Breast cancer is the most frequent cancer among women, impacting 2.1 million women each year, and also causes the greatest number of cancer-related deaths among women.
My patient, Jessica found her first breast lump on a self-exam. She was 32 years old. 

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Here is her story :

I considered myself a “Super Mom”. I could do everything by myself without asking for help. I am a successful attorney, entrepreneur with my own law firm, married, have a two-year-old, and I manage to juggle it all. I knew there was something wrong. I felt a pull; a tightness in my chest muscles and underarm while carrying my toddler. When I first felt the lump in my breast, my heart sank. I thought that the disease was a sign. A wake-up call. An opportunity for me to re-examine my life. "I have cancer". The words engulfed me like a dark abysmal sea. My partner and I curled up together in the early mornings and wept quietly so our children would not hear. Grief and despair smothered our house. 


The most challenging thing for me to accept is that I can not control everything. At some point, the shock faded, and the routines of scheduled chemotherapy, daily radiation, surgery recovery, and physical therapy gave me a sense of calm. I had several months of fertility treatments followed by an egg retrieval procedure, eight rounds of chemotherapy, a bilateral mastectomy, and several reconstructive surgeries over four years. 


Out of the grief, an amazingly strong will grew inside me to win the battle of healing my body and my soul. I fought to be healthy for myself and my family. Even though I was receiving intense chemo treatments, I dramatically changed my nutrition, focusing on eating healthy food while exercising every day. Even if it was a ten-minute walk down the street, I did everything I could to keep my body moving.


I did well with the initial surgery and chemotherapy and used the opiate pain medication and anti-nausea medication my oncologist prescribed. However, when I got through my fourth round of chemo, things began to shift. I started losing my appetite, my pain level increased dramatically. I was also having trouble sleeping through the night, as the chemo's side effect included insomnia. 


I was being treated for breast cancer at a top cancer hospital in New York City. What the doctors do not talk about is an integrative and holistic treatment. What about my diet? Nutritional supplements? What about natural ways of healing and managing my pain? I read so much about CBD for pain, inflammation, nausea, and appetite. When I asked my oncology team, no one was able to give me concrete answers. I decided to educate myself, so I read dozens of books, articles, and websites dealing with this terrible disease. As an attorney and a mom, I didn't want to take anything high in THC.


Here is how I used CBD to help me with chemo, radiation, and reconstructive surgery.

Daytime: 
I took 50 mg of CBD divided into two doses. I took 25 mg with breakfast and 25 mg with lunch.

Nighttime:

I took a CBD & CBN formula. Chemotherapy and all the additional prescription medications make me feel like I drank 10 cups of coffee. CBD & CBN helped my body and mind get through the stress and trauma of fighting cancer. It helped me relax for bed and stopped my racing thoughts at night.

Throughout the day I used a CBD salve.

I massaged the balm around my breasts, underarms, neck and shoulder blades. This helped me heal after the mastectomies and expanders. Expanders are temporary implants. There are small port tubes placed inside your body. A needle is placed in the tube to inflate the expanders. The goal is to stretch the skin and help your muscles adjust for the implant, placed under the muscles. I am a woman of color. My skin tends to scar and keloid. The CBD salve helped me decrease the inflammation, scarring, ease the nerve pain, soften the tissue around my implants.


Taking CBD and changing my nutrition made me feel better physically and gave me a sense of control. Today, at age 39, the chart in my oncologist's office reads N.E.D., the three most beautiful letters in the English alphabet. N.E.D. stands for No Evidence of Disease! 
I am in remission. I am grateful.

***
Cannabis is the only anti-nausea medicine that also increases appetite, aids with sleep. It elevates mood, something that is not easy to do when someone is facing a chronic and life-threatening illness. While doctors often write five different prescription medications—painkiller, anti-nausea, anti-anxiety, appetite stimulant, and a sedative—that may or may not interact with one another, they could recommend trying one plant medicine first, cannabis, and address all five symptoms at once. 
Since CBD is also an antibacterial, it can help the healing process and decrease the chances of infection around incisions. Researchers are exploring CBD skin formulations to increase the activity of the skin's ECS to treat inflammatory and immune-related disorders of the skin. The anti-inflammatory properties of cannabinoids are also showing promise in the treatment of chronic wounds. Dr. Vincent Maida, a palliative medicine specialist at the University of Toronto, is finding topical CBD with an extraordinary 90% success rate in healing chronic wounds. Chronic inflammation is the root cause of a non-healing wound.
Cannabis is not a cure-all or silver bullet for everything that ails you. Still, more and more research shows that it effectively addresses chronic health conditions by relieving symptoms and addressing and modulating your body's internal systems. By getting to the root of many disorders—an out-of-balance, poorly nourished endocannabinoid system—cannabis can offer more profound, more lasting relief. 
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Stress, anxiety, and even PTSD are common among cancer patients. The COVID-19 pandemic has affected patients' mental health with cancer and has increased the level of stress and anxiety. Evidence is lacking that stress alone will affect cancer treatments, but it can cause behaviors that may interfere with a patient's health.

According to my colleague, Dr. Elizabeth Comen, an oncologist at Memorial Sloan Cancer Center. 

"It's very common to experience some level of anxiety or stress when dealing with a cancer diagnosis. These are normal feelings that you don't need to hide. Post-traumatic stress disorder (PTSD), an anxiety disorder that often occurs after experiencing a very distressful or life-threatening event, is one type of anxiety you might feel. Add in the additional stress associated with a global pandemic to someone already dealing with cancer in their life, and it could overwhelm you. That is almost a volcano that is just so much for any cancer patient to bear." 

Stressed patients may develop behaviors that can, in turn, affect their outcomes. "If stress causes patients to be less compliant with their medications, to be fearful of leaving their house, or to eat poorly, or exercise less–those factors really can affect outcomes," says Dr. Comen.

Many people dealing with pain and other side effects of cancer have already tried more traditional methods before they decide to give medical cannabis a try. When you take plant-based cannabis, you're decreasing inflammation, and you're relieving pain simultaneously. 
But how can pot do this, and why? 
Humans have a natural cannabis system, or an endocannabinoid system, that our bodies create. When a person is in chronic pain, though, these natural pain relievers aren't enough. When we utilize phytocannabinoids from the cannabis plant, we are replenishing our body’s endocannabinoid system. By doing so, it helps us deal with pain and inflammation much more effectively.

Medical cannabis, if you think about it, is the only botanical medicine that can help nausea, increase appetite, decrease pain, and elevate mood. A lot of people who are undergoing chemotherapy as part of their cancer treatment and live in a state where medical cannabis is available are using it for relief. People come to me seeking relief for all types of chemo-related ailments, such as nausea, decreased appetite, pain, insomnia, or depression.

Some physicians will prescribe Marinol, or synthetic cannabis, to treat these side effects. Clinically speaking, I have seen that using phytocannabinoids is simply more helpful and much more effective in increasing appetite and decreasing pain for my cancer patients.

Daniela is an ER nurse who worked on the frontlines in New York City during the peak of the COVID-19 pandemic. Nearly three months later, she has been unable to shake the memories of the overwhelming deaths and demands of the emergency room's emotional and physical tolls. 
Daniela has the most trouble at bedtime. When she closes her eyes to sleep, she relives the trauma of treating and losing patients to COVID-19 over and over again. When she’s lucky and her sleep medication works, she can drift off, but few hours later she wakes up choking -- as if she were in a war zone. Daniela lies in bed in a cold sweat, out of breath, clenching her chest. During the day, she has trouble concentrating. She still works in the ER and feels anxious, stressed, and lives in fear of spreading the disease to family members.
Daniela was diagnosed with PTSD and began seeing a therapist every week. Her psychiatrist prescribed an antidepressant, a benzodiazepine, and a sleep aid. After six months of trial and error, the combination of medications helped with her daily jitteriness and debilitating panic attacks. However, she still felt fear, exhaustion, and isolation. 
Daniela's therapist suggested she try CBD to help ease anxiety and forget the painful memories. But as an ER nurse she treats patients with drug overdose and substance abuse daily. So when she walked into my clinic, her first words were, "I don't want to smoke it, I don't want to get high, and I don't want to sit on the couch with the munchies." 

