#110 - Hemp in Healthcare: The Science Behind CBD with Dr. Clint Sellers, Part 1

Welcome to The Factor Podcast, where we talk about the stuff they didn't teach you in school, how to grow your practice, refine your clinical skills, and get better results for your patients. We're here to help you navigate the real-world challenges of being a healthcare provider, from delivering top-notch patient care to running a business that doesn't run you into the ground. Whether you're fresh out of school or scaling your practice, we're diving into effective cutting-edge treatments to get patients better faster. We'll also talk about business strategies and tactics to help you work smarter and not harder, and the mindset shifts required to thrive as a top performer in your field so you can build a career you love without burning out. If you're ready to learn what works and what doesn't from leading experts, industry innovators, and respected clinicians across a wide range of specialties, you're in the right place, my friend. Let's dive in. Did you know there's an entire system in your body that most medical schools never teach about? Yet it impacts sleep, pain, mood, and recovery, and CBD may just be the key to unlocking it. Welcome back to The Factor Podcast. I'm your host, Jessica Riddle, and today we're kicking off a new 2-part deep dive on hemp in healthcare, clinical applications for better patient outcomes. Today's special guest instructor is Dr. Clint Sellers, a certified chiropractic sports physician and the owner of Peak Performance Chiropractic in Raleigh, North Carolina. In part 1, you'll discover the surprising history of hemp, the science of cannabinoids, and why most of us are unknowingly cannabinoid deficient. Dr. Sellers will break down the differences between hemp and marijuana, the entourage effect, and how the endocannabinoid system quietly influences everything from pain to mood to sleep. Whether you're curious about CBD or are ready to integrate it into your practice, this episode will give you the foundation that you need. Let's get started.

