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Kevin Baiko, M.D.
Medical Director of the North Carolina Cannabis Patients Network
Board Certified Diplomat of the American Academy of Cannabinoid Medicine
  
February 13, 2013
 
To:         Rules Committee Members
From:     Kevin Baiko, M.D.
RE:        HB84 – The North Carolina Medical Cannabis Act
Position: Support

I am testifying today in strong support of HB84 – The North Carolina Medical Cannabis Act.  As you may be aware, this Bill has been referred to the Rules Committee for the third time in four years.  The last two times it was effectively ignored.  I attach the results of a poll conducted by Public Policy Polling just last month, which shows that 58% of our state's population believes that doctors should be allowed to prescribe cannabis for medical use. If the majority of Carolinians are in favor of a well regulated medical cannabis program in North Carolina, don't you think this bill at least deserves a better fate than merely dying again in the Rules Committee? I urge you to give your personal attention to HB84 and forward it along so it can at least receive a floor vote THIS session.
 
As Medical Director of the North Carolina Cannabis Patients Network, I speak on behalf of thousands of Carolinians who already medicate with cannabis or who would do so if it were allowed.  Unfortunately, current state policy criminalizes these good folks for turning to an ancient herbal remedy whose efficacy and safety are only validated by the most advanced scientific research.   While the mere existence of HB84 offers so much hope to so many, the lack of compassion their representatives have demonstrated in past years by avoidance of its discussion, allowing it to die in the Rules Committee again and again, has driven many remarkable Carolinians to move away to states already authorizing medical cannabis use.  What other choice do they have?
Go directly to jail? Rely on the black market for their medicine? States with medical cannabis programs typically enroll about 1% of their population.  That would translate to nearly 95,000 people in North Carolina!  HB84 offers a safer, more sensible, compassionate choice for the thousands upon thousands here who already regard cannabis as their treatment of choice.  I'm not talking about getting high!  I'm talking about real people with real medical conditions who find that cannabis alleviates their suffering more effectively and with less side effects than the conventional medicines generally available.
 
Many Representatives, including the Democratic Party Chairman, stand in support of this legislation.  Of ourse, this is not really a partisan issue.  This is a patients rights issue. Upon meeting with Representatives and patients who met with their Reps yesterday, the three most common reasons Representatives gave for NOT being in support of HB84 were: 1) “Legalizing cannabis, even if limited to well regulated medical use, violates my religious values.”  2) “Legalizing medical cannabis would be a further risk to public safety.”  3) “Approved alternatives to cannabis, like Marinol, already exist.”  Please allow me to address these three rationales one by one.

Raised in a Christian home and having attended a private Christian school, I was familiarized with the Bible at an early age.  With the exception of the “Tree of Knowledge of Good & Evil”, I've yet to find a passage condemning the use of any plant, nor endorsing its state criminalization.  To the contrary, First Timothy 4:4 reads, “For everything created by God is good, and nothing is to be rejected, provided it is received with thanksgiving”.  Honestly, I've never been able to understand how Christian values are exemplified by denying people access to medicine that will ease suffering, improve quality of life and function.

While medical cannabis may seem like a risk to public safety, it is in fact a benefit.  First of all, people already are using cannabis here.  Does throwing them in jail make Carolina a safer place to live?  Certainly not for them!  How many cannabis related car accidents have you ever heard of?  Evidence compiled by the National Highway Transportation Administration demonstrates that cannabis users may actually be safer drivers(www.kushmagazine.com/news/2549-auto-insurance-quote-provider-says-marijuana-users-are-safer-drivers?catid=842) and another study indicates that the incidence of deaths attributed of drunk driving decreases after the enactment of medical cannabis legislation (www.theatlanticcities.com/commute/2011/11/medical-marijuana-laws-may-lead-fewer-traffic-deaths/609/).  Consider how many public safety resources being directed towards cannabis prohibition could be redirected to actual risks to public safety, like violent crimes and thefts.  Judge Jim Gray has been articulate on this issue: (www.youtu.be/b6t1EM4Onao) If public safety truly is a concern of yours, take a look at this data compiled by the Adverse Events Reporting System managed by the FDA (www.drugwarfacts.org/cms/Causes_of_Death).  In 2000, 19,445 deaths were directly attributed to FDA approved drugs. Note how these numbers quadrupled in only 10 years, during which time nearly a half a million deaths were attributed by the FDA to FDA approved medicines!  Compare these numbers to the zero deaths attributed to cannabis  use – throughout recorded history. 
 
