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Dr Dan Price Endocannabinoid Webinar
Kandice : All right thank you for joining us for educational lecture series on cannabis
each session is designed to deliver a small in-depth dose of cannabis education
my name is Kandice Hawes and I want to thank all of our customers from bud and
bloom the pottery and from the pharmacy Santa Barbara and Berkeley today we’re going to talk about the endocannabinoid system the endocannabinoid system is involved in regulatory regulating physiological and cognitive processes including fertility various activities of the immune system appetite pain sensation mood and memory the endocannabinoid system is the reason why cannabis works in humans and in animals this is a fascinating vital system and I’m really excited to learn more about it from our speaker Dr. Daniel price who is the medical director of Tikun Olam Dr. Daniel price was trained in emergency medicine at the University of California Davis did a fellowship in air medical transport and trauma at Oregon health and science university, he worked as an academic physician at the highland hospital and trauma center for in Oakland for 14 years and has authored over 40 scholarly publications doctors price’s work focuses on the use of portable ultrasound and emergencies in and in under resource settings in Africa Latin America and Asia he has also helped found mobile medical media which developed medical education resources for mobile devices Dr. price’s interest in medical cannabis arose from his own experience with back pain and from seeing patients in the ER could who could have been of help safely by medical cannabis but were instead only prescribed pharmaceutical medications which often limited efficacy and potentially offered severe side effects he helped pioneer house call a telemedic cannabis consultation service with meadow md in San Francisco where he has treated over fifteen thousand patients he recently joined Tikun Olam as a medical director to help advance the science of medical cannabis now we’re going to watch a short video on Tikun Olam.
Tikun Olam is a very personal thing it’s a one-on-one with the patient because we want to make sure that we understand the efficacy and the treatment how the cannabis is working on the human body Tikun Olam means to repair the world and that is exactly what our mission statement is
is to help people improve the quality of patients’ lives is to help people get better we have
years and years of studies and years of years of data that we can sit there and show them you know we’ve been at this a long time we’ve done this with over 20,000 patients and what we found is this specific strain with this particular method and dosage has been able to provide symptomatic relief and I think that to me is the most powerful thing that we’re excited about in California is providing so many Californians a road map to a better quality of life I’m a cell and developmental biologist and so I look at the root of all types of diseases from the cellular level we want to know from the very cell how it starts and how that cell migrates how it multiplies into becoming what we now know as disease and that’s all types of disease one of the ways that Tikun Olam has in essence garnish this reputation of being the most trusted name in cannabis is that we’ve been at this a long time we were the very first medical license issued in the world and with that, we started immediately with understanding what the patient’s ailments were and how the plant and the specific strains that we have in our portfolio how they can improve people’s lives we published an autism study was the largest study ever done in autism utilizing cannabis and we saw very striking results 90.2 percent of patients had an improved quality of life in just six months I mean what more should I say than that I oversee both the grow and the cultivation processes through multiple states and we’re absolutely delighted and excited to be bringing that experience in the medical and scientific basis that underlines all of our products and our programs here to California my background is primarily in business and emerging markets and politics and there are lessons learned from those experiences that are applicable to the cannabis industry I realized the potential of cannabis to provide so much relief to people who are suffering and work for a company like Tikun Olam who has been doing that for so long it’s really exciting to be part of that Tikun yes it’s science yes Tikun Olam is medicine but you’ve got to love the story it starts in galilee with basically a poor farmer who wants to help his friends and his family and he is helped by scientists learning that cannabis can be medicine it can help a lot of people this is like a light for everybody else on the planet that cannabis is medicine and it’s helping people now in Israel Canada sees this and they make a legal market in a continent-sized place come to Israel embrace this light and bring it back to Canada that company goes on to become the first profitable medical cannabis company in Canada it raises a hundred million dollars in the largest IPO that’s ever been done and then gets bought out for 3.2 billion dollars just a couple of years later that gives you a sense of the power and the dynamism that lies in the cannabis industry not just in Canada or in Israel but all over the world and it’s that kind of dynamism that we’re obviously very excited to be part of here in California and the united states.
all right that’s just a little bit of information about why Tikun Olam is such an amazing brand and so we’re really excited to have with us today Dr. Daniel price so please doctor to take the floor well.
