CBD Oil and Medical Marijuana for Parkinson's Disease

hey guys welcome back to another Facebook live broadcast my name is Sarah king I'm the founder of invigorate physical therapy and wellness here in Austin Texas which is a physical therapy practice 100% specialized in helping people like you who have been diagnosed with Parkinson's create their own personalized Parkinson's plan of attack and one of the areas we talked about in your plan of attack is this area of supplementation with strategies that go beyond the pill bottle and we are going to be diving straight into one of those supplemental strategies today with a really special guest so if you have heard rumors that medical marijuana may be helpful for your Parkinson's symptoms or maybe you've seen videos online and some capacity of people smoking cannabis and having a reduction in their symptoms like their anxiety or their tremor or maybe you're just skeptical or curious depending on where you're at about cannabis or medical marijuana and how it may fit into your Parkinson's plan of attack I want you to stay put because I have a really special interview for you today with dr. Michelle Sexton and Michelle is a naturopath a functional medicine doctor professor and a researcher in San Diego who specializes in helping her clients fine-tune their endocannabinoid system she'll tell me later if I said that right and educates her clients on how to incorporate medical marijuana into their treatment strategy for any chronic diagnosis so I am really excited to bring her on I'm going to do that in a moment but as we go through some of you have submitted questions about cannabis and medical marijuana and I have them ready to go for Michelle but if you have questions during the broadcast about cannabis put them in the comment section and we will make sure to address them at the end so say hi let me know where you're tuning in from it looks like Debbie's in here from Montana Theresa welcome guys aleem from connecticut we've got Sharon as always from Montana welcome back Bonnie from Newfoundland from we've got Joyce from Colorado you guys oh my gosh so many people already tuning in Margaret from Kansas City wow we've got so many people who are interested in this topic Charlotte from Arizona holy-moly Alyssa from Jersey we even have someone from Israel so obviously this topic is one that people from all over have and I'm so glad you guys are here if you during the broadcast like or dislike or want to interact you can comment as always you can like feel free to share this as we go because I know that if you guys have questions somebody know also has questions and dr. sexton is an amazing amazing resource and so let's go ahead and without further ado I'm gonna bring her on here and say hello there she is will zoom in there you go i'ma show how are you oh I'm excellent how are you today I'm doing so good I'm so excited to have you on I told you earlier that I've been nerding out about this topic and learning so much more than I thought that I actually would in preparation for this interview so I have plenty of an of questions and as a pretty big newbie to this world I love to get kind of all of my definitions straight and get the framework around what I'm about to learn and I know there are a lot of people watching who also are very new to cannabis medical marijuana the endocannabinoid system did I get at that time okay um I'm sure that I will butcher it later but I want to ask you before we dive into your background and why the endocannabinoid system is the specialty of your practice maybe you could walk us through just some basic definitions so that everybody watching is on the same page did that sounds good to you yeah I think that's a good okay so let's just start with this tongue twister first the endocannabinoid system can you walk us through what that is and why it's important so if you break down the word endo cannabinoid so endo means within and then cannabinoid is coming from the name of the plant Cannabis so it could also be endocannabinoid I guess there's different ways to pronounce it and so this is a system that we consider a complete system in the human body so what that means is that our body is making some compounds so we have enzymes we have the machinery to make compounds these compounds then have an action within the body and then they get broken down and recycled so that's a biochemical system and it got named after the cannabis plant the same way that our endogenous opioid system got named after the oak the opium plan so the opium poppy so we found the compound that bound to a specific receptor in the human body and that compound was THC coming from cannabis and we found a receptor that got named the cannabinoid one receptor so it's often just referred to as CB one so I might say that CB 1 and that that really fits strongly with THC and then there was another receptor this is a poor another protein and the body makes called CB 2 and THC also finds that cb2 receptor and so that's how the plant in that compound specific to the plant has a major action in the human body so that's sort of the connection between plants and humans wonderful and so something that I had to make a differentiation in my mind whenever I was learning about this topic was our body produces our own cannabinoids and then there's also right the ones from plants and so the we're going to talk about CBD and THC which are the plant base so maybe you could talk to us a little bit about what CBD is and what THC is and how it interacts with that system so both THC and CBD and you might know these as most people know THC is THC often you hear CBD also called cannabidiol which is its full name so these are you know shorties and the plant is making these along with hundreds of other compounds and this class of chemicals made by a plant that we call cannabinoids is pretty unique to cannabis although there are a few minor exceptions and they're made in the part of the plant that's also making the essential oil component of the plant so the essential oil is everybody's usually pretty familiar that cannabis has a strong aroma and so you know these are in little goblets that are like right on the edge of the leaf of the plant just select the essential oils they can be released into the air and that's what makes them easy to inhale and really absorbed into the body so THC has been really the major one that we have studied and that we know a lot about even though CBD was actually identified back in 1940 and THC wasn't isolated and identified until 1963 so even though we knew about cannabidiol for a long time it wasn't being researched because they didn't find it to be the active ingredient you know everybody was trying to find out what is this compound that makes these really strong effects from the cannabis plant and they they kind of ruled CBD out because it doesn't really have any what we call psychoactive effect so they're very similar compounds if you look at their chemical structure they just they're kissing cousins they're most identical though if you look at their pharmacology they almost have they really have no similarities and so when I say pharmacology I'm talking about specific action at specific receptors in the body and so that's really the the big difference is that THC is really primarily acting on our end of cannabinoid system and CBD really is not so it may be a minor action of CBD to modulate the endocannabinoid system but it's a major action of THC okay that's awesome that's a great explanation and we're going to dive more