Even Marinol (like its synthetic cannabinoid counterparts “Spice”, “K2”, etc.) has been linked to a few deaths.  And Marinol's efficacy doesn't even closely  compare to that of the cannabis, from which over 60 distinct cannabinoids, each with unique medicinal properties, have been isolated.  Cannabis is, in effect many medicines all in one plant.  Our bodies are designed to process substances from the natural world.  Isolating and concentrating substances, particularly synthetic ones risks poisoning, as this chart clearly illustrates. ms of cancer and the horrible effects of chemotherapy and radiation therapies; I've  witnessed my patients effectively cure their cancers with cannabis alone!  I could tell you  success story after success story from the ranks of my Hawaii medical cannabis patients, and will happily do so upon your request.  I know you'd be amazed just how a law like HB84 would literally make Carolina a safer, more healthful, just and prosperous place to live.  Keep in mind – this isn't just a health bill.  It's also a stimulate-the-economy, create-jobs-and-tax-revenue bill.

Please contact me by phone or email if you have any questions.  I'd be happy to meet with you and provide any further documentation you may require.  I plead with you to support HB84 - The North Carolina Medical Cannabis Act, and if you don't personally support it, please at least afford it a hearing, giving it and the countless citizens who would benefit from its enactment the attention it deserves.
 
Sincerely,
Kevin Baiko, M.D.,
Board Certified Diplomat of the American Academy of Cannabinoid Medicine,
Medical Director of the North Carolina Cannabis Patients Network,
North Carolina Resident
Kevin Baiko, MD
N.C.C.P.N. Medical Director
This email address is being protected from spambots. You need JavaScript enabled to view it.
 
January 21, 2013
 
To:   North Carolina Medical Society
        PO Box 27167
        Raleigh, NC  27611
alt

 
Dear Fellow Physicians,
 
I write on behalf of the North Carolina Cannabis Patients Network (N.C.C.P.N.) as its medical director to invite your members to an educational lobbying event at the State Capitol on February 12. Our organization is dedicated to ensuring safe and legal access of medical cannabis to those patients in North Carolina who might benefit from its use. We have been working with NC lawmakers for several years to pass legislation that would legalize cannabis for medical use in our state, and such a bill (presently entitled “North Carolina Medical Cannabis Act”) is scheduled to be re-introduced to the General Assembly later this month. The bill extracts the strongest protections for patients and physicians from similar legislation already passed in 18 other states. We hope your members will join us in our cause to support compassionate medicine in Carolina.
 
I realize that the mainstream medical community is not generally comfortable with the topic of medical cannabis. This is reflected in your society's position – that more research is needed before it would condone medical cannabis. While such a cautionary position might seem scientifically responsible, it does ignore the many double standards applied to the use of cannabis as medicine, both scientifically and politically, not to mention the wealth of compelling research data on cannabinoid medicine already available (albeit rarely published in mainstream medical journals.) True research on this ancient herbal remedy is effectively blocked by federal policy and promises little monetary incentive to the pharmaceutical industrial complex which funds most drug studies these days. Cannabis is classified as a Schedule I drug (having “no currently accepted medical use in treatment”) in the Controlled Substances Act, though the U.S. government owns a patent on the anti-oxidant & neuroprotective properties of the natural cannabinoid CBD. The overwhelming bulk of modern research that has been done on cannabis strongly affirms that it is not only safer than just about any of the medicines we physicians routinely prescribe for our patients, but that it also effectively treats a broad spectrum of ailments. A rapidly growing number of patients throughout the country use it regularly, actually preferring its efficacy and minimal side effects to the medicines their doctors prescribe. All do so at the risk of imprisonment. Without a doubt the criminal penalties concerning cannabis use do far more damage to the mental and physical health of our patients and their families than cannabis could ever do. A poll conducted earlier this month by Public Policy Polling found 58% of NC residents are in favor of passing some sort of medical cannabis legislation here. Let's face it – the era of medical cannabis is upon us and its physiologic mechanisms are increasingly well understood, yet what does our medical community know about the endocannabinoid system? Few if any learned about it in medical school, and how many of us have made an effort to learn about it or are even aware that we can learn about it?
 
