CBD has been touted as a natural wonder — “a legitimate, bona-fide antipsychotic” and an “underutilized and underappreciated” treatment within medicine, according to Dr. Sunil Aggarwal, MD, PhD, FAAPMR and practitioner at SageMD. But it’s unregulated by the FDA, relatively inaccessible outside of a handful of online vendors, and all but completely mysterious to the average consumer. Those who are interested in using this natural treatment for mood disorders, cancer, epilepsy, and pain are left with little to no resources on how to treat their symptoms at home.
In an effort to demystify CBD and better understand how much each person should take, we spoke with several doctors (Dr. Aggarwal included) to learn the ropes. As it turns out, the answer is not simple. So what do you do? Take a peek at these insightful tips from medical specialists who happen to be experts within the cannabis field.
How Do You Determine a Dose?
The funny (and frustrating) truth: there’s no way for us to tell you an exact dose, regardless of what you need, how much you weigh, etc. It’s all rooted in your biological makeup and your specific symptoms. But here’s step one: visit a doctor who can prescribe the proper treatment. Dr. Michelle Weiner, interventional pain management physician, who is board certified in physical medicine and rehabilitation, can attest to this.
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“I discuss the objectives and goals with the patient, as well as review his/her medical conditions, medications, symptoms, and previous interventions/treatments used,” she said. This not only helps determine the best dose but also the best method of taking CBD. Dr. Weiner (or your doctor) can figure out “if I need a short-acting form of CBD such as vaporizing, or a sublingual tincture for conditions such as anxiety or pain, in which one would need a faster onset option.”
It totally depends on your situation. “For example,” she said, “if my patient has difficulty remaining asleep, has a chronic condition, or is taking more of a wellness approach, a longer-acting method such as a capsule or edible would be a wiser choice.” And dosage depends on internal factors vs. your weight, typically. “However, treatment is more accurately based on our endogenous cannabinoid levels, which we do not commonly measure,” Dr. Weiner said. “How one responds to CBD is independent of their weight and more so a reflection of the body’s lack of homeostasis.”
So It Has Nothing to Do With Weight or Size?
Well . . . not exactly. “Weight has something to do with it,” said Dr. Jordan Tishler, MD, Harvard physician and president of both InhaleMD and the Association of Cannabis Specialists. “But body fat has more to do with it.” As it turns out, cannabinoids are attracted to fat, which could hinder absorption into the bloodstream. “All those cannabinoids are lipophilic,” Dr. Tishler said, so “it can get absorbed into our fat stores fairly readily.”
The theory he described infers that “if you take a bunch of CBD [orally, by mouth] but 70 percent goes to your fat, only 30 percent circulates” into your bloodstream, meaning if you took 100 milligrams, you might only get a 30 milligram dose in your blood. If you have a higher body fat percentage, this could lead to less absorption, and if you have a lower body fat percentage, you may feel more intense effects from a lower dose. Again, keep in mind that this hasn’t been studied, but it may help you evaluate how much CBD you need.
What If My Doctor Doesn’t Know About CBD?
Unfortunately, the doctors we spoke to didn’t have a set equation to give you folks at home. “I do not treat based on weight or any equation,” Dr. Weiner said. But formulas do exist — they’re just not medically or widely used yet. “In the pediatric population, there is some discussion regarding formulas because this is the method in which physicians are most familiar,” she said.
“With any herbal medicine, simple advice is to start low and go slow,” Dr. Weiner said. She told POPSUGAR that “there is a ‘sweet spot’ with CBD based on our individual endocannabinoid system.” So what works for you isn’t necessarily what’s going to work for someone else. As we’ve been saying, it’s all rooted in your biology and your needs.
But keep in mind that more doesn’t always mean better (though it can). “However, given that there is no toxicity or chance of overdose, higher levels of CBD may be necessary for an individual with cancer or severe pain,” Dr. Weiner said.
OK but Seriously, Just Tell Me How Much to Take
“In general, while 25 milligrams a day is a healthy wellness dose, some may choose to start at 10-15 milligrams per dose,” Dr. Weiner said.
Dr. Tishler described “reasonable and feasible doses” of CBD at around “10-40 milligrams per day” but said that you may not feel the desired effects until you have a much stronger dose. Dr. Aggarwal affirmed this and noted that you should “think about [CBD doses] in tens of milligrams,” which is typically significantly higher than the milligram dosage of THC. “CBD is sometimes 10 times higher than what you’d take of THC.”
Oh, and that aforementioned formula we’ve seen? It comes with Infinite CBD’s products when you order them in the mail: 1 milligram of CBD per 10 pounds of your bodyweight. Keep in mind that this is not a foolproof method, and none of the doctors we spoke with validated it, but it may help you get started if you don’t have access to a doctor who can accurately prescribe CBD for your symptoms.
What If I Don’t Feel Enough Effects?
Dr. Tishler cited antianxiety studies that proved CBD’s efficacy but noted that the doses in those studies were astronomically higher than what you’d take in a capsule or tincture. “If we want to treat anxiety, those studies that show positive results show [doses] between 800-1,200 milligrams of CBD a day — that’s about $400 to $600,” Dr. Tishler said. Ouch. So what then?
The doctors we spoke with all suggested combining CBD with THC for the best possible symptom management, whether you’re treating anxiety, chronic pain, cancer, or another mood disorder. Using all of the cannabis plant — THC included — leads to a “synergistic” treatment, according to Dr. Aggarwal. “The whole plant extraction with CBD will give you more bang for your buck,” he said. “It will do more with less.” He said, “CBD is the yin to THC’s yang” and that the two work in harmony to give the best symptom treatment. “Sometimes THC is the real workhorse for pain,” while CBD mitigates any intoxication (while also acting as its own anti-inflammatory and pain reliever).
“I use CBD as an adjunct to THC,” Dr. Tishler said. “For the average patient, I think in terms of THC with the idea of the entourage effect — if you’re using a whole plant, you get CBD and other supportive chemicals. CBD is more complementary.”