into how CBD and THC affect the body and symptoms and Parkinson's and all that here in a second but the last definition I would love to hear from you that seems simple to some but maybe some of us you and I I'm in this class right I'm learning just as much as everybody else here but maybe you can differentiate cannabis from medical marijuana from him okay so they're really all the same thing that's the easy answer okay the difference is in what we call their their chemo type or their their overall chemical composition so it's just like cousins again and I like to use the analogy of peppers because everybody knows peppers and so think of just your nice ripe red bell pepper and it's just sweet and juicy and you know you're not gonna get burned by it because there is no ingredient that makes it hot that ingredient in peppers is called capsaicin so you can think of hemp as that type hemp is the red pepper variety because by definition and by law of the var federal government hemp has to have less than 0.3 percent THC so there's really not enough of it there to be spicy okay okay and then if you go all the way to the other end of the pepper spectrum you would get something like a ghost pepper or a habanero where it is so hot that few people can even eat it and so we have tan abyss Kimo types that that could be similar where they're extremely high THC content so they've been bred over decades and decades and hybridized and selected for mutant THC producers so a lot of the recreational cannabis is more toward that end and then you have things all across the middle you know where you have chili peppers that can be kind of spicy but not too spicy and so this would sort of reflect a spectrum of ratios of CBD on the one end to THC in the other and then right in the middle would be a one to one ratio wonderful that's a great great visual I'm gathering I'm picking up what you're laying down okay so maybe now we can move into a little bit more about you you have a practice in San Diego I told everyone about a few minutes ago so tell us a little bit more about your background and how you got into treating the endocannabinoid system well I really started that eye health care journey as an herbalist and that was when I was very young I got interested in herbs so like 40 years ago and became a midwife this was in Utah I lived in Texas I was from Lubbock Texas so was just doing home birth midwifery providing herbal care to my patient put my clients and knew that I there was a need for more and so that's when I got interested in in naturopathic medicine so I moved to I had also gone back to school a late-in-life at age 40 and got a degree in horticulture because I really wanted to study botanical medicine and then that was kind of the door that led me to cannabis it was very serendipitous through a connection at the University of Washington once I got to bestir to to keep doing research and found dr. Neff Estella at the University of Washington and his lab was studying the role of this endocannabinoid system in neuro degeneration and neuro inflammation so we were really you know focused on diseases of the neurological system and how did this endocannabinoid system have a role primarily we were looking at multiple sclerosis he didn't have funding for Parkinson but brain tumors multiple sclerosis and seizure were the main things we focused on in his lab so I was there for six years and at the end of that time naturopathic doctors in Washington were added as practitioners who could recommend cannabis to their patients so it was just very much a natural extension of you know what I had been doing in research so yeah it just kind of all came together where I knew all of this pharmacology and biology of the cannabinoid system and then I opened the first cannabis analytical laboratory in Washington State and then started seeing patients so it's really just been you know a synthesis of all of these things that have you know provided me the background for what I do now and so now I am a professor at UC San Diego in the department of anesthesiology and so they really brought me into the department to help further this education and and to bring the clinical piece of it you know specifically to the pain department but it's really you know the interest as you probably know and many of your of our viewers today you know people with all kinds of medical problems diagnose these symptoms are really curious about this because it's being widely touted as a cure everything you know you could think of snake oil is the analogy that oh it's good for everything so I think it's a bit of a myth so we'll do a little bit of myth-busting today yeah I think that's probably the most thing that I find I'm hearing a little outdoor don't know if that's just me but anyway let's see if I can switch this around are you still here I am are you there I'm here okay doing a little tech can you see it okay I can see you all right a little bit of tech snafu but I think that's the biggest thing for these Facebook live broadcasts is just to have a consolidated place to ask questions and become informed so that you can make your own decisions and not have to rely on you know your neighbors opinion of what their you know experience was with medical marijuana or CBD so hopefully this will be a good resource for everyone and I know that you work with clients to address their entire we're gonna call it the ECS from here on out everyone the endocannabinoid system is easy s it's just the general system do you work with your clients on other strategies besides medical marijuana to fine-tune their ECS or yes okay tell us a little bit about that well so when the patient comes in that my evaluation has really become sort of about the endocannabinoid system because it's in every tissue in the human body it's a homeostatic system so there's implications for almost everything that our body does and even how we feel and maybe even how we think in our moods so there was a description by a researcher whose name is vincenzo de marzo and he described the endocannabinoid system as one to provide that we eat sleep relax forget and protect so I've kind of co-opted that into my assessment and so I'm asking people about all of those areas of their life and sleep being really really top and probably Parkinson patients know this already and sleep is a huge issue and one that can be well addressed eating sometimes is a problem you know everything from digestive issues to lack of appetite weight loss [Music] irritable bowel you know so just asking about all of that relaxing so stress levels we know the endocannabinoid system modulates our ability to respond to stress eat sleep relax forget is the next one so we know that this Indo cuñado system and that cb1 receptor is everywhere in our brain it is the most highly expressed protein of its class in the human brain and it's really dense in the basal ganglia which is the part of the brain that we really focus on in Parkinson's and so that's why it's made it an interesting target or you know thing to think about in terms of addressing parkinsonism and then forgetting could also have to do with cognitive decline with age there's interesting data coming out about that and then protect I'm really thinking about the immune system and how the immune system can just go awry in so many ways and in so many different diseases and so we almost always are needing to treat inflammation and the endocannabinoid system is central to this as well was that your question I think I went on I know it's something a