CBD For CTE - April 2024

How CBD Oil Works to Help With CTE

According to a study in 2018, cannabis, particularly chemovars (chemical profiles) containing both THC and CBD, may be an effective treatment for chronic traumatic encephalopathy (CTE) symptoms⁽⁴⁾. 

CTE symptoms include headache, nausea, sleeplessness, dizziness, agitation, substance abuse, memory loss, and psychotic symptoms⁽⁵⁾.

It is suggested in clinical studies that supplementation with cannabis extracts provides CBD, THC (tetrahydrocannabinol), THCA (tetrahydrocannabinolic acid), CBDA (cannabidiolic acid), caryophyllene, and other terpenoid compounds can offer better treatment for medical conditions like CTE⁽⁶⁾.

Studies demonstrated how manipulating endocannabinoid degradative enzymes, CB1 and CB2 receptors, and their endogenous ligands had shown promise in modulating and regulating traumatic brain injury (TBI) pathology’s cellular and molecular hallmarks. This action results in brain cell death, excitotoxicity, neuroinflammation, cerebrovascular breakdown, and cell remodeling⁽⁷⁾. 

Phytocannabinoids, synthetic cannabinoids, and endogenous cannabinoids show therapeutic potential in treating TBI-induced behavioral deficits such as learning and memory, neurological motor impairments, post-traumatic convulsions, or seizures anxiety⁽⁸⁾.

Research on CBD for CTE

Chronic traumatic encephalopathy (CTE) is the degeneration of the brain due to repeated head injuries or traumas⁽⁹⁾. 

Increases in brain levels of endocannabinoids in response to pathogenic events, such as traumatic brain injury, show that the ECS plays a vital role in compensatory healing mechanisms⁽¹⁰⁾.  

Preclinical research demonstrated the therapeutic and neuroprotective effects of cannabinoids such as CBD. The modifications of the endocannabinoid system in treating TBI pathology are reviewed⁽¹¹⁾.   

According to the research, CBD may be responsible for the survival benefits observed in cannabis-exposed TBI patients. Phytocannabinoids generated from plants are an understudied yet exciting class of drugs based on their neuroprotective properties in various central nervous system (CNS) injuries. 

Moreover, the researchers hypothesized that CBD and other phytocannabinoids like terpenes and flavonoids that do not bind to cannabinoid receptors show promise as TBI treatments.

Usage and Dosage

CBD may be used in various delivery techniques characterized by CBD entering the body⁽¹²⁾. 

The modes of administration include inhalation, ingestion, sublingual, topical, and transdermal absorption. The user may optimize the CBD product‘s therapeutic effect by utilizing these various delivery methods⁽¹³⁾.

To inhale or vape activated cannabis extracts, a dense cloud of visible vapor must be produced. Vape CBD products expedite the onset of action from 2 to 15 minutes⁽¹⁴⁾. 

Vaping, however, creates a greater risk for respiratory symptoms indicative of lung injury⁽¹⁵⁾.

On the other hand, the sublingual distribution of CBD oil is accomplished by applying CBD oil drops or tinctures behind the tongue and on the cheeks⁽¹⁶⁾. 

This administration method is comparable to the topical use of CBD creams, oils, salves, balms, and sprays in that it takes effect within 5 to 30 minutes.

Similarly, taking edibles such as gummies or ingesting CBD oil-infused foods and beverages results in a slower start of the action. Effects typically occur between 30 and 90 minutes after food or drink has passed through the stomach and activated liver enzymes⁽¹⁷⁾.

CBD choices are offered to customers in three distinct forms. 

Full-spectrum CBD extract contains all of the components found naturally in the cannabis plant from which the compound is extracted, including THC, the psychoactive ingredient⁽¹⁸⁾.

Broad-spectrum CBD is comparable to full-spectrum CBD, but it is purified to exclude THC components, whereas CBD isolates are pure cannabidiol⁽¹⁹⁾.

Only Epidiolex, an oral CBD medication, has been approved by the United States Food and Drug Administration (FDA) to treat uncommon and severe forms of epilepsy⁽²⁰⁾. 

Apart from Epidiolex, state regulations regarding CBD vary, and research into its potential health benefits continues⁽²¹⁾.

Pros and Cons of CBD Oil for CTE

Published reviews indicated how cannabis-based medicines hold neurological therapeutics and safety in the generally considered treatment of intractable epilepsy, Parkinson’s disease (PD), brain tumors, Alzheimer’s disease (AD), and traumatic brain injury (TBI) or chronic traumatic encephalopathy (CTE)⁽²²⁾. 

