Helping patients navigate the complex world of hemp

Photo Cred: Crystalweed Cannabis/Unsplash

By Kellie Blake, RDN, LD, IFNCP

As a registered dietitian, I love sharing the power of plants with my patients. Plants are a lifeline to longevity and positively impact health in many ways. Communicating this message becomes even more exciting when a plant not only has a variety of uses and benefits but is also easy to grow and is sustainable, as is certainly the case with cannabis sativa (C. sativa L.), also known as hemp.

Cultivated for thousands of years and primarily used in the paper, textile, and rope industries, hemp was also used in traditional Oriental medicine to treat an array of ailments. Despite its long history of use, the cannabis plant was strictly regulated in the United States with the passage of the 1937 Marijuana Tax Act. In 1970, despite having very little, if any, of the psychoactive compound tetrahydrocannabinol (THC), hemp was identified with other cannabis varieties as controlled substances.

Hemp remained illegal until the 2014 Farm Bill approved pilot programs to cultivate industrial hemp for research purposes. With the passage of The Agriculture Improvement Act in 2018, hemp and hemp seeds were finally removed from the controlled substances list. Hemp production in the U.S. remains highly regulated, however, and growers must follow strict guidelines.

There are an estimated 25,000 to 35,000 products that can be derived from hemp, and virtually every part of the hemp plant can be used in some way. The major categories include paper goods, textiles, plastics, personal care products, construction materials, livestock feed and bedding, nutritional supplements, essential oils, medicines, and food.

While the rebirth of the hemp industry has allowed for more investigation into the powerful health benefits of this ancient plant, much confusion still exists. As integrative providers, we have a unique opportunity to assist our patients in navigating the vast array of available hemp products and supplements.

Hempseeds

Hempseeds are the edible fruit of the C. sativa L. plant and have traditionally been discarded as waste or used as animal feed. Better understanding of their impressive nutritional profile has led to an entire industry dedicated to hempseed production for human use with products such as hempseed oil and hemp protein powder.

As reported in the journal Nutrients, the macronutrient content of hempseeds includes 25 to 35 percent fat, 20 to 25 percent protein, and 20 to 30 percent carbohydrate including insoluble fiber. Hempseeds do not contain cannabidiol (CBD) or THC, but in addition to their macronutrient content also contain micronutrients, natural antioxidants, and bioactive compounds like phenols, carotenoids, tocopherols, and phytosterols.

Hempseed oil

The typical Western diet contains a 15:1 to 20:1 omega-6 to omega-3 fatty acid ratio, which is associated with a variety of inflammatory conditions such as cancer as well as neurodegenerative and cardiovascular diseases. Hempseed oil one ideal option to improve this ratio, since it contains essential polyunsaturated fatty acids (PUFAs), linoleic acid (LA) and α-linolenic acid (ALA), in a 3:1 ratio, which is thought to be optimal for human health. Both LA and ALA must be obtained in the diet and act as precursors to the biologically active omega-6 and omega-3 PUFAs. Hempseed oil is also a source of gamma-linolenic acid (GLA), an omega-6 fatty acid derived from LA that has potential anti-inflammatory benefits.

Hempseed oil represents one source of essential fatty acids for vegan patients and it has been shown to have anti-inflammatory benefits for those with rheumatoid arthritis, cardiovascular disease, and atopic dermatitis. In one randomized, single-blind crossover study published in the Journal of Dermatological Treatment, patients with atopic dermatitis experienced clinically significant improvement in their symptoms and in plasma fatty acid profiles after 20 weeks of treatment with hempseed oil.

In addition to its beneficial fatty acid profile, cold-pressed hempseed oil contains more total phytosterol content than whole, unprocessed hempseeds with the most important phytosterol in hempseed oil being β-sitosterol. This phytosterol has been shown in humans to reduce high cholesterol and have beneficial effects when it comes to colon cancer. In addition, it acts as an antiviral, antifungal, and an anti-inflammatory agent.

Hempseed oil also contains a variety of phenolic compounds like flavonoids with antioxidant and has anti-inflammatory properties important for neuroprotection. In animal studies, three weeks of treatment with hempseed extract reduced inflammatory cytokines and improved learning, memory, and cognitive function. More human studies need to be conducted, but cold-pressed hempseed oil does seem to be a viable source of antioxidants to help prevent oxidative damage in the body.

Patients can use hempseed oil in supplement form, in culinary applications not requiring heat, and topically in a skincare routine. I recommend organic, cold-pressed hempseed oil, which is created without the use of chemical solvents or high-heat. This allows the finished product to retain more of the beneficial constituents of hempseeds without causing degradation of the oil.

Whole hempseeds

The carbohydrate content of hempseeds mainly consists of insoluble dietary fiber. This type of fiber can improve insulin sensitivity, decrease appetite, improve blood lipid levels, and is fermented by colonic bacteria to create short-chain fatty acids. In addition, the bioactive peptides contained in hempseeds have been shown to have antioxidant and anti-inflammatory effects. Patients can add whole or shelled hempseeds to salads, smoothies, and to baked goods.

Hempseed protein powder

Many of my patients are concerned with the potential health consequences associated with the overconsumption of conventionally-raised animal products and plant-based protein substitutes have indeed become more popular over the last couple of years. Unlike most other plant-based proteins, hempseed protein contains all the essential amino acids required by humans, but it is also highly digestible making it an ideal alternative.

