Health & Fitness

Obesity is a condition defined by a marked accumulation of excess fat. Fat that grows just below the skin, called subcutaneous fat, is the kind that jiggles and wiggles. A second type can accumulate around your internal organs; this is called visceral fat.

Both can trigger health problems ranging from numerous types of chronic disease to potentially life-threatening conditions. The Centers for Disease Control and Prevention indicates your risk of 13 types of cancer increase when you are overweight or obese. These account for about 40% of all diagnosed cancers.¹

Obesity contributes to the development of heart disease as it can lead to diabetes, increase your risk of high blood pressure, change the balance of your cholesterol levels² and lead to metabolic syndrome.³ Other health risks include lower brain volume, bone and joint challenges, sleep apnea, liver problems and gallstones.⁴

According to the CDC, the prevalence of obesity rose from 30.5% in 2000 to 42.4% in 2018.⁵ Many use their body mass index (BMI) to determine if they are overweight or obese. This is a mathematical formula that uses height and weight to determine obesity.

In some cases, large muscle mass may skew the BMI and result in a false positive. In addition, your BMI doesn't help identify risks related to excess fat. A better method of determining your risk is calculating your waist-to-hip ratio since it indicates the presence of visceral fat, which your BMI will tell you nothing about.

Molecule in Oranges May Hold One Key to Addressing Obesity

One of the reasons low-fat diets became popular was because 1 gram of fat has more than twice the number of calories as 1 gram of carbohydrates — 9 versus 4.⁶ This led people to believe they could eat more carbohydrates and still maintain their weight or even lose weight. But years of data have revealed the opposite is true.

A diet heavy in carbohydrates increases your hunger and causes you to eat even more food. The rising number who struggle with being overweight and obese has prompted the study of phytonutrients found in plant foods.

Researchers from Western University in Canada⁷ studied nobiletin (NOB), a molecule found in tangerines and oranges. Their findings confirmed those from an earlier study which noted that “results suggest that NOB improves adiposity, dyslipidemia, hyperglycemia and insulin resistance.”⁸

The team found that feeding nobiletin to animals reduced the effects of a high-fat, high-cholesterol diet.⁹ Instead of growing heavier, the mice were leaner, had lower insulin resistance and had lower cholesterol when compared to a similar group fed just the high-fat, high-cholesterol diet.

This is the most recent published study from Murray Huff, Ph.D., who has been analyzing the effect of nobiletin on metabolism for more than 10 years. He commented on the results:¹⁰

“We went on to show that we can also intervene with nobiletin. We‘ve shown that in mice that already have all the negative symptoms of obesity, we can use nobiletin to reverse those symptoms, and even start to regress plaque build-up in the arteries, known as atherosclerosis.”

The researchers began with the hypothesis that nobiletin had an effect on AMPK, an enzyme that activates energy oxidation when levels of energy are low. Essentially, this would cause the body to burn stored energy.¹¹ However, they found that even for mice that were fed a high-fat diet:¹²

" … nobiletin robustly prevented obesity, hepatic steatosis, dyslipidemia, and insulin resistance, and it improved energy expenditure in Ampkβ1 -/-, AccDKI, and iβ1β2AKO mice to the same extent as in WT controls. Thus, the beneficial metabolic effects of nobiletin in vivo are conferred independently of hepatic or adipocyte AMPK activation."

The author did not pinpoint how the molecule works, but Huff is encouraged since he believes it does demonstrate the molecule will not interfere with medications designed to interact with the AMPK system, such as metformin for the treatment of diabetes. He believes the next step is to begin human studies.