I believe I'm in a special position to help. As a Board Certified Diplomat of the American Academy of Cannabinoid Medicine, I bring considerable academic understanding of the endocannabinoid system and years of experience from practicing cannabinoid medicine to my position as N.C.C.P.N. medical director. At our February 12 event, I plan to give two short talks – one describing my cannabinoid medicine practice in Hawaii and another overviewing our current understanding of the endocannabinoid system. Attendees can also expect testimony from patients, veterans and other health care professionals, and the author of the North Carolina Medical Cannabis Act will touch on the legal aspects of bringing cannabinoid medicine to Carolina.
 
I refer those who would like to learn more about this educational lobbying event and our organization to our website (NCCPN.org), which serves as an educational and networking resource for those with interests, concerns and experience with using cannabis as a medicine. This is a great resource for patients and medical professionals alike! When there, please review my own collection of articles on cannabinoid medicine (under the heading “NCCPN Medical News”).
 
I humbly thank you for your time.
 
Sincerely,
Kevin Baiko, MD, Medical Director
North Carolina Cannabis Patient Network
It is a common joke concerning cannabis… how it can cause a user to forget what he was saying mid-sentence.  While this short term “brain fart” phenomenon is kind of funny to witness, some casually regard it as evidence that cannabis use “fries” your brain like an egg as depicted in those old “This is your brain on drugs” television messages.  While most drug propaganda pieces are hilarious to the informed viewer (whether under the influence of cannabis or not), they have scared countless trusting or otherwise naïve people into supporting the criminalization of cannabis use.  But what does actual science say? Does cannabis use actually cause brain damage?  In a word, no.  Does cannabis contribute to memory loss?  Yes and no.  Might the ability to forget serve a purpose in the healing process?  Absolutely!

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The first “scientific” study linking cannabis to brain damage emerged from the monkey suffocation studies conducted at Tulane University in the 1970’s, which clearly demonstrated brain damage in rhesus monkeys after cannabis exposure.  President Reagan cited these studies as justification to escalate the war on drugs in the 1980’s, but he failed to mention a few important facts about these studies.  First, the brain damage was actually caused by lack of oxygen from excessive forced cannabis smoke inhalation.  Second, these suffocation studies were thereafter contradicted by research at the National Center for Toxicological Research in Arkansas, which demonstrated no brain damage when equivalent quantities of cannabis smoke was administered with adequate amounts of oxygen.  Since then, even despite cannabis research prohibition in the U.S., an impressive body of scientific findings has accumulated which finds no significant link between cannabis use and brain damage.

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To the contrary, several cannabinoids demonstrate neuroprotective and neurogenic properties.  A study from 2001 found THC and CBD to be neuroprotective antioxidants and that CBD protects neurons more effectively than either vitamin C or E.  In 2006, researches at the Scripps Institute published a study comparing THC to standard of care medications being used to treat  Alzheimer’s dementia (acetylcholinesterase inhibitors).  This study found that THC is a considerably superior inhibitor to the formation of the amyloid beta plaques characteristic of the disease.  In addition to preventing neuroinflammation, cannabinoids enhance neurogenesis (new nerve cell growth).  In other words, cannabis seems to prevent brain damage, and shows remarkable promise in the treatment of such neurodegenerative disorders as Alzheimer’s Dementia.  Since then other studies have confirmed the remarkable promise in the early treatment of traumatic brain injuries and stroke, as well as slowing the progression of ALS & Parkinson’s disease.  Findings from a 2009 study in Neurotoxicity and Teratology suggest that cannabis can protect the brain from damage caused by alcohol poisoning. So cannabis, a criminalized plant, actually reverses toxic effects of alcohol, which is legal.  Adding public policy insult to drug war injury, since 2003 the U.S. government has held a patent (US Patent 6630507) for the antioxidant and neuroprotective effects of cannabinoids, yet continues to designate cannabis as a Schedule I drug for which there is “no legitimate medical use” with “high risk of abuse”, effectively stalling the advancement of cannabinoid medical research and therapeutic application.

