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Dosing

Liquid Dosing Recommendations

We recommend starting with a sublingual oil so you can start low and titrate your dose up. We also recommend that you commit to 2 to 4 months for your desired health benefits.  The key to success with your hemp product is patience and working your dose up until you get relief

One of the most important things to be very clear on is that there is no ‘across the board’ dose for CBD Oil. The very best way to find the amount of CBD that will be effective for you is to begin low 5-10 mg at bedtime. After 3 days, increase to twice daily and slowly work your dose up every 3 days. Once you get the desired results, stay at that dose. You may always increase or decrease your dose to get your desired health results. Certain conditions take a longer time and a higher dose. We have seen people get no benefit for weeks then get relief on week 7 or 8. 

It is also good to recognize that the needs of your body are not exactly the same each day. Most people find an average daily dose that is helpful but they also acknowledge that on some days, the dose needs to be increased a bit due to variables such as changes in the weather, pain from ‘over doing it’ a bit, or a stressful event.

Almost everyone who is considering CBD asks, “Why can’t I just start with the highest dose capsule?” Many folks are put off by the oral spray or sublingual (under the tongue) oil format… but it is an important tool for you and here’s why:

The oral oils allow you to begin at the modest dose of 3 to 12 mg of CBD and increase very gradually over a 2 to 4 month trial. This slow introduction greatly increases the chance that you will experience as much receptor activation as possible. If you begin at higher doses prior to ‘nudging’ your receptors you may be wasting some of the CBD. There is no advantage to starting at the highest dose.

Once you have established your “foundation” dose, then you can decide which format will best serve your needs. Capsules & soft gels are available in a variety of doses. We believe that placing the oil under your tongue provides the best absorption. We even have ointments if you have targeted issues with one joint.

There are also those who find that a capsule in the morning and a few sprays or drops in the afternoon provides their custom dose. Remember, everyone is different. In the end, you are using the introduction of CBD to slowly wake up your body, setting the stage for best results, and finding the optimal dose for your targeted wellness issues.

Introducing… The Dosing Schedule!

Health ConditionStarting Dose/
Target Dose*
Approx. Time to Relief
Stress/Anxiety3-6mg at bedtime,
up to 12-25mg per day
About 1 week
Joint Pain6-12mg at bedtime,
up to 25-50mg per day
2-6 weeks
Back Pain6-12mg at bedtime,
up to 30-75mg per day
Up to 8 weeks
Crohn’s/Colitis6-12mg at bedtime,
up to 30-75mg per day
8-12 weeks
Parkinson’s/MS6mg at bedtime, up to
12-25mg per day
6-8 weeks
Fibromyalgia,
auto-immune
diseases
6-12mg at bedtime,
up to 30-100mg per day
Up to 3 months

Increase by 1/4 to 1/2 dropper every 3 to 7 days until you’re feeling the relief you’re looking for. At that point, you can hold at that dose and don’t need to increase any further. Some people increase their dose for a few days as needed (for example, before a stressful event or greater physical exertion), and then back down to their baseline daily dose.

*Target dose is typically split twice daily. For example, a target dose of 50mg per day could be split into 25mg twice daily for a total of 50mg.

Another approach to dosing

Once you choose your starting dose, use that at bedtime for 3 days. After 3 days then use that same dose in the morning and evening for 3 days. 
Day 1-3 Dose x bedtime
Day 4-6 Dose x twice daily
Day 7-9 Dose x morning , 2x(starting dose x2) at bedtime
Day10-12  Dose 2x (twice the starting dose) twice daily
You may continue going up every 3 days or you may increase at a slower rate after the first two weeks. Whenever you get the desired relief you may stay at that dose.

Rushing through the dosing schedule does not provide any additional benefit, and may cause you to waste the CBD oil that you’ve invested in.

The first thing you will notice with CBD is you will sleep better in the first few days and then anxiety will decrease in the first 2 weeks. Pain and inflammation will take anywhere from 2-8 weeks. Autoimmune diseases take longer for results, and can take 2-6 months for best results our patients tell us.

Pay attention to your body. Maybe there are certain areas of your body that really hurt every morning when you wake, or prevent you from falling asleep at night, or flare up when you engage in a specific activity (reaching up to get something from the kitchen cabinet, swinging your leg up when you get onto your bike). Pay attention to these as you move through your first days using CBD. If at any point you feel that some of this pain that you have become used to is changing or reducing, make a note of this on the back of your chart. If at some point you realize that you are just feeling a bit better in general, make a note of this.

You can ‘pause’ your trial at any point and REPEAT that same dose for a few days to determine if that is a good daily dose for you. (i.e., on day 10 you really feel a reduction in pain… rather than moving onto day 11 you are going to do the Day 10 dose for 2 or 3 days. Maybe this is your dose? Has your pain gone from a level of 10 to a level of 6? Or less? Is your stress response easing up? Anxiety diminishing? Sleep improving?

If you have experienced a reduction in pain or anxiety but would like to see if you can get an even better result, then go ahead and proceed with increasing the dose until desired results

Once you have determined your best dose, then you can choose which format is best for you.