Evidence Suggests Nobiletin Has More Benefits

Nobiletin can been extracted from the tangerine peel used in traditional Chinese medicine.¹³ In one study, the extract, in combination with other flavonoids from the peel, was found to positively impact antioxidative defense in young chicks. Results from other studies have demonstrated significant health effects, including:¹⁴

Introduces anticancer properties in the lab, especially against colon cancer cells15

Protects against cardiac hypertrophy by inhibiting NADPH oxidase,16 an enzyme producing reactive oxygen species17

Relieves age-related cognitive impairment, as shown in a study involving mice18

Lessens cardiovascular disease in diabetes, based on results from an animal study19

Reduces myocardial injury following ischemia and reperfusion, as shown in an animal study20

Reduces seizures, as reported by researchers who conducted an animal study21

Improves arthritis, as shown in the lab and in animal studies22

Strengthens physical activity, including promoting healthy aging, exercise endurance and cold tolerance, also as demonstrated in an animal study23

Enhances autophagy and mitochondrial biogenesis24

Lowers blood pressure, according to results from an animal study25

Improves memory deficits and reduces neuronal loss, as shown in an animal study26

Vitamin C Supports Your Immune Function

Colds, flu and COVID-19 are viral, which means antibiotics are completely useless in treating them. Antibiotics are helpful if you have a secondary bacterial infection, but overuse is leading to antibiotic-resistant disease.

Citrus fruits, high in vitamin C, are important to your immune system. Other vitamin C-rich foods include green peppers, broccoli, Brussels sprouts, cauliflower and tomatoes.²⁷ Researchers have focused on identifying pathways vitamin C may use in protection against influenza;²⁸ it’s widely known to help children keep from getting upper respiratory tract infections.²⁹

Organic orange peels are another option for vitamin C. One tablespoon of orange peel has 8.2 mg of vitamin C³⁰ while 1 cup (16 tablespoons) of juice has 124 mg.³¹ When you multiply 8.2 mg by 16 tablespoons, the result is 131.2, just over the same amount in the juice. The peel has other health benefits you'll discover in "Eat Your Organic Orange Peels," but eating them comes with a caveat.

It is important to eat organic oranges, as much of the commercial crop from Florida has been liberally sprayed with antibiotics³² to help suppress greening disease. The disease is spread by the Asian citrus psyllid, which infects the trees with bacteria. Once infected, most trees will die within a few years. In the meantime they produce fruit that can't be sold.

As much as 90% of the citrus crops in Florida have been affected, which led the EPA to authorize the widespread use of antibiotics on the trees. Matt Wellington from US PIRG (Public Interest Research Groups) spoke to the Center for Infectious Disease Research and Policy (CIDRAP), saying:³³

"The EPA is gambling with our life-saving antibiotics in its proposal to massively expand their use in citrus production. Spraying thousands of pounds of a medically important antibiotic on citrus trees violates the basic principle that these drugs should be used as little as possible, and only when necessary."

Following the first season of use, the University of Florida published a study demonstrating that using oxytetracycline for six months didn't have an effect on the viability of the trees. This also showed the initial data from the company providing the drugs that the EPA used for their decision, was flawed.³⁴

The researchers did find that injecting the trees could decrease bacterial growth.³⁵ However, it is expensive and not approved by the EPA. By choosing organic oranges you won't be exposed to the chance that an antibiotic has reached the fruit, or to what has remained on the peel. You also won’t be supporting a practice that will only increase the spread of antibiotic disease.

High Fructose Levels Lead to Insulin Resistance and Obesity

To achieve the results described in the Canadian study on nobiletin, researchers estimate you would have to drink 2.5 cups of orange juice a day.³⁶ Unsweetened orange juice from frozen concentrate has 2.43 gm of fructose in each 100 gm (3.5 ounces)³⁷ serving.³⁸ In other words, if you were to drink 2.5 cups of orange juice each day, you would be consuming 13.88 gm of fructose in one sitting.

What this means in plain language is that while drinking orange juice may confer the benefits of nobiletin, it comes with added sugar that has a significant influence on obesity and related diseases. Another challenge is that your scale doesn't tell you how the fat you do have is distributed throughout your body.

Your waist circumference offers some idea, but even this measurement isn't foolproof. Some people appear thin but have the same health problems as people struggling with obesity, including high blood pressure, diabetes and heart disease. The underlying problems are visceral fat, insulin resistance and metabolic syndrome.