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With all these antioxidant, neuroprotective and neurogenic effects, an independently thinking individual may reach the conclusion that cannabis actually improves memory.  One study found that older rats subjected to one puff of cannabis demonstrate improved short term memory.  On the other hand, younger rats subjected to the same dosing demonstrated decreased short term memory.  Both groups returned to their baseline short term memory once cannabinoids had cleared their system.  There are several take home messages we can glean from these findings: 1. Younger persons may score lower on tests requiring memory retention after using cannabis, 2. Older persons may score higher on such tests after using cannabis, 3. Neither group will suffer long term impairment or improvement of memory after using cannabis.

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Of course, we tend to consider such findings with the presumption that good memory is a part of good health, but what constitutes healthy memory?  Are we better off remembering every detail of every day or only the relevant details?  What about our traumatic experiences?  I hesitate to describe a concrete ideal of mental health here, as some individuals demonstrate extraordinary memory, but not necessarily without paying a price for it.  I recently read of one autistic man who realistically drew the entire New York skyline, detail by detail, after a 20 minute helicopter ride over it.  The fact he was autistic should not go unnoticed, as autistic individuals are notorious for their tendency to suffer sensory overload in environments where most of us cope with fine.  Cannabinoid researcher Di Marzo famously described the ability to forget as one of the primary pro-homeostatic mechanisms for stress recovery and adaptation regulated by the endocannabinoid (eCB) system.  This system mediates the extinction of aversive memories and adaptive processes.  Often times it is better to forget and cannabis can help.

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Studies on fear conditioning illustrate this point.  When animals are subjected to a threatening stimulus, many instinctively freeze in fear.  This freeze response extinguishes (tapers off) over time due to stimulation of the eCB system in the amygdala.  In other words, the test subjects, learning that the stimulus is no longer coupled with the threat, suppress/forget the aversive memory over time.   However, when the eCB system is blocked, no such tapering is demonstrated.  If it wasn't for our eCB system, it would be very difficult to unlearn adaptive responses that don't serve us. We would loose our ability to overcome our instinctively rooted and traumatically incurred fears.

Our ability to forget is of particular relevance to understanding and treating the condition known post-traumatic stress disorder (PTSD).  Some events are so traumatic that the individuals psychologically re-experience the events again and again, causing them to avoid stimuli associated with the trauma and leading to significant distress and social impairment. PTSD is associated with dysfunction in many of the same brain regions hosting an abundance of eCB receptors (including the amygdala.)  It is hardly surprising then that many suffering PTSD self-medicate with cannabis.  One recent pilot study conducted in Israel demonstrated a reduction of chronic combat PTSD symptoms amongst the subjects medicated with cannabis.  Whatever the actual mechanism, the most common report from my PTSD patients is that cannabis blunts their post-traumatic symptoms and helps them calm down.

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Most, if not all of us, experience multiple traumas in the normal course of our lives:  sprained ligaments, strained muscles, broken bones, bruises, burns, etc.  Osteopathic theory suggests that our body “remembers” these traumas, and as such holds the body in a dysfunctional state until the traumatic forces stored in the tensegrity of its tissues - or the memory thereof - can be released.  To facilitate this release, I routinely prescribe exercises and stretches to follow my patient's cannabis use.  Not only does the cannabis relax muscles, ease pain and increase body awareness – all invaluable aids to physical therapy, I believe it actually helps the body to forget old traumas and to relearn how to move functionally again.  Not only does it aid in trauma resolution, it can therapeutically and educationally enhance the experience of yoga, body work, martial arts and other body-mind exercises.  Honestly, if I have one complaint about cannabis, it is this: its capacity to help us relax, loosen up and let go, can undermine one's sense of discipline – perhaps helpful for those trying to extinguish old habits, perhaps counterproductive for those trying to cultivate the discipline required to establish new lifestyle practices.