little tangents are always okay because I wanted to get at just a general overview emphasizing that medical marijuana is one part of a general holistic program oh not necessarily yeah you were saying what else can we do it's it's not just cannabis that's gonna affect our endocannabinoid system so stress reduction is a huge part of it and there's so many things you know as all of you guys probably know that you can do from you know actively doing something my meditative things engaging and enjoyable physical activity making sure you have plenty of positive social interactions having lots of touch and skin-to-skin contact massage chiropractics acupuncture deep breathing activating the vagus nerve singing and all of those things are going to also you know affect the end of cannabinoid system tone as well what we call it and then there's a lot of different foods that that have been shown to also interact with the endocannabinoid system so omega-3 fatty acids that come from Coldwater fish hemp seeds hemp oil those are you know food products walnut sardines eggs black pepper has a compound in it that binds to the cannabinoid to receptor olive oil there's there's a whole family of cannabinoids other than two main ones that we hear a lot about chocolate they actually contain one of our indica naba noids Ananda my herbs other herbs are going to have compounds echinacea has some compounds that interact with the indica cannabinoid receptor and then we know that exposure to plastics in our environment plastics plasticizers can be in a lot of cosmetics body products everything from deodorants to smell good things so people really need to be careful about everything they put in or on their body yeah definitely and that all lines up very similar to what we talk about a lot and invigorate it's just this holistic program so let's dive into cannibal what cannabis cannabidiol Canon but everything that I can't say at all let's dive in to some of the specifics so from your research or your anecdotal kind of experience in the clinic because I know not everything is backed up by perfect research studies how does how does cannabis play into a Parkinson's plan of attack for someone who's been diagnosed with Parkinson's who has Parkinson's symptoms and I can kind of maybe we could go through symptom by symptom to talk about how maybe using cannabis in a treatment program would affect different symptoms do you want to talk as a whole about Parkinson's in cannabis first and then we can hit those symptoms one-by-one yeah let's just say to start with you know why why doesn't a cannabinoid system for parkinsonism so the snippy answer is neurobiology so the biology of our central nervous system and you know we were talking about that part of the brain that's you know responsible for parkinsonism Sande symptoms and the cannabinoid one receptor is very dense and at play there and so we know that even though dopamine receptors decline you know as disease progresses we don't know that that same thing is happening with the cannabinoid 1 receptor so it's going to still remain a target and we know that it has neuro protective potential this has been shown in in animal models of Parkinson's cannabinoids our antioxidant we know that there is a change in this endocannabinoid tone that mirrors the disrupted dopaminergic signaling and so and there's also what we call cross talk between the two systems where it's been shown that the cannabinoid receptor and the dopamine receptor actually join up together and then there's new signaling that happens so there's a lot of reasons to think about doing it but in practice you know we don't have a lot of ton of evidence on it so we know from ancient writings you know very old history of the use of cannabis as a medicine before it was really prohibited here in the United States and about the 1930s it was being made by numerous drug companies in the early 1900s and you know one of the things that it was touted for was tremor but the problem with all of those products was that nobody could predict the potency so you know that they could have gotten a preparation from anywhere on that spectrum that we were talking about because the plant was very diverse and we had no way to to say this was a red pepper one and this was a hot pepper one so it kind of fell out of repute because you know opium and heroin had been identified in 1864 and so you know we could quantify it and say oh you we know you're going to be taking this much but with cannabis preparations we couldn't say we didn't even know what the active ingredient was so we couldn't say yeah we know you should take this much so so it was you know wasn't really pursued as a medicine and then of course in our federal government hasn't really allowed you know for prospective studies with cannabis and even to this day the only product available for research studies is inhaled cannabis so any of the research that you see about Parkinson and cannabis you know probably came from Europe and it may be from a variety of types of cannabis medicine it could have been just people smoking cannabis there was there's a couple of products in Europe available for study but really if you look at the whole body of the research most of it has been done with cannabidiol okay which is the CBD oil can have a dial yes okay just to regroup for people who are watching so is it possible in your practice and I haven't I didn't preface you at this question but is it possible in your practice when you're say someone comes to you and says I have tremor are you going through your mind and saying okay this specific if we're talking about the range of pepper right from our lowest CBD to our are from CBD the THC kind of spectrum are you able to say okay for tremor I recommend more of CBD to THC I would recommend something that you inhale versus something that you smoke versus something like an oil are you able to kind of go through that prescription almost as a provider to say to structure someone's program or is it a lot more general recommendation and then experimentation I often get pretty specific and you know it's not really a cookbook style recipe because I'm taking so many things into account and I think something that's really important I'm probably for this patient population is you know balance issues or dizziness and so that may play a big role in in ultimately what I recommend the evidence on tremor is really really sparse so you know when we're talking about motor symptoms and treating motor symptoms THC would be the compound because at this point CBD hasn't been shown to have any pharmacology that would suggest to affect motor symptoms so the and again that I have found it very hit-or-miss with THC and tremor in personal clinical experience and then as far as whether it's inhaled or taken orally a lot of that is patient preference you know I the they're kind of two different characters really because if you if you have the plant material and I'm I'm not a fan of vape pens at all and I would just I tell people to just say no to vape pens and there's there's a lot of reasons contamination issues pesticide accumulation they're just harsh they're too concentrated and they're easy I know but we just don't have enough evidence to say they're really safe or efficacious at this point but using a vaporizer with the whole plant or you get all of those compounds the terpene compounds everything that you smell it's just a very it's like taking an IV in terms of the rapidity with which it gets into your bloodstream it's just it's there within