For the most part fructose is consumed in liquid form, often as high fructose corn syrup. However, even when the fructose is from fruit, the number of grams you eat still counts. The burden of metabolism will fall to your liver³⁹ and excess fructose will promote the development of visceral fat collecting in your abdominal region. This raises your risk of heart disease and metabolic syndrome.

Although it's not inherently toxic, when you eat too much your liver can't handle the metabolism. As I've written before, I suggest keeping your total fructose below 25 gm per day, including whole fruit. The amount of fructose in 2.5 cups of orange juice is more than half this amount.

If you eat any other fruit, certain vegetables, processed foods or beverages,⁴⁰ you are likely to easily go well over the limit and increase your risk of metabolic syndrome, even if you maintain your weight.

Simple Strategies Help Weight Management and Support Health

The challenges of weight loss and maintenance are affected by many factors, including what type of food you eat, when you eat, movement, sleep and exercise. The first two factors are foundational to your health and weight maintenance since, no matter how hard you try, you can't out-exercise a poor diet.

Your body needs the right nutrients to feed your cells, neutralize toxins and balance your weight. A great way to accomplish this is to use the KetoFast protocol I developed following the release of my best-selling book “Fat for Fuel.” Using the KetoFast protocol your body regains metabolic flexibility and increases your ability to burn fat for fuel.

This helps support your mitochondria and brain cells while reducing your risk for many chronic diseases associated with metabolic syndrome and obesity. The combination of fasting and eating a ketogenic meal plan is done in phases, so you aren't overwhelmed by the changes to how you eat. You'll discover more about the process at "KetoFast Explained."

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In this interview, Dr. Thomas Levy, a cardiologist widely known for his work with vitamin C, discusses his most recent book, “Magnesium: Reversing Disease.” In light of the current COVID-19 pandemic, which was in full swing at the time of this interview, March 24, 2020, our discussion also includes some other strategies you can use to prevent and treat this and other respiratory illnesses.

Personally, I believe the fear of the pandemic and collapsed economy leading to depression and increased suicides will be more harmful than the disease itself, considering the mortality rate is now believed to be similar to the flu, which is around 0.1%.¹

That said, if this pandemic is teaching us anything, it’s that your immune system is your primary defense against infectious disease, so the best thing anyone can do is to educate themselves about how to do that. The same applies when facing acute illness, as there are many ways to boost your immune function even in the short term.

Vitamin C Is a Powerful Antiviral

As noted by Levy, vitamin C is one excellent option. “I personally believe, from the research and literature, vitamin C is the primary agent that stimulates and maximizes the potency of the immune system. So, I don't think it can be undersold,” he says. Levy recommends taking 2 to 3 grams, three or four times a day, for this purpose. 

I agree with this dosage for acute purposes, but not as a daily supplement. You simply do not need upward of 12 grams of vitamin C every single day. Many could definitely use some vitamin C every day, however. According to Levy:

“Epidemiologically there's no question — if the whole population just took 1 gram or 2 grams a day, I believe it would have enormous impact on the general public health and the incidents of infectious disease.”

As for my objection to such high daily doses, Levy replies:

“There's a difference between preventing disease and resolving disease. A larger amount of vitamin C in your bloodstream is going to give you a greater resistance against a given pathogen load than a lower amount, even if that lower amount is in the ‘normal’ range."

Vitamin C can also be administered intravenously. Levy, who has performed many intravenous vitamin C procedures, typically uses a pH-balanced solution of sodium ascorbate dissolved in water, buffered with sodium bicarbonate. In this manner, 12 grams of vitamin C can be pushed in as little as five minutes without irritating the lining of your blood vessels.

I personally prefer oral liposomal vitamin C, which can still allow you to reach the kind of blood levels you’d normally only get with an IV. Levy recounts a small trial he recently did at the Riordan Clinic, which measured intracellular levels of vitamin C. Here, oral liposomal vitamin C resulted in substantially higher intracellular vitamin C levels than is seen with oral, nonencapsulated vitamin C.