Cannabidiol (CBD) and tetrahydrocannabinol (THC) are the two most abundant natural compounds found in both cannabis and hemp. Cannabis has a higher concentration of THC while hemp has a higher concentration of CBD. Legal hemp must contain 0.3 percent THC or less. Both CBD and THC are sold as gels, gummies, oils, supplements, extracts, vape cartridges, flower, and more. THC is the primary psychoactive compound in cannabis that produces the high; CBD doesn't cause any mind altering euphoria. CBD comes in different formats and I suggested a broad spectrum product which contains terpenes and cannabinoids but zero THC so she could relieve her stress without the high and won’t have to worry about failing a drug test at the hospital. I also worked closely with Daniela's psychiatrist and psychotherapist to monitor her progress.  

“ Statistics show that women suffer twice as much PTSD as men but this goes underreported...””



Although Daniela didn’t want THC two recent studies indicate she might have benefited from it. According to researchers at New York University and Vanderbilt University, PTSD patients have been shown to have lower levels of the "bliss molecule," anandamide, compared to people without PTSD. 
If you read this blog regularly you’ll know that our brains make their own cannabis molecules (endogenous cannabinoids). Anandamide (named after the Sanskrit word for bliss, ananda) helps temper stress and balance the nervous system, so we do not spiral out of control on high sympathetic overdrive. The endocannabinoid system, or ECS, is a system of receptors that modulates and interfaces with all of the other systems throughout the body. It regulates physical functions, such as movement, pain sensation, and immune responses, and cognitive or mental capacities, like perception, mood, and memory. Anandamide clear painful memories and reduce our stress levels. 
How Cannabinoids Enable Forgetting (Not The Same Thing as Memory Loss)



Take, for example, forgetting. Forgetting is a crucial aspect of treating anxiety, stress, and PTSD. Trauma survivors have been found to have problems with neurotransmitter signaling of serotonin and glutamate. Excessive glutamate signaling will lock in painful fear-related memories. Both THC and CBD can help release these painful memories by facilitating memory extinction and help survivors switch off those traumatic memories. 
Here's how it happens chemically. Cannabinoids mediate the neurotransmitter GABA, which signals to our body that we are safe and directs the body to relax. GABA also helps to reduce anxiety, foster sleep, and relax the muscles. CBD and THC tell the brain to increase the flow GABA, which creates the calming effect. My patients report it taking the edge off, turning down the volume on anxiety and stress. Once their racing thoughts and the "fight or flight" response tail off, patients say they feel better or "more comfortable in their skin." They can often quell racing thoughts that paralyze them at work or cause them to lie awake at night.
Women More Prone to PTSD



Not only do women and men respond to cannabis differently, but they also react differently to PTSD. Statistics show that women suffer twice as much PTSD as men, but because most trauma research focuses on male combat veterans, this fact is overlooked. According to the National Center for PTSD, around 10% of women have PTSD some time in their lives compared to 4% of men.
Recent neuroscience has also shown that certain lucky people have a genetic variation in the brain that makes them inherently less anxious and more able to forget unpleasant experiences. These "more carefree" folks also have brains that produce higher levels of anandamide, the body's own THC. Normal endocannabinoid system functioning helps people's nervous systems reset and recalibrate more quickly after stress exposure. Researchers and clinicians agree that vulnerability to PTSD and stress resilience results from an interaction between ECS, genes, and the environment.

More backing came from researchers from University College London who showed that a single CBD dose helped increase blood flow to the hippocampus. When vessels that supply blood to the brain are clogged or damaged, the result is a decline in cognitive function, memory loss, and difficulty making executive decisions. Mobility and balance get impaired, too. Increasing blood flow to areas of the brain helps maintain cognitive faculties as we age and perhaps increase memory in patients with Alzheimer's. (The mechanism of action for increased cerebral blood flow on the brain is unclear, and while this study is promising, more research is needed).


According to the UCL researchers, the hippocampus is like a "flash drive," meaning it aids in storing and retrieving memories. People who have experienced damage to their hippocampus may have difficulties storing and recalling information. This brain structure (along with the amygdala and prefrontal cortex) also plays a role in the ability to overcome fear responses. Traumatic stress can be associated with lasting changes in these brain areas. 

It's important to mention that many people with PTSD, anxiety, and Alzheimer's might be on prescription medication or antidepressants. If you supplement with cannabinoids be sure to discuss with your doctor as they can interact with these meds and amplify their effects. Be sure not to over-consuming one or the other. If the doctor increases your Zoloft, that doesn't mean you should up your cannabis intake.
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As for Daniela...after the first month of CBD supplementation her therapist reported that she seemed less anxious, more clear-headed, and their sessions were more productive. She also noticed an improvement in the quality of her sleep and mood. She’s on the road to recovery.

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Can CBD improve gut health?

Michael is a 15 year old high school student who came to my office with his parents. When he was just four Michael had a "nervous tummy." For years doctors thought he was lactose and gluten intolerant. He was fatigued and his body ached constantly. He was embarrassed because his constant diarrhea and constipation forced him to plan his life around the restroom. After batteries of endoscopies and colonoscopies he was finally diagnosed with Colitis. In the next few years Michael tried every medication; anti-inflammatory, steroids, anti-diarrhea, pain meds and antibiotics. 


Nothing stopped his deep, penetrating stomach cramps and bleeding colon. After all conventional therapies failed, his gastroenterologist recommended a bowel resection — removal of his colon. Michael was so frustrated; he began searching online for help. He came across thousands of websites where patients talked about how they cured Colitis or managed their symptoms by smoking pot. Some of these patients had detailed instructions on growing marijuana, lists of recommended varieties and dispensaries or recipes for pot- brownies. The sources of information and mis-information were endless. 


Three months ago Michael admitted to his parents that smoking cannabis helped him tremendously with the pain and cramping. Before cannabis, he would wake up five times a night, sitting on the toilet with searing cramps, trying not to wake his parents in the room next door. After only a month of cannabis use he started sleeping through the night and he noticed that the blood and mucus in his stools lessened significantly. His parents realized that Michael was going to use cannabis with or without their consent, which is when they appeared in my office in search of medical guidance.


I see a lot of Michaels in my practice. According to a cross-sectional study presented at Digestive Disease Week, approximately one-third of patients with inflammatory bowel disease report actively using cannabis, and 45% report using cannabis for the management of their IBD (Irritable Bowel Disorder) related symptoms. Many others anecdotally report that medical cannabis helps in managing stomach pain, bloating, nausea, and appetite. Unfortunately, due to US federal laws that block medical cannabis research, large studies for the efficacy of cannabis and IBD are lacking. But early studies have shown that cannabis can indeed help people with digestive diseases and few patients with these symptoms have the time or patience to wait for large clinical trials.

The Cannabinoid Connection

Have you ever wondered why you have butterflies in your stomach when you are stressed? Why do you run to the bathroom before speaking in front of an audience? These are clear examples of how your gut responds to stress. There is a gut-brain connection that links the nervous system to the gastrointestinal system.

There are two competing components to your nervous system: the sympathetic and parasympathetic system. The sympathetic system is the fight or flight response. This system kicks into gear when you have to perform public speaking, meet a deadline, or when you're exercising. The sympathetic system causes your pupils to dilate, heart rate increases, blood pressure rise, and sweat. The parasympathetic system helps you digest your food, sleep, dream, relax. These days, many of us stressed out people are living in a perpetual state of a fight or flight. We are overworked, overtired, anxious about the future. This constant stress results in digestive issues such as bloating, irregular bowel movements, reflux, and rapid weight gain/loss. Stress may cause a decrease in blood flow and oxygen to the stomach, which could lead to cramping, inflammation, or an imbalance of gut bacteria.


CBD, IBS and COVID 


This past April, Michael’s father caught and survived COVID. His father is a healthy, active 57 year old with no history of any heart or lung disease. However, he does have IBS. His GI disorder is not serious as his son’s. As an IBS sufferer, he does have to be mindful of what he eats and he knows that stress exacerbates inflammation in his gut that lasts for months. 


Luckily, his COVID symptoms were mild and he did not require hospitalization. He quarantined in a spare bedroom and was able to manage the mild fever, fatigue and body aches with rest and hydration. The majority of his complications were not lung related, but gut related. His IBS got considerably worse -- diarrhea, abdominal cramping and bloating. His symptoms are under reported but not uncommon. According to the American Journal of Gastroenterology, half of patients hospitalized for COVID-19 have digestive symptoms and develop gastric problems. In fact, many patients complain about nausea, diarrhea and stomach pain before they complain about the coughing, shortness of breath and COVID fever. 


NOTE: Coronavirus can be detected in the stool. This makes hand washing crucial to prevent fecal/oral transmission. Scrub your hands for at least 20 seconds.