minutes and that's I know where you've seen the videos of people with Parkinson and severe tremor where they actually I know one guy like takes a big bong hit right on the video right and you you visibly see his tremor just dissolved and there may be sex differences you know there's just so many individual genetic differences that I we don't know yet how to predict who might benefit and who might not but I think inhaling with THC is probably the best way to get to motor symptoms and it doesn't have to be the habanero pepper type of THC cannabis it can be even really low dose but as long as there's some there it has it's going to have more impact on the motor symptom than CBD okay so can you walk us through when you say low dose THC and inhaled is that a specific strain I'm assuming that's a specific strain that's lower compound you know in California we have access to so many different I call them chemo types I know the strain is like a common name that people use but that that name that term has never been used in horticulture okay dr bacteria yeah you would have to have you know a chemical analysis where you can see how the percent it's usually the percent of CBD or THC and so in California we have those analyses and you can look and see you know is it 16 percent CBD and 1% THC so you know that's one that I have access to and I may start if people are gonna inhale that would be like a starting dose or you know the chemo type to start with and they can they can add THC by pinches to increase the THC content so typically people are just doing a self experiment you know where they start at a really low dose and then they can slow it'll add to like making enchilada sauce where you put a tiny bit of chili powder and it's not hot enough yeah so you add another pinch okay using a THC chemo type you can add it pinched by a pinch like that so that's that's a self titration model of inhalation with the flower type okay and is that breakdown percentage-wise only available when you are getting medical marijuana obviously a recreational marijuana somebody probably doesn't have the breakdown of you know what they're inhaling or one in cow and all the states that are legal you know they all came with quality control regulation and so I I believe all of the states that have passed medical marijuana laws are even recreational you know nothing can be sold at the retail level unless it's gone through that testing and labeled for potency so there's no differentiation in the marketplace between a medical product and a recreational product it's just okay cannabis products and I mean I differentiate them because there are some products where people can get that low-dose most of the recreational product it's like ten milligrams and a you know and whether or not you can divide that and get a lower dose or not depends on the product type okay so when you say low dose what is that is that a percentage is that but when you go to an extract now like a oil you know a CBD oil or a cannabis oil people that's that term oil is kind of relative because extractions can be done many different ways and it's important and how they're extracted because a lot of times if they're heat extracted then all of those terpenes are lost and so the product really gets reduced now to just the cannabinoid content on the other hand maybe saying the terpenes are still there and so they make all their product a sativa or an indica and this is based on some old nomenclature or old naming and this is on the process of being rethought because we know so much more now by looking at the entire chemical composition that when you when you go to an oil or something that's going to come you know in a bottle like with a dropper then this is usually going to be milligram dosing now and you know that's that's where I start and so with THC milligram dosing sometimes I start people on half a milligram literally or a quarter of a milligram because I just have a sense that they're very sensitive or they may tell me they're sensitive they may have balance issues dizziness you know we don't want to provoke that and often if somebody has a pre-existing dizziness or balance problem my experience has been that it may exacerbate that so being very careful and then you know does it depends again like for nighttime and treating sleep that could be different dosing from the daytime so I was really talking about THC in that milligram dose at that point okay yeah we're in the THC for motor symptoms which when we say motor symptoms you're referring to something like tremor rigidity what other motor symptoms have you found THC to be helpful with spasticity but I mean that's not as big of a problem in Parkinson as it is an MS I have what am i alright don't actually this dystonia or dyskinesia maybe because I think they're related and the other cool thing about THC and I don't I don't think the same data exists for CBD is that it's been shown to release to cause a release of dopamine it's not like most drugs of abuse you know like cocaine something that people get really addicted to the reason part of the reason for that addiction is this dopamine flood that happens in the brain and that's just this overwhelming sensation of just feeling so good and hyper and you're on top of the world you could do anything and we know that THC has a similar effect but it's not a big flat like that it's more like just this little trickle but it does contribute to this overall sense of well-being and you know feeling better as you go up and dose that can change it's it's what we call biphasic so at low dose THC can reduce anxiety at high dose it might cause anxiety and so this could be this could be true for any of the motor symptoms so I've had some Parkinson patients who tell me they're you know that their symptoms actually worsen when they try th see I've had some say they worse than even with CBD so every it's so individual and everybody's really different okay yeah that's very true about all of our people diagnosed with Parkinson's everyone's unique and so I want to take a moment here to also say to everyone watching this is not medical advice this is a general conversation around medical marijuana so if you are interested in trying any of this stuff for yourself make sure that you are doing it with a qualified healthcare team which we'll talk about here in a little bit but just to plug that in here so we we talked a little bit about motor symptoms and now maybe we could switch into non-motor symptoms for Parkinson's and maybe what that might look like so things like pain obviously let's just start maybe with pain and then that might not that come with rigidity that might come with some of the motor problems but it sounds like that's a background that you have so can you speak a little bit about how you go about constructing a program for someone who is having pain as one of their primary symptoms so for pain a lot like the motor symptoms THC is the go-to molecule for me again and this is because we have a lot of evidence some I'm a very evidence-based practitioner so I go to the clinical literature I read it all I try to synthesize it and see how does it apply to my patient population so we have really good data showing that cannabis containing THC can be effective for neuropathic type of pain and these have mostly been smoked or inhaled cannabis so I think this is a bit of a I call it I call them urban legends so a legend around CBD is that you can take it and get all the benefits of cannabis without the THC but if you think about what I said in