Thank you, Jessica. Like she said, we're here to talk about hemp in healthcare. I'm Dr. Clint Sellers. I'm a certified chiropractic sports physician, and I own Peak Performance Chiropractic out in Raleigh, North Carolina. For anybody that wants to get ahold of me, like Jessica said, I, I've posted my social media contacts here and my personal email. Feel free to reach out to me after this offline with any questions that you might have. What we're really going to jump into today, we'll do a little hemp overview, Hemp 101, talking about the endocannabinoid system and some of the cannabinoids, and then really how to gauge quality brands and quality products and how to do that easily within the landscape that we're in. Then we can talk about some, some common patient needs and dosing, which tends to be really probably the number one question that I get from, from patients or friends and other practitioners. Dosing can be pretty, pretty tough, so we'll, we'll definitely cover that as much as we can. We won't get into really any specific patient stuff today, so just disclaimer, like, this isn't, this isn't designed to really give out direct medical advice today. It's more of an overview, um, where we're at in the industry and what are the potential uses. The CBD industry is— it's really ever-evolving. Regulations are changing all the time, and to date there isn't a ton of research that's out there. There is some really, really good stuff that is out there, but The, the industry is still learning and it's still growing, and there are some really great companies out there that are really pushing the envelope. The one that I have worked with for— been lucky enough to work with for the last couple years is Ananda Professional. They're doing a lot in the industry for research development. They're located out in Lexington, Kentucky. And they have by far the best products I've seen on the market, hands down. So first thing we'll do, let's jump into learning a little bit more about hemp, where it comes from and how it works. Hemp has been around and has been in pretty continuous use for over 8,000 years. The first known usage of it was an emperor in China in 2737 BC, and he made a CBD tea that they used for gout, malaria, and rheumatism at the time. And then we, we see it used pretty, pretty continuously throughout history after that. It was actually a really, really big part of the US pharmacy world for quite a while until about 1937. And that's when the Marijuana Tax Act got enacted, and that increased the pricing and made it harder to get. They also— around that same time, there was a movie called Reefer Madness that came out, and that movie was— it was an exploitation film that was really designed as a scare tactic, and it basically said that marijuana was a gateway drug to All sorts of different crimes and suicide. So around, around that time, you see a big shift, and then you've got this Congressional Research Service that was enacted with the introduction of morphine and opioids. So we see a big shift in our industry going to more of the traditional Western medicine we see today with, with pharmaceuticals and such. A lot of people tend to get Hemp and marijuana mixed up, or a lot of patients come in asking about it. What is the difference? They are both from the same family. The difference really being the THC levels. So you'll— hemp you'll find is federally legal and you can get it over the counter and it must have less than 0.3%. So it's about a third of a percent. Of THC per weight. Marijuana, on the other hand, we all know is not federally legal and it has a much higher concentrations of THC, so upwards of 5 to 35%. So marijuana is intoxicating. You've got psychoactive effects. Hemp is not. Then we can really break hemp down into major and minor cannabinoids. There are actually over 100 endogenous and exogenous cannabinoids that are known currently. Those can be further broken down into the major and minor categories. So the major ones we know of in our— in the industry, we're talking about CBD and THC. There are other minor cannabinoids that show up in lesser concentrations. They're not quite as researched to date, but they are really showing some great potential in therapeutic usages. Some of them you may have heard of are CBN, CBG, CBC. Like I said, there's quite a few of them. The slide we're seeing right here, this is a breakdown of a full spectrum hemp extract. We'll talk about that in a second, but you can see large concentration of CBD, smaller concentrations of other, these other minor cannabinoids. Key terms that we really, we need to learn and focus on when it comes to this topic. We already talked about hemp and marijuana. Big difference is THC. Remember hemp, less than or equal to 0.3% THC by weight. Marijuana, more than 0.3%. CBD is a cannabinoid molecule that is abundant in hemp plants. Remember the CBD is non-intoxicating, and that's where we get a lot of our therapeutic benefits Cannabinoids are molecules that interact or exert effects on our endocannabinoid system. The endocannabinoid system being our bodily biological system, it's composed of CB1 and CB2 receptors, and that has various pathophysiological functions, including maintaining homeostasis. So these are located all throughout the body. We'll talk about this a little more in a minute, but just remember endocannabinoid system, CB1 receptors, CB2 receptors that do different things throughout the body. When it comes to products or hemp extracts, you'll see 3 varying kind of varieties. You could say you've got isolate CBD, which is just purified CBD molecules. There's nothing else in it. Then you can get into broad spectrum and full spectrum. The main difference between these 2 is the THC. So in a broad spectrum extract or product, you won't find any detectable traces of THC, but that product is going to contain CBD molecules as well as other minor cannabinoids. You'll also get some terpenes in there, some flavonoids. But remember, broad spectrum, no THC. Full spectrum, on the other hand, same as broad, except that's where you get up to that 0.3% THC. The reason that that matters is this term entourage effect. These terpenes and these minor cannabinoids, they all work very harmoniously to enhance each other. So adding these other minor cannabinoids, you'll get a greater effect from the CBD just by having those in there. And you can also use those to really target kind of what you're going for within the body, which is pretty cool. THC, we, I think all of us probably know that's the intoxicating part or cannabinoid molecule that's in the hemp plant. And then endocannabinoids, those are the endogenous cannabinoids we produce within our body. The 2 most well-studied and identified are anandamide and 2-AG. So endocannabinoids, obviously inside our body, but then phytocannabinoids are cannabinoids produced in plants. Right now there are over 140 known phytocannabinoids. Currently that we know about. Anandamide, that first endocannabinoid, that one focuses or really plays a role in CB1 receptors. 2-AG, that plays a role in both CB1 and CB2 receptors. So you can kind of see where targeting can also come into play a little bit more there. CB1 receptors are really primarily in our CNS. So that, that's a main receptor of the endocannabinoid system. Lots in our central nervous system, and it's actually the most abundant G-protein coupled receptor in the brain. CB2 receptors, those are less in the CNS and more in our periphery. And our immune cells. So hopefully that gives a little understanding of how to kind of break down that endocannabinoid system. And you can see it in this next slide, for those of you who can see it, where those receptors tend to be in more abundance throughout our body. So we can use those different products, target different receptors to do different things within that endocannabinoid system, because that whole system is a neurotransmitter system that uses the cells to tell the body what to do, including homeostasis, a lot of other things that it regulates— sleep, mood, energy, lots of different things that we can really focus on. Can be used to supplement that system if we're deficient or if we're not making enough.