Moreover, the study reported that cannabis has analgesic (painkiller), anxiolytic, and anti-inflammatory characteristics. However, no studies examining the precise pharmacotherapeutic potential of these compounds in traumatic brain injuries have been conducted⁽²³⁾. 

According to the WHO (World Health Organization), CBD is generally well tolerated and has an acceptable safety profile⁽²⁴⁾.

However, additional research is necessary to understand the effects of the variety of pharmacologically active cannabinoid chemicals in the brain to shed light on its benefits and side effects⁽²⁵⁾.

Interactions with other medications, side effects, potency in THC and CBD levels, and acceptable therapeutic dosages must all be established to reduce adverse side effects⁽²⁶⁾.

In neurocognitively impaired persons, the complexity of this medication might result in reduced compliance and serious dependence concerns. As a result, milder, more complete medicines are required to treat TBI symptoms⁽²⁷⁾. 

Effectiveness and Safeness of CBD

The type of CBD used, the dosage, and the individual’s body composition contribute to the difficulty of predicting when and how CBD will take effect⁽²⁸⁾. CBD works for some conditions, but certainly not in all medical conditions.

There are no studies directly examining CBD‘s effects on chronic traumatic encephalopathy, and there are only existing hypotheses to date.

According to the WHO (World Health Organization), CBD is generally well tolerated and has an acceptable safety profile⁽²⁹⁾.

Additionally, testing reveals that many products do not contain the ingredients listed on the label. The CBD product may contain less CBD than claimed⁽³⁰⁾. 

Since several jurisdictions legalized marijuana products, including CBD, for recreational and medical purposes, evidence supporting CBD accumulates⁽³¹⁾.

CBD Oil vs. Alternative Treatments for CTE

CBD administration following injury was demonstrated to provide long-lasting neuroprotection. The research findings indicated that dosing with CBD following a brain injury reduced the volume and extent of brain damage, decreased brain inflammation, and prevented neurological behavior impairment⁽³²⁾.

The benefits of CBD include a wide range of medical conditions as it provides potential therapy targeting the CNS (central nervous system).  

CBD is one of the several other cannabinoids in Cannabis sativa, with THC (delta-9-tetrahydrocannabinol) and other compounds like terpenes and flavonoids⁽³³⁾.

CBD has been associated with various potential medical advantages. It has anti-seizure, antipsychotic, neuroprotective, antidepressant, and anxiolytic effects that have shown promise in various medical applications⁽³⁴⁾.

CBD’s neuroprotective benefits appear to be related to its enhanced anti-inflammatory and antioxidant properties. These benefits may help with concussions.

Meanwhile, aside from CBD, alternative therapies are used in small scientific trials to treat concussions and other brain injuries, demonstrating substantial benefits for individuals with CTE⁽³⁵⁾. These treatments include:

• Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric oxygen therapy (HBOT) shows restoration of neuroplasticity in the brain while rejuvenating cognitive functions. This process happens by boosting tissue oxygenation in the brain⁽³⁶⁾.

According to a case study published by Dr. Kenneth P. Stoller, a 15-year-old high school football player who had lost his ability to read due to two concussions was treated with steroids, opioids, black-box antidepressants, and HBOT showed an increase in reaction time⁽³⁷⁾. 

• Stem Cell Therapy for Brain Tissue Repair

Numerous former NFL players afflicted with CTE are pursuing stem cell therapy. After being infused into the brain, pluripotent stem cells can develop into neural cells and multiply, thereby replacing damaged cells and assisting in the repair of brain tissue⁽³⁸⁾.

Researchers discovered in 2016 that infusing patients’ stem cells lowered brain inflammation and protected brain tissue associated with cognitive skills. These benefits directly address the symptoms mentioned above and the causes of CTE⁽³⁹⁾.

• Ketogenic Diet to Reduce Inflammation

The brain experiences a type of metabolic energy crisis following a concussion. Glucose uptake rushes to the wounded part of the brain but subsequently decreases when inhibited by inflammation⁽⁴⁰⁾. 

This action leads to ketone bodies, produced by the liver and used peripherally as an energy source when glucose is not readily available. The ketogenic diet works as a neuroprotectant in clinical studies⁽⁴¹⁾.