In conclusion, cannabis does not cause brain damage.  If anything, it seems to prevent many of the neurodegenerative processes associated with normal aging, chronic dementia and traumatic brain injury.  It has proven an invaluable medicine in the treatment of post-traumatic stress conditions.  Many of my patients use it only at day's end... to forget about their stresses and pain enough to get a healing night's rest and...

 

Now, what was I saying?

 

(Scientific references available upon request.)

Cannabis and kids – the connection scares people. As a doctor who has personally witnessed countless health successes among my ranks of patients who medicate with marijuana, I can testify to the healing power of the plant. In an age of such physical, mental and societal imbalance, many believe this herbal key to human homeostasis promises to revolutionize our diseased world as we know it. This, of course, threatens a wide cross-section of individuals, not the least of which those who find themselves in positions of “power” in aforementioned diseased world, and so we are bombarded with propaganda declaring pot as a dangerous and addicting menace to society. While most of these declarations, even those purporting to be backed by science, fall flat on their face to most as strained attempts to keep down the beach ball of truth (that cannabis is a powerfully effective and relatively safe herbal remedy), those concerning how cannabis might impact childhood development seem to invoke the highest degree of caution. Should parents be worried about their kids using cannabis? Are children harmed directly from cannabis use? How does maternal cannabis use effect the unborn or nursing child? How does childhood use of cannabis effect mental and physical development? I believe that simply asking these kinds of questions is a healthy first step in responsibly approaching this often emotionally loaded subject.
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Truthfully answering such questions to everyone's satisfaction, even in this era of eroding prohibition, is not so simple. If we put aside hemp's empowering potential as a source of nutrition, clothing, manufacturing, fuel, etc. and just focus on its medicinal and recreational potentials, its status is already elevated by its effects on human consciousness into more than just a matter of science. Religious objections to cannabis use can only be over-ruled by spiritual revelation, and the fact that so many former religious objectors claim to actually have such revelations upon using cannabis may only strengthen the resolve of those who believe that pot undermines spiritual focus or distracts us from God. The politics of cannabis prohibition (and big money behind it) practically outlaw any research on cannabis unless a study's proposed design is to strengthen claims that cannabis is somehow dangerous. The so-called “war on drugs” has scared and misinformed generations of parents and children with its reefer madness propaganda machine, crippling critical thought and biasing scientific inquiry. Of course, our natural, at times irrational, parental wariness, caught between the sermons and laws of church and state, renders scientific assurance all the more inherently limited when applied to the safety of our kids.
While a review of 20th Century cannabis prohibition propaganda offers many baseless and even hilarious reasons to fear cannabis - that it incites violence, causes brain damage, leads to use of “harder” drugs, and the like..., they all seem to draw from a fear of the mind-altering properties of cannabis. This fear naturally intensifies when children might be involved. After all, the human nervous system is extremely complex and shouldn't be messed with, at least in its formative stages, right? Even if cannabis use itself causes no harm to a child's brain, what about the risk that its mind-altering effects could cause deficits in judgment leading to unsafe behavior? Couple these questionable hazards with very real legal consequences that the criminalization of cannabis has brought us, and it's understandable how many parents, even those who are regular users themselves, regard pre-adult cannabis use with displeasure. It's one thing to feed a vice as an adult, but one invites harsh condemnation to enable a child's “drug” use, or worse yet to expose a newborn or the unborn to questionable habits. Or so it seems to some, but are these concerns justified?
