Requesting feedback on my planned CBD regimen

[daveu]

Hi all,

My name is Dave. I have had ME/CFS for 14 years. I experience a range of symptoms but some of the primary ones are chronic exhaustion, non-refreshing sleep, headaches, brain fog, and neuro inflammation. The medication I take daily is amitriptyline 25 mg daily, duloxetine 60 mg daily, and low dose aripiprazole 1.5 mg daily. I also take a number of supplements daily.

I experience severe inflammation in the tendons in my forearms (this is described on my medical record as "severe myalgic pain in both forearms").

I have been wanting to trial CBD for my ME symptoms, forearm inflammation, general anxiety, and difficulty falling asleep. I have also been encouraged by success stories like this one: https://www.healthrising.org/blog/2...c-fatigue-syndrome-m-e-cbd-oil-success-story/.

I live in the UK where marijuana is illegal for the general public, and CBD products may only have a maximum THC content of 0.2%.

I asked my ME specialist if he thought it was safe for me to trial CBD and he said the following:

"CBD oil inhibits the liver drug metabolising CYP2D6 enzyme and thus the serum concentrations of selective serotonin reuptake inhibitor (duloxetine in your case), tricyclic antidepressants (amitriptyline), antipsychotics (possibly aripirazole although you are on a very low dose) may be increased and potentially cause problems. I suspect that you will be fine if the doses of the duloxetine and amitriptyline are on the low/average side and it is not the THC component that is the culprit. If considering the CBD oil then start at 10% of the lowest starting dose and then increase by 10% every 4 days to see if you tolerate it. If any problems then stop the CBD immediately."

My plan is as follows:

1. I'm going to buy 3 g of CBD Isolate powder (effectively 0% THC) from here: https://vapoholic.co.uk/eliquid/cbd-calm-pure-cbd-isolate-powder/
2. I am then going to dissolve the 3 g of CBD Isolate powder in 100 mL of hot milk and then mix that milk with 2900 mL of chocolate milk (thus a ratio of 1 mg to 1 mL)
3. I will then take 1 mL orally a day for four days as per the instructions of my ME specialist. I will measure out the 1 millilitres using the following glass droppers from amazon.co.uk: https://www.amazon.co.uk/Pipette-Dropper-Transfer-Dropping-Pipettes/dp/B09Y5KXYNC/
4. Then if I have no ill side effects I will build up to 2 mL a day for four days, and so on, intending to build up to 10 mL a day.

I would appreciate it if anyone who has experience with CBD can let me know if they think the approach above is sensible? I would appreciate any other feedback/suggestions as well

Thank you very much.

 

[katabasis]

Hi, Dave. I think that, while your measurements for the volumetric dosing are sound, you ought to do this another liquid besides milk. To begin with, 3 grams of CBD is a large number of doses, and if you dissolve the whole 3 grams in milk, the milk will likely go bad before you finish using the CBD.

Conceivably, you could freeze the milk to make it last longer, but this results in another issue: fat distribution. CBD is soluble in milk because milk contains fat. The fat consists of miniscule droplets, and for normally processed (i.e. 'homogenized') milk, these droplets are equally sized. But if you freeze the milk, this can affect the size distribution of the droplets in unpredictable ways. When the fat droplets have different sizes, they tend to partition themselves unevenly within the bottle. For instance, totally un-homogenized milk often develops a layer of 'cream' at the top when left undisturbed for a while. If the milk loses homogeneity, it may be harder to achieve consistent CBD dosage.

A better solvent than milk, which would last longer and not have these homogeneity issues would be either glycerol or MCT oil.

That said, I think it would be much easier to simply buy a pre-made CBD tincture. It looks like the site you linked to sells a 1500 mg/15 mL tincture - https://vapoholic.co.uk/eliquid/cbd-calm-tincture/ - using MCT oil, which is a common type of fat. Unless you have an issue with the MCT oil for some reason, this seems to be the easiest solution.

Of course, the dosage per mL is much higher than you want (100 mg / mL), but it should be easier to get a lower dosage either by using a few drops (after counting, how many drops there are in a mL), or by further volumetric dilution into, say, milk. For instance, if there were 20 drops per mL, and you wanted doses of 1 mg, you could thoroughly mix two drops into 100 mL of hot milk. This would give you 1 mg per 10 mL, and you'd be able to use all these doses before the milk went bad. The remaining tincture would be shelf stable for quite a while.

Also, separately, there is the issue of bioavailability. The oral bioavailability of CBD is quite low, and 1 mg is also a pretty low dose, so with both of these factors, you may not really get much of an effect from it. Supposedly the oral bioavailability increases if you take your dose with a fatty meal, but not by that much. The bioavailability taking CBD sublingually is much higher, and the MCT oil tincture (for instance) is well adapted to this route of administration.

It looks like you are starting your dose as low as possible, which is reasonable especially considering you have ME/CFS, but if you end up increasing your dose and want a more consistent and potent RoA, I would give sublingual a shot.

