To get one thing out of the way, the reason cannabis was being discussed at all at Nutrition 2019, the two-year-old annual conference organized by the American Society of Nutrition (ASN), was less because of emerging new science around its health effects, and more about bridging the gaps between commercial interest and the science supporting its health benefits and safety.
While CBD, hemp, and cannabis dominated at industry-driven shows like Expo West or SupplySide East (which targets manufacturers, distributors, product developers, and more), their presence was barely noticeable at science-driven shows such as last week’s IFT in New Orleans and this week’s Nutrition 2019.
In fact, in Baltimore, it was limited to one two-hour session on Sunday, titled Cannabis: Emerging Health Effects and Implications.
“Nutritionists in general are a bit skeptical of developments like this,” Dr Paul Coates, board member of the ASN and former director of the Office of Dietary Supplements at the National Institutes of Health, told us. “But the reality is that CBD has gained a lot of traction as a potential food additive and as a component of dietary supplements and related products in the marketplace.”
During the session, the conversation highlighted how most research on cannabis and its constituent chemicals has been done in a drug context, and despite product development in the food, beverage, and supplement space, the research in this realm is still scant.
Booming market interest
Take a look at search data for CBD. When Google first started tracking searches on its platform back in 2004, there were far more searches for ‘hemp’ than ‘CBD’ or ‘Cannabidiol,’ two ways of spelling a now popular compound that is extracted from hemp leaves.
That started to shift in July 2016, when searches for ‘CBD’ and ‘Cannabidiol’ overtook ‘hemp,’ before shooting drastically upwards and peaking in May 2019, when media coverage put the spotlight on FDA’s first public meeting on what to do with CBD from a regulatory perspective.
Even though the Farm Bill that passed in 2018 lifted hemp from being a Schedule I drug, CBD is still not a legal ingredient that may be put in food, beverage, or dietary supplements because it was approved as a pharmaceutical drug known as Epidiolex last year. Once a drug ingredient, it cannot go into the food system, according to current FDA rules.
Despite this regulatory reality, product developers and marketers have rampantly released products using hemp and CBD on the market, in everything from canned beverages to lotion to oil drops of the extract. Yesterday, the grocery chain Kroger announced that it will join Walgreens, CVS, Vitamin Shoppe, and GNC in selling CBD products in nearly 1,000 stores, though it is starting with topical products, which experts say is less of a legal risk.
Data aggregator Statista projected the legal cannabis market—which includes products derived from cannabis—to reach $4.7 billion in 2025.
Clues about its use in food, beverages, supplements
But when it comes to ingestible products for non-pharmaceutical use, the data on its stability, safety, and health benefits are still very scant, according to Dr Roger Clemens, a professor at the USC School of Pharmacy who was a panelist during the session.
“This applies to everything derived from cannabis—cannabidiol, any of the terpenes, flavonoids, pick one!” he told us at the conference.
There’s only one thing we know for sure, he said, which is that the pharmacokinetics, or how compounds travel in our body, in a food system is different from the pharmacokinetics if you inhale it.
“But the challenge of a food matrix, in regards of how it’s processed, where are the pharmacokinetics in those products? We don’t have those data,” he said.
“What happens when you put it in a brownie, a gummy, a beverage? We don’t have those kinds of data. It contains it, maybe, but how do our bodies access those? We don’t have those data.”
03-Jun-2019 By Stephen Daniells
Friday’s public meeting was an illuminating day of presentations, with multiple viewpoints and interests being aired. On the dietary supplements side, there were strong calls for companies to take the front door with the Agency.
We do know some things. During the session Dr Daniele Piomelli of the University of California Irvine’s Center for the Study of Cannabis had one misconception he wanted to dispel—that we know little about cannabis from a research standpoint.
There have been 24,000 studies published on cannabis between 1999 and 2016, which were the subject of a systematic review published in January 2017 called The Health Effects of Cannabis and Cannabinoids.
However, the report focused more on drug outcomes: The plant’s therapeutic evidence in chemotherapy-induced nausea (conclusive evidence), sleep apnea and sleep disturbances associated with fibromyalgia and chronic pain (moderate evidence), and post-traumatic stress disorder (limited evidence).
It also outlined limited evidence of ineffectiveness in areas such as Alzheimer’s disease and glaucoma.
Endocannabinoids controlling the energy balance, weight management
Dr Piomelli highlighted discoveries from the past 10 to 15 years about the role the endocannabinoids have in energy balance. Cannabinoids have receptors in our body to help us get and keep energy. “It’s one of the most original findings, and was completely unexpected,” he said.
It led to more research and product development in the anti-obesity realm using THC, the psychoactive constituent of cannabis.
As the New York Times reported in May, Sanofi-Aventis released a THC product that could suppress appetite by blocking CB1 receptors called Rimonabant in 2006, but it was pulled from the marketplace because of side effects including depression and suicidal behavior.
Dr Richard Mattes at Purdue University spoke during the session about the effects of cannabis on sensory function, appetite, food intake, and body weight during the session. While the popular trope is that weed leads to the munchies, clinical trials on this topic have offered mixed results—some research on this shows that some doses of THC suppress the will to eat.
Why data on CBD has been scant
Research on cannabis’ compounds is limited because it has been listed as a Schedule I drug, said Dr Susan Weiss of the National Institutes of Health’s National Institute on Drug Abuse (NIDA), a biomedical research agency of the US Department of Health and Human Services. Dr Weiss chaired the session on cannabis at the Nutrition 2019 conference.
Even the mechanisms and nature of cannabis in the context of drugs and drug abuse, of which Dr Weiss is an expert, is still not widely understood. “It hasn’t been easy to do research on cannabis or cannabis products or anything derived from cannabis, which includes CBD…because the DEA has in the past only allowed there to be one source of all cannabis products used in research,” she explained.
Until very recently, research on cannabis in the US only used cannabis that came from NIDA’s supply, contracted to researchers at the University of Mississippi. “And we have a limited supply, we don’t have the same sort of diversity that is available in state’s that have dispensaries, that have legalized it,” Dr Weiss said.
There are still big question marks around the future of cannabis research, she added.
Though the DEA is not going to be involved in regulating cannabis and its compounds as a controlled substance, “it’s still not so clear how this is going to impact research. For clinical research in people, you’re still going to have to go through the FDA and get what’s called an IND,” or investigational new drug approval, Dr Weiss said.
Cannabis-derived compounds will continue to be a point of interest for NIH’s many centers, NIDA as well as others such as the National Cancer Institute, for its pharmaceutical properties, she added.
Is CBD ‘clean label’?
Despite scant data on CBD’s use in food, beverage, and supplements, the market has boomed. To Dr Clemens, CBD’s popularity in the US is ironic because it’s the same place where the poorly-defined yet often-used term ‘clean label’ trend has boomed.
“In the US many people complain that we don’t have safety data on certain food additives, yet they embrace CBD whole-heartedly,” he said. “You can’t have it both ways.”
“Cannabinoids have more than one syllable. People say they don’t want ingredients they can’t pronounce, but they’ve learned to pronounce cannabidiol and can’t pronounce pyridoxal phosphate, which is vitamin B6.”
One of the most pressing issues for nutritionists regarding cannabis is to get definitions straight, ASN’s Dr Coates opined.
“Nomenclature is working against us. Cannabis, hemp (seed), and CBD are not the same thing, but they tend to enter conversations as if they were the same or closely related,” he said.
“Getting clarification on the specific one under discussion would make communication easier.”