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THE HOLOS EXPERIENCE
Achieving balance with good medicine
Joseph Cohen D.O.
Medical Director
Holos Health & Journey 2 Life
Boulder, CO
The Endocannabinoid System
• Animals have had an endocannabinoid system for
over 600 million years.
• The cannabis plant, with its phytocannabinoids,
was introduced 35 million years ago.
• Anandamide and 2AG, the 2 primary
endocannabinoids- discovered 20 years ago
• Endocannabinoids provide us with balance and
homeostasis- an adaptigen.
– They moderate the flow of of neurotransmitters,
keeping our nervous system running smoothly.
The Human Endocannabinoid System
The Endocannabinoid System
• Receptors are found throughout our body: CB1 receptors in brain &
CB2 in immune system (and both distributed throughout the body).
– Lock and key- receptors and cannabinoids must be a perfect fit
– Activation of CB1 receptor is responsible for psychoactive and physical
effects commonly associated with cannabis consumptions
– Activation of CB2 receptor control the release of cytokines that promote
inflammation and immune function.
• Very complex regulatory system with broad and diverse functions.
• Due to its ubiquitous activity it provides a bridge between body and
mind.
• One of the most significant receptor systems in the human bodynot taught in medical schools.
Cannabis as a Functional Medicine
Cannabis and Functional Medicine
Functional Medicine
The prevention, early assessment and
management of chronic disease by correcting
core imbalances to restore health to the
greatest possible extent. This may require the
elimination of triggers of disease, such as toxins
in our food, our air and our water.
Cannabis and Functional Medicine
Food is your medicine- food is your poison
• Gluten, toxins and inflammatory foods
– Hybridized wheat makes us sick
– GMO’s, Monsanto and Dow
• The medical/industrial complex
– Medical school education and pharmacology, procedures, nutrition
and the endocannabinoid system
– The average doctor visit is 7 minutes in the US
• Diagnosis code, prescriptions and procedure recommendations
• Looking at the whole patient
– It all starts in the gut
Cannabis and Autoimmune Disease
• Pathophysiology of AI disease (it all starts in the gut)
• Autoimmune disorders respond well to cannabinoids
• MS and Sativex (GW Pharmaceuticals)
– Whole plant- 1:1 ratio CBD:THC
• Fibromyalgia, SLE, Rheumatoid and other AI arthritic
conditions, Crohn’s and Inflammatory Bowel Disease,
etc.
• Cannabis & functional medicine in treating
autoimmune disorder (Holos- skit)
Cannabis as Mind / Body Medicine
Cannabis as Body/Mind Medicine
• Cannabis can lower stress, therefore having a
positive effect on adrenals (neuroendocrine).
• Improves mood (anxiety, depression, bipolar)
• Cannabis may treat the following:
– ADD/ADHD
– OCD
– Autism
– Seizures
– PTSD
PTSD and Anxiety Disorders
Cannabis and Sleep
•
Cannabis sativa L. has been utilized for treatment of pain and sleep disorders since
ancient times. This review examines modern studies on effects of Delta9tetrahydrocannabinol (THC) and cannabidiol (CBD) on sleep. It goes on to report
new information on the effects on sleep in the context of medical treatment of
neuropathic pain and symptoms of multiple sclerosis, employing standardized
oromucosal cannabis-based medicines containing primarily THC, CBD, or a 1 : 1
combination of the two (Sativex). Sleep-laboratory results indicate a mild
activating effect of CBD, and slight residual sedation with THC-predominant
extracts. Experience to date with Sativex in numerous Phase I-III studies in 2000
subjects with 1000 patient years of exposure demonstrate marked improvement in
subjective sleep parameters in patients with a wide variety of pain conditions
including multiple sclerosis, peripheral neuropathic pain, intractable cancer pain,
and rheumatoid arthritis, with an acceptable adverse event profile. No tolerance
to the benefit of Sativex on pain or sleep, nor need for dosage increases have been
noted in safety extension studies of up to four years, wherein 40-50% of subjects
attained good or very good sleep quality, a key source of disability in chronic pain
syndromes that may contribute to patients' quality of life.
Cannabis and Sleep
Neurodegenerative Disease
Cannabinoids and Neuroprotection
Neuroprotection: mechanisms and strategies used
to protect against neuronal injury, degeneration or
death in the CNS. Neuroprotection prevents the
onset of neurodegenerative disease.
• Acute: TBI, stroke
• Chronic: ALS, Parkinson’s, MS, Alzheimer’s,
Huntington’s Disease, Tourette’s Syndrome
• Withdrawal from ETOH, benzo’s & narcotics
Glutamate Excitotoxicity
• Excitotoxicity: Nerve cells are damaged or killed by
excessive stimulation by neurotransmitters such as
glutamate.
