Photo by Taisiia Stupak on Unsplash

By Lisa Profera MD

As I wrote in last month’s article: “The science is finally catching up with what people have known and experienced for thousands of years. These are exciting times.” In the previous article, I discussed CBD (cannabidiol), the new superhero of plant-based medicine and how it works in our endocannabinoid system (ECS).

Humans have evolved on this planet with cannabis plants for thousands of years, and our bodies recognize cannabinoids and terpenes as natural compounds. Cannabis was used as medicine in the Neolithic era as early as 12,000 years ago, and has continued to be used in some capacity in numerous cultures throughout history. The vilification of cannabis as a dangerous and toxic substance is relatively recent history—an idea that only gained traction in the US in the early 1900s—and was mostly driven by political and racist agendas (more details on this found in the book Smoke Signals by Martin Lee, 2012).

It turns out that cannabis is an amazing medicinal plant with hundreds of biologically active components. The biochemical constituents that exist in a plant extract are naturally balanced and do not act alone. In fact, the symphony of compounds packaged by nature work better together—greater than the sum of their individual parts. This is known as synergy, and is commonly referred to as the “entourage effect.” Pharmaceuticals are synthetic isolates (mostly single chemicals mimicking something natural). When something is packaged in an “unnatural form,” the natural response of our immune system is to react to the foreign invader, to reject it or fight against it. This is why so many people experience side effects from synthetic pharmaceuticals and over-the-counter medications.

As part of my lifestyle medicine practice, I do recommend medical marijuana products for my patients with qualifying medical conditions as outlined by the State of Michigan. Cancer, PTSD, autism, arthritis, cerebral palsy, inflammatory bowel disease, Parkinson’s, HIV, and many more conditions qualify for medical marijuana use. These guidelines also include any conditions that cause chronic pain, muscle spasms, seizures, severe nausea, or cachexia. See the complete list at the link at the bottom of this article*. As more and more compelling research is published, more conditions are added. Dr. Tod’s list of chronic conditions treated with cannabis can give you an idea of its potential**.

Many of these patients suffer chronic pain conditions which are otherwise debilitating, causing loss of function and loss of work days. CBD is a non-psychoactive chemical found in medical marijuana that is a potent pain reliever, anti-inflammatory, and antioxidant. It also reduces nausea, anxiety, relaxes muscles, and relieves spasms. Many of these patients would otherwise be dependent on other anti-inflammatory agents, which can have serious gastrointestinal side effects, and/or opioids, which can cause dependence, addiction, and death. 

Overuse of prescription narcotics has become a huge problem in the medical field in the USA. In fact, states that have legalized medical marijuana have noticed a sharp decline in the number of narcotic prescriptions and opioid overdose-related deaths. CBD oil is a safe, effective alternative that has helped many people lead functional lives. There are no cannabinoid receptors in the brainstem, so medical marijuana cannot cause respiratory depression (the cause of death in opioid overdose). Since I have been helping people with CBD for a few years, it is very gratifying to hear that they are doing much better two to three years later when I see them for a follow-up visit—off of opioids and many other synthetic medications. 

What is the difference between CBD derived from hemp and CBD derived from marijuana?

This is where the nomenclature gets confusing. Hemp and marijuana are the same cannabis plant. The federal government has defined a plant as “hemp” when it contains less than 0.3% THC by dry weight (Section 7606 of the Agricultural Act, recently renewed when Congress approved the 2018 Farm Bill). THC, CBD, and the other phytocannabinoids are produced mainly by the trichomes of female flowers; a very small amount is produced in the leaves.   

By this definition, every female cannabis plant is considered “hemp” until it flowers and produces THC. The male plants are mostly used for breeding or are discarded. There are some rare strains of cannabis that are naturally low in THC while having very high amounts of CBD and other phytocannabinoids. Finding a grower that has these strains is considered the “golden ticket” of medical cannabis.