 

[katabasis]

As for the actual effects of CBD, I think it is possible you will see some benefit. CBD has anti-inflammatory and immunomodulatory properties which could both alleviate ME/CFS symptoms to some degree. I have tried CBD, and while it did not have any negative effects, it didn't help me much either, but the potential benefits vary from person to person. At the very least, CBD is safe and generally has few side effects, so it's probably worth a shot.

As to whether CBD will interact with other medications you are taking, I agree with your doctor that you probably won't have any problems. To begin with, you are starting with such a low dose that any enzyme inhibition is probably not significant. If you work your way up to, say, 10 mg of CBD, this is still a relatively low dose.

I looked up which CYP450 enzymes CBD inhibits, and it appears that this includes CYP3A4, CYP2B6, CYP2C9, CYP2D6, and CYP2E1. Amitriptyline is metabolized by CYP2D6 and CYP2C19 - the former is inhibited by CBD, but the latter is not, so at least there will be some CYP metabolism happening. Likewise with duloxetine, which is metabolized by CYP2D6 and CYP1A2. If anything there might be more of an issue with aripiprazole, whose metabolizing enzymes are primarily CYP2D6 and CYP3A4, both of which CBD inhibits. Perhaps because you are taking such a low dosage of this drug it will be less of an issue.

 

[Judee]

@CSMLSM ?

 

[hapl808]

As for the actual effects of CBD, I think it is possible you will see some benefit. CBD has anti-inflammatory and immunomodulatory properties which could both alleviate ME/CFS symptoms to some degree. I have tried CBD, and while it did not have any negative effects, it didn't help me much either, but the potential benefits vary from person to person. At the very least, CBD is safe and generally has few side effects, so it's probably worth a shot.

Just be aware - I found it temporarily helped with muscle pain, but then seemed to have a rebound effect the following day if I didn't take it again. I didn't experiment that much and could just be my body chemistry anyways.

 

[daveu]

Thanks @katabasis, your excellent feedback gave me a lot to think about!

You make a completely excellent point which I hadn't thought of at all: the milk could go off!

I really like your idea of using the pre-made CBD tincture from the same website. I also really like the idea of increasing the bioavailability by taking the CBD under my tongue.

In terms of dilution I was just wondering: could I take the 1500 mg/15 mL tincture, then take 1 mL of that and dilute that further in 100 mL of MCT oil (e.g. https://www.hollandandbarrett.com/shop/product/hunter-gather-mct-oil-100-organic-coconut-60062423) thus getting 1 mg/mL. Would that work?

 

[katabasis]

Thanks @katabasis, your excellent feedback gave me a lot to think about!

You make a completely excellent point which I hadn't thought of at all: the milk could go off!

I really like your idea of using the pre-made CBD tincture from the same website. I also really like the idea of increasing the bioavailability by taking the CBD under my tongue.

In terms of dilution I was just wondering: could I take the 1500 mg/15 mL tincture, then take 1 mL of that and dilute that further in 100 mL of MCT oil (e.g. https://www.hollandandbarrett.com/shop/product/hunter-gather-mct-oil-100-organic-coconut-60062423) thus getting 1 mg/mL. Would that work?

Yes, that is the dilution you would use. You should also use a separate dropper/pipette for the diluted CBD; the dropper that comes with CBD tincture will have a significant amount of residual CBD tincture in it.

Anyway, I hope you see some benefits from this!

 

[daveu]

Yes, that is the dilution you would use. You should also use a separate dropper/pipette for the diluted CBD; the dropper that comes with CBD tincture will have a significant amount of residual CBD tincture in it.

Anyway, I hope you see some benefits from this!

Thank you for your help @katabasis

 

[Mouse girl]

You do need a bit of thc for pain relief. I don't know the amount. it is legal here but there are no regulations sooooo most of the stuff is just who knows what is in it! My doc did loads of research on it and only after that did he start suggesting trying very few drops of cbd oil that actually was tested in labs and didn't have mold, pesticides, or other unknown chemicals and knew how much cbd and how much thc. I started with a couple of drops. Only took it for four days. It made me soooooo sick. I could not function, could not think, sleep, move around easily (and i could do things, leave the house, drive, read, lots of stuff compared to many). It also gave me very strange neurological symptoms that took me months to recover from. I couldn't drive for months due to this and I have never not been able to drive, except for times when i have needed to stop, lay down and rest for an hour or so to get more strength.

it did relieve pain but so not worht it for me. others aren't as sensitive and they do like it for pain. I also think it helps if people like the out of it feeling that pot gives people, i was never a fan.

just make sure you know what you are getting. or if you are in the trail, well, you just have to see what happens.

 

[daveu]

Thanks @Mouse girl , you make some good and really important points. I'm hoping avoiding THC (using CBD Isolate) and starting with a really low dosage will allow me to avoid the worst of it if CBD turns out to not be for me _fingers crossed_

I'm trying to make sure the CBD oil is high-quality by following the guidance on this post: https://medium.com/cbd-origin/10-th...uy-cbd-online-or-anywhere-really-db9813f32884 [$ paywall]