Health & Lifestyle

Just how safe, and effective, are the CBD remedies you buy on the High Street? As the recommended daily maximum dose is cut from 70mg to 10mg

From chewing gum to coffee, fizzy drinks, vapes, tinctures, salves and gummies, you name it, there’s now a High Street CBD product for it. 

CBD, or cannabidiol, is an extract of the cannabis plant without the tetrahydrocannabinol (THC), the part that induces a high. 

People who use CBD believe it can help with a range of problems, including easing pain, improving sleep, reducing anxiety, even fighting cancer or the side-effects of cancer treatments (although High Street products don’t actually make these claims). 

CBD products can be expensive – for instance, Holistic Herb Premium CBD oil oral spray costs £39.99 for 30ml, while Grass & Co EASE CBD Oil will set you back £72.49 for 10ml. 

Consumers have clearly embraced CBD – in 2021, a report for the Association for the Cannabinoid Industry revealed that the UK market was worth £690million, up from £314million in 2019. 

But if you use CBD, should you be considering whether to cut back? 

CBD products can be expensive - for instance, Holistic Herb Premium CBD oil oral spray costs £39.99 for 30ml, while Grass & Co EASE CBD Oil will set you back £72.49 for 10ml (stock image)

CBD products can be expensive – for instance, Holistic Herb Premium CBD oil oral spray costs £39.99 for 30ml, while Grass & Co EASE CBD Oil will set you back £72.49 for 10ml (stock image)

Last week the Food Standards Agency (FSA), the regulator that oversees the safety of supplements as well as food, reduced the recommended safe daily dose from all consumables, including supplements, from 70mg to just 10mg per day; the equivalent of four or five drops of 5 per cent CBD oil – the most popular way to take CBD. 

CBD products will be pulled

A high Street chain is removing high-strength CBD products from sale – including some promoted by presenter Claudia Winkleman.

The move by Holland & Barrett follows new safety guidance from the Food Standards Agency (FSA), which raised concerns about damage to the liver and thyroid from long-term consumption of cannabidiol, which is derived from the cannabis plant.

CBD products, including drinks, drops, capsules and gummies, are sold on the back of claims they boost health and wellbeing. But the FSA has cut the maximum safe daily limit of consumption from 70mg to 10mg.

Many big-selling products contain more than 10mg of CBD in a single serving, and Holland & Barrett has decided to remove them from sale. These include products in the range by Cannaray CBD, whose brand ambassador is Ms Winkleman. It is claimed that CBD has anti-inflammatory and stress-relieving properties. It is different from THC, which also comes from the cannabis plant and gives the high associated with smoking the drug.

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The regulator said this was because of concern about possible long-term effects of CBD use, such as liver damage or thyroid problems.

This was based on the conclusions of two independent scientific committees which looked at data on a wide range of products. 

While the FSA emphasised there was ‘no acute [i.e. immediate] safety risk’ from consuming more than 10mg of CBD a day, its chief executive, Emily Miles, said: ‘We have always advised the public to think carefully about taking edible CBD products and, as with all foods, we continue to review our advice based on the evidence we gather from the industry. 

‘We understand that this change to our advice will have implications for products currently on the market that contain more than 10mg of CBD per serving.’ 

This new guidance does not affect medicinal cannabis, which is prescribed by doctors for conditions such as epilepsy. 

As Dr Mikael Sodergren, head of the Medical Cannabis Research Group at Imperial College London, explains: ‘People using cannabis-based medicines on prescription often take daily doses which far exceed 10mg per day, but in those cases – for epilepsy or palliative care or cancer pain, for instance – the potential benefit is considered to be sufficiently high when treatment has medical oversight to manage any side-effects that may arise.’ 

Dr Sodergren, who is co-founder of Sapphire Medical Clinics, a specialist medical cannabis clinic, adds: ‘The important point is that if you are considering treating a medically diagnosed condition with cannabis-based medicines, or any medicine for that matter, you should consult a doctor or specialist clinic.’ 

There are lots of products that contain more than 10mg of CBD per serving, according to the FSA, and ultimately it will be up to consumers to manage their dose. 

‘While I think the FSA is playing it safe, I do think people might be alarmed by this news,’ Sultan Dajani, a pharmacist based in Southampton, told Good Health. 

‘The problem is that many products contain varying amounts of CBD so it’s difficult to manage intake. 

‘And even if you stick to the recommended dose for one product, perhaps with an oral spray, when you combine that with drops, lip balm and a CBD coffee, you can easily surpass the 10mg limit,’ he says. 

‘I have a lot of patients who use CBD oil for insomnia, anxiety and pain relief and they can buy it without a prescription. Since I started stocking it four years ago, demand has trebled.’ 

In its new advice, the FSA also suggests there may be greater risk with taking CBD in supplements over time, even at lower doses. 

CBD, or cannabidiol, is an extract of the cannabis plant without the tetrahydrocannabinol (THC), the part that induces a high (stock image)

CBD, or cannabidiol, is an extract of the cannabis plant without the tetrahydrocannabinol (THC), the part that induces a high (stock image)

‘The more CBD you consume over your lifetime, the more likely you are to develop long-term adverse effects, such as liver damage or thyroid issues,’ said Professor Robin May, the FSA’s chief scientific adviser. 

As Sultan Dajani explains: ‘CBD is a biologically active compound and as such it may also have unintended consequences. 

‘There’s a lot we still don’t know about how it acts on the body, and whether it can lead to unknown effects. It’s not something you should take for a chronic condition for a long period of time.’ 

So how serious is the risk of damage? 

‘The FSA has taken a precautionary approach in its advice,’ says Harry Sumnall, a professor in substance use at Liverpool John Moores University. 