This definition of “hemp” is arbitrary and has no scientific basis. Historically, industrial hemp referred to the strains of cannabis used for rope, canvas, and other fiber-derived products. Because it typically has low concentrations of phytocannabinoids, it was not used for medicine. The 0.3% was a taxonomic delineation found in a botanical textbook, not a medical one (A Practical and Natural Taxonomy for Cannabis by Small and Cronquist, 1976). Even though you will find CBD products virtually everywhere you look these days, the FDA does not recognize hemp-derived CBD as a food supplement or a medicine. CBD oil from cannabis with greater than 0.3% THC is considered medical marijuana. CBD oil from marijuana plants with less than 0.3% is considered medicinally superior to that derived from industrial hemp. 

Since 1970, THC has been considered a Schedule I drug, along with heroin, LSD, and ecstasy. Schedule I substances are considered dangerous and have “no currently accepted medical use” according to the DEA***. THC has been shown in numerous medical studies to have legitimate medicinal value as a treatment for severe nausea and anorexia in cancer patients, as well as a treatment for glaucoma, certain brain tumors, and more, yet the 1970 classification still stands. Most opioids are Schedule II substances. Think about that.

How can CBD help me?

Since CBD is a master regulator of the ECS, it can basically help anyone who has an imbalance in that system. Since the ECS is the most widespread system in the human body, any malfunction of this system can result in widespread problems. This is the subject of a lot of interesting research. Scientists who study this system have found that many diseases are caused by either underactivity or overactivity of the ECS. While some people may be genetically predisposed towards ECS dysfunction, others may develop it over the course of their lifetime. Some of the medical conditions that have been linked to ECS dysfunction are autoimmune diseases, seizure disorders, fibromyalgia, irritable bowel syndrome, complex regional pain syndrome, cardiovascular disease, depression, anxiety, schizophrenia, multiple sclerosis, nausea, motion sickness, Huntington’s disease, Parkinson’s disease, menstrual disorders, and failure to thrive in newborns. Poor activity of certain enzymes that break down our endocannabinoids has been implicated in obesity and type II diabetes. Furthermore, our bodies have the ability to up-regulate or down-regulate our CB1 and CB2 receptors depending upon what is off-balance. This system is complex, but once the proper balance is achieved, the healing can begin. This is another reason why single isolates such as high-potency CBD distillates from hemp or synthetically-made pharmaceuticals don’t work as well and can cause many side effects.

What is the best type of CBD?

The best CBD oil is derived from cleanly-sourced, CBD-rich strains of marijuana (some have ratios of about 20:1 CBD to THC). Technically, this product would contain 1% THC, which is above the legal designation. If you have your State of Michigan medical marijuana card, you can have access to this type of very therapeutic product. Research shows that a small amount of THC helps your CBD work better. In practical reality, 1% THC is really not going to make most people “high.” In fact, CBD actually blunts the psychoactive effect of THC. 

THC is now legal for recreational use in Michigan. It does have medicinal value, like CBD does. With proper guidance from a health professional who understands cannabis, a patient can experience the health benefits without the unwanted psychoactive effects.

It is extremely important to get a 100% “clean” product from a reliable source with third-party lab testing. Many growers use synthetic fertilizers and growth factors to maximize their yield. Even “USDA Organic” certified regulations allow for the use of over 40 synthetic pesticides and fertilizers as long as the grower adheres to their accepted “dosing schedule.” There are people growing cannabis in a more natural manner (with natural fertilizers using polyculture techniques and natural means of pest control). Most growers grow their plants indoors with artificial lighting and soil conditions. Outdoor growing is considered more desirable, since the full UV spectrum produces a greater host of phytocannabinoids and terpenes for an optimal entourage effect. 

Since all cannabis plants are bio-accumulators, the plants have an affinity for absorbing heavy metals and other contaminants from the soil in which they are planted. A good grower will monitor and test the soil conditions. Since this is largely unregulated, there can be huge variability in product quality and purity. Farmers that grow industrial hemp for other purposes can make extra money selling their excess hemp plant material to CBD processors. This plant material can be tainted with pesticides, heavy metals, molds, fungi, and other potentially harmful things. Hemp has been intentionally planted in certain polluted areas around the world to help clean up the soil. This is known as phytoremediation, and these plants should not be sold to people for medicinal use. Because hemp plants are naturally CBD-poor, it takes a very large number of plants to extract a small amount of CBD. This significantly raises the risk of contamination, and toxins can be more concentrated. Stay away from hemp products sourced from foreign countries.