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Ironically, cannabis seems to help many users do just that. The homeostatic properties of the endocannabinoid (eCB) system relax the mind and body out of stressful paradigms and postures once taken-for-granted . For many this relaxation comes and goes with the so-called “euphoric” (feeling good) effects of cannabis, but others learn from such experiences. Why fear a substance that helps people break free of stress-endowed conditioning – conditioning not only concerning the substance itself, but any conditioning that causes unnecessary stress? Chronic stress IS the modern day killer. Relaxation coupled with the slight alterations in how the world is perceived naturally leads many cannabis users to question given “truths”, rules, not to mention the authority of those perpetuating them.
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Then again, fear of consequence is a time-tested tool in a state's control of its populace. Many parents use this tactic too. Could this explain why “euphoria” is often listed by authorities (governmental, religious, etc.) as a dangerous side-effect of marijuana? Our criminal justice system certainly turns cannabis use into a risky, stress-ridden, downright scary practice when consequences like jail time or loss of parental custody can result. Is the use of cannabis even remotely as dangerous as the legal system penalizing its use? The overwhelming body of science on the matter informs us in no uncertain terms: ABSOLUTELY NOT!
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Honestly, there haven't been many controlled studies specifically measuring the effects of cannabis on childhood development, presumably due to legal restrictions on such studies. Most studies, especially maternal studies, have failed to isolate cannabis use from the use of other drugs (pharmaceutical or illicit) as a variable to measure relative risk of developmental defect, etc. However, one study did just that, perhaps because it took place in Jamaica, where cannabis remains a time honored folk remedy. This study demonstrated no negative effects in the babies exposed to regular maternal cannabis dosing (ranging from light to heavy) during their pregnancy. In fact, at the five year follow-up, children who were exposed to cannabis while in the womb demonstrated superior cognitive abilities compared to the control group whose mothers abstained from cannabis use (Dreher, et al). I am not aware of any such study focusing on cannabis use during lactation, but anecdotal evidence only seems favorable for mothers who use cannabis when breastfeeding. Breastfeeding is easier for the infant when the mother is at ease herself, and it turns out that human breast milk naturally contains eCBs, whether or not the mother uses cannabis. This finding makes sense considering how the eCB system calms the gastrointestinal system and stimulates appetite. Apparently, infants thrive on cannabinoids.
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Please don't mistake anything here as a call to supplement everyone with ganja. Like I said, cannabis is a powerful medicine. With power comes responsibility, and by that I mean that all cannabis use warrants reasonable caution. Positive effects need to be weighed against negative effects for each patient. Cannabis is a remarkably safe substance to use, regardless of its route of administration, but safety doesn't necessarily equate with optimization. For example, adolescents using cannabis tend to demonstrate temporarily worsened short-term memory function while using cannabis. On the other hand, short-term memory amongst elderly subjects tends to temporarily improve (Wenk). However, this finding doesn't mean that cannabis always compromises mental function in all pre-adults any more than it always optimizes mental function in older subjects. Adolescents with attention deficit disorder regularly report an optimization of their mental state when using cannabis, including: improved focus, calmness, impulse control and school performance. While an impressive body of evidence is accumulating linking its neuroprotective properties to the prevention and treatment of senile dementia, cannabis may well exacerbate symptoms in certain Alzheimer's patients. As with the effects and side effects of any medicine, some patients might find that cannabis causes certain mental or physical functions to improve while other functions worsen while using it. In advocating cannabis as a medicine, as opposed to a lifestyle, I am admitting that, even among pediatric populations, it's a good treatment option for some, and a not-so-good treatment option for others. No doubt, many subpopulations would be better off to avoid cannabis entirely, but the evidence just doesn't support any conclusion that cannabis is dangerous to babies, children or teenagers, in general.
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(Scientific references available upon request.)