thank you so much Kandice and one thing that I just wanted to um add on to that video is that the thing that I love about Tikun Olam is that it is based on science it’s the only company where they because they came out of Israel they were able to do the research and there are over um 13 published studies in the peer-reviewed literature where you can actually buy the stuff that’s been studied that that is just not um true of any other company so when you’re looking for a company when you’re looking for a medicine you want something you can trust and you know that you can trust Tikun Olam because they’ve actually done the studies and that they’ve been peer reviewed and that this is um this is real medicine and we’re going to talk today about the endocannabinoid system and I remember when I was first learning about medical cannabis and I remember thinking to myself this sounds so much like snake oil because how can you say that it affects nausea and it affects mood and it affects pain and it um is helpful in all of these different areas how can one plant do all those different things and it wasn’t until I discovered the endocannabinoid system and that I realized the reason that cannabis can do all of these different things is that we have a physiologic system in our body that the cannabis plant can interact with and that’s called the endocannabinoid system and the endocannabinoid system is this physiologic system that works with all of the other systems of the body so the respiratory system the heart the cardiovascular system the skeletal system the skin the immune system all of these different systems of the body um are interfaced with the endocannabinoid system because the endocannabinoid system is the conductor of the symphony if you think of all of these other physiologic systems of the body as being um the players in the symphony whether you’re a trumpet player or a violin player the conductor is um directing you and that’s what the endocannabinoid system does and the reason that it interfaces with all of these different systems is that it promotes balance it helps the body stay in balance and be most productive and it regulates sleep and mood and memory reproduction pain stress appetite I could go on and on the list is really long and it’s because the endocannabinoid system interfaces with all of these other physiologic systems of the body and this endocannabinoid system is old it has evolved over millions of years and is present in all vertebrates from fish to humans all of us have endocannabinoid systems and it was discovered in the late uh late 80s or early 90s over that period in Israel by Dr Raphael Meshulam as Kandice mentioned and it’s relatively recent so most doctors are actually unaware of the endocannabinoid system not only because it’s so recent but also because it um isn’t taught in medical schools only about 13 of medical schools teach the endocannabinoid system that’s changing but it’s something that because of the war on Drugs it unfortunately, has tragically been ignored but there are over 21 000 peer-reviewed studies in the literature that look at the endocannabinoid system and cannabis so it’s actually very well studied and we have a long ways to go the problem is currently the way it’s scheduled by the federal government it’s schedule one and so that means it’s very it’s essentially illegal to do research on cannabis in this country it’s a real tragedy but the benefit of Tikun Olam coming out of Israel is that in Israel they are much more forward thinking in terms of cannabis used as medicine and medicine in general and so the research was able to be done in in in Israel and we benefit from that now here in the united states as well so in terms of uh the endocannabinoid system the key word the medical word is homeostasis is balance is I think one way to think about it is to use the um metaphor of goldilocks and the three bears and that uh fable talked about goldilocks coming into the bear’s house and looking for something that was just right the porridge was too hot or it was too cold but she wanted it just right that’s what the body needs the cells in the body operate most effectively when conditions are just right so temperature needs can’t be too hot it can’t be too cold it needs to be just right the blood sugar levels need to be just right not too high not too low the cell operates best when things are in balance and that is called homeostasis and what the endocannabinoid system does is it works with all of these physiologic systems of the body to help bring it back into balance so the body operates most effectively so there are three main parts of the endocannabinoid system um they’re the endocannabinoids which are chemicals in the body they’re messengers that you can think of as keys that fit into locks the locks are the receptors and the Kandice go ahead if you wouldn’t mind putting the image up on the screen what we’re going to look at here are the um there we go so the endocannabinoid receptors are the second part of the system so here we see cb1 and cb2 receptors these are the two main receptors that have been discovered there are other ones that uh we won’t mention that are in the process of being investigated but these receptors live on the cell membranes and they listen to conditions outside the cell and under certain conditions when it’s necessary they will transmit a message to the inside of the cell and produce an effect whether that’s a calming effect or whether that’s an uh inciting effect it’s going to have that effect because the endocannabinoids bind to these receptors these receptors are located all throughout the body cb1 receptors are most abundant in the brain actually let’s go back to the endocannabinoids first before we um go on but these receptors are scattered throughout the body and all of