Accurate Education: Synergy between CBD & PEA

Cannabidiol (CBD) is noted for its therapeutic benefits as an anti-inflammatory, anti-convulsant, anti-psychotic, anti-oxidant, neuroprotective and immunomodulatory agent. CBD is effective for pain, inflammation and anxiety. It is a strong antioxidant and may offer benefit for oxidative stress, the underlying process behind many diseases of aging.

The following is a list of conditions that may respond to CBD:

For more information regarding CBD, See:

Cannabidiol (CBD) – Introduction

Cannabidiol (CBD) Clinical Use and Dosing

Palmitoylethanolamide (PEA) – Clinical Use

PEA is a natural food ingredient with medicinal properties that was first identified in 1943 and in the 1950s discovered to be an active anti-inflammatory agent in chicken egg yolk. PEA is widely distributed in different body tissues, including the nervous system, and is synthesized on demand following stress, injury and/or pain and it accumulates in tissues with inflammation.

Amongst many other therapeutic benefits, PEA reduces inflammation and pain in different chronic pain conditions:

1. Arthritis – osteoarthritis & rheumatoid athritis
2. Fibromyalgia
3. Peripheral neuropathies – diabetic neuropathy & chemotherapy-induced peripheral neuropathy
4. Carpal tunnel syndrome
5. Opioid Tolerance and Hyperalgesia
6. Low back pain – herniated disc disease, failed back surgery syndrome, other
7. Sciatic pain
8. Dental pain
9. Neuropathic pain – related to stroke & multiple sclerosis
10. Inflammatory Bowel Disease
11. Chronic pelvic pain
12. Shingles pain (postherpetic neuralgia)
13. Vaginal pain (vulvadynia)
14. Traumatic Brain Injury/Chronic Traumatic Encephalopathy

Safety of PEA

PEA is naturally produced by the body and has no reported serious side effects or drug-drug interactions, making it an extraordinarily safe treatment option. Over the last decade, especially in Europe and the Netherlands, more and more clinical research and practical experience have confirmed its safety and effectiveness for chronic pain.

For more information regarding PEA, See: Palmitoylethanolamide (PEA)

Intestinal Pain

The stomach and intestinal gut provides a barrier between the external and internal environment. This barrier is selectively permeable, allowing absorption of nutrients and water from gastrointestinal contents, while preventing the transfer of noxious material such as bacteria and lipopolysaccharides. During episodes of inflammation, the barrier becomes compromised, allowing transfer of noxious material into the systemic circulation, leading to disease states such as inflammatory bowel disease (IBD) including Crohns Disease, Ulcerative Colitis and septic shock.

Because inflammation causes an increase in the permeability of gut barrier, the use of cannabis and PEA for their analgesic and anti-inflammatory effects have been investigated regarding the integrity of the gut barrier. A 2021 study demonstrated for the first time in humans that PEA and CBD prevent increases in permeability in the inflamed gut. This add to the body of preclinical research that demonstrates the anti-inflammatory and permeability-reducing effects of PEA and CBD in the gastrointestinal tract. This holds significant promise for the development of future intestinal therapies treating disorders of increased intestinal permeability such as IBD. Because the integrity of the gut barrier closely parallels the integrity of the blood-brain barrier, an important player in many disease processes, further investigation of CBD and PEA is warranted.

Specific dosing of CBD needs to be guided individually, taking into account desired therapeutic benefits related to specific symptoms and disease processes as well as the potential for drug-drug interactions with other prescribed medications. Dosing should be guided by a physician knowledgeable about cannabis and cannabis-based products. CBD suppresses the “high” caused by THC when provided at an 8:1 CBD:THC ratio.

Incidentally, due to lack of government regulation and oversight, CBD products sold online are often mislabeled regarding constituents, qualitatively and quantitatively. Caution is necessary when purchasing CBD products, including confirmation of product quality by obtaining 3rd party chemical analyses that evaluate product contents. Without this information, predicting accurate dosing from a product becomes very unreliable. Legitimate manufacturers provide these chemical analyses on demand and will often have them available on their websites.

CBD can be effective at a very wide range of dosages. It has been found that very low doses can have a very profound impact, from as little as 2.5 mg of CBD daily depending on method of delivery. Doses up to hundreds of milligrams have also been used safely and effectively. In a study that evaluated daily oral doses of 700mg, CBD was found to be nontoxic and other studies have reported CBD doses up to 1500mg/day to be safe. It has also been reported that cannabinoids may have a biphasic or triphasic effect, in that a low dose may provide a certain effect, but higher doses may provide different or opposite effects.

A very high dose may also not provide additional benefit over a low dose, so it’s best to start with a low dose: 2.5-5 mg of CBD initially (maybe 10 mg at the most), depending on the product and method of use. A typical starting CBD dose for most people would be a total of 10-12 mg of CBD a day, divided into 3 daily doses. If the desired effect is not achieved at a low dose, then higher doses can gradually be introduced until the therapeutic goal is achieved or side effects or expense deter further increased dosing.

The use of tinctures sublingually will be expected to provide a more rapid onset of effect but may not last as long as an oral dose. Orally administered (swallowed) CBD oil can last for four hours or more, but the onset of effects is much slower (30-90 minutes) than a tincture administered sublingually (under the tongue). Tincture dosing is generally performed with a 1 ml dropper which provides about 20 drops/ml.