Cannabis is amazing medicine.  In addition to being far safer than the majority of available "drugs" available over-the-counter or by prescription, it effectively treats a wide variety of conditions – so wide that no other known medicine, man-made or natural comes close to being a rival.  This is because of the endocannabinoid (eCB) system, whose profound role in human physiology is only just beginning to be understood in modern scientific terms.  Cannabis affects us so is because we intrinsically produce our own forms of its cannabinoid constituents and receptors which respond to both our intrinsically produced eCBs as well as the phytocannabinoids found in the cannabis plant.  The primary role of this system seems to be to maintain a healthy internal balance (homeostasis) amongst all the organ systems and throughout the body-mind in general.  Whether or not we supplement this system with cannabis, we are still "wired" with its homeostatic mechanism.  And so questions arise... How can we optimize its function?  And more specifically, how do daily lifestyle choices affect its function?

 

By the term "lifestyle" I mean the way we tend to live on a day-in-day-out basis.  This includes the foods we tend to eat, the exercise we tend to get, the way we tend to deal with stress, the habits we tend to cultivate and the healthcare interventions we tend to employ.  For the most part, our lifestyle is the sum of all the choices we make, consciously and unconsciously, and these choices affect the way our eCB system works.  In fact, this is probably where most disease processes start.  If our goal is to optimize our health, it makes sense to optimize the function of the system that manages our body's homeostasis.  This starts with the foods we eat.

 

Endocannabinoids are synthesized from essential fatty acids – specifically from the Omega-6 fatty acid -aracidonic acid (AA).  Since essential fatty acids cannot be synthesized in our bodies, we need AA in our diet to synthesize the eCB anandamide.  Dietary supplementation with AA increases levels of anandamide and another eCB, 2-acyl-glycerol (2-AG).  eCBs are paracrine hormones, because (rather than being released into the bloodstream for transport to other portions of the body) they are made locally for local use and quickly degraded.  It turns out our bodies also use AA to synthesize several other types of paracrine hormones – leukotrienes, thromboxanes and a subtype of prostaglandin (PG2) – all of which contribute to inflammation.  Our bodies make two other types of prostaglandins (PG1 & PG3) – which are both anti-inflammatory – from Omega-3 fatty acids.  eCBs are also anti-inflammatory, but curiously, supplementing with Omega-3 fatty acids decreases serum endocannabinoid levels.  However, Omega-3 fatty acids seem to be required for eCB-mediated neuronal function.  So, how might this information guide us in our dietary choices?

 

The easiest answer is to balance our intake of Omega-6 & Omega-3 fatty acids.  Both are necessary for our eCB system to function optimally and while a little passing inflammation here and there is part of our body’s natural healing process, chronic inflammation leads to chronic pain, disease and disability.  Suggested optimal ratios of Omega-6 to Omega-3 fatty acid dietary intake vary from 1:1 up to 4:1.  The average American consumes a ratio of well over 10:1, and often as high as 30:1.  Omega-6 fatty acids are abundantly found in corn, many cooking oils (corn, safflower, sunflower, soy), as well as corn-fed livestock.  The fattier the meat, the more AA that is found therein.  Unless from free range sources, our meat, dairy and egg products drive our fatty acid ratios into ranges that tend to lead to inflammatory based disease.  Foods rich in omega-3 fatty acids include wild fish and game (and their byproducts) as well as certain seeds (flax, pumpkin, walnut).  Not surprisingly, hempseed oil boasts a ratio of 3:1.  Practically speaking, we seem to be better off by limiting our meat and dairy intake to wild sources while steering away from oils high in AA content towards oils high in Omega-3 fatty acid content. 

 

Exercise also seems to influence how our eCB system functions.  Exercise increases eCB receptor expression.  In other words, the more we exercise the more sensitive we are to cannabinoids – be they intrinsically sourced (endocannabinoids) or extrinsically sourced (phytocannabinoids).  Exercise also leads to a release of the eCB anandamide.  Many are familiar to the "runner's high" phenomenon, wherein extended exercise leads to euphoria.  It turns out this is not caused by "endorphins", but rather – you guessed it – by our endocannabinoids.  It is a "high" afterall.

 

Most people associate the word "dieting" with an attempt to lose weight.  It turns out being overweight directly influences our endocannabinoid system, which in turn influences overall health.  Many disease states are associated with obesity.   Fat cells (adipocytes) produce excessive eCBs, which stimulate appetite, encouraging weight gain and development of worsening obesity.  This vicious cycle makes weight loss all the more difficult.  Caloric restriction (fasting) reduces both eCB and eCB receptor CB1 expression.  The eCB system may be our link between pleasure and eating.  Rimonabant, a CB1 receptor blocking pharmaceutical, was developed as a weight loss drug.  It truly helps people lose weight, but it also tends to cause such severe depression that people are much more prone to suicide when using it, so it is not approved for use in the U.S.  However, combining caloric restriction with regular aerobic exercise increases CB1 expression – enabling us to both lose weight and maximize the cannabinoid mediated sense of reward simultaneously.