“In this particular study, we also looked at the effects of hydrocortisone, in particularly with liposomal vitamin C … The presence of hydrocortisone massively increased the amount of vitamin C that goes inside the cell. This is very interesting, because … hydrocortisone is considered your No. 1 anti-inflammatory agent. My opinion … [is] that [this] is because it exerts such a profound effect on putting vitamin C inside the cells.”

Contraindication to High-Dose Vitamin C Treatment

The only contraindication to high-dose vitamin C treatment is if you have glucose-6-phosphate dehydrogenase (G6PD) genetic disorder.² G6PD is required for your body to produce NADPH, which is necessary to transfer reductive potential to keep antioxidants, such as vitamin C.

Because your red blood cells do not contain any mitochondria, the only way it can provide reduced glutathione is through NADPH, and since G6PD disorder eliminates the major source of NADPH, it causes red blood cells to rupture due to inability to compensate for oxidative stress with glutathione.

Fortunately, G6PD deficiency is relatively uncommon, and can be tested for. People of Mediterranean and African descent are at greater risk of being G6PD deficient. Worldwide, G6PD deficiency is thought to affect 400 million individuals, and in the U.S., an estimated 1 in 10 African-American males has it.³

“If you do have someone that's positive, you need to remember that the reason the red blood cells are hemolyzing is because they have increased intracellular or intra red blood cell oxidative stress,” Levy says, “and this is due to decreased glutathione [and] vitamin C levels inside the cell, [and] increased calcium levels inside the cell.

So, you can bolster these people up by giving, usually, liposomal or intravenous forms of glutathione a day or two before, as well as intravenous magnesium. This builds up the resistance of the cell …

[We] counsel the patient … to drink a lot of water, stay well hydrated, and tell us if they notice any change at all in the color of their urine. And you'll find out early on, long before there's a massive hemolysis that's life threatening, whether something [is going wrong].

That is the overall approach, but I also have to follow up and say, especially, at the Riordan Clinic, where I'm a consultant, I don't think we've ever seen that, not even once.

Obviously, in certain populations — let's say if the Riordan Clinic was in Africa — then it might be a whole lot more concern, but there's a lot of people of color that come to the Riordan Clinic and it just has not turned out to be a problem. Although, with the reports and the literature as they are, you're probably not doing yourself any favors legally if you don't check the [G6PD] test.”

Other Important Immune Boosters

Levy adds:

“It's very important to take Vitamin D as well. Probably somewhere along the lines of 10,000 to 15,000 units a day, at least, during the time of the epidemic … A good preparation of zinc also helps arm the immune system. General supplementation should always include vitamin K as well, and magnesium, which we'll talk about.

I consider vitamin C, magnesium, vitamin D, and vitamin K2 to be the premier, top four supplements for promoting and maintaining good health, mainly because they're the primary antagonists to calcium accumulation, and excess calcium inside the cell … I consider to be the primary pathophysiology in all disease.”

Nebulized Hydrogen Peroxide Inactivates Viruses

Levy also discusses nebulization with hydrogen peroxide, which you can read more about in “Hydrogen Peroxide Protocol for Coronavirus” that was posted in my April 9 newsletter.

“Hydrogen peroxide absolutely destroys everything on an open wound. Well, guess what? When you put a fine mist of it inside your sinuses, nose, and throat, it nukes the virus there too … When you're systemically ill with influenza or coronavirus … the thing that's fueling it is an ongoing massive replication of the virus in the sinuses, nose and throat.

When you can effectively knock that down 99%, you ‘lop the head off the snake.’ And then the body is in great shape, especially with the support of things like vitamin C to mop everything up. Ozone is also fantastic, [but] ozone is not readily available for most people …

In the nebulization I'm talking about, [you use] over-the-counter, 80 cents a bottle at Walmart, 3% hydrogen peroxide. If you don't mind a little discomfort, you can do the full strength, but you can get a great effect with 50% or 25% of that concentration or less. The bottom line is, whatever aggravation it causes to nose and sinuses, those rapidly resolve once you stop the nebulization.