At Factor, we literally get dozens of inquiries every year from product companies that want to partner with us for distribution through our online store or to tap into our global provider network. But we're highly selective, and about 99% of the product samples that were sent just Usually aren't a great fit. When CBD became a hot item in healthcare a few years back, I was intrigued enough to want to learn more, but I was a little overwhelmed with all the options out there, and I wasn't quite sure who to trust when it came to some of the claims that were being made. Then I met Dr. Clint Sellers, and I was introduced to Ananda Professionals. He sent me a few samples of the products he uses with his patients, So that I could experience the results firsthand. And I have to tell you, I was a little blown away. I was getting better sleep and saw a noticeable difference in my focus and post-workout recovery. That's when I knew this was a product line I wanted to partner with. And now we're excited to be offering the Ananda Professionals line of products in our Factor online store. Ananda Professionals is a line of CBD products designed specifically for healthcare providers and their patients. They're committed to quality, transparency, and rigorous third-party testing. In fact, they're created and produced in the only LEED Platinum certified operation in the United States so that you know exactly what's in every bottle and more importantly, what's not. Whether you're looking to offer CBD in your practice or add a safe, effective option for your patients to use at home, Ananda Professionals sets the gold standard. You can learn more and explore the full line of products in our Factor online store. Just click the link in the show notes to get started and stay tuned on more details about the full program we're working on so that you can offer these products directly to your patients. Back to the show.

Typically the next number one question at that point would be, how do we know if we're not making enough? And the answer is basically nobody is. And that is because the only endogenous cannabinoids that we, we take in is through breast milk. So after we're done breastfeeding, we're typically not getting any cannabinoids in our normal daily lives. It used to be that Cows would eat hemp, we would eat the cow, we would get some that way. But Western diet, it really pretty much zeros. So most everybody's going to be deficient in cannabinoids, which leads to kind of this, you don't use it, you lose it within our body. So we're not stimulating that endocannabinoid system. So those receptors will tend to almost go dormant.

Mm-hmm.