Michael’s father is now fully recovered from COVID, but his digestive system has not returned to normal, even 3 months later. He is managing his IBS with a mix of CBD, probiotics, prebiotics, meditation and a low FODmap diet that eliminates certain carbohydrates from wheat and beans. 


From my vantage point, there is a connection between CBD, IBD and COVID that deeper research would certainly shine some light on. CBD (cannabidiol) is a potent anti-inflammatory and pain reliever and it may potentially be useful in the treatment of IBD and related gastrointestinal conditions. It appears to reduce inflammation in the digestive tract and help relieve the anxiety and stress linked to GI disorders. CBD and hemp oil (which is not the same thing as CBD but which is a rich source of omega fatty acids) are two good ways to reduce inflammation and help an unhappy gut. If you are thinking about integrating CBD for digestive issues, do not stop taking your prescribed medications, talk to your healthcare provider and try the LowFODmap diet. 

Aiden is 7 years old. He has special needs and uncontrolled epilepsy. For the last several years, I have been part of the team of health practitioners caring for Aiden. Aiden’s parents, Osiris and Nina found relief for their child with cannabis medicine. 

Check out Osiris & Nina's podcast " Love & Cannabis".
Aiden's parents fight to raise awareness, educate the public, and share their journey with raising a son with epilepsy.
 Treatment of Seizures with Cannabis Medicine
Documented cannabis use for the treatment of seizures dates back centuries and can be found in Sumerian texts. In the U.S. epilepsy is at an all-time high. During the past decade, we have seen a lot of developments in epilepsy therapy from new devices and new medications and the advancement of dietary therapies, yet despite all of those advances, we still have approximately 30% of people, both children, and adults with epilepsy, whose seizures cannot be fully controlled despite available therapies. 

Epilepsies have an extraordinary impact on a patient’s quality of life. Not only does it affect cognitive and behavioral functions, but if uncontrolled, it can lead to permanent disability.  Patients lose the ability to work and earn a living. There are two major constituents in medical cannabis, CBD (Cannabidiol) and THC. Cannabidiol is the major, non-psychoactive ingredient or compound. CBD as a treatment option for seizures represents a challenge and a unique opportunity.

In my medical practice patients come to seek my advice after they have exhausted all pharmaceutical options (anti-seizure medications), and even very aggressive treatments – brain surgery, special restrictive diets (ketogenic/paleo-type diets). Patients who come to me have usually tried over a dozen medications that have failed them.


On June 25, 2018,  Epidiolex became the first cannabis-derived pharmaceutical approved by the FDA in the U.S. Made from CBD extract, the drug is not psychoactive and has been approved for two rare forms of epilepsy: Lennox-Gastaut syndrome and Dravet syndrome. Dr. Orrin Devinsky, the principal investigator of the study behind Epidiolex, stated that “the CBD binds with a novel receptor in the brain and thereby dampens down too much electrical activity. CBD seems to be a relatively unique mechanism of action that’s not shared by any of the existing seizure medications.”  CBD  is thought to act on specific brain receptors and likely modulates calcium activity in neurons.

For the last 15 years, I have been treating children and adults who have treatment-resistant epilepsy. I work as a team with their neurologists to help integrate medical cannabis safely. Over 50% of my patients have a reduction in seizures after a trial of various CBD extracts. Many patients report decreased frequency, severity, and duration of the seizures. And interestingly, they report back that where the patient had a seizure before and it would take all day to get over that groggy and “hungover” feeling, the patient feels they can recover faster and feel like themselves again.


CBD can interact with prescription medications, especially current anti-epilepsy medications as well as increase liver enzymes. It is best to consult your specialist and a physician who is experienced in integrative cannabis medicine before you try CBD for seizures. To assess safety and efficacy patients should be continually monitored and re-assessed to develop a personalized care plan tailored to their needs.

Sleep and Seizures: A Complex Interplay

Research shows that there is a significant relationship between sleep and people with epilepsy.  Sleep is especially important if you have epilepsy. Most types of seizures are affected by sleep. 


If you have epilepsy, lack of good, restorative, sleep makes most people more likely to have seizures. It can even increase the intensity and length of seizures. Some forms of epilepsy are especially prone to sleep problems. Children and young adults with epilepsy require more sleep than adults.


Sleep is crucial to our physical and mental functioning. The most recent research indicates that sleep is essential to all of the body's repair and restore functions. When we are at rest, the body learns what's wrong and physically "relearns" how to contend with the complexities and stressors of everyday life. Restful sleep has been proven to improve memory recall, regulate metabolism, and reduce mental fatigue. 

During sleep, the brain reorganizes and recharges itself, and the body removes waste byproducts that have accumulated throughout the day. It's almost as if our dream life represents our struggle to get back to balance.


When people are sleep deprived, they suffer. Their cognitive abilities decline, their behavior, and their judgment becomes erratic. Fatigue makes us more emotional, anxious; more strung out, more on edge.

Anxiety, stress, and chronic sleep deprivation all inhibit GABA, a naturally occurring brain chemical that directs neurons to slow down or stop firing. This neurotransmitter also helps to induce sleep, relax muscles, and calm down. In essence, GABA directs the body to chill out.

Medical cannabis is not a silver bullet. Patients and the medical community need objective and unbiased data on safety and efficacy to endorse cannabis to treat epilepsy. Patients are looking for reliable information, but have few trusted healthcare-provided resources.

Wishing you all the best in health.
Dr. June Chin 

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According to the National Sleep Foundation, some 50 to 70 million Americans experience insomnia at some point in their lives. Based on what I'm hearing from my patients, this number is through the roof thanks to the scourge of COVID. If getting some shut-eye is becoming harder for you, know that you're not alone.

Make no mistake; sleep is crucial to our physical and mental functioning. The most recent research indicates that sleep is essential to all of the body's repair and restore functions. When we are at rest, the body learns what's wrong and physically "relearns" how to contend with the complexities and stressors of everyday life. Restful sleep has been proven to improve memory recall, regulate metabolism, and reduce mental fatigue. During sleep, the brain reorganizes and recharges itself, and the body removes waste byproducts that have accumulated throughout the day. It's almost as if our dream life represents our struggle to get back to balance.


When people are sleep deprived, they suffer. Their cognitive abilities decline, their behavior, and their judgment becomes erratic. Fatigue makes us more emotional, anxious; more strung out, more on edge. It's no fun, and yes, it gets worse as we age in large part due to hormones, prescription medications, and chronic diseases.


As you've probably noticed, not all sleep aids work for everyone. There is no perfect drug that produces a regular sleep and dream pattern like a genuinely restful night sleep does. Many medications produce a tolerance that requires higher and higher doses. When some people stop taking them, they suffer nasty withdrawal symptoms, including severe insomnia. 

There's no conclusive evidence that cannabis works infallibly for everyone with insomnia. Still, my own clinical experience of treating patients with it for over 15 years shows it is at least as effective as conventional pharmaceuticals. Getting to the right dose requires some experimentation, so if you're not willing to invest a little time doing this, medical cannabis may not be a solution for you. 


Below are some of the most common questions I'm hearing about insomnia and cannabis these days. 


Why and how does cannabis work for sleep disruption?
Anxiety, stress, and chronic sleep deprivation all inhibit GABA, a naturally occurring brain chemical that directs neurons to slow down or stop firing. This neurotransmitter also helps to induce sleep, relax muscles, and calm down. In essence, GABA directs the body to chill out.


Cannabis modulates GABA, helping return the body to its more normal functions. Careful cannabis dosing may help stop the racing thoughts that cause disrupted sleep and panicked awakenings during the night. It can also be used to treat what is called "parasomnias," sleep disorders characterized by abnormal movements, behaviors, or perceptions during sleep, like jaw grinding, sleepwalking, or nightmares. 


The cannabis molecules produced by your own body (endogenous cannabinoids) make you resistant to stress, similar to the way endorphins provide natural relief from pain. Integrating optimally dosed cannabis products can help bring the body back into a state of balance.



Some of the research I've read online and in blogs say marijuana is no better than sleeping pills, that it doesn't provide a good night's sleep, and robs the body of REM sleep.

Prescription sleep aids (i.e., Ambien, Lunesta, etc.) don't deliver a restorative sleep. They replace our normal sleep cycles and dreams and result in "counterfeit sleep" -- studies show they only increase natural sleep by 8 minutes. Instead, they produce a type of sleep amnesia -- you forget that you had a crappy night! Benzos (i.e. Xanax, Klonipin, etc.) are often prescribed for insomnia, but they are only supposed to be used short term, 2 - 4 weeks maximum. If taken longer than that, they can be as addictive as opioids. Weaning from Xanax and Ambien can take up to a year because of the severe withdrawal symptoms and emotional dependence.  