For long-term usage, it’s a good idea to use food grade hydrogen peroxide. But don’t hesitate to use the regular peroxide if you are actively dealing with a virus and don’t want to lose time trying to obtain the food grade form.”

Why Magnesium Helps Reverse Disease

As mentioned, Levy believes excess calcium inside your cells is a primary contributor to most disease, and magnesium is a natural calcium channel blocker. That makes it useful for a wide variety of scenarios involving oxidative stress.

This is also why I recommend magnesium as a countermeasure to electromagnetic field (EMF) exposure. To learn more about the adverse health effects of excessive calcium, listen to the interview in its entirety, as Levy delves into greater detail than summarized here:

“’Magnesium: Reversing Disease’ came as a natural sequel to my earlier book in 2013, ‘Death by Calcium.’ When I did the research for that book, I had no idea … how clear cut the data was. But the bottom line was — and this is why magnesium, vitamin C, vitamin D and vitamin K are so good — is they all are natural calcium antagonists.

They all help dissolve preexisting calcifications and they all help to normalize the calcium in the body. Each one, individually, decreases all-cause mortality — decreases your chance of death from anything — which means they favorably impact every cell in the body.

As I reviewed more and more studies, it became apparent to me (and I've not found an exception to this yet) that every cell that is ‘diseased’ has increased calcium levels inside the cell. And the higher they get, if you go without killing the cell, that's when you undergo malignant transformation. It's the highest levels of calcium that also result in cancer.

It was also very apparent, even before I began the magnesium book, that magnesium was the No. 1 calcium antagonist and general metabolic calcium function inhibitor. It mirrored everything. More calcium increased your chance of death by all causes, less decreased it. More magnesium decreased it, less magnesium increased it …

Magnesium is directly involved, one way or another, with 80% of all the chemical reactions in the body. So it’s a significant player everywhere. As you go down, disease by disease, No. 1, it becomes apparent that magnesium deficiency by itself causes many diseases, but perhaps even more importantly, magnesium deficiency, if it doesn't cause a disease, makes all the diseases worse.

Because, once again, the more calcium you get inside the cell, the more oxidative stress, the less enzymes and other biomolecules function normally, and the more you bring that micro environment inside the cell to a reduced level, things start functioning normally …”

Magnesium Is Antimicrobial Too

Levy also points out that some forms of magnesium are antimicrobial as well. In 1939, Dr. Frederick Klenner cured 60 out of 60 cases of polio in children and infants using oral and injectable vitamin C. According to Levy, a French investigator in the 1940s did the same thing but with oral magnesium chloride solution.

Both of these historical accounts are outlined in Levy’s book. According to Levy, while magnesium is not an antioxidant per se, it exerts through other mechanisms a profound antioxidant effect inside cell — largely by displacing calcium, allowing vitamin C to accumulate and optimizing glutathione synthesis. 

I review this very mechanism in my latest book, “EMF*D” as well. The intracellular concentration of calcium is about 50,000 times lower than the extracellular. But when you get an excess amount of calcium inside the cell, it causes nitric oxide and superoxide levels to increase.

Those two molecules, once they're formed, instantaneously go on to form a really pernicious molecule called peroxynitrite, a reactive nitrogen species (RNS), which stays around about 9 million times longer than hydroxyl free radicals.

This longevity allows it to travel throughout the cell, causing tremendous damage to stem cells, cell membranes, proteins, mitochondria and DNA. Essentially, EMF exposure triggers an increase in intracellular calcium levels, meaning it causes oxidative stress, and magnesium is an elegant solution to mitigate this damage. Most are also deficient in magnesium, so supplementing is a good idea for most people.

Magnesium chloride appears to have the most potent antimicrobial effects. Levy cites research showing the magnesium sulfate form and the magnesium chloride form have opposite effects on pathogens. In one in vitro study the sulfate form encouraged infection while the chloride form suppressed it.

“I think the chloride entity is extremely important for the anti-infectious property of magnesium,” Levy says. “So, if you're taking magnesium for the purposes of infection, take magnesium chloride.