the beginning that they share no pharmacology that then you can understand why this is really not true but you'll see it over and over again about CBD it's it's still cannabis you can have all the benefit and not be high or stoned my clinical practice is really heavily weighted with pain patients and I can tell you from experience of around 300 patients now CBD does not treat their pain I think another thing that's happened th-these a really potent molecule so one or two milligrams which is a really low dose can be very effective for a lot of people you know too effective maybe for some CBD at two milligrams is not going to do anything it's never been studied at that dose for anything so I like the products you see for CBD might be five milligrams in a spray or twenty milligrams in a capsule I rarely see anything higher than that and I've asked these companies how did you arrive at that dose because if you go to the medical literature nobody's ever studied that dose and even in the Parkinson literature the lowest dose of CBD that's been studied with 75 milligrams if we look in effects on anxiety psychosis hundred of hundreds of milligrams which really makes it unaffordable for most people so until we can have cannot can have a dial in dosing that's relevant at an affordable price th C's really still the go-to molecule and so for pain again that low dose of THC with a very slow titration to tolerance so you're looking for the best benefit with the least amount of side effect and I think that a lot of people get hung up on that side effect because there's been so much stigma around but what I was just saying and what I hear patients say well I don't want to be stoned or well I don't want to be high and so I ask people what what does that mean to you let's talk about that you know because you're on opioids you know are you high you know and so it's often just a stigma and they'll describe the way people might look you know and that's so they don't want to be associated with that so I think there's a lot of stigma around that and I think it's really probably keeping people back from some of the benefit of the whole plan of cannabis by still you know identifying with that stigma about THC because it's a very important powerful medical molecule yeah I am there is no judgement pass in this broadcast of doing it or not doing it but I do think that that's valid investigating the stigma and why you feel the way that you feel so let's continue on with the non-motor symptoms I'm seeing everyone's questions coming in too I'm Lauren who's moderating this is collecting them and we'll get to we'll get to them so stay tuned we are gathering your questions but as far as non-motor symptoms are concerned the next big one that or well there are three so we've got anxiety we've got sleep and we've got appetite so maybe we can kind of run through those when you have someone come to you what's your mindset around maybe anxiety to start with so I think cannabidiol can be effective for anxiety again we're not really sure of the dose and you know if you're just buying product off the Internet you can't even be assured that the dose that it says it is is actually what it is the dose that was associated with decreasing anxiety was in a study of public speaking and that was a 400 milligram dose and again so this was isolated CBD and we have a little bit of evidence suggesting that when you take it in the context of the whole plant you may not need as high of a dose as these drug studies where they're using just the isolated compound so I have people get in I usually start people on maybe twenty to twenty five to fifty milligrams a couple of times a day and avoiding it after evening I wouldn't use cannabidiol for sleep except during the day not not to sleep during the day suggesting that taken early in the day might improve sleep at night but okay CBD is thought to be alerting not not like a big stimulant but just cognitively clearing things up so I think for anxiety it can be an important one but again avoiding it late in the day so maybe taking it twice a day I usually say 8 p 8 a.m. and 2 p.m. and then sleep so I have the best success with THC for sleep at night I have a really great protocol using melatonin along with THC dosing at night and have some great success stories from patients even suggesting that due to improved sleep their tremor during the day is better so just by treating sleep we can improve so many symptoms and many many diseases and often people aren't even aware of how poorly their sleep qualities for their sleep quality is so you know and sleep behavior disorder as well and oh sorry let me back it up one second because you said you combine THC with melatonin are those both in the liquid well THC would be inhaled I would imagine and then melanoma usually I usually give the Tutsi oral at night because when you take it orally and it's going through the digestive system our body makes a metabolite and so you get a much longer effect with inhalation that there's not a lot of that metabolite and the effect isn't usually gone by a few hours but when taking it orally you can get a longer effect so I have I'm getting a melatonin supplement and then the oral cannabis preparation at night that HD so that the research on sleep is 2.5 to 10 milligrams of THC at night again sometimes I'll start people on a much lower dose I had a woman I have a patient with restless leg syndrome which is you know it's a dopaminergic motor problem and she was very scared and so started out with a little tiny dose and when she finished up that product I had her switch over to the one I usually use where the starting dose is two point five milligrams and she was going to try to take half of it that accidentally got the full 2.5 but emailed me the next day and said she had the best night of sleep she had had in a long time and slept all night and felt great so know if people are afraid of it night times a good time to start it because you're going to be asleep anyway and you may need help with sleep the sleep slip is that sleep behavior disorder there was a trial of cannabidiol 300 milligrams for it was only four people six weeks and they didn't really show you know huge effects it was a small you know case series that they did so then they went on to do there's been some trials of 300 milligrams a day of CBD and the results just haven't been that mind-blowing you know that patients are reporting you know improved quality of life couldn't measure anything showing that was neuroprotection the scoring on the UPD RS wasn't effective affected significantly by taking CBD and again that was 300 milligrams a day so a lot of people can't even afford that it was tried for dystonia CBD at 100 milligrams a day increased up to 600 milligrams a day but there wasn't any effect on dystonia shown but nobody had worsening of symptoms or side effects what else the tremor went isn't interesting it hasn't really been prospectively tried but some people report a reduction in tremor so like we started out saying there may be some you know population that's going to get the benefit and we just don't know how to predict who that is I think another thing that comes up is psychosis sundowners syndrome so psychosis CBDs has been the one more study THC at high dose can actually cause psychosis yeah can I ask you about that because I have heard in my research that taking THC if you have a cognitive impairment to start with it's not recommended by a lot of physicians to take to use medical marijuana in your treatment program