Or the body's not producing as many of them. So we're not quite ready to take them in if it's been a long time since we have. This is why sometimes you'll hear people say that first time that they smoked pot, for example, nothing happens. Like, oh, I didn't feel anything. That's because those receptors aren't ready for it to be reintroduced into the body. So then they do it, the system ramps up, they start to produce more, their body is more ready for it. And then if they, if they do it again within, you know, a reasonable amount of time, all of a sudden, bam, they get high as a kite, or, and they weren't expecting it. That is because of, of the system ramping back up. You'll see the same thing happen with some CBD users. They'll come into your office and they'll say, I tried CBD, but it really didn't do anything for me. Well, that could be because one, they didn't dose it correctly, or two, it could be because those— the system needed to be ramped back up before they could get that full therapeutic benefit from it. This is Dr. Raphael Mechoulam, I believe. He's the chemist who identified the endocannabinoid system. And he's quoted here saying, I can't list all the physiological symptoms and conditions affected by cannabinoids because there are too many. So the guy that, that identified it and spent a lot of time researching it is basically saying like he doesn't even know the end of, of where, what all can be done with it. Speaks to the importance of the endocannabinoid system. And then the other part too is this isn't really highly taught, especially not in medical, nursing, or pharmacy schools. The last, last numbers we looked at, it was around 13% of schools even talked about it. So we as more holistic practitioners are in a very good place to be able to kind of really move this in the right direction and utilize this for our patients. So getting back to the isolate, broad spectrum, full spectrum, where that really comes into play. CBD has a ton of, of potential and really some awesome uses for it, but just straight CBD isolate by itself, of the 3 that we've mentioned, would be the least medicinally beneficial compared to full spectrum would be the max beneficial. Due to that entourage effect, all these different minor cannabinoids and potentially a little bit of THC are playing a huge role in enhancing the effects that you get. So let's see what that looks like. This is a dose-response curve of isolate, broad, and full spectrum products. You can see the bottom line there, it's that orangish color. That is the CBD isolate, and you see a very slow, steady, kind of low blood concentration over time versus that bluish line is the full spectrum. You get this nice spike early on. So you can see here where lower dosage with a much higher effect with a full spectrum. Broad's not too far behind, but the, that little bit of THC definitely gives it a boost. But even both compared to just the regular isolate, much higher effect at a much lower dosage. So again, when you're talking about that, the importance of it would be isolate CBD really requires about 5 to 10 times the dose of full spectrum. So when we're talking about giving this to patients or, or taking it yourself, what that really means is lower dosage, decreased side effects, decreased drug interactions, decreased risk of hepatotoxicity, better tolerable, better safety. Lower dosage obviously is always a, a better option. When it comes to drug interactions, while we're talking about that, the only The only one I've ever actually heard of is to be careful with blood thinners and warfarin specifically to just stay away from when it comes to hepatotoxicity or some of these other, other things. Or a lot of patients will ask about, is it possible to take too much or overdose on CBD because they're still comparing the two between Is it a drug? Is it marijuana? Or is it a safe product? The risk of overdosing on CBD is, is very, very, very low. It's very hard to do. The typical CBD product you'll see is probably around 600 milligrams per bottle. So it takes 600 milligrams per kilo of body weight to overdose. So the average person weighs about 55 kilos. So that, that equates to taking about 55 bottles of a product in order to reach that kind of a number. Probably not gonna happen just from an ingesting standpoint, but your body would probably get sick from any oils or something in that product, or you would eventually just get tired and go to sleep before you could ever reach that point. It's not impossible, but highly, highly, highly unlikely. So why we care really as practitioners, like let's get into a little bit of some studies and how it can help our, our friends, family, patients, et cetera. This is a study by Brightfield in 2020. They compared CBD product efficacy to traditional medications. And if you look over here on this, on the right side, you'll see the top conditions that they treated. Joint pain, depression, insomnia, and anxiety. And I don't know about, about you guys in your practices, but these things tend to kind of come together, at least in pairs, maybe all 4. But most people with joint pain, they could be also experiencing insomnia and depression because of it. A lot of people with insomnia may also have depression, anxiety, and joint pain. So this is a great, great potential and a great opportunity for us to look at our patients from that 300-foot view, look at them as a whole and treat them as a whole on top of the things that we're doing in our office. Some cool stuff that they found. 80% of those CBD users said that the CBD product, the cannabis product, was very or extremely effective as a treatment option. Which is pretty amazing by itself. 42% of those users stopped using their traditional medications and now they use CBD products instead. A lot of us are always looking at ways to potentially get patients off of pharmaceuticals. Right there, 42% of them moved away from those pharmaceuticals. If you look on this left side, the CBD products versus over-the-counter or prescription, you've got 42% of those in the studies said that the cannabis or CBD product was much more effective than the over-the-counter. Another 25% said it was more effective. So those numbers are looking pretty awesome. Prescription medications, 30% said that the CBD was much more effective. Another 22% said more effective. So again, this stuff's working for patients and it's working very well compared to other things. In that study, what the products or treatments that those people were were using other than CBD. 71% over-the-counter pain relievers was the biggest. We've also got herbal remedies, topicals and ointments. 37% were using topicals and ointments. A lot of our patients are using those. Prescription painkillers, anxiety meds, sleep meds. 41% of the people in that study are now using a CBD product instead of those products. 37% are using both. 21% alternate between the two. And the cool thing, only 1% are actually using those other treatments instead of the CBD. And this was their top Pain management. Pain patients all day long. 33%, they called this an unwinding category, which they included anxiety, relaxation, and stress in there. 18%, general wellness. That's where you've got your sleep and cognition people, energy people. And then 9% of those users were for specific medical conditions like GI and other things. And then the last one here, the British Journal of Pharmacology, they came out after a study saying the dose required for CBD alone is 10 times higher than when it's combined with THC. So take that back to that full spectrum, broad spectrum kind of entourage effect. So hopefully that gives a good general idea of, of CBD and kind of the The overview of it, but when it comes to providing or recommending these products to our patients, like how do we as practitioners know who to trust and who is a reputable and good, good brand to kind of tie our names to? Because I know in our office we spend a lot of times when it comes to any kind of supplement, making sure we're providing or recommending the best possible stuff we can. And in the CBD world, there's some easy, quick ways to judge that. Real quick though, an overview of, of why it's important for us to do the work. This is a slide showing FDA inspections. So every CBD manufacturer should be inspected by the FDA, but they only know to, to inspect them if they register.

Mm-hmm.