Side Effects of CBD

Many CBD therapies and products are associated with minimal side effects. For example, Epidiolex users may experience diarrhea or other gastrointestinal difficulties. Specific individuals may suffer tiredness when taking CBD⁽⁴²⁾.

CBD interacting with other medications may result in altered concentration. This action may result in the medicine not working properly or increasing the risk of experiencing adverse effects. While such drug interactions are typically difficult to predict, they can result in unpleasant and sometimes severe side effects⁽⁴³⁾.

Moreover, CBD use may pose adverse reactions, including dry mouth, diarrhea, decreased appetite, tiredness, and exhaustion⁽⁴⁴⁾.

To prevent unwanted interactions, users must obtain medical advice before using any CBD product, especially if they are using drugs, herbal products, or supplements⁽⁴⁵⁾.

What Is CBD?

CBD is an organic compound from the Cannabis sativa plant. This nonpsychoactive phytocannabinoid component is an essential compound extracted directly from the hemp plant, a relative of medical marijuana⁽⁴⁶⁾. 

CBD is one of the many phytocannabinoid compounds present in medical cannabis plants. CBD is a natural substance derived from hemp plants which by taxonomic categorization is a plant belonging to the Cannabis sativa L. family⁽⁴⁷⁾. 

CBD, and all cannabinoids, work by interacting with our body’s endocannabinoid system (ECS), containing millions of ECS receptors (CB1 and CB2 receptors)⁽⁴⁸⁾. 

Moreover, this system brings the organs back into their balance or homeostasis⁽⁴⁹⁾.

Clinical findings in neurology suggest that cannabidiol exhibits a broad range of therapeutic effects in people and preclinical disease models, including antipsychotic, anxiolytic, immunomodulatory, anti-inflammatory, neuroprotective, and pro-cognitive benefits⁽⁵⁰⁾.

What Is Chronic Traumatic Encephalopathy (CTE)?

Chronic traumatic encephalopathy (CTE) is a progressive, debilitating neurodegenerative disease likely characterized by extensive tau protein buildup. This buildup results in brain damage as abnormal protein buildup leads to cell death⁽⁵¹⁾. 

CTE, formerly known as dementia pugilistica or “punch-drunk syndrome,” has garnered widespread attention due to its apparent prevalence among long-term athletes, such as American football players and victims of repetitive head injury from various sources, including other contact sports and warfare⁽⁵²⁾.

CTE is believed to be caused by repeated neurotrauma or brain trauma due to concussions and even repetitive subconcussive strikes that may cause damage to brain neurons⁽⁵³⁾. 

History of Chronic Traumatic Encephalopathy Recent Developments

The long-term effects of repeated head traumas have been documented for nearly a century. Dr. Harrison Martland first described in 1928 what is now known as chronic traumatic encephalopathy (CTE) in a series of boxers and other victims of brain trauma⁽⁵⁴⁾. 

Numerous seminal articles have been published over the years, including one by neurologists Macdonald Critchley, in his 1957 report introduced the term “chronic traumatic encephalopathy,” Anthony Herber Robert’s study in 1969 provided evidence of the prevalence of neurological impairment in retired fighters, and Professor J.A.N. Corsellis’ initial description of the pathology of CTE⁽⁵⁵⁾. 

The postmortem findings of CTE pathology in deceased professional American football players, first published by Dr. Bennet Omalu, who spearheaded research into chronic traumatic encephalopathy, drew public attention to the subject of CTE in sports. 

There is now broad consensus on the diagnostic criteria for CTE and an acknowledgment that it can occur in any activity involving repeated head trauma⁽⁵⁶⁾.     

What Causes CTE?

CTE is a degenerative brain illness that can only be diagnosed after the individual’s death. Related to specific brain impairments that affect brain functions, CTE appears to be caused by repeated traumatic brain injuries, such as concussions and recurrent head impacts⁽⁵⁷⁾.

Researchers to date have a limited understanding of the causes of CTE. The type and number of head impacts that raise the risk of CTE are also uncertain⁽⁵⁸⁾. 

Genetic, environmental, or lifestyle factors may also contribute to the brain changes found in people diagnosed with CTE following death⁽⁵⁹⁾. 

To date, it is essential to determine the role of a person’s medical history, genetics, lifestyle, and environmental elements to understand better the risk factors for CTE⁽⁶⁰⁾.

How Is CTE Diagnosed?