because you are at risk for further decline can you maybe speak to that a little bit I don't think we have any evidence for further decline I think again you know it just comes down to individual patients so much because like with agitation and severe behavior problems in patients with Alzheimer's and so here we could be talking about atypical Parkinson actually giving you know a a particular dose of THC can really calm people down and I think often when we talk about using THC people just immediately go to that yo type because that's really all that's been studied and that's where all of this negative talk we hear about it comes from is only studying it as a drug of abuse with harms and dangers we're getting ready to publish a study on effects where we asked cannabis users about effects and interestingly the older population so they were greater than 50 years of age reported less cognitive negative cognitive effect than younger people so we don't know why that is it could be changes in the brain as we age it could be that as we get older we're already forgetful so if cannabis makes this a little more forgetful it's not that big of a deal because usually those you know those effects are short-lived they're transient they don't hang around once the drug wears off and as far as permanent damage there's never been any evidence shown that either THC or cannabidiol harm neurons okay yeah I think someone just asked this question so it just came up the neuro protective benefits you've said it doesn't harm neurons that actually potentially could narrow protective protect and decrease inflammation so family wonderful how do the antioxidant effect and this has been mainly you know we can't it's hard to measure this in humans that it's been measured in animals where we can measure you know oxidative products and how using cannabinoids whether it's our endogenous compounds or the the cannabis compounds or other synthetic molecules that have been developed that we can reduce the burden of these reactive oxygen species so you know you've got to think of antioxidants like shock absorbers we have oxidative damage happening all the time and we need all the shock absorbers we can get we all need that but if you have Parkinson's that's really associated with you know this act of destruction of neurons and so the brain is constantly needing to clean all that up you want every a kind of antioxidant on board that you can get and that you know CBD may have that effect we don't have you know with a disease that progresses slowly over time it's hard to study but we hope you know using a combination of lots of things that we can slow progression yeah this is great an insight too and I know that you public well he said that you were working on publishing but you did a quality-of-life survey with dr. mish Lee I believe and I read that it overall the the survey came out essentially and said that was a specific to Parkinson's or did this include different now it is like it was just a survey of cannabis users and so that dataset was the one users who identified only as medical users and so he said what are you using it for how effective do you think it is and what's your quality of life and so that that was basically showing that people using cannabis their quality of black wasn't worse than the general population in fact they they were medical patients and then they scored almost on par with healthy subjects in terms of their quality of life yeah so I don't think any fear of destroying the quality of life by using medical cannabis yeah which is a true fear but from a lot of people who have heard information about yeah marijuana is a drug of abuse it's a gateway drug if you take it you'll get stoned and you'll just fry your brain all the good things that I know that I learned in dare class yeah we called it we call that propaganda yes and so I think that time is evolving and you know things are changing and so being informed you can choose to participate or not but inform yourself and try to identify your biases so we are we have been going for quite some time I want to keep diving into some of these questions because we have a lot from our audience and actually let me look up I how long are we going till 4:30 it's usually an hour so we're supposed to have about five more minutes so I'm gonna dive into questions and maybe we can be try and be as succinct as possible so we can get in a lot because I have a lot of people submitting their questions so number one we've got this one from David Dorsey and he asked what specific strains do you recommend for muscle spasms I know strain we've been cited is not the best word he says he's had some success with ac/dc a CBD dominant strain available in flour and that has a very mild of phoria so maybe we could just back up to the core question which is specific advice for muscle spasms so you know the short answer is always go for Less THC rather than more if you can find a chemo type containing CBD it's going to have less THC and aim for you know about a 5% THC content if you're going to be inhaling so there does there is gonna be some of that euphoric part of it because that's the THC and that's the anti [ __ ] compound okay that's a great answer so I pretend THC calm component if you're inhaling for some of those muscle muscle motor symptoms sorry he also had a second part to his question which we may have your table because it kind of goes off the beaten path but it says as medical marijuana is recommended treatment for many conditions what's your opinion regarding the legislation of reasonable THC levels in patients who are employed and/or still drive a vehicle yeah that's under that's under debate it's being studied here at the Center for medical cannabis research at UCSD so they have a active driving study going on and so we're really trying to determine is there a number that can predict an impairment or not or is it too variable across humans and does tolerance develop so can people just like they do when they're taking benzodiazepines or opioids or gabapentin or other drugs that can affect cognitive function you know use your own best judgment and there are people out there driving on a lot of those drugs all the time and so we know that people may gain tolerance to those negative effects and still be able to drive safely but this is something that needs more research and it is being researched ok that's great so follow up where was that USD haha yeah UCSD has yeah Centre for medical cannabis research CMC are and I'm not sure when those results will be in but ok they're hard at work great ok Bettina Kelly asks my boxing instructor asked one of the men who smokes marijuana for Parkinson's not to do so before class for safety reasons how does smoking and exercise work I think they go together really really well I think again it's dose related but if it's someone who's you know used to their own dosing and they know what they can handle I think it's a little irresponsible to tell them to just say no if they can handle themselves THC maybe activating stretch receptors and another thing that it may do is increase the strength of muscle contraction because acetylcholine is another neurotransmitter that is released and that's the main neurotransmitter at the nerve muscle Junction and so I have a lot of patients that actually use it exercise enhancement oh ok ways to do an exercise class and call it stone play actually you know we asked them to get stoned and come in to exercise because we think it actually facilitates movement and coordination