 

In this modernized world stress is a major killer.  It contributes to virtually all known disease processes.  This may be one of the primary reasons people supplement their eCB system with cannabinoids from the cannabis plant – to relax.  Cannabis certainly aids in this process.  Unfortunately, chronic stress down-regulates CB1 expression.  Over time, this loss of our body's receptiveness to eCBs just leads to the experience of mounting stress.  Anecdotal evidence suggests that stress reduction techniques such as meditation, yoga and deep breathing exercises reverse this down-regulation.  It is worth mentioning here that while cannabis use is relaxing to body and mind, and while its mind altering properties can help us look at stressful circumstances with creativity and even humor, it does not make those stressors go away unless we integrate that creativity and humor into our daily lives.  Stress is more often a matter of how we react to perceived threats than actual threats, but our bodies don't know the difference.  Cannabis use can counteract the stress response, but until we learn to see things for what they really are (and cannabis can help us do just that), we run the risk of depending on a plant to treat a delusive symptom that only self-realization can truly cure.  Fortunately, cannabis use is a remarkably safe habit.

 

But what of the other substances of habit regularly used to cope with the stresses of modernized life?  Alcohol is far more dangerous than cannabis, both in terms of what it does to a user’s body and what the user’s body (or motor vehicle) can do to others.  Furthermore, chronic exposure to ethanol down-regulates CB1 expression.  Alcoholics are less responsive to both eCBs and phytocannabinoids.  The reverse seems to be true for regular coffee drinkers, as chronic caffeine exposure potentiates CB1 dependent stimulation.  Curiously, despite the recent demonization of tobacco use for its negative impacts on personal and public health, chronic nicotine exposure increases CB1 expression in parts of the brain, especially in adolescents.  It is often cited that while cannabis is not physically addicting, its use can lead to psychological dependence.  Whether or not this latter point is true, we all know that alcohol, caffeine and nicotine can be highly addicting. Could it be that our eCB system plays a role in psychological dependence to these substances?  Many of my patients have confided that their cannabis use helped them not only break their habits of alcohol and tobacco use, but also their use of high strength prescription painkillers, methamphetamines, heroin and cocaine, all of which are horribly addicting.  Cannabis, it turns out, is a "gateway drug" – a gateway OUT of addiction.  It's not an "entry" drug – it’s an exit drug.

 

In addition, to diet, exercise and self-medication, many rely on "alternative" health care therapies to maintain health and treat disease.  Osteopathic and chiropractic doctors often employ techniques to remove restrictions to nerve flow between the central and peripheral nervous systems.  This kind of bodywork has been shown to both increase anandamide levels and to help the transport of the CB1 receptors from where they are synthesized (in nerve cell bodies in the spinal cord) to where they do their job (at the distal nerve terminal somewhere in the body’s peripheral nervous system).  Given the eCB system's role in maintaining homeostasis, this is a huge endorsement for maintaining good spinal health.  Another alternative approach to health care - acupuncture, has been shown to increase anandamide levels in the skin and to upregulate CB2 receptors in the skin.  I highly suspect that future studies will demonstrate wide-ranging changes in the eCB system throughout varying organ systems, depending on the specific acupuncture points piqured.

 

When we consider the endocannabinoid system’s role in maintaining physiologic balance, it makes sense that its maintenance should be approached in balanced fashion.  For this system to work optimally, its receptors must be fully expressed throughout the body.  For these receptors to work, the body must be able to produce adequate quantities of the appropriate eCB’s to signal the receptors.  While simple supplementation (smoking/eating cannabis), certainly signals these receptors, it doesn’t do so with the selective finesse of which a healthy eCB system, is no doubt capable.  Diet, and specifically a healthy ratio of Omega-6:Omega-3 fatty acids (not exceeding 4:1),  plays a crucial role in synthesizing a healthy balance of paracrine hormones (including eCBs).  While excess alcohol consumption is best avoided, exercise and weight management, as well as maintenance of proper structural and energetic health (especially of the spine) all contribute to a properly functioning endocannabinoid system.

 

(Scientific references available upon request.)

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