the different systems they live on the cell membranes and they um allow different parts of the body to communicate with each other so endocannabinoids are endo means within they’re made within the body so that’s in contrast to Phytocannabinoids Phyto means plant in Greek and so phytocannabinoids come from the plant endocannabinoids are made within the body and these are messengers that are made on demand from omega-3 fatty acids so those are great omega-3 fatty acids that you are getting in your salmon for example are what make up the building blocks of endocannabinoids and there are two main endocannabinoids that have been discovered although others are felt too likely also um work within the endocannabinoid system and these two endocannabinoids um are called 2ag which lives mostly in the central nervous system and is actually present in human milk it’s present in mother’s milk and so the very first milk that the baby gets has endocannabinoids in it and those endocannabinoids give the baby a wonderful peaceful feeling of being loved and um getting the nutrition from the milk and helps the baby um bond with the mother it’s a really a beautiful um situation that’s brought to us by um the endocannabinoids and particularly 2ag the other endocannabinoid the first one that was discovered these were discovered in Israel by Dr Raphael Meshulam and this the other endocannabinoid is called anandamide and it’s derived from the Sanskrit word Ananda which means bliss or joy and anandamide is often called the bliss molecule it’s responsible for runner’s high many of you may be familiar with the concept of runner’s high that you can get this blissful feeling after exercising particularly aerobic exercising and we used to think that those that um blissful feeling of runner’s high was due to endorphins and in keflans which are the body’s own opioid molecules that work with the opioid system but we find out now that actually it’s the endocannabinoid system that produces that blissful feeling and it’s that bliss molecule called anandamide that produces that feeling it also is responsible for memory early embryonic development and many other um effects throughout the body so those are the endocannabinoids those are the keys that fit into the lock of these receptors so the receptors sit on the cell membrane and they’re the lock and when a key fits that lock it opens up these effects within the body that are either stimulatory effects or calming effects and we’ll talk a little bit more about those the endocannabinoid receptors are um they’re two um main ones that have been discovered but others that uh as I mentioned are being investigated cb1 receptors are most abundant in the most abundant receptor in the brain of all the receptors in the brain serotonin dopamine glutamate these other neural uh neurotransmitters in the brain are directed by uh cb1 receptors so it interfaces with a lot of other different uh receptor systems within the brain but cb1 receptors are located in the brain and the central nervous system but are really scattered throughout the body as you can see in the diagram cb1 receptors are responsible for the intoxicating effects of both endocannabinoids and THC so the reason that people feel high when they use cannabis is because THC binds to this cb1 receptor and has its effects now anandamide also binds with the cb1 receptor and produces the um blissful feeling of runner’s high now why don’t we if anandamide is present in the body and made by the body why aren’t we high all the time well the reason is because endocannabinoids are made on demand they’re only made when they’re needed so it conserves um these uh building blocks and it allows the body to only respond when it’s needed to promote balance to promote this homeostasis and so um it’s broken down very quickly and these metabolic enzymes are the third part of the endocannabinoid system we’ll talk about these in just a moment but the THC is not broken down in the same way that anandamide is and it’s not an on-demand system and that’s why THC effects last longer than anandamide effects which are um on demand and produced for a specific purpose of bringing the body back into the goldilocks zone back into balance when things are just right so cb1 receptors also work with motor function and cognition they regulate release of other hormones as I mentioned serotonin dopamine glutamate um and so forth cb2 receptors are scattered throughout the body and mostly outside the immunes excuse me outside the central nervous system in places like the immune system they are present on the cells of the immune system and we’ll talk a little bit more in a moment about inflammation and how cannabis or excuse me how cannabinoids help regulate um inflammation which is a key uh part of how our bodies work so it also is uh cb2 receptors are also responsible for our pain perception and modulation of pain neuro protection and so forth so one question that comes up is why don’t cannabis overdoses cause death and the way opioid receptors do or the way opioids do so what happens with the opioid and the reason people die from overdoses of opioids is that they get too much and um the whether it’s fentanyl or oxycodone or whatever it happens to be when they get too much these opiates bind to the opioid receptors and their opioid receptors in the parts of the brain the part of the brain that um affects breathing and it basically shuts that off and so people stop breathing and die because of asphyxiation fortunately and the reason that cannabis is so safe is there aren’t there are very few endocannabinoid receptors in the brain stem where breathing and circulation are controlled and so you just aren’t going to affect those areas um in the same way because there aren’t receptors in that part of the brain and that makes