In general, hemp is a poor source for the other beneficial phytocannabinoids found in cannabis plants, such as CBG, CBN, and many more that contribute to the entourage effect. Since industrial hemp is naturally low in CBD, large quantities of it are often distilled to produce a high-potency CBD oil. Unfortunately, during distillation, any other phytocannabinoids and terpenes that may have been present are destroyed. The result is an unbalanced product or monocannabinoid. The high-dose CBD oils you may find on the web or in stores (2000 or 3000mg per ounce) may be too much CBD for some people to handle, especially if they are taking other medications or have liver disease. 

Our liver metabolizes 60-80% of all pharmaceutical drugs though the Cytochrome P450 system (CYP450). Since CBD and THC inhibit CYP450, the metabolism of other drugs can be slowed, resulting in toxic drug levels. The synthetic CBD isolate, known as the drug Epidiolex, has caused significant interactions with other anti-epileptic drugs, whereas low-dose whole-plant CBD extracts do not. People with liver disease or genetically-inherited CYP450 dysfunction are also at high risk. 

Monocannabinoids such as those found in popular CBD isolates lack the entourage effect provided by a balanced full spectrum product. There can also be a greater risk of drug interactions. Despite this, the first synthetic single molecule cannabinoid has been approved by the FDA and is manufactured by GW Pharmaceuticals. Epidiolex has been approved for use in children with certain types of seizure disorders. The average annual cost of this medication is $32,500. Some insurance companies will cover this, but for those patients without good insurance, the cost is prohibitive. In comparison, a typical dose of a high-quality full spectrum CBD oil for a 50-pound child would cost less than $2,000 a year.

Besides other phytocannabinoids, the additional terpenes found in cannabis are also found in other plants (most commonly in their essential oils). The top five terpenes found in cannabis are β-Myrcene, β-Caryophyllene, d-Limonene, α- and β-Pinene, and terpineols. These are also found in different parts of some plants such as hops, black pepper, citrus rind, and pine needles. Other familiar terpenes such as linalool are found in some strains of cannabis, but are more commonly associated with lavender.

Don’t be fooled by the labelling. Products that say “Pure CBD” or “No THC” are often isolates or distillates. If they are cheap, I would be suspicious of a foreign source or mass-produced industrial hemp not intended for medicinal use. “Full Spectrum” or “Broad Spectrum” CBD products are superior. Products are often mislabeled. In a 2017 study published in JAMA (The Journal of the American Medical Association), 69% of products studied were labelled incorrectly. Some products had little to no CBD in them whatsoever. Availability of third-party testing results can be helpful. Look for products that not only list the total amount of CBD in the bottle, but also the milligrams per dose.

CBD can blunt the psychoactive effects of THC while enhancing its anti-inflammatory properties. As stated previously, a little THC helps your CBD work better. The two go hand-in-hand. Referred to as “the power couple,” THC and CBD work together synergistically. When dosed correctly, CBD can magnify the beneficial effects of a very small amount of THC without its unwanted psychoactive effects. Micro-dosing THC (about 1mg) with CBD is a very effective strategy for medical marijuana patients. According to a 2005 report published in Nature, the administration of a low dose of THC (1mg/day) orally in mice with atherosclerosis resulted in a “significant inhibition of disease progression.”

These cannabinoids have great potential to help so many people, and we’ve only been brushing the surface. As it should be with any medicine, the quality and sources of CBD really do matter. The marketplace is rife with misinformation, which can be confusing to the consumer. In the next article in this series, I will cover dosing and modes of administration for various CBD products. Stay tuned!

BIO: 

LISA PROFERA, MD

Owner and Founder of PROJUVU MD

Aesthetics and Lifestyle Medicine in Ann Arbor, MI

doTERRA Essential Oils Wellness Advocate

BEMER Independent Distributor

www.projuvu.com

1-844-PROJUVU

drprofera@gmail.com

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