THC will decrease the amount of time it takes you to fall asleep, however, it does block REM sleep just like alcohol. CBD also reduces the amount of time it takes to fall asleep and helps you get a more restful night's sleep. Combining both THC and CBD in the right dosage and ratio can be very useful in helping chronic sleep sufferers in my clinical experience.


I've heard that once I start using medical cannabis, I'll have to increase the amount I use constantly.

You can indeed build a tolerance to cannabinoids if you use them regularly. But it's also easy to reset or "resensitize" your receptors by stopping use for a few days. If you need increasingly higher doses of cannabinoids to get to sleep, simply take a break for 4 or 5 days. (You can take 2 to 5 mg of melatonin, or 650 mg of Valerian, and Magnesium Taurate while you take your cannabis holiday). Staying off cannabinoids for 4 or 5 days will allow your receptors to flush themselves out. After this break, you can begin again by taking a minimal amount -- one or two vapor puffs or a few milligrams of tincture -- until you feel a shift. Start there. You'll probably be surprised to learn that you'll get the same relief on a much lower dose. You can increase that dose slowly over the next few days if required. 


CBD reduces the amount of time it takes to fall asleep, and it decreases overall body inflammation and calms the nervous system. If taken throughout the day in a microdose regime, it can balance your circadian rhythm and help you with effortless sleep.


I often notice that when something upsets me during the day, it comes back to haunt me in the middle of the night, and I wake up and can't get back to sleep. Any ideas on how to contend with this?

That's a stress response, and cannabinoids also work to mitigate stress. In these cases, 10-40 mg of CBD -- or in some cases CBD that is supplemented with 1-3 mg doses of THC -- can reduce the anxiety that occurs during the day.

Here's how CBD directs the brain to activate the parasympathetic nervous system, which induces a state of calm. It works well for social anxiety and everyday stress, plus more extreme forms of anxiety such as panic attacks. One small study showed it even "reduced anxiety in public speakers," so if you're gearing up for that online TED Talk, take note!

Some of my patients carry a CBD vape pen or tincture with them during the day. If they know they have a stressful situation like a job interview or a confrontation coming up; they use it in advance to help keep calm. Others use it to steady themselves after an anxiety-provoking situation. You may want to try these strategies.  

I just can't get to sleep these days. My mind won't stop chattering.
To fall asleep faster, you'll want to use a CBD: THC combination before bedtime. A little THC is a good idea because, as the feelings of being mildly high taper off (60-90 mins), it produces a sedative effect that encourages sleep. Low light enhances CBD's calming effects.

• If you're inhaling flowers, begin with a small dose the size of a matchhead. 
• If you're using a vape pen, begin with a few puffs of a CBD or 1:1 CBD: THC oil and keep the room dark. 
• If using a tincture, try 20-25 mg of 20C:1T or 1C:1T tincture 60-90 minutes before bed. You can experiment with the time you dose. This should keep you asleep for 4-6 hours.

I can get to sleep, but I'm up in the middle of the night and can't get back to sleep.

• Try a capsule or an edible to stay asleep--the effects take longer to come on, but they last longer. 
• Try adding 1mg THC to a CBD capsule three or four hours before bed. If that's not enough to keep you asleep for 6-8 hours, gradually titrate the dose 1 or 2 mg every few nights until you get to the optimal, minimum effective dose and reach your desired effect.
• Be sure to titrate slowly in small 1mg increments. Too much THC can amp you up -- you don't want that -- or leave you foggy in the morning!
• Another option is to keep a CBD: THC vapor pen by the bed. If you awaken in the middle of the night, take a few puffs to lull you back to sleep.

Can I use other supplements? Can I mix with sleeping pills? 

Some of my patients alternate between cannabinoids, pharmaceuticals, and other supplements like 650 mg Valerian or 2 to 5 mg Melatonin, a hormone released in response to darkness. They find that alternating their meds produces different sleep quality and doesn't make them reliant on just one form of medication.

CBD. What is the right dose? Some say it makes you drowsy. Others say it makes you alert. What's the deal?

CBD can be either sedating or stimulating, depending on your endocannabinoid system and the dose. Generally, CBD doses higher than 40 mg may cause drowsiness while lower doses (under 40 mg) may cause alertness--this isn't true for everyone, and you'll need to experiment. 


Everyone says I need to use Indicas to get to sleep, but last night, I vaporized an Indica strain, and my mind just raced all night. It was crazy.

Right. Indica and Sativa aren't the most reliable indications of effects. Research indicates that terpenes -- those powerful smell molecules that give cannabis its pungent odor -- are better guides to what might make you sleepy. If you're in a legal state, you'll be able to find the flower's terpene content by checking the lab tests. Any good dispensary staff can help you with this. 
There are at least 17 terpenes in cannabis, and each strain has a different combination in a different amount. If you're shopping for sleep-inducing flowers be sure to look for strains (chemovars) high in linalool and myrcene. Avoid more stimulating strains with high amounts of pinene or limonene.


I have read about CBN.
What are some of CBN’s effects/benefits?

CBN is another cannabinoid that has stronger sedative properties than CBD. When THC degrades due to exposure to air and light, CBN is formed. CBN is prominent in old, dried cannabis flower. Consumed in large quantities, CBN can produce paranoia, something you might experience after smoking low-quality, improperly stored pot. Storing cannabis in airtight containers makes it last longer and slows the process of naturally produced CBN.  When dried cannabis is crispy or completely brown, that could be a sign that it is older or was stored improperly, and may make you sleepy.

How is CBN different from CBD?

CBN is a different cannabinoid. CBN has stronger sedative properties than CBD. It has demonstrated anti-convulsant, appetite stimulation, and anti-inflammatory effects, especially when in the context of other cannabinoids. Adding CBN boosts the relaxing and sedative effects of CBD.  Tetrahydrocannabinol (THC) can produce euphoric and sedating side effects. As a byproduct of THC degradation, cannabinol (CBN) retains the sedating effect without the euphoria. Some consumers prefer the less euphorigenic effects of CBN.

What else can I do? I hate not knowing if I'm going to sleep or lay awake all night.
I don't blame you--not knowing if you'll be able to sleep in itself stressful, and you're wise to avoid that!
There is a lot of research in the field of "sleep hygiene." Much of it is based on common sense methods of winding down. Make these tips habits or create some rituals for yourself.
 

• Begin winding down about 90 minutes before sleep. Turn off your screens and lower the lights. Illuminated screens can reduce melatonin production and keep cortisol levels raised at night

• Put your phone on "Silent" and dock it outside your bedroom

• Turn the clock away from you to avoid obsessing about sleep

• Have a soothing cup of herbal tea—chamomile or "Sleepy Time" are relaxing. Stop taking caffeine by 2 or 3 pm and don't drink more than one or two glasses of alcohol at night

• Take a warm Epsom salt bath at night

• Try a weighted blanket. Research indicates that sleeping under a heavier weight reduces the cortisol stress hormone and stimulates the production of serotonin, the feeling good hormone

• Go to bed at the same time every night and set the alarm at the same time every morning. The body likes consistency. 

• Take an early morning walk. Thirty minutes of exposure to light within two hours of waking can help sleep disorders as well as seasonal affective disorder. Avoid exercising in the evening -- it can make your heart pump faster and keep you awake longer. 

 

• Intermittent Fasting or Time-restricted eating. This idea is constraining our eating within a specified time window during the day ranging from only 8 hours to up to 12 hours per day, usually earlier in the day to align better with our circadian rhythm. For example, if you wake up at 7 am, you should stop eating at 7 pm. Research shows that the benefits of time-restricted eating include more restful sleep by balancing our circadian rhythm and improved metabolism.

 

• Check prescription drugs for side effects. Note that many medications contain caffeine.

• Rule out hormone imbalance/deficiencies, hypothyroidism, hypoglycemia, and weak adrenal function. 

 The bottom line on using cannabinoids for insomnia:  

• CBD can be either sedating or stimulating, depending on your dose and your endocannabinoid system.
• Small amounts of THC are sedating. 
• Cannabis meds can work well with supplements and pharmaceutical sleeping meds. In many cases, they may help you decrease the dosage, frequency, or need for prescription sleep aids. 
• Using cannabis meds is not "take two pills and call me in the morning." One size does not fit all. You have to do some experimentation to titrate and find your optimal dose, but once you do, stick with it! 

