The Portland Clinic pharmacy team offers important cautions for those thinking about trying cannabidiol, more commonly known as CBD. CBD has a lot to offer, but why stop there? Where CBD falls short, other supplements can pick up the slack. Here are five other supplements to take with CBD. WebMD provides information about interactions between St. John’s Wort and antipsychotics-sibutramine.
Can I Take CBD Oil And St John’s Wort Together
If you’ve been thinking about trying cannabidiol — more commonly known as CBD — welcome to the rapidly growing club. Interest in CBD as a treatment for pain, insomnia, anxiety and other complaints has been rising steadily ever since Oregon and other states legalized cannabis (marijuana).
CBD is one of many natural chemical compounds found in cannabis, but unlike the plant’s other well-known chemical, THC, it has no psychoactive or mind-altering effects. Instead, CBD owes its popularity to its therapeutic effects. Before you try it, however, be aware that it carries potential risks, as well — especially if you take other medications or have liver problems.
To date, the only FDA-approved use of CBD is a prescription medication called Epidiolex, which treats seizure disorders. Other over-the-counter uses, while widely promoted, need further study to support their claims. These include the following:
With its naturally sedating effects, CBD is used by many people as a sleep aid.
Anxiety and depression
CBD has shown promising results for many people with these issues.
Pain and inflammation
Some patients with arthritis and cancer find CBD helpful in reducing these symptoms.
Much remains unknown about how CBD works, its therapeutic benefits and its safety. For your own safety, it’s important to be aware of the known risks. They include the following:
CBD liver harm
CBD can be harmful to the liver. People with liver impairment should be cautious or avoid it.
CBD medication interactions
Because of its effect on the liver and liver enzymes, CBD can interfere with many medications, either increasing their levels in the blood to potentially toxic levels, or decreasing levels and reducing their effectiveness. Certain seizure medications, antidepressants, muscle relaxers, and drugs that can suppress the central nervous system (such as benzodiazepines, sleeping pills and opioids), among many other medications, may have strong interactions.
It’s important to talk to your doctor or pharmacist before using CBD to make sure you’re not taking a medication that will interact badly with it.
CBD drowsiness and other side effects
Because CBD causes drowsiness on its own, it also increases the drowsiness caused by other medications, including antihistamines (such as Benadryl), benzodiazepines (Xanax, Ativan, Valium), antipsychotics, antidepressants and opioids, as well as alcohol and supplements such as kava, melatonin and St. John’s Wort.
CBD’s sedating effects are similar to alcohol, so it’s not a good idea to use it if you need to drive or to do anything that requires mental alertness. Other common side effects of CBD include diarrhea and changes in appetite and mood.
CBD safety and regulation
Over-the-counter CBD products are not regulated by the FDA. Although most are extensively tested, there is still a possibility of error (such as the mix-up reported last September in The Oregonian), so be wary that products might not be 100% CBD as labeled.
Considering CBD? Talk to your doctor or pharmacist first
If you have questions about how your medications will interact with CBD, reach out to your doctor or local pharmacist for help. Pharmacists are great resources and can help come up with alternative therapies if CBD is not a good option for you.
Five Supplements You Should Be Taking With Your CBD
CBD has a lot to offer, but why stop there? Where CBD falls short, other supplements can pick up the slack. Here’s five other supplements to take with CBD.
Cannabidiol (CBD) is quickly becoming one of the most popular nutritional supplements on the market. It’s highly revered for its ability to regulate metabolic, immune, and neurological homeostasis — which is a fancy word meaning “balance.”
Negative health conditions can be attributed to an imbalance of one organ system or another. As a result, CBD is suggested to offer a wide range of health benefits throughout the body.
Although CBD has many uses, combining it with other synergistic nutritional and herbal supplements can optimize its effects.
In this article, we’re going to highlight why you should be combining your CBD with other supplements and which supplements you should consider for different symptoms.
Let’s get started by discussing exactly why you shouldn’t rely on just CBD to manage your symptoms.
Table of Contents
Why You Should Combine CBD with Other Supplements
The use of CBD as a form of medicine isn’t a new concept — people have been using it for centuries to treat everything from pain and inflammation to age-related cognitive decline.
However, people rarely use cannabis on its own to treat conditions.
In all forms of herbal medicine, plants are combined to enhance their effects based on the symptoms presented.
This is a common practice in herbal medicine, even in the modern world.
Only in the modern era have health practitioners chosen to take a more reductionist approach to medicine. Instead of combining multiple herbs or medicines to leverage their strengths and weaknesses, a single compound is prescribed.