If you're getting an IV, use magnesium sulfate. If you're taking it orally, just for the magnesium, then any of a number [will work, including] magnesium glycinate, magnesium threonate and magnesium gluconate — all of those are great.”

Another excellent source of magnesium is molecular hydrogen tablets. Each tablet provides 80 mg of elemental ionic magnesium. The tablets, which must be dissolved in water, provide you with highly absorbable pure ionic elemental magnesium, and have no laxative effect.

On Magnesium Testing

Levy does not think an RBC (red blood cell count) test is accurately reflective of your magnesium level. He explains:

“Red blood cells don't have cytoplasm and they're not really a good reflection … No. 1, if your blood level is low, you're low [on magnesium]. You don't need to go any further in testing. No. 2, if your blood level is ‘normal,’ then the next step is to go to … ExaTest.com.

They get sublingual swabs and measure intracellular levels of not only magnesium but calcium and a couple other electrolytes as well … It appears to be your best direct reflection that we have so far.

Maybe something better will come out down the road, but right now it looks like the best way for you to really know what your magnesium level is [and] get an idea of how well-suppressed your calcium levels are inside your cells …

It's not an outlandishly expensive test, but it's going to run about $250 or $300, so you don't want to just get it for no reason at all. But if you're dealing with problems that could be secondary to magnesium deficiency, it's good to rule that out as being a major contributor to whatever it is you might be treating.”

Side Effects of Excessive Magnesium

As for dosage, it’s virtually impossible to overdose on oral magnesium, as it has a built-in mechanism to prevent toxicity. Like vitamin C, excessive oral magnesium will simply come out the other end, as loose stools. That’s when you know you’ve exceeded your ideal dose.

One exception to the nontoxicity rule is in elderly individuals with constipation who are given large doses of magnesium citrate. If the magnesium preparation fails to work, it can sit in the gut, causing it to be overabsorbed. “That's about the only subset that I know of for oral magnesium,” Levy says, adding:

“Obviously, then, you can very easily harm yourself by taking too much magnesium too rapidly intravenously. But that's also it's therapeutic effect, and it's a known entity.

As a matter of fact, in dental surgery they have something called magnesium-induced controlled hypotension, because surgeries on the jawbone bleed so badly they want to use something to deliberately bring blood pressure down to controlled hypotensive levels until you get hemostasis, and then they back off on the magnesium and your blood pressure comes back up.

But the point I make about that is, if you give enough magnesium, you can take any blood pressure and bring it down it zero. Within those confines though, it's very, very safe … Ironically enough, our pseudo-enemy calcium is one of the ways you bring people out of that [hypotensive state].”

Magnesium for Migraine

The reason magnesium lowers your blood pressure is because it’s a vasodilator: It enlarges your blood vessels. And, if you inject it rapidly enough, you will get very warm, sometimes almost hot and sweaty. Importantly, for people with migraines, IV magnesium will typically resolve a migraine very rapidly.

“Upon my review on migraine, let me say, it's my humble opinion that migraine is completely and totally a magnesium deficiency disease,” Levy says. “That's how significant magnesium is in the physiology of that.

Interestingly enough, at about the same time I was writing on migraine in my book, a friend called me who was going through some horrible situations with a syndrome I had never heard before, called reversible cerebral vasoconstriction syndrome, and even having a slight bit of a subarachnoid hemorrhage.

I read up on it and said, ‘This looks identical, basically, to migraine physiology. Start dosing your magnesium like there's no tomorrow.’ She did and she eventually came out of it. I guarantee you she hasn't gotten off magnesium since, and she's had no recurring episodes.”

The Toxic 3: Calcium, Iron and Copper

In his book, Levy reviews why you don’t want elevated levels of calcium, iron or copper. All three can be quite toxic and cause significant health problems.

“They're what I call the three toxic nutrients,” Levy says. “They're certainly, without any qualification, essential at lower doses for normal metabolism. Calcium plays a role in just about everything — the contraction of your heart. Iron is essential for blood production. Copper plays a similar but lesser role to iron in many of the things that it does.