As always, consult your health care provider before making any changes to your prescription medication.Wishing you the best in health!

Dr. June Chin 

Stress, Cannabis, Prescription Meds, Quarantine! How to balance it all ?

“Stress can make people feel like they are in a fog all the time or that everything is moving in slow motion. Sound familiar?

These days, most patients are contacting me for three reasons: 1) insomnia, 2) anxiety 3), and managing PTSD symptoms, all of which are stress related. So I thought it was a good time to address the relationship of COVID-19, stress and cannabis. When used correctly, cannabis can help put you in a relaxed state which makes it a key ally in fighting stress—and there are several biochemical reasons why this so. This blog is based on the most common questions I’m getting from my patients.

Why do I feel so out-of-focus? I was going to use some of this extra time to learn tap dancing and read Proust but I’ve never been less productive.
I’m not sure cannabis can help you finish Proust but it can certainly soothe your stress responses, which could encourage your productivity.

Intense trauma can temporarily rewire the body’s nervous system and trigger our sympathetic nervous system which activates our “flight or fight” response. Keeping up with COVID-19 can put your nervous system into a constant white-knuckled, holding-on-for-dear-life response. Hyperarousal means increased blood pressure and adrenaline. Short, fast breathing and heartbeat. Short-tempers and blown fuses. It can also cause people to re-experience traumatic memories that cause a vicious cycle of being too agitated to relax and too stressed to sleep. These changes can impair the immune system’s ability to respond to acute and chronic infections and can disrupt digestion, sleep, focus, and libido. It can also make people feel like they are in a fog all the time or that everything is moving in slow motion. Sound familiar?

But I haven’t been traumatized. I’m just constantly worrying about my health, my family’s health, the health of the economy.  
You don’t have to be directly exposed to a traumatic event. Right now fear is more prevalent than the virus. Simply contending with overwhelming situations and information or sensory overload can affect some people so profoundly that they develop symptoms of PTSD. These symptoms can include:
·      Anxiety
·      Sensitivity to light and sound 
·      Insomnia due to racing mind or trouble staying asleep
·      Irritability and jumpiness
·      Emotional sensitivity
·      Heart racing/palpitations
·      Blood pressure changes
·      Digestive issues 
 
Cannabis is a holistic, integrative plant medicine that can ease the body into a state of calm. When used correctly, it can:
·      improve mood
·      reduce anxiety 
·      promote restorative sleep
·      suppress nightmares. 
 
How can cannabis help anxiety and stress?
Did you know that our brains make their own internal cannabis molecules? It’s true. And one of them, anandamide (named after the Sanskrit word for bliss, ananda), helps temper stress and balance the nervous system, so we are not spiraling out of control on a high sympathetic overdrive.  

Take, for example, forgetting. Forgetting is a crucial aspect of treating anxiety, stress, and PTSD. Trauma survivors have been found to have problems with neurotransmitter signaling of serotonin and glutamate, which also correlate with the fight-or-flight response. Excessive glutamate signaling will lock in painful fear-related memories. Cannabinoids can help release these painful memories by facilitating memory extinction. This helps survivors switch off those traumatic memories. 

Here’s some deep chemistry to explain how this occurs. Cannabis mediates the neurotransmitter GABA (gamma-aminobutyric acid). GABA signals to our body that we are safe and directs the body to relax and power down. It helps to reduce anxiety, foster sleep, and relax the muscles. CBD and THC tell the brain to increase the flow GABA, which creates the quieting and calming effect. My patients report it works to“take the edge off and turn the volume on anxiety and stress way down. Once their racing thoughts and the “fight or flight” response tail off, patients say they feel better, “more comfortable in their own skin.” They can often quell racing thoughts that paralyze them at work or cause them to lie awake at night.

If you’re not an experienced cannabis user I recommend starting with CBD, which can ease the body into a state of “calm focus,” or very low amounts of THC in conjunction with CBD. Sometimes, just a few puffs on a vaporizer or no more than 2.5 mgs of THC will do the trick. You can always add more if you want more relief.

 It seems that my girlfriend is responding to cannabis so much more strongly than me (I’m a guy). Are there gender differences?

Not only do women and men respond to cannabis differently, they also respond differently to PTSD yet almost no one is aware of this. Statistics show that women suffer twice as much PTSD as men but because the majority of the trauma research focuses on male combat veterans this is overlooked. According to the National Center for PTSD, around 10% of women have PTSD sometime in their lives compared to 4% of men.

Thanks to the hormone estrogen, women are more sensitive to the effects of the cannabinoids and terpenes in the plant. We experience several distinct physiological changes throughout our lives (pregnancy, menopause) that drastically alter the amount of estrogen in our system. Understanding how cannabis can help us regulate hormonal flux and ease these transitions can be a revelation for women interested in health and wellness. Estrogen makes women more sensitive to cannabis, primarily THC. THC and your hormones interact quite a bit so your cycle can influence your high.
Researchers at Washington State University found that women experience the effects of THC most powerfully when their estrogen has peaked and is beginning to fall. This happens a day or two before you ovulate. Preclinical studies have shown that the interaction between estrogen and THC makes women more sensitive to the compound in general, which is why they seem to get more benefit out of the herb as a chronic pain fighter than men.

My husband is so much more carefree than I am. He also uses more cannabis. What’s the relationship between high use and low stress?

Recent neuroscience research has shown that certain lucky people have a genetic variation in the brain that makes them inherently less anxious and more able to forget unpleasant experiences. These folks, whom you categorize as carefree, also have brains that produce higher levels of anandamide, the body’s own version of THC. Normal endocannabinoid system functioning helps people’s nervous systems to reset and re-calibrate more quickly after stress exposure. Researchers and clinicians agree that vulnerability to PTSD and resilience to stress are the result of an interaction between ECS, genes and environment.

How much cannabis should I use to keep my stress at bay?
That’s the big question with cannabis meds. Everyone’s endocannabinoid system  is different and people’s experience with cannabis makes a difference when it comes to dosing. My15 years of treating patients with cannabinoid medicines have taught me that patients who are willing to experiment to create their own personal dosing regimen get the best results.

The "Start Low, Go Slow, Stay Low" dosing method begins with a CBD product, which you take in low doses (5-15 mgs) two to four times daily. You can increase the dose every 1 or 2 days until you feel relief. If you get no relief after a few weeks, try adding in a small amount (2.5 mgs of a tincture or a few vapor puffs) of THC to activate the CBD. Escalate your dose until you find relief. Inexperienced users may want to work with a health coach to get started. Experienced users will be more familiar with adjusting their doses to find optimal relief. The dosing guide below lists the average activation times and length of time effects will last. Refer to it until you are familiar with the timings.
​
Tips for Increasing Your Dose
After 3 or 4 dosing cycles, you’ll know if you need more relief. If you do, there are three ways of proceeding.
·      Increase the amount of each dose of CBD
·      Increase the frequency of dosing – i.e., go from twice a day to every four hours
·      Add small amounts of THC to each dose of CBD and chart the effects.

The doses of THC in this method are very low and calibrated so that you don’t feel high. You may feel slightly elevated at first but you won’t feel out of control if you follow these guidelines. Any feelings of being altered will diminish after a few days. If it feels too strong, simply lower your dose of THC. Unless you are an experienced user we recommend not exceeding 5mg THC to start.

You’ll also learn what works best for you faster if you keep a record of how much you’re taking and how it’s making you feel. You can share this with your practitioner.  The goal is to reduce symptoms without causing impairment, decreasing motivation, or increasing avoidance behaviors. 

Other than using cannabis, what else can I do to calm myself immediately?

The other side of the sympathetic nervous system is the parasympathetic nervous system, which releases all sorts of chemicals to help us feel relaxed and safe. The parasympathetic system regulates our digestion, our connection to others and our sleep, which is the only time the body can repair itself.  Cannabis helps to ease the body into the parasympathetic nervous system.
In her upcoming book, Good Chemistry, the psychopharmacologist Dr. Julie Holland lists a few things patients can do to flip from “fight or flight” into the “tend and befriend” mode. I’ve used some of these techniques with patients over the years and though they may sound simple, they work.

