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Cannabis and Health
The Endocannabinoid System
Dr. David Allen from 2014 on the discovery of the endocannabinoid system.
CBD Nation – Full Review
CBD Nation is an excellent documentary about CBD and cannabis that most people will never watch. You can watch it on Prime Video for $4.99 (rental) or $7.99 (purchase). 
Maybe it was supposed to be released in theaters. Maybe it will be free next year. It’s worth paying this small price to watch this year. If you have friends and family who are skeptical about medical cannabis, buy it for them as a gift.
The film starts with a study that found high levels of pharmaceuticals in bay mussels. The obvious contrast is with the cannabis plant that can heal without many of the side-effects of harsh drugs. We then hear true stories of patients, including young Jayden David who had life-threatening seizures. The legal medical cannabis industry is a patient-driven phenomenon. Harbourside Medical Center in Berkley provided Jayden with a CBD tincture in 2011. This medication virtually eliminated his seizures.
Jayden David’s epilepsy was controlled with CBD from cannabis.
Raphael Mechuloum is interviewed briefly at strategic points throughout the film. Mechuloum is the Israeli researcher who discovered THC also discovered the seizure-blocking effects of CBD 35 years ago.
Medical cannabis and CBD are presented as alternatives to harsh pharmaceuticals; and as promising treatments for difficult syndromes such as Graft versus Host Disease (GVHD). This leads to a presentation of the endocannabinoid system – our body’s natural system that helps maintain balance. Our bodies produce natural cannabinoids that maintain the balance of other systems in the body. Cannabis appears to be a plant that contains substances that help our bodies maintain and restore balance.
Rylie Maedler was the inspiration for Rylie’s Law legalizing medical cannabis for children in Delaware
Rylie Maedler was a young girl when she developed an aggressive bone tumor that began destroying the bones in her face. Her mother began researching alternative treatments for shrinking tumors and started Rylie on cannabis oil. Surprisingly these treatments worked to regenerate the bones in her face and to shrink the tumor. She did not require the reconstructive surgery that is usually needed. The Delaware legislature unanimously passed “Rylie’s Law” to legalize medical cannabis for children like Rylie.
Veterans with PTSD are then featured. Colin Wells is a founder of the group “Veterans Walk and Talk” who use medical cannabis and hike several times a week in Southern California. The founder of Irwin Naturals then describes his mission to offer CBD at reasonable prices.
The film is professionally produced and it makes a strong case for cannabis medicine. I wish this documentary could be widely viewed without paying a fee, but I guess that’s not realistic. Check it out on Amazon Prime Video or Apple Video. It’s worth the small cost of admission.
‘CBD Nation’ trailer hints at a great Documentary
The documentary film CBD Nation premiers August 25th on Amazon Video, iTunes, and other streaming services. Forbes described the film this way:
Featuring leading experts in cannabis and medicine, including Raphael Mechoulam—the Israeli scientist who discovered THC, the endocannabinoid system and the therapeutic efficacy of CBD to treat medical conditions—the 83-minute film exposes 60 years of often ignored published reports and ongoing research.
The trailer gives a pretty good idea of what is covered. Maybe this will help even more people recognize that cannabis does have healing properties.
Hemp Flower and Full Spectrum Hemp Oil are the Future of CBD
The FDA is increasingly cracking down on CBD products in the marketplace. New rules are expected later in 2020 and there has been a lot of speculation about what might be banned. The FDA is charged with (among other things) protecting the public from unsafe foods and drugs. They also have responsibility for regulating “dietary supplements.” They have been active in warning companies that make health claims when marketing CBD, and many companies use the familiar “dietary supplement” label when listing how much CBD is in their products.
Hemp flower is an agricultural product; and is obviously not a dietary supplement. It closely resembles marijuana, and a few states have even banned “smokable hemp” because it is hard to distinguish it from marijuana. It remains legal in most states, and it is one of the least expensive ways to get CBD and other cannabinoids into your system. The 2018 Farm Bill made hemp legal federally, and the FDA does not appear to have jurisdiction over the sale of agricultural products such as hemp flower.
In 2020 most hemp flower is CBD-dominant, with CBD being the primary cannabinoid present. CBG-dominant flower is newer and less is known about it and its effects. Studies thus far have found anti-cancer and anti-microbial benefits. Research is ongoing. If highly-processed CBG products become popular the FDA may step in and regulate them too. CBG flower and CBG-dominant full-spectrum hemp oil will be harder to regulate.
Full spectrum hemp oil is only one step removed from the hemp plant. Hemp oil is created when hemp is processed in such a way that the alcohol and/or oil soluable components are extracted from the plant. These are then dissolved in a neutral oil (such as MCT oil) and they resulting “hemp oil” is sold in small bottles. This oil generally contains CBD if the hemp strain is a high-CBD hemp strain. If the hemp strain is a high CBG hemp strain then the resulting hemp oil will be an oil that is high in CBG instead.
The FDA gets involved based on the labeling of products such as CBD oil. If the label includes instructions for taking the product by mouth, then the FDA likely has reason to view it as a dietary supplement, a medication, or a food product. If the label is mute on the use of the oil, then the FDA may not have any reason to regulate the sale of the product.
Those of us living in the U.S. are currently awaiting the FDA’s new regulations. While you wait, consider trying hemp flower. Most people seem to be smoking it like marijuana, but vaping is safer. (Vaping the dry herb is much safer than vaping a commercial liquid product.) You can also heat it and eat it. The cost per milligram of CBD is much lower in the raw product and you have a better chance of getting the “entourage effect.”