cannabis much safer for example than opioids good news there so um the metabolic enzymes the again the three parts of the immune of the endocannabinoid system are the receptors the endocannabinoids and then these um enzymes that synthesize the endocannabinoids on demand and then break them down again and they break them down very quickly and so the effects are short-lived and only occur when they’re needed so it really allows the body to fine-tune the effects of the um what they’re what they’re trying to do and trying to bring the body the sole purpose is just to bring the body back into the goldilocks zone where things are just right and the cells are able to perform at optimal in optimal conditions so um these enzymes are only take effect when they’re needed and there are two of them one is called pha f-a-a-h which breaks down anandamide and the other one is called mag-l um which breaks down 2ag and those enzymes keep the system running well and that is uh those are the three components of the endocannabinoid system what I’d like to do now is talk about two different functions of the body and we can take a closer look at how the endocannabinoid system works in those specific settings the first one is um how do endocannabinoids regulate brain cells firing so within the brain we have neurons these brain cells and neurons communicate with each other and endocannabinoids are within that system and they um produce retrograde signaling they allow if you have for example two neurons that are sitting next to each other and one is communicating with the other if that communication system becomes overwhelming and out of balance the um the listening say you have a talking for example a talking neuron and a listening neuron um that listening neuron if it’s overloaded is able to talk back and produce this retrograde signaling to the um sending neuron that I’m overloaded you need to quiet down and one way to think about this is if you I live in an apartment and if my if someone in the apartment next to me is too loud I can go next door and ask them to turn down their music and that is what the endocannabinoids do they’re able to give that feedback to the um sending neuron that they’re producing too many signals they need to calm down and that is going to bring the um neurons back into the goldilocks zone where things are just right and the communication is optimal so another system that we can talk about is inflammation as I mentioned before so inflammation is the body’s response to infection or injury and what it does is the inflammatory system which is very complex it’s able to remove germs and damaged tissue and bring that part of the body back into um the goldilocks zone um back into balance and take care of the uh down and dirty functions that are needed for um maintaining that system so for example you have you have these cells running around the blood system that are set up to detect infection and if you have bacteria in there the body’s immune system recognizes that and secretes chemicals that start a whole cascade of um effects to try to remove the germs what it also does at the same time that it’s releasing these chemicals trying to recruit other blood cells to come in and engage in the fight it also releases endocannabinoids because the endocannabinoids want that inflammatory process to be in balance we don’t want too much inflammation which is for example chronic inflammation is damaging to the body we don’t want chronic inflammation we just want inflammation to take care of that infection or take care of damaged tissue we also don’t want the body to continue to have inflammation and directed against bod the cells within the body that’s called an autoimmune disease and where the body attacks its own cells and endocannabinoids help prevent those and keep the inflammatory response in check and it tells it to do what it needs to do and then stop and that way we prevent further injury and return the body in that area to the goldilocks zone so how do plant cannabinoids like THC and CBD work within the endocannabinoid system excuse me how do they work with yeah with the endocannabinoid system um and THC we’re going to dive a little deep I don’t want to confuse people but we’re going to go a little bit deep but THC binds to cb1 and cb2 receptors it produces the high because of that it modulates inflammation it reduces pain intraocular pressure nausea muscle tension the list goes on and on but it does it by binding to the cb1 and the cb2 receptors that’s different than CBD which is the second most common compound in the plant for those of you that aren’t familiar with it THC is the most common compound and um does the things that we just talked about CBD is the second most common compound in the plant it’s non-psychoactive so it doesn’t make you feel higher stone which is nice in many cases and it operates in a number of different ways which are very interesting it doesn’t really bind to cb1 and cb2 um in the tr in a traditional sense what it does do is it increases levels of anamide again an edomite is that bliss molecule um and that does a lot of different very positive things for the body as an endocannabinoid and it increases levels of anandamide by inhibiting breakdown by the enzyme fall that we talked about so it inhibits fog and so anandamide builds up in the system and it increases our body’s own endocannabinoids and is great in that regard that is one of the ways that um CBD helps in particular with stress and anxiety it um you can think of anxiety as being a normal stress response in the body that’s out of balance and anandamide and CBD help calm the anxiety and bring that system back into balance help bring our brains back into our goldilocks zone so the other thing that CBD does is it interacts with a lot of other different systems in the