Breathe through your nose. Believe it or not, simply breathing through your nose for five or ten minutes can trigger the parasympathetic nervous system and snap you out of fight or flight. This is because taking shallow breaths through the mouth can trigger the sympathetic nervous system.
 Balance the flow of negative thoughts. If you can’t stop thinking about how terrible things are at least give equal time to fantasizing about other things working out ok, or even well.  

Sing, chant, or make music.

Swim or float on your back with your arms and legs wide. If you can get to a sensory deprivation tank where it’s dark and quiet, the body can stop paying attention to sensory input and the mind can be more free.

Havening. This is a self-soothing technique in which you cross your arms like you’re hugging yourself. There are plenty of videos online.

Do nothing. Put down your phone. Get off your screens. Focus on your breath or something in your field of vision. As Julie writes, “Try to be as fascinated by your breath as your Instagram feed. If you stop what you’re doing, sit down, pay attention to your breath instead of what you’re going to make for dinner, don’t tell anybody, but you’re meditating.”
Get out in nature. Cannabis helps connect you to your body and to the natural world. The vastness of natural world can help you put your concerns in perspective.​

My patient who is 5 months pregnant and suffering from debilitating morning sickness with vomiting and nausea throughout the day, asked me "If you were pregnant, would you use cannabis?".

This is a question I get quite often.
My answer is that it all depends.
The benefits must outweigh the risks.
Every so often another scary piece about cannabis damaging the brains of babies and children crops up, just as it did in this piece in the New York Times: “Pregnant Women Turn to Marijuana, Perhaps Harming Infants”. The story pointed to several preliminary studies indicating that pregnant women who use cannabis risk having babies that are underweight and possibly cognitively impaired. 
Dr. Stacey Kerr, physician and medical advisor to Hawaiian Ethos, a medical cannabis dispensary in Hawaii discussed this important topic with Medical Cannabis Mentor. 
In utero development is not to be taken lightly, so it’s crucial to parse myth from fact. Of course, a pregnant woman should exercise caution when using any medication or substance that might affect the health of her baby as her blood is comingled with that of her fetus. But cannabinoids don’t function like other molecules and at this point, there’s a small, but growing amount of evidence that they might actually might further a baby’s development, or at least do no harm. It’s not the commonly expressed point of view, but it’s crucial to remember that most of the science in the US has been carried out by the National Institute of Drug Abuse, which has a mission to only investigate the harmful effects of the plant while ignoring the benefits. Twenty years ago, science assured us that the concept of medical marijuana was a joke. Yes, science, too, can change its collective mind.  


Here’s what we know
The most prevalent cannabinoids found in cannabis, THC, and CBD, are bioidentical to two chemicals produced by the human brain, anandamide and 2AG. The next question is: Why does the brain produce these chemicals? What is their function? 
The answer, in part, was offered by the late Dr. Ester Fride, an Israeli neuroscientist who was investigating the ways cannabinoids influence a newborn’s development. Her science showed that without a functioning endocannabinoid system newborn rats failed to suckle or begin maternal bonding. They died much sooner than babies with functioning endocannabinoid systems. Fride concluded that endocannabinoids are essential to a baby’s ability to thrive.

Equally compelling is the work Dr. Melanie Dreher, the Dean of Nursing at Rush Medical Center in Chicago. In the early 1990s Dreher traveled to Jamaica to investigate a group of rural and impoverished Rastafarian women and their infants. These “Roots Daughters” smoke ganja as a daily health ritual; they rely on it to maintain appetite, rest and allay nausea during pregnancy. They also serve a mild ganja tea to their families as a health tonic -- when you’re poor it’s less expensive to forestall illness than to treat it once it hits.


Dreher followed 30 Roots Daughters and their babies for five years until the children entered school. She found that infants whose moms smoked ganja socialized more quickly made eye contact more quickly, and were easier to engage than the babies of non-smokers. There were no developmental differences between the groups. In fact, on tests for verbal ability, motor, perceptual and quantitative skills, memory, and mood, the kids of smokers scored higher. 
“Given what everyone else was finding at the same time, we thought [our findings] were pretty darned interesting and a little counterintuitive,” Dreher told me. 


Though her findings were unprecedented they were published in 1994 to resounding silence. In the wake of that silence, Dreher applied to NIDA for additional funding to return to Jamaica to follow the same children at age 10 but her request was denied. Instead, NIDA continued to commission more studies from which researchers concluded that exposure to (extraordinary quantities of) cannabis in the womb might harm the brain, lower IQ, and damage “executive function.” Different variations on these dire warnings are still being trumpeted today.
Life Not Matching Research
Women throughout the world have been using cannabis as a natural medicine for centuries with no apparent harm, so for an alternate interpretation of the findings cited in the Times, I spoke to Dr. Stacy Kerr, a family physician and cannabis educator in Santa Rosa, CA. Dr. Kerr is one of the rare physicians who openly discusses her use of cannabis (probably because she works in a state that has had an operational medical marijuana program since 1996). “I grew up in the 1960s and we used cannabis when we were pregnant, and we were pregnant a lot,” Kerr, a mother of two, now in their 40s, tells me. “I delivered kids who were exposed in utero and watched them through childhood and into adulthood and I’m not seeing the results of these studies play out. I’m a physician and I want to believe these studies, but real life outcomes weren’t matching the research predictions.” 
With the assistance of other researchers and a statistician, she examined the research most frequently quoted and found some notable discrepancies with the ways the samples were put together and the extrapolations of the findings. 
In the studies of babies being born at lower weights, she discovered that all the women surveyed were asked if they had used any psychoactive substances (not specifically cannabis) and were also all from lower socio-economic backgrounds at a public hospital. Both factors could have influenced the results. She also points out, crucially, that there was no difference in the Apgar score, the measures the 5 key indicators of a baby’s health just after birth. 
The other frequently quoted study by claims that kids of cannabis using moms do less well in life and are slower in school. But this research, according to Kerr, was skewed by factors other than prenatal exposure. 
Are cannabinoids the same as other molecules?
The final claim is that prenatal exposure to THC somehow miswires the brain and impairs cognitive development. Indeed, endocannabinoids are active in the fetal brain. They help neurons grow in the correct direction and yes, using cannabis does add additional cannabinoids into to the equation, perhaps displacing those that occur naturally in the body. But there is no research to date showing that displacing those naturally occurring endocannabinoids is definitively problematic. 
In fact, there is another study hinting that additional cannabinoids seem to somehow protect neural functioning. Those researchers looked a complex neural process called “global motion perception” that is damaged in kids with abnormal brain developments, such as autism or fetal alcohol syndrome. (Kids with impaired GMP are characterized as “seeing the trees but not the forest.” They see individual details in their field of vision but not the entire frame.) In addition, exposure to both cannabis and alcohol seemed to cancel each other out. 
Kerr’s conclusion: “It’s not ‘drink alcohol and use cannabis and your baby will be just fine,’ but it is interesting that exposure to THC in brain improved this indicator of neural development.” 
A question of intent
Clearly, the mystery of cannabinoids and pregnancy is yet to be solved. In the meantime, I asked Kerr if she were pregnant again if she’d use cannabis? To my surprise, she hesitated before answering. 
“I hesitated because pregnant women today are going crazy --  there’s always another article on more that we can’t do, so for me, it comes back to intent and how you use cannabis as a medicine. If I am nauseated or in pain, or if I have a two-year-old who’s going crazy and making me so irritable that I’m yelling at the kids and my husband and if taking a puff relaxes me and makes me nicer then, sure, I’d use it. 
“That said, there is also such a thing as cannabis abuse disorder so if a patient is using too much and the kids aren’t being fed or the house isn’t getting cleaned I’d think about it differently and advise them to stop.
“But making women afraid that something drastic is going to happen if they take a vapor hit or a puff on a joint based on the current science isn’t beneficial.” 
The take-home message:

A pregnant woman should be careful when using any medication or substance that might affect the health of her baby because any time you give a medicine, the primary concern is how much of that medication gets passed through the placenta.

When you are pregnant, you should be abstaining from as many extraneous chemicals and toxins as possible. Our internal endocannabinoid system plays a critical role in modulating female and male reproductive systems and there is a whole galaxy of endocannabinoid receptors in the uterus, the ovaries, and the fallopian tube.

There are not enough long term studies related to CBD use and pregnancy or any human trials yet to make an evidence-based decision.
However, if your symptoms cannot be treated in any other way and you are endangering your baby by not getting enough nutrition and the benefits outweigh the risks, then CBD and cannabinoid medication can be an option. 

As always, please consult your doctor before integrating medical cannabis as it can also interact with your current medications and supplements.

