differently and work gradually over time. Start low and increase slowly until you reach your patient’s wellness goals. Once your patient reports this experience, that will signal the appropriate amount for them to continue on. The titration process itself may take about 30 days. Generally speaking, your patients should feel consistent effects in 4-6 weeks of regular administration. Results come by way of steady use, which will make any beneficial changes more sustainable.
Timing of Servings
In general, it’s recommended that your patients take their ingestible product at the same time each day, but you may on occasion advise them differently. For example, you may counsel your patient to increase frequency to three times per day, and suggest they consume a little more in the morning or before bed, depending on their individual circumstances.
To Sum Up
Ingestible and topical applications are two of the most common ways that CBD is administered. Topical CBD interacts with endocannabinoid system receptors in the skin that are local to the site of application. However, humans have endocannabinoid system receptor sites throughout our bodies, from the central nervous system and immune system, to organs in the periphery. Rather than choosing between ingestible and topical CBD, offer your patients more drug-free options by including both! This combination approach can optimize your patients’ health and wellbeing by providing external, direct, and local balancing effects as well as internal, systemic, and overall balancing effects.