brain well in the brain and the rest of the body it’ll interact with over 37 different receptors of different types and 12 of those in the brain 12 different receptor systems within the brain so it really has um broad effects and very positive effects but it’s quite complex the other thing that CBD does is that it binds it binds to the cb1 versus it binds next to the cb1 receptor I guess is one way to think about it so that it in it makes it makes the THC molecule have a lower affinity for the cb1 receptor so that’s the THC and the CBD which produces the high for example is greatly is modulated by CBD and so it’s a great way for people who are looking to um not be intoxicated to modulate that effect of THC by including CBD in the mix um so CBD has a great effect at decreasing the side effect uh side effects of THC um as you guys um come up with questions please write those in so that we can address them but we have just a few more things that I’m going to cover and then we’ll move to questions so one of the things that you may have heard of is endocannabinoid deficiency syndrome and that is really a great way to be able to look at some of the illnesses that have been poorly understood by um by scientists and physicians so endocannabinoid deficiency syndrome as you could probably detect would be low endocannabinoid levels that are associated with certain illnesses like migraines or fibromyalgia or irritable bowel syndrome these are physicians at some times in the past have thought these weren’t even real conditions but we’re finding out now that they truly are real conditions and that they are caused by low levels of endocannabinoids and so this really explains how treating them with supplemental cannabinoids from the cannabis plant is able to make such a huge difference oftentimes patients who have migraines or fibromyalgia or irritable bowel syndrome find that nothing else works and they can try a lot of different medications pharmaceutical medications and they find that only cannabis is able to provide relief and that’s because cannabis works within the endocannabinoid system and that’s their problem is they have low levels of these endocannabinoids with the endocannabinoid deficiency syndrome so it’s like having uh too little vitamin c you’re going to supplement that with vitamin c that you could take as a dietary supplement the same thing would be true of cannabis as a supplement for these endocannabinoid deficiency syndromes so it really is a nice way to explain how cannabis is able to provide relief when other medications can’t so another question that comes up is why do different people have different experiences with cannabis for some people um they have a negative experience uh with the psychoactivity for example for other people it makes them relax and calm and feel good and the reason that people have different experiences is that everyone has a unique endocannabinoid system and that has to do with the number of receptors that you have the sensitivity of the receptors in producing an effect within the body the enzymes that break down these endocannabinoids all of these different components of the endocannabinoid system are unique to different individuals and so what that does is it tells us you can’t it’s not like a pharmaceutical medication where you can say 15 milligrams of this particular medication is going to produce this effect we don’t know that with cannabis and so a lot of times what you have to do is trial and error to find your best dose and that’s really um the key goal as a medical cannabis patient is finding the right medication and finding the right the proper dose for you as an individual and so we’ll talk more about that as we go along but that’s the reason why people have different experiences using the same plant because all of us have a unique endocannabinoid system and endocannabinoid tone so another question that comes up is how is it best to dose cannabis if we if all of us have these different um experiences and that’s why the rule of thumb start low and go slow is so important because for a couple of reasons one is that lower doses often are more effective there was a study done on cancer patients with pain and they found that they gave three different doses of cannabis and they found that the highest dose actually didn’t help patients the moderate dose was helpful but the lowest dose was actually what produced the best pain relief and so often um this is true with nausea for example and other um positive medical effects that you’re looking for so starting low is often more effective the other thing is that you’re a lot less likely to have side effects at a low dose and this includes psychoactivity and it’s nice to be able to get pain relief during the day without being incapacitated by the intoxicating effects of THC and you can add CBD to the mix to help alleviate that and the other thing is using a low dose so it really is beneficial that way cannabis and THC in particular is often described as being biphasic and biphasic means that there’s it has two different effects at two different doses so for example anxiety often can be alleviated with a low dose of cannabis and I often think of the feeling with a low dose is sort of like big sigh it’s going to be okay things are going to be okay whatever I’m working through I can I can make it through this but at a high dose high doses of THC can produce actually worsen anxiety and can produce panic attacks and even paranoia and anyone who’s had too much of an edible knows that it’s no fun to get too much THC and unfortunately with edibles that effect lasts for hours and so starting low is especially important with edibles but uh tuning into that biphasic effect you want to start with a low dose to try to avoid the negative effects that can be produced at a high