As the nation starts to prepare to reopen facilities and ease social distancing, patients have been wondering how to boost their own immune system in response to COVID-19.

We discussed this with friend and colleague Dr. Kevin Spelman Ph.D., a molecular biologist, and researcher on botanical medicines and cannabis. 

Check out this book I am reading-- "GOOD CHEMISTRY"- The Science of Connection, from Soul to Psychedelics By Julie Holland M.D.
This is a brilliant book I can't stop thinking about, especially during this social distancing era. "We are suffering from an epidemic of disconnection that antidepressants and social media can’t fix. This state of isolation puts us in “fight or flight mode,” deranging sleep, metabolism, and libido. Dr. Holland helps us to understand the science of connection as revealed in human experiences from the spiritual to the psychedelic."

Preorder now! Book comes out in June!

• What can I do to boost my immune system? Can plant medicines significantly help?
  
  

Despite much mainstream medical opinion to the contrary, they absolutely can. To understand how to “boost” the immune system it’s important to understand the three ways botanicals can power up immune cell response in advance of illness and once it has attacked.


Nourish – Like any bodily system, the immune system must be nourished. Our immune cells derive from our bone marrow and healthy bone marrow is key to having the right immune cells that are ready to respond. Whether we need to decrease an immune response or ramp it up to fight an infection, keeping the entire system well-nourished is like having an emergency plan prepared and ready to go.
Respond  -- Plant meds offer a more complex modulation than pharmaceutical medications, which either stimulate or inhibit but not both. Certain phytonutrients can create entirely different responses in our bodies depending on our health and our illness. In the case of the immune system, this allows modulation of response, potentially increasing immune function when it is feeble or decreasing it when it is overly excited.
Adapt -- to different attackers. It’s important that our coping strategies for stressful situations (such as quarantines) don’t get the best of us. Our stress response is mainly run by the Hypothalamus-Pituitary-Adrenal axis and there are herbs called adaptogens which can strongly support the HPA axis. This is key to a healthy immune response because too much of the frenetic energy of the HPA axis can suppress immune function.

• What role can cannabinoids play in this?

Endocannabinoids are made on-demand, that is they respond to physiological shifts or changes in our lives to which we must adapt. This suggests that our ECS maintains homeostasis by nudging our internal environment to respond to the changes in our external environment. Exogenous cannabinoids such as CBD and THC plus other cannabinoids can support this ability to adapt to external threats such as neurological and immunological issues.
 

• What botanicals would you recommend and at what doses? 

The key to getting the most from botanicals is using the correct dose and buying the freshest product. The correct dose is typically significantly larger than what the label recommends and the freshest product is often available as cultivated or wildcrafted herbs.


To Nourish:

• Astragalus –  raw herb 4000 – 8000 mgs/day; powdered extracts 500 - 1000 mg/day
• Selenium 200 mcg
• Vitamin D 2000 IU
• Vitamin C 3000 mgs/twice a day.

To Respond:
Echinacea. Using up to 3000 mg /day (raw root) or up to 500 mg/day of a powdered extract can help in mounting a robust immune response if infected.
While there was one NIH study on Echinacea that resulted in failure, a number of analyses of all available studies have shown a positive effect. Results from meta-analyses outweigh results from any one study.


To Adapt: 

• Ashwagandha up to 6000 mg/day raw herb or up to 750 mg/day of powdered extracts. 
• Ginseng and maybe cannabinoids but I’ll get more specific about that a bit later.

     

• So…what’s more effective, tinctures, or raw herbs?

It really depends on what you are after, liquid dosing, or capsule dosing. At higher doses, ground-up herb is the cheapest way to go. Tinctures work well but tend to be pricier. No one really eats fresh Echinacea but it can be juiced.
 

• I’ve read contradictory things on cannabis. Will it depress or enhance immune functioning?

The jury is still out. There is evidence that says cannabinoids can be immunosuppressive as well as upregulating (increasing the cellular response) of immune function. Most likely, it will depend strongly on who the patient is, what kind of immune issue they are having, or whether cannabis is friend or foe in preventing or treating infections. One aspect appears to be fairly consistent though: in cases of tissue damage from overactive immune activity, cannabinoids appear to be helpful, as immune responses that go on for too long or too strongly can damage tissue in the body.

• What about microdosing cannabinoids. Can you really get a therapeutic response from low doses that you don’t even feel?

As Ethan Russo, MD, Ph.D. suggests, It is not necessary to be high when using medical cannabis for most conditions.
With tinctures and soft gels in oils, I like 4:1 or 3:1, especially as they attenuate the side effects of THC and lessen the high. 
With ingestibles less than 2 mgs of THC could have an effect. 

• And CBD?

There is an abundance of immune research showing very significant anti-inflammatory activity for CBD. However, it is my opinion, as well as that of many other clinicians, that most of the suggested dosing in the CBD marketplace is too low to get the benefits or the optimal effects. I would start with 30 mgs a couple of times a day. If it does nothing, take more. Rare people will need far less, others will need far more. If I were having an acute inflammatory issue I would up my dose to over 100 mg of CBD. 

• Are there any foods I should eat/avoid

Avoid… high sugar, alcohol, nutrient-deficient foods such as white flour, packaged foods and heavily processed foods. A good strategy is to limit your shopping to the perimeters of grocery stores to avoid the processed stuff in the middle. Also, if you pick up a packaged food item and can’t pronounce the ingredients on the label, walk away from it. 
Eat More…. plants, including full-spectrum foods such as berries, leafy greens, fresh veg, mushrooms (shitake, maitake and chaga, which can be used as part of a soup stock). Good quality meats and fish can also be a nice “spice” as a protein addition to stir-fries, soups, salads, etc.

• Where do I find raw herbs or herbalists? And how will I know their products are good?

Checking in with your local herbalist in your community, town, or city can be a great relationship to build. Make sure that they are members of the American Herbalists Guild as this will guarantee a certain amount of professionalism.

• What about growing my own?

As cannabis growers know growing your own herbs can be very therapeutic in many ways. Being outside, being part of the life process, and ending up with a therapeutic product are all very rewarding steps in making your own remedies.


Kevin Spelman, Ph.D., MCPP is a molecular biologist, researcher, clinician, educator, and industry consultant. He has advised the White House, the US Department of Defense and foreign governments on issues and policies concerning natural products. As a clinician, he practiced clinical phytotherapy for 20 years in the US and Latin America. ​

Are cannabis users more at risk for COVID-19? Should we stop smoking now? What are the best ways to use the plant during the pandemic?

 This new enemy is invisible and deadly, and it attacks regardless of race, creed, class, or color. It has made everyone aware that making some reasonable sacrifices now will help avoid utter catastrophe -- and personal suffering -- later.

One significant adjustment is occurring in our culture of sharing. Handshaking as a way of greeting will likely give way to bowing or touching your heart. People will probably begin to wink at each other (or "smize," smile with the eyes) since smiles are harder to see beneath a face mask. The idea of sitting cheek by jowl in a crowded restaurant sharing an intimate meal will be put on pause until we come to a new understanding about slowing the ways novel infectious diseases take hold and spread. 

So many of my patients are asking about other ways to use cannabis mindfully to lower their stress or make these times of social distancing and self-quarantining less difficult. There's also a lot of confusion about the effects of cannabis on the immune system. Here are some of the most commonly asked questions and what I recommend for smart, sensible cannabis use in the time of COVID-19.

Should cannabis users refrain from all smoking/vaping during this time?
Avoiding lung irritation is the first line of defense against this illness.  
Any inhaled substance may affect the respiratory system. Cannabis smoke can cause visible lung irritation and microscopic injury to the pulmonary epithelium (the tiny cells that line most of the respiratory tract as respiratory mucosa). Exposing lung tissue to vape aerosols (e-cigarettes) can increase the release of inflammatory cytokines, macrophages, neutrophils, and lymphocytes. Basically, the lung tissue is trying to mount an "immune response." 

Most healthy individuals can recover from this lung irritation -- but right now, I recommend you reduce your exposure to all irritants. Keep your house is dust-free. Get out into fresh air. Lower your use of aerosol products. Don't inhale bleach, ammonia, or anything with a noxious odor -- even small doses can irritate the eyes, skin, and respiratory tract.

Studies also show that angiotensin-converting enzyme-2 (ACE2) receptor increases in the lungs of smokers and patients with COPD. This makes smokers of anything more susceptible to COVID-19, and this is why scientists and physicians are recommending that users who smoke or vaporize stop. Of equal concern is the coughing that often occurs when inhaling products. Coughing can disperse COVID-19 pathogens into the air, and this is what we all want to avoid.