To diagnose CTE, experts need to examine a person’s brain after death. Doctors examine individuals with CTE for abnormalities throughout their brains⁽⁶¹⁾. 

Medical experts use this procedure to determine whether an individual has CTE or another disease, such as Alzheimer’s disease or no condition⁽⁶²⁾. 

Doctors are still unable to identify CTE in a living person due to their limited understanding of the disease condition and its causes⁽⁶³⁾.

Who is at Risk of Developing CTE?

Individuals who have sustained recurrent head trauma are at risk of developing CTE⁽⁶⁴⁾. This category includes wrestlers and boxers, athletes who participate in contact sports like football, hockey, soccer, and military men⁽⁶⁵⁾. 

Current Treatments Available for Chronic Traumatic Encephalopathy

CTE is a diagnosis that can only be made during an autopsy by examining brain sections⁽⁶⁶⁾.

CTE cannot be treated. However, because CTE is associated with recurring concussions, it may be prevented. Individuals who have sustained one concussion are at an increased risk of suffering another head injury. The current approach for preventing CTE is to minimize mild traumatic brain injury and to avoid further harm following a concussion⁽⁶⁷⁾.

However, it may be possible to reduce the chance of developing CTE by minimizing the number of times receiving a blow to the head. Managing brain trauma appropriately when it occurs can also help avoid the disorder. For athletes, this includes leaving the game following a concussion, resting, and adhering to “return to play” guidelines⁽⁶⁸⁾.

CTE can only be definitively identified following a person’s death during an autopsy. Researchers are working to develop diagnostic tests that will allow for the official identification of CTE while individuals are still alive⁽⁶⁹⁾.

Chronic Traumatic Encephalopathy Statistics

A study of the brains of over 200 deceased football players — including 111 from the National Football League (NFL) — finds that approximately 90% of the players suffered from a brain disease called chronic traumatic encephalopathy (CTE)⁽⁷⁰⁾.

According to the Centers for Disease Control and Prevention (CDC), traumatic brain injury (TBI), or concussions, results in 1.4 million deaths, hospitalizations, and emergency department visits every year⁽⁷¹⁾. Additionally, between 1.6 million and 3.8 million TBIs occur yearly due to sports and recreation⁽⁷²⁾.

CTE is classified as mild to severe. In 2017, researchers discovered that the condition was “often severe” in former NFL players, with 71% of these players having severe CTE⁽⁷³⁾.

The researchers discovered that 96% of men with severe CTE and 89% of men with mild CTE had exhibited behavioral or mental disorders, including impulsivity, melancholy, apathy, and anxiety⁽⁷⁴⁾.

Additionally, they discovered that 95% of men with severe CTE and 85% of men with mild CTE had demonstrated impairments in their cognitive abilities, including difficulties with memory, concentration, and language⁽⁷⁵⁾.