‘In the absence of long-term human safety data on CBD, it has looked at animal studies and recommended a maximum daily dose of 10mg, which is 100 times less than doses associated with harm after long-term administration of CBD in animal studies. 

Ask the AI doctor 

How accurate is health advice from the artificial intelligence bot, ChatGPT? 

This week’s question: What can I take for a bad headache? 

ChatGPT says: There are several options. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin or naproxen sodium can help. Acetaminophen is another over-the-counter pain reliever that can help. However, be careful not to exceed the recommended dosage as it can damage your liver. 

Dehydration can cause headaches, so make sure you drink enough water through the day. 

If you’re experiencing a migraine or tension headache, lying down in a quiet, dark room can alleviate symptoms. Applying a cold or warm compress to your forehead or the back of your neck can help headache pain. 

Massaging your temples or neck can also relieve tension headaches. If your headache persists or worsens, consult a medical professional. 

Expert comment: Dr Andrew Dowson, clinical lead for East Kent and Bromley Headache Services, says: ‘This advice is reasonable but it sounds like it is written by an American. Acetaminophen is the giveaway – we call it paracetamol. Also, naproxen is only available on prescription here. 

‘If it is your first or worst headache, the best advice is to seek medical help.’ 

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‘This 100-fold safety factor is commonly applied when recommending maximum doses of products that could be repeatedly taken over long periods of time.’ 

The question is whether the risks are outweighed by the benefits. 

This means looking at the evidence for the benefits of the doses of CBD in High Street products. 

When applied to the skin, inhaled as vapour or eaten, CBD interacts with cannabinoid receptors on nerves in the brain and nervous system throughout the body, which send signals that help regulate movement, mood as well as pain and inflammation. These receptors are concentrated in several brain regions but are also spread around the body, which could explain why CBD may have widespread effects. 

But how much effect CBD products have on these receptors is not clear – not least as the doses used in gold standard clinical research have been significantly larger than what’s available on the High Street. 

According to a research review, published in January in the journal Clinical and Translational Science, ‘recommended daily oral dosing of such products tends to be less than 100 mg CBD per day and often in the range of 10–25mg per day – an order of magnitude lower than the doses that have demonstrated efficacy in clinical trials [i.e. 600–3000mg]’. 

At these bigger trial doses, only a few human studies – involving small numbers of people – have reported positive (but sometimes mixed) results for CBD for anxiety, pain and sleep. 

For example, a 2019 study in the Brazilian Journal of Psychiatry involved just 57 men treated with varying oral doses of CBD before a simulated public speaking test – a known way to provoke anxiety. This found that those given the lowest dose (150mg) and the highest dose (600mg) had no reduction in anxiety, but there was a sweet spot at 300mg which significantly reduced anxiety during the speech. 

When it comes to pain relief, an earlier study, published in Neurology in 2005, found that cannabis containing CBD and THC helped patients with multiple sclerosis, but it’s not clear whether this was due to the low dose of CBD – 2.5mg per spray – or the THC. 

In another study, reported in 2020 in Current Pharmaceutical Biotechnology, researchers in China gave patients with nerve pain in their limbs a placebo or 250mg of CBD applied to the skin. The group who received the CBD experienced a significant reduction in their pain compared with those given the placebo. 

‘And although many people report benefits from low-dose CBD products to help them sleep, the findings from human studies are inconclusive,’ says Dr Sodergren. 

The biggest difference between CBD used in clinical trials and in High Street products is the dose. ‘Research has shown that some commercial products contain very little CBD – or even none at all,’ says Professor Sumnall. 

CBD products aren’t like standardised pharmaceuticals – indeed a previous Good Health investigation found that some High Street products had less, or in some cases more, CBD than stated on the label (with one having twice the stated dose). 

They may also contain other ingredients such as THC. 

Research commissioned by the FSA in 2022 discovered that, from a sample of 30 products found on the High Street, THC was detected in 87 per cent, with 12 found to have illicit cannabinoids in the product including THC above the 1mg threshold allowed. 

People who use CBD believe it can help with a range of problems, including easing pain, improving sleep, reducing anxiety, even fighting cancer or the side-effects of cancer treatments (although High Street products don't actually make these claims) (stock image)

People who use CBD believe it can help with a range of problems, including easing pain, improving sleep, reducing anxiety, even fighting cancer or the side-effects of cancer treatments (although High Street products don’t actually make these claims) (stock image)

Pesticide residues were found in all the products. 

By contrast, in clinical trials the CBD is purified, manufactured to a high standard and given at a higher dose – ‘it is also taken regularly and under medical supervision,’ says Professor Sumnall. 

He argues that much of the benefit people gain from over-the-counter products could be down to the placebo effect – it ‘can be powerful’, he adds. 

Last week Professor May warned: ‘As well as side-effects, CBD can lead to interactions with other supplements, herbal products and over-the-counter and prescription medications.’ 

This is because many drugs are broken down by enzymes in the liver, and CBD may compete for, or interfere with, these enzymes, leading to too much, or not enough, of the drug in the body. 

Potentially serious drug interactions with CBD include a common blood thinner, warfarin; a heart rhythm medication, amiodarone; levothyroxine, a drug for an underactive thyroid gland; and several medications for seizures, including clobazam, lamotrigine and valproate. 

So where does all this leave the consumer? 

‘I t’s clear that CBD has potential,’ says Professor Sumnall, ‘But we’re at a very early stage of that research’. 

Sultan Dajani adds: ‘My customers are asking me today if they should be worried. 

‘My advice is not to worry because the non-prescription doses are very low – as long as you don’t use multiple CBD products at once. I would also not advise their long-term use.’ 


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