• Glutamate Excitotoxicity is found in the following:
– Spinal cord injury, stroke, traumatic brain injury,
neurodegenerative diseases such as Alzheimer’s, MS, ALS,
Parkinson’s, Huntington’s Disease, alcohol and
benzodiazepine withdrawal.
• Cannabinoids actually can prevent glutamate
excitotoxicity and can be used in both prevention
and treatment of these diseases.
Glutamate Excitotoxicity
• Cannabis is an ideal medicine to help patients
wean off of benzodiazepines, narcotics and
alcohol.
– It reduces the need for these substances while
easing withdrawal symptoms.
– Prescription drugs- a leading cause of death in US
Cannabinoids and Neuroprotection
“Scientific information disseminated by governmental organizations that
promote and enforce cannabis prohibition laws would have you believe that
consuming cannabis has no benefit for your brain and nervous system, and in
fact has severely detrimental effects, with no exceptions. This must be the
case, right? After all, how else can we account for the draconian penalties
meted out for some violators of the cannabis prohibition laws? Clearly
cannabis use must insidiously ‘rot’ away one’s brain, right? Wrong. Nothing
could be farther from the truth.”
“Although inhaling cannabis smoke may acutely stimulate the brain’s natural
‘forgetting faculty’ by no means does this imply that cannabis is causing ‘brain
damage’. Rigorous peer-reviewed scientific work has consistently
demonstrated that chemicals in cannabis, especially the cannabinoids, are
actually neuroprotective and can be used to prevent and treat neurotoxicity
and neuroinflammation. As your head begins to stop spinning, prepare to be
startled by many other ground-breaking discoveries coming out of the
emerging field of cannabinoid medicine.”
•
Sunil Aggarwal, M.D., PhD and Gregory Carter, M.D. The Pot Book Ch. 25, pg.295
Cannabis and Neuroprotection
• Cannabinoid receptors in the CNS, when
activated, trigger signals in the brain that are
linked to neuronal repair and cell
maintenance, and the release of other
compounds that further activate
neuroprotective responses,
• Phytocannabinoids can enhance the
protection provided by our endocannabinoid
system.
Pain and Addiction
• Pain is the most common symptom for which patients report using
medical cannabis.
Table II: Conditions (CDPHE August 2014)
(**Does not add to 100% as some patients report using medical marijuana for more than one
debilitating medical condition.)
Reported Condition
Number of Patients
Reporting Condition
Percent of Patients Reporting
Condition**
Cachexia
1,085
1%
Cancer
3,648
3%
Glaucoma
1,234
1%
HIV/AIDS
686
1%
Muscle Spasms
16,928
15%
Seizures
2,497
2%
Severe Pain
108,157
93%
Severe Nausea
11,267
10%
Pain and Addiction
• Pain is by far the most common symptom for which
patients report using medical cannabis.
– 93% of CO patients report pain as an indication.
• The key to effective use for pain is finding the
“sweet spot”. Dose is critical
– Higher dose does not equate to more pain relief
Pain and Addiction
• Types of pain include acute, chronic and neuropathic.
– Cannabis works best for chronic and neuropathic
– Terpenes such as beta-caryophyllene, myrcene, etc. enhance the antiinflammatory and pain relieving effects of cannabinoids.
• Combining CBD and THC are most effective
– CBG may be a more powerful pain reliever than THC and THCV and is
non-psychoactive.
• There may be an endocannabinoid deficiency in
those who suffer from migraines and from
fibromyalgia.
– Low dose prophylaxis with cannabis may be effective.
Pain and Addiction
• Cannabis is an ideal medication to give to patients wanting
to wean off of narcotics, benzodiazepines and alcohol.
• Narcotics
– Cannabis can be used as an adjunct treatment for opioid pain
medications.
• Potentiate the effect of narcotics therefore many patients can
immediately reduce their dose by one half.
• Narcotics, especially when combined with benzodiazepines,
is a leading cause of death in the US.
– Overdose deaths have declined by 25% in MMJ states according
to a report in JAMA Internal Medicine.
Benzodiazepines vs. Cannabis
VS.
Pain and Addiction
• Benzodiazepines: Valium type of medications used mostly
for anxiety and insomnia
• Anxiety: CBD is an excellent antianxiety medicine
– Do not recommend THC dominant strains, especially sativas as
these can increase anxiety, cause panic attacks and paranoia.
• Insomnia: THC combined with CBN (oxidized THC)
– CBD may actually keep people awake
– Cannabinoid profile, dosage, timing, and delivery method are
critical when treating insomnia.