So if they don't tell the FDA what they're doing, the FDA doesn't know that they should go in and check them out. You can see by this graph though, even with the registered ones in 2009— for those of you who can't see the graph, there were about 13,000 inspections done that year. 2011, it ramps up to about 18,000, and then you see this big drop-off, and then it kind of swings back up. And then around COVID time, huge drop-off. And as of 2023, there was one inspection done on CBD manufacturers by the FDA. Moral of the story there, they're not really protecting us in the— in this market. It's up to us to know what we're providing. When it comes to looking into these, these different products, and this really, this counts across all supplements, we need to worry about things on a safety perspective, like heavy metals and pesticides and solvents, microbials, E. coli, salmonella, that kind of thing. And then foreign materials too, hair, metal shavings, glass. I have a lot of patients that they'll come in and we'll talk about CBD and they'll say things like, oh yeah, I get CBD from my buddy who makes it in his basement. And first of all, I've got a lot of questions there as far as where's this stuff coming from, but also how are they making it? Like, is it a clean environment? What's going into this? Are there pesticides? Where are they getting their product? So knowing the quality of the brand and what they're doing helps us to get a better understanding of this. And then we've got impacts to satisfaction too: flavor, color, smell. Like patients want something that tastes good, feels good, easy to use, consistent outcomes. Like they're gonna they know we know that they're getting. The same thing every time. Not as important as safety really, but also something really to consider there. And then processing it, we should, we should really understand kind of this seed to seal mentality of how are they farming it? How are they growing it? What's pesti— are they using pesticides? Are they organic? How are they refining it and bottling it and manufacturing it? And if we can't physically go see all those things, we need a way to quickly evaluate those things from where we are, which is why every CBD product should have a scannable QR code on the bottle, on the box, literally anywhere on that product that you can see. I've got a few right here, like QR code right there. When you scan that, it should take you to a certificate of analysis that's got all sorts of information. It should be very extensive, and you should be able to see all these things that we've been talking about— lot specific, what they're testing, etc., etc. So transparency from the company and ease of finding it is very important. It actually took me to a certificate of analysis, but really it was like one line and said, we tested this stuff and you should trust us, was basically what it said. Not, not gonna work for me. I'm not gonna trust that company. The certificate of analysis, you also should be able to use to determine the spectrum of that product. So you'll see here on the left side, that's an isolate CBD product.

Mm-hmm.

Everything on there is non-detectable except for the CBD. You can see right there on the label, on the certificate, nothing is in that product except for CBD. Next to it, you'll see the full spectrum list and you'll see Delta-9 THC number, CBD number, CBC, there's some in there, CBG is in there. So that product has THC, CBD, and other minor cannabinoids. That is a full spectrum product. If that was a broad spectrum product, it would look just like that, just with non-detectable THC. And you should see things like this on that certificate of analysis. What are they testing for? Microbials, mycotoxins, solvents. All of these things should be listed, and obviously they should pass all of these inspections, but they should be telling you exactly what they're doing and what the results were, lot specifically, based on every product that goes out. And it should show you how it was made and, and where the different ingredients are coming from. So you'll see here, this is an Ananda product. It's, it's a full spectrum soft gel. The ingredient list at the bottom here, hemp seed oil, organic, who manufactured it, what the lot number was. The gelatin came from Nutrafood Ingredients. There's your lot number. So you can look at this product and know exactly where everything that's in it came from. And then do they have third-party certifications on there? It's really easy for a company like that one I just talked about says, we were doing these things, we tested it. It's good. I promise. But do they have somebody that's coming in and backing them up and saying, yes, these guys are doing the things they say they do. We're also going to put our name on it. So they are backing up what they're putting out. You should see that when you scan that QR code. Cool. So that hopefully that gives you an idea or a little better understanding of how to judge a quality brand. The good ones, I know Ananda, they're super transparent. I've got reps I can talk to. I've been to their farms. I've been to their facility. Really, really high-level, great company to work with. I know there's other good ones out there, but that's who I work with and, and judge things off of. And they've really set the bar pretty high for me.

That's all for today's episode with Dr. Clint Sellers. Today we learned the science behind hemp and CBD. And why the endocannabinoid system is such an important yet often overlooked part of human health. But we're just getting started. In Part 2, we'll explore how to choose quality products, best practices for dosing, and real-world case examples of CBD use in patient care. Be sure to join us for the next episode so you don't miss these practical strategies that you can apply right away in your own clinic. Part 2 drops in 2 weeks. As always, you can find the link to the full webinar replay of today's training linked in our show notes, and I've included a list for you of Dr. Seller's favorite CBD products. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R- To find out more information about all that we have to offer. We have a variety of online offerings as well as our hands-on Factor Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.