dose also using a low dose prevents tolerance and tolerance is where the body requires increasing doses of the medication in order to achieve the same effect and what happens is when the body gets too much THC for example the receptors are overloaded and they shut down they say I don’t need all of these receptors because I’m overloaded with THC so it does what’s called down regulation of those receptors it decreases the number of receptors and so you need more and more of the medication to produce the same effect well that’s not good for the body and that’s called tolerance you’re a lot more likely to get other side effects when you use these higher doses and so um what can you do to alleviate that tolerance if it does develop well you can try to prevent it by using low doses but you can also do something called a tolerance break well what is the tolerance break well what a tolerance break is taking a break from cannabis for two or three days and what happens is the body is essentially able to recycle those endocannabinoid receptors and replenish them and there was a study done at Harvard in 2016 a brain scan study and they found that just two days of going without THC basically allowed the body to replenish all of its endocannabinoid receptors and return back to um that goldilocks zone that that just right zone and one of the things that’s important is when you do a tolerance break and you finish the two or three days that you take a break without cannabis it’s super important to go back to using cannabis at a lower dose because you’re going to be so much more sensitive all of those receptors are up there just listening for THC or whatever the endocannabinoid is or the cannabinoid and so it’s much more sensitive so you want to start at a lower dose I used to tell patients to start back at half the dose of what they were taking before they um put a pause on the their cannabis consumption but in talking to patients over time that have done tolerance breaks I’ve come to regard that really as a quarter dose going back to starting to use cannabis at a quarter of the dose that you were using when you hit the pause button and then you’re able to really dial into just the right amount that optimal amount that works best for you as an individual what is your what’s your goldilocks dose what’s your just right dose so those are the main things that I wanted to cover in our conversation and it’s been great talking with you guys I really want to spend time answering your questions so um Kandice how are we doing do we have questions that have come up oh yeah we definitely have some questions some really good ones um so the first question is does hemp CBD interact the same as a cannabis CBD what is in the body that’s a really good question so um CBD is CBD it’s a molecule that um is the same molecule whether it’s coming from hemp or whether it’s coming from cannabis the key difference in in my understanding is that the other chemicals that you get in the plant are going to be different when they come from cannabis you’re going to have a lot more different cannabinoids that come along with the CBD THC uh CBN um CBG a lot of other chemicals that are beyond our discussion today um other chemicals as well called terpenes which give the smell to plants that also have um medical effects there are over 200 different terpenes in the cannabis plant um there are over a hundred different cannabinoids that interact with the endocannabinoid system and so you have a lot of different chemicals within the plant that work together synergistically and that’s often referred to as the entourage effect the idea is that the medical effects that you get are greater than the sum of the parts that this entourage is able to give you um additional benefits and that’s something that you get in cannabis based the schema CBD as opposed to hemp-based CBD now I will say that in the way tycoon has done it there is a tycoon hemp brand for people that live in states that don’t have legal medical cannabis and the thing that tycoon hemp did was in addition to including CBD in their products they also include terpenes that include that come in the plant and so it really is significantly better than just an isolated molecule of CBD which you can buy purified CBD that’s like 98 pure it’s a white powder and that’s pure CBD you would not get the benefit of some of the terpenes for example are one of the terpenes is called little lull which is um commonly um known because it is present in lavender so you know that it’s calming it’s helpful with sleep it’s helpful uh has a nice calming effect and little lull is present in um cannabis and hemp uh into coon products um many cocoon products there are a lot of other terpenes um that we could go into but uh if that comes up in other questions we can we can address those that’s great and I did notice the different terpenes that uh Tikun does add and that’s a good explanation of why they do that um another question that somebody wanted to know is can you actually get tested for endocannabinoid deficiency is there oh that’s a really good question and you can for example do a lumbar puncture to put a needle in someone’s back and take out a sample of the cerebrospinal fluid which is the fluid that surrounds the brain and the spinal cord and that can give you information about um for example anandamide in the brain we know that anandamide levels in the brains of patients with PTSD are low so this is an endocannabinoid deficiency syndrome they don’t have enough anamide and that’s why patients with PTSD do so well with cannabis because um THC mimics anandamide and is helpful in that regard CBD also increases anatomic levels again by inhibiting fog and so you can do those tests but they’re that’s a big deal to put a needle in someone’s back and it’s very rarely