» THC initially stimulates and its metabolites are sedativetherefore inhaling cannabis is recommended 1 hour prior
to going to bed.
» Oral cannabis is best for those who awaken during the
night.
Pain and Addiction
• Benzodiazepine addiction
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–
–
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Benzos are highly addicting
Slow weaning over time
Withdrawals can last up to 2 years
Cannabis can not only be used to replace the need for
benzos, but can ease withdrawal symptoms
– Benzos, when combined with opioids, can slow or stop
respirations, while cannabis does neither.
Pain and Addiction
• Alcohol Abuse
– Cannabis can replace alcohol as a recreational drug
– Since legalization in CO, highway fatalities are at near
historic lows.
– Alcohol abuse has devastating effects on individuals and
society.
– Cannabis can help treat withdrawal symptoms from
alcohol abuse.
– We see many patients at Holos who have successfully
weaned off of alcohol with help from cannabis.
The Prescription Drug Epidemic
100 people die from drug overdoses every day
in the United States.4
Cannabis for the Cancer Patient
Treatment of Neuropathy, Nausea & Anorexia
after Chemotherapy, Radiation and Surgery
Use as a Chemotherapy Agent
Treatment of cancer related side effects
• Pain Relief
– Works centrally with the CB1 receptors as well as
peripherally with both CB1 and CB2 receptors
– Also has anti-inflammatory effects (CB2)
– Most effective treatment: combination THC/CBD
• Neuropathy
– Seen in cancer patients, especially those given certain
chemotherapy agents. Also seen in AIDS patients
– Studies show cannabis significantly reduces
neuropathic pain
– CBD alone had no effect on pain in the study
Treatment of cancer related side effects
• Cannabinoid: Opioid interactions= synergy
– Patients can reduce the dose of opioids in half when using
cannabinoids.
– Reduce dose of opioids= decreased side effects
• Antiemetic effect
– Marinol (THC)
• Anxiety, depression and sleep can be positively
effected by use of cannabinoids
One medication can treat anorexia, nausea,
pain, depression, anxiety and insomnia.
Cannabinoids as Anticancer Agents
• In addition to the treatment of neuropathy, nausea &
anorexia after chemotherapy, radiation and Surgery
cannabis may be a Chemotherapy Agent.
• THC, when used in combination with chemotherapy agents may improve
outcomes. (glioblastoma- mice studies)
• CBD, when combined with THC reduces the growth of several types of
tumors and is more effective than THC alone.
– Therefore, less THC is needed resulting in less psycho-activity.
• Whole plant cannabis, with all 100 cannabinoids (plus 120 terpenes), may
further reduce side effects of THC and further increase therapeutic effects.
Cannabinoids as Anticancer Agents
• Thus far, studies have been done on laboratory animals and in the
test tube. Since we do not have human trials, we cannot claim that
concentrated oils can “cure cancer”.
• We should never recommend that patients forego or postpone
conventional medical therapy in favor of self-medicating with highpotency cannabis oils.
– Potentially treatable cancers may become incurable in some
cases.
• Since cannabinoids might improve anti-tumor activity of
conventional chemotherapy while reducing side effects, oncologists
should not discourage their use.
• It’s about the whole plant
Cannabinoids as Anticancer agents
• Lots of anecdotal information about curative effects of
cannabis.
• We have seen many patients in our practice that have
had significant improvement
• We need to have human trials before we can make any
claims
• “Many providers would frown on the use of a relatively
benign inhaled psychotropic agents while freely writing
prescriptions for pharmaceutical agents with
significantly greater cost, potential for addiction or
abuse, and more negative societal impact overall”
Cannabis and Sleep
• THC, especially indica dominant strains, 1 hour
before bed for best results
– Metabolites of THC enhance sleep
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•
•
•
CBD may inhibit sleep (except pain or anxiety)
CBN, from oxidized THC, enhances sleep
Inhale to fall asleep, ingest to stay asleep
Low to moderate dose for sleep, otherwise
too stimulating
Carl’s Story
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Carl: 2011
Obesity
Type 2 Diabetes
CVD (hypertension and hyperlipidemia)
Several years of heavy narcotic use after severe
MVA w/ addiction (disabled s/p injuries)
• Several years of heavy benzodiazepine use w/
addiction
• Feeling depressed and hopeless
Care with our clinic including:
• Nutritional and exercise support
• Nutritional supplementation
• Medical cannabis
• Counseling while weaning off addictive meds
Carl’s Story
• Normal Body Composition
• Off all medications with reversal of
diabetes, hyperlipidemia,
hypertension and depression
• Off all narcotics and benzodiazepines
• His only medication is grown in his
garden
• Writing children’s books
• In love!
Carl 2013
Carl’s Garden