CBD Oil for Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS or ME/CFS) is an extremely difficult illness to treat. It features dozens of symptoms believed to stem from the dysregulation of multiple systems throughout the body. Cannabidiol (CBD) oil is a hot, up-and-coming treatment right now that's being touted as a fix for all kinds of diseases. It's only natural that a lot of people with ME/CFS would develop an interest in CBD oil as a possible treatment.

But is CBD a safe and effective treatment for this complex and debilitating disease? Thus far, we have no specific research on CBD for ME/CFS, so it's too early to have an answer to that question.

Another possible deterrent for people considering this treatment is that CBD oil—which comes from hemp—gets wrapped up in the controversy over medical marijuana. That may make some people hesitant to try it. Additionally, it's been hard to find a straight answer about whether it's legal, but that concern should be going away soon.

CBD stands for "cannabidiol," which comes from the cannabis plant. That's the same plant that gives us marijuana. However, CBD—as an oil or in other forms—doesn't have psychoactive properties. That means it doesn't provide the "high" associated with marijuana.

The substance in marijuana that gets you high is called THC (tetrahydrocannabinol).  Growers who want to maximize the plant's psychoactive effect use breeds and techniques that result in higher levels of THC. On the other hand, cannabis that's grown for hemp is generally richer in CBD than THC, and that's where CBD comes from.

CBD products that are extracted from cannabis are being used for a lot of medical purposes, and you can find many claims online about miraculous results.

But are these claims true? And would it work as well for you? From a scientific standpoint, the answers are more like "we don't know" and "possibly" and "some claims appear to be true" than a firm "yes," and it depends on which claims you're looking at.

People are using CBD oil for a whole lot of different medical purposes, including:

• Chronic pain and inflammation, including neuroinflammation (a suspected feature of ME/CFS)
• Social anxiety disorder
• Insomnia
• Halting the growth of cancerous tumors
• The pain of glaucoma
• Epilepsy, especially in children
• Bipolar disorder
• Multiple sclerosis
• Parkinson's disease
• Schizophrenia
• Movement problems caused by Huntington's disease
• Help with smoking cessation

As of June 25, 2018, CBD oil has been approved by the U.S. FDA as an oral solution (Epidiolex) for the treatment of seizures associated with two very severe forms of epilepsy that usually affect children: Lennox-Gaustaut and Dravet syndromes.

Research in the United States for other diseases is still in the early stages. That's because legal restrictions have for decades made it extremely difficult to study the medical benefits of marijuana or any of its components, which are called cannabinoids. Promising research is being done, though, on multiple conditions. Down the road, it's likely that we'll eventually see many applications submitted to the FDA.

Anyone who's studied ME/CFS for very long will not be shocked to hear that, so far, we don't have any research done on CBD oil as a treatment for this disease. That doesn't mean we don't know anything, though.

CBD is being researched for numerous conditions, and many of those conditions share features with ME/CFS. While we can't say for certain that those results apply to similar conditions, they provide some basis for informed speculation.

Also, we're likely to see CBD investigated for ME/CFS before long, for several reasons.

First, we just don't have good treatments for ME/CFS. In fact, none are FDA approved. And while dozens of different medications and other interventions are used to help lessen the symptoms, many of them are only marginally effective and only help a fraction of those with the condition. Side effects tend to be a problem for this group, as well.

Second, we have a pain epidemic in the U.S. While not all ME/CFS involves pain, many cases do. Current treatments are inadequate, though, so there's a big financial incentive to find something that's better at relieving ME/CFS pain.

Third, we're currently struggling with an opioid addiction and overdose epidemic in the U.S. Several studies have shown that when a state legalizes marijuana, either medicinally or recreationally, the number of opioid prescriptions drops. That's good news for doctors looking for safer pain treatments, for law enforcement agencies struggling to control the tide of illegal use, and for lawmakers trying to find solutions.

Fourth, CBD oil is believed to be effective against pain and inflammation, and, in its pure form, it's generally regarded as safe. Especially in light of the theory that ME/CFS is related to neuroinflammation, and the wealth of evidence pointing to it being an inflammatory disease, it's pretty obvious that there's a potential benefit that should be explored.