But I've yet to see a person that I think is legitimately deficient in copper. But whether or not that person exists, the more important one is iron. Iron, in my opinion, you should never supplement if you do not have an iron deficiency anemia — hypochromic, microcytic anemia — because for all the things iron does, it's very tiny amounts of iron that are needed …

You need relatively massive amounts to make a normal blood count. So, if you're making enough blood, you have enough iron for everything else. Combined with that … you'll be absolutely appalled to see what's been put in our fortified enriched foods for the last 70 years. I've got news for you — I'm not nuts — they put in metallic iron filings.

Now how on Earth that's nutritious is beyond me, but even if they put in a legitimate supplemental form of iron, still, the more iron you accumulate, the greater your bodywide oxidative stress is. And excess oxidative stress is what we're trying to avoid.”

Be particularly careful if you have beta thalassemia, like I do, or sickle cell anemia. Taking iron when you have these conditions is the kiss of death, and I've seen that done to so many patients. To learn more about magnesium and its health benefits, be sure to pick up a copy of “Magnesium: Reversing Disease.”

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Founder of The Beach Life, Richard Kerrigan takes us through a full-body, 30-minute workout as part of the body+soul LIVE @ home online workout series. Press play to get started!

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Founder of The Upbeat, Libby Babet takes us through a heart-pumping 4o-minute dance-based cardio workout. Get ready to bounce to the beat!

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Founder of Fluidform Pilates Kirsten King takes us through a 30-minute mat Pilates session as part of the body+soul LIVE @ home online workout series. Press play to get started!

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Researchers investigated the group of microorganisms classified as Asgard archaea, and found a protein in their membrane which acts as a miniature light-activated pump. The schizorhodopsin protein draws protons into the organisms' body. This research could lead to new biomolecular tools to control the pH in cells or microorganisms, and possibly more.

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While researchers have suggested that individuals who base their self-worth on their financial success often feel lonely in everyday life, a new study has taken initial steps to better understand why this link exists.

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If you have chronic arthritis pain, you may be wondering about cannabidiol (CBD) as a treatment. CBD, along with delta-9-tetrahydrocannabinol (THC) and other chemicals, is found in marijuana. But unlike THC, CBD is not “psychoactive” — that is, it does not cause the intoxication or high associated with marijuana use.

There’s a good chance you’ve tried it already: according to a Gallup poll in August of 2019, about 14% of Americans report using CBD products, and the number one reason is pain. The Arthritis Foundation conducted its own poll and found that 29% reported current use of CBD (mostly in liquid or topical form), and nearly 80% of respondents were either using it, had used it in the past, or were considering it. Of those using it, most reported improvement in physical function, sleep, and well-being; of note, a minority reported improvement in pain or stiffness.

Perhaps you’ve been tempted to try it. After all, most types of arthritis are not cured by other treatments, and CBD is considered a less addictive option than opiates. Or maybe it’s the marketing that recommends CBD products for everything from arthritis to anxiety to seizures. The ads are pretty hard to miss. (Now here’s a coincidence: as I was writing this, my email preview pane displayed a message that seemed to jump off the screen: CBD Has Helped Millions!! Try It Free Today!)

What’s the evidence it works? And what do experts recommend? Until recently, there’s been little research and even less guidance for people (or their doctors) interested in CBD products that are now increasingly legal and widely promoted.

But now, there is.

A word about arthritis pain

It’s worth emphasizing that there are more than 100 types of arthritis, and while pain is a cardinal feature of all of them, these conditions do not all act alike. And what works for one may not work for another. Treatment is aimed at reducing pain and stiffness and maintaining function for all types of arthritis. But for certain conditions, such as rheumatoid arthritis, conventional prescription medications are highly recommended, because these drugs help prevent permanent joint damage and worsening disability.

In addition, individuals experience pain and respond to treatment in different ways. As a result, it’s highly unlikely that there is a single CBD-containing product that works for all people with all types of arthritis.

What’s the evidence that CBD is effective for chronic arthritis pain?