done it’s really more for research purposes there is a group at Stanford that is working on developing tests to try to give us a sense of the person’s endocannabinoid tone and what um how things might work best for individuals based on their own endocannabinoid system part of the problem is again these endocannabinoids are made on demand so and they are broken down very quickly so they really don’t um it’s difficult to measure them in at the exact right moment when they should be effective um so that can be that makes the whole process a little more challenging that’s really interesting to know though I never even knew that you could actually test for that and like you said right now it is kind of complicated not something most people do but I mean that kind of gives you a future into the window of you know cannabis treatment in the future you never know like 20 years down the road we may have a sensor on us that says you know your levels have gone down you need to bring it up a little bit you know something like real time which is really kind of fascinating um and who knows what’s going to happen 10 years down the road this this industry moved so quick I really wouldn’t doubt that we would have something like that down the road absolutely and another way of evaluating that is looking at our genetic makeup and sort of the 23andme and looking at your genetic profile um at some point we’re going to be able to say what is your based on your genetic makeup how well what is going to work best for you yeah and really have individual personalized medicine based on your genetics yeah that’s amazing another question I get a lot of the time and someone put into the question um and answer box here was what about Drug interactions and especially those kind of Drugs that have grapefruit counteractions should people be careful of combining those yes that’s a really good question and overall we know that cannabis is very a very good actor it doesn’t interfere with most medications and we know this from the studies that were done on epidiolex epidiolex is a primarily CBD compound that is the first medication that was approved by the FDA derived from cannabis it’s derived from the whole plant but it’s almost all CBD and it’s approved for certain types of seizures in children but they went through a lot of great research in the process of developing epidialex and there were interactions with some of the anti-seizure medications so I would say if you um if you are taking medications and you have a seizure disorder that’s something that you definitely want to go over with your physician um the other thing I would say is that uh CBD can have an effect on the liver and how the liver enzymes break down other Drugs and some Drugs like the blood thinner warfarin is um impaired and so you can get a greater effect of warfarin with a lower dose so which what that means is you want to work with your physician they do um tests to try to find you know the best range for the medicine but you want to be very careful about that and you might wind up using a lower dose of warfarin if you’re going to be using it with cannabis so fortunately cannabis is a good actor but there are a few medications that will have that effect yeah that’s why I always recommend people that are wanting to use cannabis that are on medications go and see a cannabis physician or talk to your own physician if they feel like they’re educated enough it’s really not an expensive process nowadays it gives you that peace of mind and then you also get that recommendation at the end of the day that gives you discounts and tax savings so always better to play safe than be sorry you know I really agree with you on that and cannabis is an extremely it’s one of the most complex plants on the planet and one of the most beneficial medically but it’s that you having an expert who knows the cannabis plant and knows your medical condition really gives you a an upper hand in getting the best results from the medication as uh possible yeah definitely um someone also asked what’s the best tycoon product for immune support so someone was trying to boost their immune system that’s a that’s a really good question I would say it depends on what your goals are if you are looking for something that you can use on a daily basis that um you need to be fully functional I would use something called um one of the strains called Avidekel ,avidekel is a 15 to 1 ratio of CBD to THC so it’s almost all CBD although it does have a small amount of THC which helps the CBD work better and it has a very nice terpene profile as well with pinene in it which really helps with focus and memory so it allows you to be very functional during the day uh while still getting the benefit of the CBD if you’re looking for something that I would say um if you can tolerate psychoactivity then using a low dose of something called Alaska is a very good one of my favorite strains of Tikun products is called midnight it’s a one-to-one ratio of CBD to THC so it’s a nice balanced mixture it also is high in the terpenes um linalool and limonene limonene elevates the mood so if it makes you feel better it’s particularly good for people that have anxiety or depression and it uh it’s a very nice um balanced mellow medication that has the benefits of equal amounts of CBD and THC um so I like I like midnight a lot too perfect yeah I do a lot of recommending of all the Tikun products but especially the Avidekel so um so uh one question about um the testing so first of all I want to ask where people can access the studies and then someone’s asking when testing the effectiveness of the products which benchmarks are used like inflammation brain activity do you happen to have an answer for that um is it’s probably anecdotal and test results like looking at blood levels