Can I Take CBD Oil And St John’s Wort Together

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WebMD provides information about interactions between St. John’s Wort and antipsychotics-sibutramine. 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. Products containing cannabidiol (CBD) are very popular, promising relief from a wide range of maladies. But if you are considering taking a product containing CBD, be aware that if you are taking any other prescription or over-the-counter medications, supplements, or herbal products, CBD can interact with them and cause unexpected …

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.

Medical warning:

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.

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.

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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.

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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 [10]. 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.

Cortisol then:

  • 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 [3].

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 [6], while Boswellia is better for stopping the related enzyme 5-LOX [7].

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.

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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 [8], 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 [9]. 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 [4].

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 [5].

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?

CBD and other medications: Proceed with caution

Products containing cannabidiol (CBD) seem to be all the rage these days, promising relief from a wide range of maladies, from insomnia and hot flashes to chronic pain and seizures. Some of these claims have merit to them, while some of them are just hype. But it won’t hurt to try, right? Well, not so fast. CBD is a biologically active compound, and as such, it may also have unintended consequences. These include known side effects of CBD, but also unintended interactions with supplements, herbal products, and over-the-counter (OTC) and prescription medications.

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Doubling up on side effects

While generally considered safe, CBD may cause drowsiness, lightheadedness, nausea, diarrhea, dry mouth, and, in rare instances, damage to the liver. Taking CBD with other medications that have similar side effects may increase the risk of unwanted symptoms or toxicity. In other words, taking CBD at the same time with OTC or prescription medications and substances that cause sleepiness, such as opioids, benzodiazepines (such as Xanax or Ativan), antipsychotics, antidepressants, antihistamines (such as Benadryl), or alcohol may lead to increased sleepiness, fatigue, and possibly accidental falls and accidents when driving. Increased sedation and tiredness may also happen when using certain herbal supplements, such as kava, melatonin, and St. John’s wort. Taking CBD with stimulants (such as Adderall) may lead to decreased appetite, while taking it with the diabetes drug metformin or certain heartburn drugs (such as Prilosec) may increase the risk of diarrhea.

CBD can alter the effects of other drugs

Many drugs are broken down by enzymes in the liver, and CBD may compete for or interfere with these enzymes, leading to too much or not enough of the drug in the body, called altered concentration. The altered concentration, in turn, may lead to the medication not working, or an increased risk of side effects. Such drug interactions are usually hard to predict but can cause unpleasant and sometimes serious problems.

Researchers from Penn State College of Medicine evaluated existing information on five prescription CBD and delta-9-tetrahydrocannabinol (THC) cannabinoid medications: antinausea medications used during cancer treatment (Marinol, Syndros, Cesamet); a medication used primarily for muscle spasms in multiple sclerosis (Sativex, which is not currently available in the US, but available in other countries); and an antiseizure medication (Epidiolex). Overall, the researchers identified 139 medications that may be affected by cannabinoids. This list was further narrowed to 57 medications, for which altered concentration can be dangerous. The list contains a variety of drugs from heart medications to antibiotics, although not all the drugs on the list may be affected by CBD-only products (some are only affected by THC). Potentially serious drug interactions with CBD included

  • a common blood thinner, warfarin
  • a heart rhythm medication, amiodarone
  • a thyroid medication, levothyroxine
  • several medications for seizure, including clobazam, lamotrigine, and valproate.

The researchers further warned that while the list may be used as a starting point to identify potential drug interactions with marijuana or CBD oil, plant-derived cannabinoid products may deliver highly variable cannabinoid concentrations (unlike the FDA-regulated prescription cannabinoid medications previously mentioned), and may contain many other compounds that can increase the risk of unintended drug interactions.

Does the form of CBD matter?

Absolutely. Inhaled CBD gets into the blood the fastest, reaching high concentration within 30 minutes and increasing the risk of acute side effects. Edibles require longer time to absorb and are less likely to produce a high concentration peak, although they may eventually reach high enough levels to cause an issue or interact with other medications. Topical formulations, such as creams and lotions, may not absorb and get into the blood in sufficient amount to interact with other medications, although there is very little information on how much of CBD gets into the blood eventually. All of this is further complicated by the fact that none of these products are regulated or checked for purity, concentration, or safety.

The bottom line: Talk to your doctor or pharmacist if using or considering CBD

CBD has the potential to interact with many other products, including over-the-counter medications, herbal products, and prescription medications. Some medications should never be taken with CBD; the use of other medications may need to be modified or reduced to prevent serious issues. The consequences of drug interactions also depend on many other factors, including the dose of CBD, the dose of another medication, and a person’s underlying health condition. Older adults are more susceptible to drug interactions because they often take multiple medications, and because of age-related physiological changes that affect how our bodies process medications.

People considering or taking CBD products should always mention their use to their doctor, particularly if they are taking other medications or have underlying medical conditions, such as liver disease, kidney disease, epilepsy, heart issues, a weakened immune system, or are on medications that can weaken the immune system (such as cancer medications). A pharmacist is a great resource to help you learn about a potential interaction with a supplement, an herbal product (many of which have their own drug interactions), or an over-the-counter or prescription medication. Don’t assume that just because something is natural, it is safe and trying it won’t hurt. It very well might.

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