Finally, while anecdotal evidence isn't proof of anything, we already have an abundance of it from people with ME/CFS. When patients with difficult-to-treat conditions tell their doctors something works, you can bet it gets them interested.

A 2017 ​paper published in Expert Opinion on Therapeutic Targets suggested CBD as a possible way to diminish the activity of brain cells called glia that can lead to central sensitization. That's a hypersensitive central nervous system and a major feature of ME/CFS and other central sensitivity syndromes such as fibromyalgia, irritable bowel syndrome, and migraine.

CBD is believed to help with your body's homeostasis, which is keeping things like temperature, respiration, and blood flow in proper balance. Homeostasis tends to be out of balance in ME/CFS.

While it's less well documented in ME/CFS, a condition called endocannabinoids deficiency, characterized by lower amounts of naturally produced endocannabinoids in certain individuals, has been linked to fibromyalgia, making cannabis products a promising treatment.

A 2016 review published in Cannabis and Cannabinoid Research found evidence that CBD is effective in treating migraine and irritable bowel syndrome, which are related to ME/CFS. It also stated that some cannabis-based treatments appeared effective for fibromyalgia. The authors stated that CBD is often preferable to patients because it doesn't include the high and other effects of THC.

As mentioned earlier, several studies have suggested that CBD can fight inflammation. That's a big deal for a disease that research links to chronic inflammation, and possibly to neuroinflammation as an underlying cause.

A 2017 French study on Alzheimer's disease suggests that CBD lessens oxidative stress, diminishes mitochondrial dysfunction, and suppresses pro-inflammatory activity. All of those things could prove helpful against known and suspected dysfunctions associated with ME/CFS.

A 2011 study out of Italy suggested that CBD may lower intestinal inflammation via control of the neuro-immune axis. While that study was on inflammatory bowel disease, changes to the neuro-immune axis could be beneficial in ME/CFS, as well.

We don't have a full picture of the possible side effects of CBD. Some reported side effects include:

• Changes to liver enzymes used to process drugs
• Dry mouth
• Low blood pressure
• Lightheadedness
• Drowsiness
• Increased tremor in Parkinson's disease, at high doses

The following effects are possible but require more study, according to the World Health Organization:

• Alteration of hormonal levels
• Immune system stimulation at low levels, and immune suppression at higher levels

The immune system effects will be especially important for ME/CFS, which is believed to involve a chronically overactive immune system.

The question "Is CBD legal in the U.S.?" has never been easy. A lot of hemp growers and CBD sellers have long claimed that their product is legal in all 50 states as long as it contains less than 0.3 percent THC. However, in 2018, the 9th Circuit Court of Appeals ruled that the law used to justify that claim doesn't apply to hemp. People have been arrested, tried, and gone to prison over CBD.

However, the 2018 Farm Bill is changing the federal status of hemp so that it's a legal agricultural product. The bill sailed through the U.S. Senate in June of 2018 and the House of Representatives on December 2018. It's expected to be signed into law soon.

Now, let's consider state laws. Some states have legalized marijuana, either for medical or recreational use. That makes CBD products legal there. Other states have specifically legalized CBD but not marijuana.

So, once the Farm Bill becomes law, what does that mean for people in states with laws prohibiting CBD?

Technically, federal law overrides state law. That doesn't mean, though, that your state will automatically stop making arrests and pressing charges.

The website ProCon.org has information about which states have laws specific to CBD oil. A site called Governing maintains a map of where marijuana is legal in some form.

You have a lot to consider when it comes to any form of treatment, and even more when it comes to CBD. Be sure to consider the pros and cons, including the legal ones. Discuss this option with your doctor to make sure you're not endangering your health. As with any treatment, watch for side effects.

With legal changes in-store and more research coming, things may change rapidly when it comes to CBD oil and other cannabis-based treatments. It's likely that we'll know a great deal more about the effectiveness and safety of these products a few years from now.