in a lot of cases yeah I am I play a lot of soccer and I have a lot of soccer friends who would definitely attest to that testimonial there so then we have our Arkana I'm sorry if I'm mispronouncing your name is there a chance of addiction and we talked about pain she had another question about pain so is there a chance of addiction I would say there's a chance probably like with anything you know there are people that have more addictive type of tendencies than others and so because of the feel-good effects of cannabis I think that that population could have a similar experience with cannabis in our survey that we're getting ready to release these results when asked if they had difficulty stopping the majority said no and if you asked by age group older people were more likely than younger people to say that it is not addicting so changes in the brain over time probably have a big role and we need to know more about all of this but in terms of you know addiction what we often look at is withdrawal and so we know that withdrawal from cannabis if you're a heavy chronic user of THC you can have some withdrawal symptoms but they're very mild compared compared to other drugs and this endocannabinoids system that could have been hammered and you know causing those withdrawal effects because it's a system of homeostasis it bounces back really quick so that withdrawal is short-lived and there's not a lot of drug craving that seems to go hand-in-hand with it I think that's a big fear of a lot of people who are considering as you probably know a few good so alright let's see miss Bonnie Robson she submitted a question and I think we probably addressed it earlier it's about pain and tremor but I'll read it and if there's anything additional you want to add that we haven't covered yet um you can hop in but she says that she has a lot of hip and leg pain especially at night and tremor is becoming worse that was medical marijuana helped with those problems which we know is potentially yes and what are the side effects which we talked about a little bit is there anything additional that you wanted to add that we haven't covered I think it you know if you're using it at night for pain the side effect is going to be less pain and better sleep I mean the only thing I caution people about is again if they have any kind of dizziness or unsteadiness if they get up in the night you know to use a walker if they use any kind of assistance to just be sure and use it until they really know if it's gonna work on their balance issues if they're a fall risk you know being extremely cautious but yeah for sleep and pain THC is my go-to and not the CBD okay all right I'm going to scroll through the comments here I'm going to pull someone's question up we've got a lot of comments you guys are all saying hello I love seeing you guys in here let me well let me ask the question then I can maybe find it and pull it up but um let's see Roger Jenkins asked how do you verify quality and what is the shelf life um well I don't know if this is in an illegal State because again like I was saying in states where it's legal there's pretty much quality control testing that's required but even if you're ordering something online I would request to see the certificate of analysis and see if it's been tested for you know mycotoxins so those are things that mold or fungus can make that can be dangerous just bacterial contamination pesticide contamination there's a lot of talk about heavy metals although we haven't actually seen a lot of heavy metal contamination yet but yeah I usually ask the companies I would like to see your certificate of analysis and you want to know that it comes from a third party not that they're just testing it themselves and telling you but they've asked someone else to test it that's reputable that's given that result out okay that's a great input he's in Indiana I'm not sure actually if it's legal there but we know Roger from way back and so glad you're here all right so then Theresa asks and she says which is better for symptoms of Parkinson's sativa or indica cannabis and I know you said strains are kind of the wrong term but maybe you can clear up some urban herbal urban legends urban legend legend yes oh those designations sativa and indica were originally based on the way the plant looked when it was growing so a sativa was one that was tall and had skinny narrow leaves and an indica was usually a bushier fatter leafed plant and now because there's so much hybridization we know from a number of analyses that have come out of California because you know it's been legal here for a while and we've had laboratories doing analysis that you can't really separate them out even if something's called a sativa or an indica if you look at the complete chemical profile of all of those smelling molecules called the terpenes plus the cannabinoids there's not a lot of differentiation and so the hybridization has really caused loss of biodiversity and so why about those terminologies are still widely used in the popular culture if we were gonna you know use that from a medical perspective we we don't have the answer of what makes it a sativa or an indica I have my own suspicions and so in terms of the question I can't answer it I usually go with plant chemo type that has pining content because pining is a really potent antioxidant and it may also inhibit the breakdown of acetylcholine and I think that I just love acetylcholine and I think it's good for lots of things cognitive function you know muscle strength immune health and so it may be you know what effect are you looking for and there's definitely those ones that are going to give a head b-body and more of a sedation feeling and right now you know other than asking the budtender and taking somebody's word-of-mouth recommendation we don't have a way of really delineating those things okay hopefully Teresa that answers your question all right we've got this is a quick one I'm sure but Susan asks good point with stress and can you use cannabis as an alternative to xanax so I have a lot of people that are you know trying to wean off of benzodiazepines and they're hard for something they're really really hard for some people and I've had a couple of patients with extreme extreme anxiety and they're in their Parkinson disease and so you know using a mix of the CBD and the THC in terms of cannabis I mean I have other add-ons that I'll often use with patients because it's not always straightforward but low dose THC is gonna be really anxiety or you know can treat anxiety so again you know 1 to 3 milligrams really low dose and then hot as high of CBD as you can afford okay and you said sometimes you use add-ons what does that mean add-ons just you know other things to to treat the whole person so I'm you know looking at their diet their gut function their microbiome because we know that like a ketogenic diet it was just published that ketogenic diet may actually increase GABA production in the brain and this is this was a mechanism of how it's treating seizure but more gaba in the brain everybody should want hmm so you know diet and probiotic foods prebiotic foods using in acetylcysteine to boost glutathione so you just have more any Senate protection lithium to slow down dopamine transport sometimes other herbal combinations so you know there's just there's other options and sometimes you have to throw everything at somebody yeah definitely okay great answer are you okay if we go a few more minutes are we keeping you from yeah I can do