While there are laboratory studies suggesting CBD might be a promising approach, and animal studies showing anti-inflammatory and pain-relieving effects, well-designed studies demonstrating compelling evidence that CBD is safe and effective for chronic arthritis pain in humans do not exist. A randomized trial of topical CBD for osteoarthritis of the knee has been published, but in abstract form only (meaning it’s a preliminary report that summarizes the trial and has not been thoroughly vetted yet); the trial lasted only 12 weeks, and results were mixed at best. One of the largest reviews examined the health effects of cannabis and CBD, and concluded that there is “substantial evidence that cannabis is an effective treatment for chronic pain in adults.” But there was no specific conclusion regarding CBD, presumably because definitive studies were not available.

Of course, there is anecdotal evidence and testimonials galore, including reports of dramatic improvement by people who tried CBD in its various forms (including capsule, liquid, topical, and spray) for their pain. But we are still waiting for well-designed, scientifically valid, and rigorous clinical trials (such as this one in progress) that are so badly needed to answer the question of just how helpful CBD may be to people with chronic arthritis pain.

Are there downsides to CBD treatment?

As with any treatment, there can be downsides. CBD is generally considered safe; however, it can still cause lightheadedness, sleepiness, dry mouth, and rarely, liver problems. There may be uncertainty about the potency or purity of CBD products (since they are not regulated as prescription medications are), and CBD can interact with other medications. For pregnant women, concern has been raised about a possible link between inhaled cannabis and lower-birthweight babies; it’s not clear if this applies to CBD. Some pain specialists have concerns that CBD may upset the body’s natural system of pain regulation, leading to tolerance (so that higher doses are needed for the same effect), though the potential for addiction is generally considered to be low.

There is one definite downside: cost. Prices range widely but CBD products aren’t inexpensive, and depending on dose, frequency, and formulation, the cost can be considerable — I found one brand that was $120/month, and health insurance does not usually cover it.

Are there guidelines about the use of CBD for chronic arthritis pain?

Until recently, little guidance has been available for people with arthritis pain who were interested in CBD treatment. Depending on availability and interest, patients and their doctors had to decide on their own whether CBD was a reasonable option in each specific case. To a large degree that’s still true, but some guidelines have been published. Here’s one set of guidelines for people pursuing treatment with CBD that I find quite reasonable (based on recommendations from the Arthritis Foundation and a recent commentary published in the medical journal Arthritis Care & Research):

Dos:

• If considering a CBD product, choose one that has been independently tested for purity, potency, and safety — for example, look for one that has received a “Good Manufacturing Practices” (GMP) certification.
• CBD should be one part of an overall pain management plan that includes nonmedication options (such as exercise) and psychological support.
• Choose an oral treatment (rather than inhaled products) and start with a low dose taken in the evening.
• Establish initial goals of treatment within a realistic period of time — for example, a reduction in knee pain that allows you to walk around the block within two weeks of starting treatment; later, if improved, the goals can be adjusted.
• Tell your doctor(s) about your planned and current CBD treatment; monitor your pain and adjust medications with your medical providers, rather than with nonmedical practitioners (such as those selling CBD products).

Don’ts:

• Don’t make CBD your first choice for pain relief; it is more appropriate to consider it if other treatments have not been effective enough.
• Don’t have nonmedical practitioners (such as those selling CBD products) managing your chronic pain; pain management should be between you and your healthcare team, even if it includes CBD.
• For people with rheumatoid arthritis or related conditions, do not stop prescribed medications that may be protecting your joints from future damage; discuss any changes to your medication regimen with your doctor.

The bottom line

If you’re interested in CBD treatment for chronic arthritis pain or if you’re already taking it, review the pros, cons, and latest news with your healthcare providers, and together you can decide on a reasonable treatment plan. Depending on the type of arthritis you have, it may be quite important to continue your conventional, prescribed medications even if you pursue additional relief with CBD products.

We may not have all the evidence we’d like, but if CBD can safely improve your symptoms, it may be worth considering.

Follow me on Twitter @RobShmerling

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