There is Early Evidence that Medical Cannabis may improve Executive Functioning
The stereotype is that marijuana makes you stupid. This certainly seems to happen in the short run. Marijuana has been shown to negatively impact cognitive processes in adolescents. Short-term memory suffers in adults too; as pot smokers forget things – why they just entered that room, for example. In medical cannabis this is considered “the negative side-effect of impairment.” When dosing medical cannabis the goal is usually to dose low enough that impairment is minimized. Research has shown that in some cases cannabis is neurprotective. It may prevent damage to brain cells. Can medical marijuana help improve cognitive functioning?
A 2016 study led by Staci Gruber, Ph.D. suggests that medical marijuana may actually improve executive functioning in adults. Dr. Gruber works at the McLean Hospital Imaging Center in Belmont, Massachusetts and is on the faculty of the Harvard Medical School. She and her colleagues followed 24 certified medical-marijuana patients over a three-month dosing period. Their cognitive skills were measured with a battery of tests that included the Stroop Color Word Test and Trail Making Test.
Subjects in the research improved in their speed of performance on these two tests and their accuracy remained constant. The authors acknowledge that there is a possibility that this improvement in speed is due to “practice effects.” We tend to do better on a test when we have taken the test before. The authors cited past studies that people taking these particular tests don’t usually improve, even with weekly “practice.”
The authors note that the medical marijuana patients participating in the study also reported improvements in many of their symptoms.
You can read the full study here:
Splendor in the Grass? A Pilot Study Assessing the Impact of Medical Marijuana on Executive Function
What to Tell your Doctor if you use CBD or THC
It’s a good idea to tell your doctor about anything you are taking that might influence other medications. If you have been told to avoid eating grapefruit with a medication, for example, then you may need to use caution with CBD as well. A recent study looked at the in-depth issues when taking CBD with other drugs. They explore the cytochrome P450-complex enzymes in particular. It turns out that the interactions are complex but usually mild. The authors conclude that CBD is usually a very safe substance.
My doctor was supportive of my taking CBD. She reported that it has helped some of her patients and that she has even recommended it at least once. I see other doctors for a couple of chronic illnesses, and they showed no interest in the fact that I take CBD.
Many physicians are not familiar with the fact that our bodies produce natural cannabinoids that seem to help maintain balance or “homeostasis”. The endocannabinoid system has been studied since the first endogenous cannabinoid was discovered in 1992. Anandamide was discovered by Raphael Mechoulam (the scientist who earlier discovered THC and CBD) along with NIMH researchers William Devane and Lumir Hanus. It attaches primarily to the CB1 receptor in our bodies. In 1995 Mechoulam discovered the second major endocannabinoid “2-arachidonoylglycerol” or “2-AG” which attaches to both CB1 and CB2 receptors.
Supplementing our natural endocannabinoid system with phytocannabinoids (plant-based cannabinoids) has some risks. These risks are seen mostly with THC. It’s probably even more important to tell your doctor about any THC use. Heavy users of marijuana can develop tolerance, with higher and higher doses needed over time to get the same effect. Very heavy THC use can also lead to a rare disorder called cannabinoid hyperemesis syndrome. The most troubling symptom of this disorder is severe bouts of vomiting. Persons susceptible to psychosis should probably avoid THC because there is evidence that it can contribute to a psychotic episode. As noted above, CBD has not been found to have such risks.
Many people who live where marijuana is illegal do not report THC use to their doctor. They may fear that such a disclosure will become a part of their medical record and that the information will eventually make its way to their insurance company or someone else. It’s probably a good idea to report THC use in any case, but it is especially important if you have any symptoms that may be related to such use.
How does CBD work to decrease the risk of Psychosis?
It has been known for some time that THC may make psychosis worse in persons who are at risk for schizophrenia and other psychotic disorders. There have also been studies finding that CBD decreases the risk of psychosis in these people. The mechanism of this antipsychotic property has been elusive. A team of researchers from King’s College in London Performed an interesting double-blinded placebo study that was published last year in JAMA Psychiatry.
The authors studied 33 persons deemed “at clinical high risk” (CHR) for psychosis and compared them to 19 health control participants. 16 of the CHR subjects received a single 600mg dose of CBD and the remaining 17 received a placebo. Control participants did not receive anything. According to the researchers “All subjects were then studied using functional magnetic resonance imaging (fMRI) while performing a verbal learning task.”
This design allowed the researchers to see what is happening in the brain in real time while participants are using their brains to perform a standard task. They found that “Cannabidiol [CBD] may partially normalize alterations in parahippocampal, striatal, and midbrain functions associated with the CHR state.” They believe that these brain regions are involved in psychosis and that the CBD acted as a therapeutic agent to normalize brain function in these areas.
All subjects had been asked to avoid alcohol, cannabis, and other recreational drugs prior to the study and a urine test was performed to confirm that they complied with these instructions. They performed some fairly complex statistical analyses comparing the different groups – control participants, placebo participants, and CBD participants. In general the participants at high risk for psychosis showed brain patterns intermediate between the placebo participants and the controls. CBD apparently partially corrected the problems that were developing in their brains.
Will CBD ever be used as a treatment for psychosis? That’s not as far-fetched as it sounds. High dose CBD (in the form of Epidiolex) is already FDA approved to treat certain seizure disorders. It could certainly be studied as a treatment for psychosis as well.
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