blood levels and stuff say again what do you guys test maybe um afterwards like the patients like based on their anecdotal results and maybe do like blood tests to see if like the levels have like balanced out and stuff like that um most of the studies have looked at people’s responses for example um patients with autism that we that were we’re in the uh video those patients will often be able to decrease their use of other medications because of the use of cannabis and the fact that they’re having fewer rage episodes there’s less violence they are able to Dress themselves they’re able to have greater um social interaction and uh uh advancement in their cognitive functions and what they’re able to do they’re able to take a shower themselves or Dress themselves so there’s a lot of different things that we can look at seizures you can look at the number of seizures the duration of seizures patients often are able to get off of other seizure medications when they find the right uh um combination and uh they’re having a laboratory test is often difficult um we just don’t have those laboratory tests for a lot of the things that we’re looking for and so we have to look at these other um markers um last question here we’ve had some really good questions and those hours just flowing by um but people wanted to know are there studies done with terpenes or the entourage process that people can be directed to and then are terpenes added to the cocoon products or they um they naturally occurring with the cannabis really good questions so let me answer the last one first uh the great thing is that tycoon strains were developed for medical efficacy they were not developed for maximum THC levels maximum harvest all of these other things that other strains from other companies often are developed for they were developed specifically for medical indications so the plant you you want the plant the way it appears in nature because that’s been studied and shown to be effective so you want all of the terpenes the way they occur naturally in the plant and what tycoon does is it is batch specific so they um they take out they extract the terpenes they extract the cannabinoids and they combine everything in the same way from the same batch so you know you’re getting everything whole plant medicine is what it’s often called and what you want is the whole plant because you know from studies that have been done that those whole plants are effective and uh you get all of that with tycoon products which is a real advantage there uh remind me again some of the other question where somebody can find information about the entourage system and uh research on terpenes so um and this goes back to the other question to access to coon research you can go to the tycoon website which is takunOlam.com and it’s the way it appears in my email and you can go to all of the studies are there in a uh and you can access any one of them there is a study that was done on CBD that looked at purified CBD compared to whole plant CBD as a tycoon product and what they found was it’s a little bit complex but they found that the it works much better they found that the not only were the patients symptoms treated better but also they um had a bell-shaped curve dose response curve in purified CBD which is not what you want what you want is a dose response curve so that the higher the dose you give the you get a more of an effect and it’s that’s the way Drugs that operate best in the body operate with a bell-shaped curve a higher dose is going to produce a less of a positive response and that’s what was true with purified CBD whereas whole plant CBD um because of the entourage effect gives you a much better response not only that but often because you’re combining it with these other chemicals in the plant you’re often able to use lower doses a good example of that is epidialex often kids would be taking hundreds of milligrams of CBD of epidialex because they needed to keep these seizures down under control whereas if they’re using a whole plant extract say from Avidekel the high CBD um to coon strain they’re able to use a much lower dose because they’re combining it with these other um chemicals in the entourage that’s a good point I’m glad that you were able to bring up that research because I’ve also heard that same thing and that’s something that people should know the two the differences and how they’re both beneficial but one is still you know more beneficial to you um I know we still have a couple questions out there but we’ve run out of time so please feel free to email Dr dan to check out his website which we have listed there or else you can email me um thank you by the way um if you would like a personal consultation I do those um in person and online um most of them online now actually especially with covid 19 but you can just go to my website uh www on it’s on the screen Dr Dan cannabis dot com and you can request a consultation and I love to interact with patients and it’s a way to really try to get a very personalized treatment with cannabis in a way that’s going to work best for you that’s amazing I’m glad that you got to share that with everybody and I’ll definitely be sending people to that website um thank you so much for joining us doctor this has been great and thank you to our audience who’s been with us um I know that I learned a lot I loved the metaphors that you gave us it really helped us understand and I really liked how you talked about the dose dosing and also about tolerance because I think that’s really important and I hope that we were able to share some information with everybody watching that will help them become better informed cannabis consumers and that you will be able to find some relief so thank you everybody and we’ll see you for another episode thanks everyone