Bronchitis is another well-known side effect of cannabis smoke. It's not uncommon for regular users to develop a cough, chest congestion, and some phlegm. These symptoms are usually temporary and go away when you stop smoking, but it's best to avoid them in a respiratory flu pandemic.
 It's also allergy season, so everyone's respiratory health is going to be compromised.

Also, be aware that the degree of lung injury depends on multiple host factors: 

• Elderly patients are more vulnerable to lung injury than younger people
• People with allergies are more susceptible to bronchospasm than nonallergic people
• People with Reactive airway disease, Cardiovascular disease, Diabetes, and Auto-immune diseases are also more at risk.

What's the difference between cannabis smoke and tobacco?
The inhalation patterns of cannabis smoking are different than cigarette smoking. Compared to tobacco, cannabis inhalations are 66% larger in puff volume and a 33% larger in inhaled volume. Cannabis smokers also hold their breath four times longer and take in five times the concentration of carboxyhemoglobin. Carboxyhemoglobin is formed in carbon monoxide poisoning and leads to oxygen deficiency in the body.

Is vaping less dangerous than smoking? 
The long term effects of vaping aren't entirely known, but not are all vaporizers are the same.
If using vape pens, watch out for oil cartridges that are thinned with PEG (polyethylene glycol – it produces hazardous chemical byproducts which destroy lung tissue) or Vitamin E acetate, which have been linked to lung injury and chemical pneumonia. One way to avoid Vitamin E acetate is to buy cartridges in the legal market. Most, if not all, of the tainted products were found in the illegal market.
If you use a flower vaporizer, the key to a healthier draw is temperature control—a joint burns at around 950 degrees. Vaporization occurs at 350-400 degrees -- the sweet spot is around 390 degrees. That temperature variance makes a big difference if you want to protect fragile lung tissue. 
Clearly, vaporizers with technology that allow for temperature control are worth the investment. Some brands worth looking into include Firefly 2+, Crafty, and Pax 3.

If vaporizing, be sure to follow these harm reduction methods: 

• Flower vaporizers are preferable to vape pens 
• Wash your hands before and after a vaporizing session
• Sterilize the mouthpiece with an alcohol swap between inhalations 
• Take small "sips" of vapor. The smaller the sip, the more control you will feel, and the less  coughing will occur 
• Keep your temperatures as low as possible
• Vaporize outside and away from people. When exhaling, be sure that you are not facing another  person. Don't vape on the street if people are behind you.

Can you explain how COVID-19 affects the lungs of those who are infected? In layman's terms, please!

When COVID-19 attacks the respiratory lining becomes injured, causing inflammation. This irritates the nerves in the lining of the airway and can spread into the gas exchange units (alveoli). This article illustrates the changes COVD-19 can have on the lungs.
Normal, healthy lung tissue is light and fluffy, like whipped cream. COVID-19 coats the lung tissue with a yellow ooze and turns the lung texture to marshmallow. This thick coating blocks the free flow of oxygen. As the virus invades and takes over, patients lose their ability to breathe and may need a ventilator. At this point, the marshmallow coating of the lung tissue begins to stiffen, and the lungs' capacity to take in oxygen diminishes. This is often the point when the patient's life hangs in the balance. This virtual reality video brilliantly illustrates COVID-19's path of destruction. 

COVID-19 patients can be placed into four broad categories:

1) Patients who are "sub-clinical." This means they have the virus but have no symptoms.
2) Patients who have minor symptoms: fever, cough, headache, fatigue. These patients are still able to transmit the virus, but they may not be aware of it as these symptoms are common in so many other illnesses.
3) Patients who have an infection in the upper respiratory tract -- coughing, congestion, and flu-like symptoms.
4) Patients that are admitted to hospitals and likely to develop complications such as cardiac symptoms or severe illness that leads to pneumonia.

In COVID-19 the lining of the respiratory system becomes injured, causing inflammation. This, in turn, irritates the nerves in the lining of the airway and can spread into the gas exchange units (alveoli) at the end of the air passages. If these air sacs become inflamed, it can cause a flood of fluid and inflammatory cells into the lungs, and patients end up with pneumonia. 

Could cannabis' benefits outweigh potential harm for those who are affected or even at risk?  Should COVID-19 patients abstain entirely?

No, I do not believe you have to abstain from cannabis, but you should explore alternatives to inhaling.

Cannabis has medicinal and therapeutic benefits. It is anti-inflammatory, anti-anxiety, anti-pain, antiviral and immune-modulating. THC in small doses have been found to be a bronchodilator and has been shown to quell the cytokine storm (when the immune system goes into overdrive and causes an inflammatory flare) in animal models.  

Cannabinoids have also been shown to decrease the overall inflammation in the body, which means it's one less thing for your body to fight against. You can also lessen inflammation through diet and regular restorative sleep. Anything that reduces inflammation or stress in your body and mind benefits your immune system. So whether you're using cannabis for muscle spasm, to keep calm, or to sleep – it can be a therapeutic adjunct to your self-care, wellness, or health regimen. 

What about CBD? 
CBD has antiviral and antibacterial properties, but its main virtue is that it decreases inflammation. As mentioned above, the common thread of all disease states is chronic inflammation. Diseases as diverse as Diabetes, low back pain, or migraines that come are all the result of some underlying inflammation. Reduce the inflammation, and very likely, you'll reduce the symptoms of many illnesses.

Should medical cannabis patients be shifting to edibles or drinkables? 
In the last few months, I have been encouraging patients and adult use consumers to change the way they're consuming. Consider exploring edibles and drinkables. See if a 5 mg or 10 mg chocolate bar or drinkable works for you, or experiment to find your optimal dose. Just start low and go slow. Once you know your dose, edibles, or drinkables can turn a hike through the woods or a park a more sensory adventure. You smell, see, and hear nature more vividly. You'll likely feel closer to the people you're with, even if you are 6 feet apart. Remember that ingesting takes an hour or two for effects to kick in -- so time your dosing accordingly!

Can I use cannabis to relieve stress?
Cannabis interacts with GABA receptors in our brain. GABA tells our body to power down. It reduces the fight or flight response, which is associated with stress. This can be extremely helpful during this time of uncertainly and when many of us are afraid for our own health or the health of loved ones. Cannabis can also help with panic attacks and insomnia as the prevalence of depression and PTSD mounts in response to this pandemic. 

It's important to mention that a lot of people with anxiety might be on prescription medication or antidepressants. So be careful when you are supplementing with cannabinoids as they can interact with these meds and make their effects more powerful. Talk to your doctor to be sure you're not over-consuming one or the other if the doctor increases your Zoloft, that doesn't mean you should also up your cannabis intake.

What foods or supplements can I take to boost my immune functioning? 
1. Brazil nuts are the richest known source of selenium, a trace element that is essential for your thyroid and immune system. Be careful not to over-consume because you can get selenium toxicity -- just 2 nuts per day.
2. Spirulina is blue-green algae rich in protein, vitamins, minerals, and antioxidants to boost the immune system and help protect against allergic reactions. It has antiviral and anticancer properties!
3. Vitamin D3 helps modulate innate and adaptive immune responses. Vitamin D deficiency is associated with increased autoimmunity and susceptibility to infection.
4. Goji berries are packed with antioxidants and known for their immune-enhancing qualities and ability to fight harmful free radicals and inflammation. Full of vitamins A & C.
5. Exercise! It helps move lymph fluid through the lymphatic system. Lymph fluid contains white blood cells that fight infection.
6. SLEEP! Without restorative sleep, optimal immune function is nearly impossible!​

The Bottom Line?

1. Smoking cannabis raises the risk of COVID-19 complications. Since it can irritate the nasal passages and respiratory system, you are weakening your immune defenses and increasing your susceptibility to any infection. This includes a cold or flu, not only COVID-19.​ Minimizing inhalation in favor of edibles, drinkables, tinctures is safer and smarter. 
2. Don't share joints, pipes, or vaporizers. This will help stop the contagion. So does frequent hand washing (especially after opening a door or touching your face), social distancing, and reducing the number of people you come in contact with. 
3. This new enemy is invisible and deadly, and it attacks regardless of race, creed, class or color. Many people are asymptomatic and still carry COVID-19. You may not be coughing or having a fever, but lack of symptoms are not accurate ways of determining your health or anyone else's.