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1. Chronic Traumatic Encephalopathy http://pnl.bwh.harvard.edu/education/what-is/chronic-traumatic-encephalopathy/
2. The United Chemicals of Cannabis: Beneficial Effects of Cannabis Phytochemicals on the Brain and Cognition https://www.intechopen.com/chapters/62431
3. Cannabis and CBD Research https://www.concussionalliance.org/cannabis-research#
4. Cannabis Therapeutics and the Future of Neurology
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200872/
5. ibid
6. Cannabis Therapeutics and the Future of Neurology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200872/#
7. Endocannabinoids: A Promising Impact for Traumatic Brain Injury https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5314139/
8. ibid
9. Chronic traumatic encephalopathy https://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/symptoms-causes/syc-20370921
10. Endocannabinoids: A Promising Impact for Traumatic Brain Injury https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5314139/
11. ibid
12. Healing with CBD page 189 https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
13. ibid page 190
14. ibid page 190
15. Can vaping damage your lungs? What we do (and don’t) know https://www.health.harvard.edu/blog/can-vaping-damage-your-lungs-what-we-do-and-dont-know-2019090417734
16. ibid page 193
17. ibid page 191
18. Full-spectrum cannabis extracts VS CBD isolate https://www.fundacion-canna.es/en/full-spectrum-cannabis-extracts-vs-cbd-isolate
19. Healing with CBD Page 80 https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
20. FDA Approves New Indication for Drug Containing an Active Ingredient Derived from Cannabis to Treat Seizures in Rare Genetic Disease https://www.fda.gov/news-events/press-announcements/fda-approves-new-indication-drug-containing-active-ingredient-derived-cannabis-treat-seizures-rare#:
21. ibid
22. Cannabis Therapeutics and the Future of Neurology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200872/
23. ibid
24. World Health Organization Reports CBD Oil Is Generally Safe https://www.rtor.org/2019/07/05/who-report-on-cbd-oil/#
25. Cannabis in the Treatment of Traumatic Brain Injury: A Primer for Clinicians https://www.cambridge.org/core/journals/canadian-journal-of-neurological-sciences/article/cannabis-in-the-treatment-of-traumatic-brain-injury-a-primer-for-clinicians/CFE33D823A97A1FF1089EC97859041DE
26. ibid
27. ibid
28. Why are women using CBD products — and do they work? https://www.health.harvard.edu/newsletter_article/cbd-products-are-everywhere-but-do-they-work
29. World Health Organization Reports CBD Oil Is Generally Safe https://www.rtor.org/2019/07/05/who-report-on-cbd-oil/#
30. CBD products are everywhere. But do they work?
    https://www.health.harvard.edu/newsletter_article/cbd-products-are-everywhere-but-do-they-work
31. ibid
32. Cannabis and CBD Research
    https://www.concussionalliance.org/cannabis-research#
33. Cannabidiol in Parkinson’s disease
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7115444/
34. Use of Cannabidiol in the Treatment of Epilepsy: Efficacy and Security in Clinical Trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6514832/
35. How Can NFL Players Treat Their CTE Symptoms? https://tbitherapy.com/how-can-nfl-players-treat-cte-symptoms/
36. ibid
37. ibid
38. ibid
39. ibid
40. ibid
41. ibid
42. What are the benefits of CBD — and is it safe to use?
    https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/is-cbd-safe-and-effective/faq-20446700
43. CBD and other medications: Proceed with caution https://www.health.harvard.edu/blog/cbd-and-other-medications-proceed-with-caution-2021011121743#
44. What are the benefits of CBD — and is it safe to use? https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/is-cbd-safe-and-effective/faq-20446700
45. CBD and other medications: Proceed with caution https://www.health.harvard.edu/blog/cbd-and-other-medications-proceed-with-caution-2021011121743
46. Cannabidiol (CBD)-what we know and what we don’t
    https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476
47. What are cannabinoids?
    https://adf.org.au/drug-facts/cannabinoids/#
48. ibid
49. Endocannabinoids and the Control of Energy Homeostasis* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2586261/
50. The United Chemicals of Cannabis: Beneficial Effects of Cannabis Phytochemicals on the Brain and Cognition https://www.intechopen.com/chapters/62431
51. Chronic Traumatic Encephalopathy http://pnl.bwh.harvard.edu/education/what-is/chronic-traumatic-encephalopathy
52. Cannabis Therapeutics and the Future of Neurology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200872/#
53. Chronic Traumatic Encephalopathy http://pnl.bwh.harvard.edu/education/what-is/chronic-traumatic-encephalopathy/
54. History of Chronic Traumatic Encephalopathy https://pubmed.ncbi.nlm.nih.gov/32777841/
55. ibid
56. ibid
57. Chronic Traumatic Encephalopathy (CTE)
    https://www.cdc.gov/traumaticbraininjury/pdf/CDC-CTE-FactSheet-508.pdf
58. ibid
59. ibid
60. ibid
61. Chronic Traumatic Encephalopathy (CTE)
    https://www.cdc.gov/traumaticbraininjury/pdf/CDC-CTE-FactSheet-508.pdf
62. ibid
63. ibid
64. Chronic traumatic encephalopathy https://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/symptoms-causes/syc-20370921#
65. ibid
66. ibid
67. Chronic traumatic encephalopathy https://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/symptoms-causes/syc-20370921
68. Chronic Traumatic Encephalopathy (CTE) https://my.clevelandclinic.org/health/diseases/17686-chronic-traumatic-encephalopathy-cte
69. ibid
70. Striking Study Shows How Football Affects the Brain https://www.livescience.com/59936-football-players-brains-cte.html
71. Traumatic Brain Injury–Related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2007 and 2013 https://www.cdc.gov/mmwr/volumes/66/ss/ss6609a1.htm
72. ibid
73. Striking Study Shows How Football Affects the Brain https://www.livescience.com/59936-football-players-brains-cte.html
74. ibid
75. ibid

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