SPECIAL NOTES

  1. The dosing trial is meant to continue until you get relief. CBD takes 4-12 weeks to see the results you desire depending on what you are using it for. The key is patience and working your dose up every 3-7 days until desired effect. 
  2. CBD & your prescription medications: With rare exception (e.g., blood-thinning medications ), there is no conflict with medications during the  dosing trial. If you find that CBD is a good tool for you and you are interested in ongoing use, then it is wise to speak to your prescribing physician. CBD makes use of some of the same pathways in the body that many common medications use. Over the long run this “competition” for pathways may lessen or increase the effectiveness of a medication. Your physician can monitor this at your check-ups and make dosing adjustments if needed. Do not make these adjustments on your own. If you are taking a specialized medication or have an acute health condition with related medications, please speak to us about this prior to beginning your trial.

Topical vs Oral Applications of CBD

We often receive questions about whether to apply hemp topically or take it orally. Topical hemp works great for patients with pain or inflammation in a single joint, such as a knee, elbow, or foot. The topical formulations generally do not penetrate deep enough to be used for chronic back pain, although we do have a patient who uses it with heat, and she says it helps dampen the pain. The topical pens seem to work well for headaches if you apply it on your temple. Patients with neuropathy, especially in the feet, use the cream or ointment with some benefit, but we generally recommend to add oral CBD with the topical, so the two can work synergistically. There are transdermal creams that absorb well enough to elicit blood levels similar to that of oral formulations. These transdermal creams are a great choice for people who do not tolerate the oral formulations. One drawback of using the topical formulations is that they tend to be a little more expensive than their oral counterparts. 

My personal bias is that hemp is so healthy for a multitude of symptoms. It helps balance out your own endocannabinoid system. It helps balance your immune system which in turn works on chronic inflammation.  It is a great antioxidant, neuroprotectant, anxiety reducer, pain reducer, and auto-immune disease modifier. This begs the question, why would you not take it internally? There are so many benefits to taking it internally, that many of our patients plan to use it long term for a continued healthy lifestyle.

What Do Bioavailability and Sublingual Mean For Me?

Bioavailability explained

There are many reasons why we may want to take CBD-rich hemp extracts, whether it be to improve symptoms of a chronic condition, or just for general health maintenance and well-being. In all cases, we want to get as much out of every dose as possible. For this, the bioavailability of CBD and other cannabinoids must be maximized. Bioavailability means how much of a substance is able to enter the bloodstream unchanged.

Maximizing Bioavailability

So how can we maximize bioavailability? When a drug is given intravenously (IV), the bioavailability is 100%, because it gets past barriers such as the intestinal wall and liver metabolism. When a medicine is taken orally, it may not be absorbed through the intestines because of insufficient time. Being highly water soluble or not dissolving enough are two reasons why a drug may take longer to be absorbed. Poor digestion, binding to other substances, or use by the intestinal bacteria are other reasons why it may not be absorbed. After a nutrient, medicine, or something else is absorbed from your gut into the bloodstream, it passes through the liver. In the liver, a portion of an absorbed substance is metabolized (changed), which makes the affected substance more water soluble. This is to prepare it for the next time it enters the liver, where it is readied for excretion.

All about sublingual administration

So what does sublingual mean, and what does it have to do with bioavailability? Sublingual administration of medicines is when it is designed for absorption under the tongue, not in the stomach and intestines like food. “Sub” means “under”, and “lingual” means “relating to the tongue.” As this also means direct transfer into the blood, it avoids issues relating to the intestinal barrier. These include inability to be absorbed, interaction with other nutrients or drugs, or use by normal intestinal bacteria. It also avoids being directly shuttled to the liver and resulting changes to its structure.

Of course, CBD is also vulnerable to issues that can affect intestinal absorption, as well as being processed by the liver. Because of this, a small study in 2003 set out to find any differences in the bioavailability of CBD and THC when taken in different ways. The dosage methods tested were oral, oro-pharyngeal (throat), buccal (inside of the cheek) and sublingual. When CBD was taken sublingually, the half-life was 86 minutes, while oral use had a half-life of 65 minutes. The term “half-life” means the time taken for half of the tested substance to be removed from the body.

Another measure of bioavailability, known as “area under the curve” (AUC), also showed a superior score for sublingual CBD. The two AUC scores for sublingual use were 408.53 and 427.33. However, the scores for oral use were 345.68 and 362.04. The AUC measurement shows the total exposure of the body to a medicine once it is given. Therefore, a higher AUC can mean a greater potential to be effective.

Liposomes offer increased bioavailability

Liposomal hemp extracts may be even more bioavailable, as the type of fat that the hemp extract would be surrounded by can enable easy, efficient absorption. While more human trials are needed, sublingual CBD and CBD-rich hemp extracts may be better than taking a regular capsule, as it could bypass many obstacles between the cannabinoids and their intended destination.

Further reading:

https://www.merckmanuals.com/professional/clinical-pharmacology/pharmacokinetics/drug-bioavailability

http://www.pharmtech.com/considerations-developing-sublingual-tablets-overview

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