Using a single compound (pharmaceutical) has advantages during the research stage because it’s easier to see what is responsible for a given result. Compounded medicines, on the other hand, are much harder to study because it’s challenging to identify exactly what effect each component is producing.
However, most people don’t care about knowing exactly which compound is producing the bulk of the effects — they just want to feel better.
By far the best way to leverage health supplements is through intelligent formulation. This works by taking 2 to 5 supplements that work well together to produce a more significant overall benefit.
For example, let’s say you’re taking CBD for joint pain — a popular application of the compound. Now, you could stop there and let the CBD do its job alone, but it’s going to have limitations.
CBD helps block pain and lower inflammation — both of which are common causes of the pain associated with the condition.
However, what happens if the cause of pain is a loss of cartilage tissue? CBD isn’t going to do much to support that process — so it’s better to combine it with something such as glucosamine, which is beneficial for repairing cartilage. Taken together, you can both speed the repair of your cartilage tissue in the joint and provide symptomatic support for the pain.
This is just one example of when it’s more beneficial to combine other supplements with CBD to achieve better results. Let’s go through five more examples.
Top Five Supplements to Take with Your CBD
Choosing which supplements to use alongside your CBD is going to depend on the symptoms you’re trying to address.
1. CBD & L-Theanine for Anxiety
There are many causes of anxiety, but the effects we feel during an anxiety attack are a direct result of overactivation of the nervous system — known as the fight-or-flight response.
CBD calms the nervous system through its ability to increase the activity of a neurotransmitter known as GABA — which acts as the brake pedal for the nervous system.
When our nervous system speeds up too fast, GABA slows it back down again.
Stepping on the brake pedal is great, but only if you ease off the gas pedal at the same time.
This is where L-theanine comes in.
L-theanine is an amino acid found in the tea plant (Camellia sinensis). Its structure closely resembles a neurotransmitter known as glutamate — which is essentially the gas pedal in the brain. It’s one of the primary stimulatory neurotransmitters in the brain.
The similarity in the chemical structure of L-theanine to glutamate allows it to bind to glutamate receptors — only it doesn’t produce any effects . Instead, L-theanine blocks glutamate from hitting these receptors — effectively stepping off the gas pedal to allow CBD to calm us down.
2. CBD & Ashwagandha (KSM-66) for Stress
An effective stress response is critical for maintaining optimal health.
Stress comes in all forms, but all stress has a similar effect on the body. It activates a region deep within the body known as the hypothalamus. The hypothalamus then sends hormones to the adrenal glands, which initiate the production of a hormone known as cortisol.
- Inhibits the immune system
- Inhibits digestion
- Increases heart rate
- Increases blood pressure
- Dilates the airways
- Stimulates the brain
- Forces the liver to dump glucose into the bloodstream
Cortisol is helpful in the short term for activating the stress response when it’s necessary — but if allowed to persist for too long, it can cause serious long-term problems, including insomnia, brain fog, lowered immunity, and weight gain, and even more serious complications such as diabetes and heart disease.
Ashwagandha supplementation has been shown to lower cortisol levels over time with regular use [1, 2]. There are several theories as to how it achieves this. The predominant idea is that it increases the conversion of cortisol to inactive metabolites by increasing the ability of the hypothalamus to regulate cortisol levels and handle stress.
CBD pairs nicely with ashwagandha because it achieves similar results by acting on other areas of the nervous system, including GABA .
These compounds may work together to alleviate chronic stress from the top down.
3. CBD, Curcumin, & Boswellia for Chronic Inflammation
Inflammation is incredibly complex — entire textbooks are dedicated to the topic without even grazing the surface.
Inflammation can vary a lot depending on the cause of the inflammation, which means that the inflammation experienced during an autoimmune disorder is very different from the inflammation experienced when you injure yourself.
Long-term (chronic) inflammation is also very different from short-term (acute) inflammation.
CBD is excellent for addressing both chronic and acute inflammation because it blocks many of the molecules involved in triggering inflammation. However, it has its limits.
Adding curcumin (the active constituent in turmeric) and Boswellia (another name for frankincense) may further enhance the effects of CBD by offering additional anti-inflammatory benefits through different mechanisms.
Curcumin and Boswellia stop inflammation by blocking key enzymes involved with manufacturing inflammatory compounds known as COX and 5-LOX.
Curcumin blocks COX , while Boswellia is better for stopping the related enzyme 5-LOX .
Taking all three supplements together is going to offer the most profound benefits because all of these actions are important for stopping inflammation.