The protein powder industry is an undeniably big business with much deception and poor quality throughout, so I educate patients to always opt for whole foods first over supplements. However, patients can seek out non-genetically modified, organic hemp protein powders to add to smoothies and baked goods.

Cannabidiol (CBD)

CBD is one of over 100 pharmacologically active phytocannabinoids extracted from the flower of the C. sativa L. plant that interact with the human endocannabinoid system (ECS). The ECS is a complex signaling system within the human body that works to restore and maintain homeostasis. We create our own fatty-acid-derived neurotransmitters called endocannabinoids, that act on CB1 and CB2 receptors located throughout the body to help regulate processes like sleep, appetite, pain, and immunity. The most well-studied endocannabinoids include anandamide-N-arachidonylethanolamine (AEA) and 2-arachidonylglycerol (2-AG), but exogenous cannabinoids like CBD, found in the hemp plant, can also interact with the ECS to provide potent health effects.

As reported in the journal Molecules, the interaction of CBD with the ECS has been shown to be effective in the management of seizures, pain, inflammatory conditions like cancer, vomiting, anxiety, depression, addiction, skin disorders, and brain dysfunction. For example, both in vitro and in vivo models indicate CBD has the ability to induce apoptosis in a variety of cancer cells with minimal harm to normal cells.

In addition, CBD action on CB2 receptors can decrease cancer cell growth and metastasis. A large retrospective case series where CBD was used as an adjunct to usual psychiatric treatment for anxiety and sleep complaints found CBD use was associated with improved outcomes, specifically anxiety decreased by 79.2 percent and sleep scores improved 66.7 percent in the group using the CBD. Moreover, as reported in the journal Mayo Clinic Proceedings, the evidence for the use of CBD for pain in inflammatory and neuropathic disorders is tremendous and CBD may be beneficial in the treatment of addiction disorders and has been shown to decrease heroin-seeking behavior.

A variety of CBD products are available:

• Pure CBD oil is added to foods and beverages, but can also be taken sublingually.
• CBD tinctures are combined with a carrying agent like an alcohol or flavored oil and then taken sublingually. CBD tinctures can also be made into spray form or packaged into pump bottles.
• Topical CBD comes in the form of lotions, lip balms, and salves to be applied directly to the skin.
• CBD pills are a powdered form of CBD taken orally.
• CBD edibles contain CBD added to food items like gummies, candies, and pastries.

When helping patients choose CBD products, I look for quality, quantity, and ingredients. There should be an easily accessible third-party certificate of analysis (COA) where patients can view the amount of CBD in milligrams per dose, as well as the product ingredients. There should be no chemicals, pesticides, additives, microbes, or herbicides on the COA. Full or broad-spectrum, as opposed to CBD isolates, are the most desirable options as they contain a variety of cannabinoids and terpenes allowing for a more potent effect in a smaller dose.

While confusion still exists, CBD contains very little, if any THC, so it has no psychoactive effect. In fact, CBD products must contain less than 0.3 percent to be marketed and sold. While more human studies are needed, CBD is known to have a great safety profile with limited abuse potential.

The hemp plant is certainly versatile and while research is on-going, there is much excitement about the potential role hempseeds and CBD may have in the prevention and treatment of numerous health conditions. While I am personally very optimistic about this plant, I always remind patients of the importance of the lifestyle overall as opposed to one supplement or ingredient. When educating my patients on using hemp and CBD products, I encourage the use of high-quality options and thorough investigation of the source.

References

Burns-Whitmore, B., Froyen, E., Heskey, C., Parker, T., & San Pablo, G. (2019) Alpha-Linolenic and Linoleic Fatty Acids in the Vegan Diet: Do They Require Dietary Reference Intake/Adequate Intake Special Consideration? Nutrients. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835948/

Callaway, J., Schwab, U., Harvima, I., Halonen, P., Mykkänen, O., Hyvönen, P., and Järvinen, T. (2005) Efficacy of dietary hempseed oil in patients with atopic dermatitis. The Journal of Dermatological Treatment. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/16019622/

Farinon, B., Molinari, R., Costantini, L., and Merendino, N. (2020) The seed of industrial hemp (Cannabis sativa L.): Nutritional Quality and Potential Functionality for Human Health and Nutrition. Nutrients. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/32610691/

Rupasinghe, H.P.V., Davis, A., Kumar, S.K., Murray, B., and Zheljazkov, V.D. (2020) Industrial Hemp (Cannabis sativa subsp. sativa) as an Emerging Source for Value-Added Functional Food Ingredients and Nutraceuticals. Molecules. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571072/

Simopoulos, A.P. (2002) The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomedicine & Pharmacotherapy. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/12442909/

Small, E. and Marcus, D. (2002) Hemp: A new crop with new uses for North America. p. 284–326. In: J. Janick and A. Whipkey (eds.), Trends in new crops and new uses. ASHS Press, Alexandria, VA. Retrieved from: https://www.hort.purdue.edu

U.S. Department of Agriculture. Hemp. Retrieved from: https://www.usda.gov/topics/hemp

VanDolah, H., Bauer, B., & Mauck, K. (2019). Clinician’s Guide to Cannabidiol and Hemp Oils. Mayo Clinic Proceedings. Retrieved from: https://doi.org/10.1016/j.mayocp.2019.01.003