By blocking these enzymes on top of key inflammatory messengers by CBD, the inflammation process comes to a screeching halt.
4. CBD, Glucosamine, & Chondroitin Sulphate for Joint Pain
CBD is useful for alleviating joint pain involved with both rheumatoid arthritis and osteoarthritis because of its analgesic and anti-inflammatory benefits.
Inflammation is a key component of the underlying causes of arthritis, but it’s not the only cause.
One of the biggest problems leading to chronic joint pain as a result of arthritis is a gradual breakdown of cartilage in the joints. Cartilage is designed to protect the joints so that bone doesn’t rub directly against another bone. Instead, the cartilage and a slippery fluid called synovial fluid allow the joints to move freely without causing any damage to the bones.
As the cartilage disappears, the rubbing of bone on bone causes extreme pain and worsens inflammation — ultimately leading to even faster degeneration of the cartilage and a buildup of scar tissue.
CBD is effective for reducing symptomatic pain in the joints and fighting inflammation — but it does very little for restoring lost bone cartilage.
This is where glucosamine and chondroitin sulfate comes in.
Both of these supplements are known for their ability to provide essential precursors for the body to repair both the cartilage and the cells responsible for producing synovial fluid (chondrocytes).
Taken together, the CBD can help lower inflammation and treat pain, while the glucosamine and chondroitin sulfate help to restore cartilage tissue over time.
5. CBD & St. John’s Wort for Depression
Depression can be debilitating to our health, especially if allowed to persist for long periods.
CBD is a good option for treating depression primarily for its anti-inflammatory benefits. Neuroinflammation is a key driver of depression , but it’s not the only cause.
Most antidepressant medications work by increasing serotonin levels in the brain — something that CBD isn’t able to do.
However, another herb — St. John’s Wort (Hypericum perforatum) — can do this.
This herb works similarly to common SSRI medications used to treat depression . It blocks the reuptake and breakdown of serotonin in the brain, causing levels to increase outside the neurons.
This ability to increase serotonin, combined with the powerful anti-inflammatory effects of CBD, provides a powerful combination for alleviating symptoms of depression.
Of course, always consult with your doctor before taking any supplements to treat depression, especially if you’re already taking antidepressant medications. Both CBD and St. John’s Wort may interact negatively with this type of medication — in which case, they should be avoided.
Bonus CBD Supplementation Tip
Grapefruit Juice to Prolong the Effects of CBD
CBD — like any other compound we consume — is eventually metabolized and deactivated by the liver.
The liver is an incredibly versatile organ. It can break down nearly any compound that enters the bloodstream thanks to a set of enzymes known as the cytochrome P450 isoenzyme complex.
Depending on the chemical structure of the compound being metabolized, different enzymes will step up for the job.
When it comes to CBD, the liver mainly relies on two enzymes — CYP3A4 and CYP3A5 .
Therefore, if we inhibit the activity of these enzymes, it will take much longer for the liver to break the CBD down.
There are a few things that can achieve this, but nothing as strong, or as readily available, like grapefruit juice .
This has led to a lot of people drinking grapefruit juice or taking grapefruit juice extracts, alongside their CBD supplementation — effectively lowering their required daily dose of CBD and providing long-lasting relief.
Cautionary Note: Grapefruit juice also inhibits other liver enzymes, so you should never take this supplement if you’re taking other medications as it may cause side effects. It’s especially important to avoid grapefruit juice if you are taking blood thinners or other medications to treat high blood pressure.
Key Takeaways: Supplements to Take with CBD
CBD is an incredible health supplement. It has a lot to offer a wide range of different medical conditions. However, like many other compounds, CBD is even better when combined with other herbs and supplements.
Choosing which supplements to combine it with depends on the symptoms you’re treating.
By leveraging the benefits of CBD alongside other supplements, we’re able to provide even greater benefits toward reversing, preventing, or alleviating symptoms.
This is the difference between a holistic approach versus a reductionist approach. Which one will you choose?
Cannabidiol; Tetrahydrocannabinol/Strong CYP3A4 Inducers Interactions
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
Your medicine may speed up how quickly your liver processes cannabidiol (CBD) and tetrahydrocannabinol (THC).
What might happen:
Your blood levels of CBD and THC may decrease and they may not work as well.
What you should do about this interaction:
Let your healthcare professional (e.g. doctor or pharmacist) know that you are taking these medicines together. Your doctor may want to change or adjust the dose of one of your medicines.Your healthcare professionals (e.g. doctor or pharmacist) may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.