a little bit my computer batteries get pretty low okay okay and we've just got a few more here Barbara asks about how does this help with mobility she says she joined late so Barbara we talked about mobility and motor symptoms and cannabis at the beginning of this broadcast pretty in-depth but you did ask about freezing and so we didn't talk about freezing have you had any clinical experience working with people who have freezing episodes and what's been their outcome some no I have not had anybody with that particular symptom okay this app related to the dyskinesia or is this something different it's more of a synchrony motor yeah it's um they'll report often that their feet feel like they're stuck to the ground especially when they're anxious or you know in crowded situations it happens a lot in like narrow hallways going through a door okay that's kind of yeah okay so that could be a cerebellar effect I guess where you don't really know where you are in space and so that's why you kind of don't want to go through the doorway so am I getting that right it's more of a proprioceptive yeah dysfunction yeah so that bracer about again I mean that's what I I kind of worry about that with THC mmm you know it's totally untried and I mean we need so much research honestly you know because we have nothing else for these things so we really need the doorway to open that we can really prospectively go and take a look and find out is this going to help or harm somebody the symptom definitely and I will say that I've had clients here in Texas have procured cannabis from some friends and if they are if they're freezing is specifically exacerbated by stress and anxiety they do fine until they just get really anxious and stressed out they have reported that it does help them get out of freezing episodes a little bit faster and it's probably from their perspective they were feeling less anxious and less stressed which can help improve yeah that makes the freezing at all yeah treating the anxiety and then having that unanticipated effect of at helping other symptoms yeah all right let's see mammy says what about hemp oil to rub on your body where the pain is I haven't heard of this yeah so that's a question I get a lot because you know a lot of people are wanting to avoid any psycho activity they don't want to take anything orally or have any risk of you know having any effect of a THC but I'm not sure if maybe if you were here earlier when we were talking but there's no proven way that CBD is a pain reliever and so my personal experience is that a lot of my patients come and get referred to me for pain and they come having already tried a topical preparation and I just I personally have not seen it be effective I think it really depends on the type of pain if it's a minor musculoskeletal you know inflammation it may reach the site but for neuropathic type pain or neuralgia we really think it has to be given orally and systemically to affect that type of pain and not CBD we again we have no zero evidence in humans that CBD is an analgesic so it may have some anti-inflammatory action and so if there's a strong inflammatory component to pain people may get some benefit but again you know nerve pain neuropathic pain neuralgia is really more receptive to the THC compound okay you are making this very easy to understand I love it yeah all right Norman asks our dosages at any level a danger to Parkinson's people in recovery so people who are working on improving their Parkinson's symptoms getting better healing their body are there any dosages that are dangerous well what does it in recovery mean I'm not sure is that are we talking about recovery from addiction or recovery from oh you know I don't know I am I made an assumption that there are a lot of people in the Parkinson's community that say they're in recovery from their Parkinson's diagnosis just as like okay way to talk about there but I actually don't know um maybe you could talk about recovery yeah recovering addicts or you know maybe you could talk about that people have concern about it you know if they're in a a or they were ever even a tobacco smoker you know they they have a idea that you know this could be really harmful but there's a another idea that of a concept called harm reduction where cannabis and the amount of harm that it may cause is so much less than other drugs of addiction that if cannabis can help people get off of tobacco or decrease their alcohol consumption or cut back on their benzodiazepines or their opioids that it's it's a harm reduction approach in that there's less harm that could be caused by the cannabis than other drugs and may be you know a good level of benefit to boot so if that's the kind of recover we're talking about you know it's becoming trendy here in California there's actually an addiction recovery center that uses cannabis to withdraw off of drugs so you know the mindset is really changing around that and if you're just talking about recovering from Parkinson I don't know of any danger other than what I've already talked about like fall risk or worsening of symptoms it could create a fall risk like low blood pressure I know if you're sure well that's more enhanced with inhalation and with higher doses of THC taking it orally hasn't been shown to cause a rapid blood pressure drop but if people are hypotensive I do tell them to be alert that it could enhance any hypotension they already have okay great and Susan asks what about effects to address fatigue which we didn't hit on well when I think about fatigue you know the first thing I think about is what's happening with sleep you know are you getting good quality of sleep because we have you know what's called an ultra Thien rhythm at night where phase one is falling asleep that should not take more than 15 minutes you go into stage 2 that's where these sleep behavior disorders occur so that's the part of sleep where you could still be awakened easily and then there's stage 3 and stage 4 and we know that on Parkinson patients often have really severely reduced melatonin levels and so by giving melatonin with THC at night to get people into those stage 3 & 4 sleep and stay there can really address the Teague and narcolepsy during the daytime yeah other and I would start there with fatigue just you know start by treating sleep if you've already done that and you still have a lot of fatigue I mean you might benefit from you know a consultation with a naturopathic doctor or a you know a holistic or functional medicine type doctor that's going to look at a lot of different things like chemical screens your blood count omega-3 fatty acid levels your homocysteine your iron thyroid function DHEA sulfate you know there's a whole host of things to look at to determine where is that fatigue coming from and where do we need to supplement yeah and I have a lot of thoughts follow-up questions but one of them was um Norman I think Norman I've got a whole list of people asking questions it wasn't Norman it was Paul Paul Cordell asks he's very vocal in sleep so if you're saying that THC and melatonin can help you reach the deeper levels of sleep I would imagine that that would help with some of these sleep disorders like you were talking about yeah I think being vocal is a stage to sleep disorder it's part of you know sleep behavior disorder so that's you know that's where we think there can be some value I've got a couple of SPD patients right now you know that I'm hey waiting to hear back from I've we've developed a collaboration with the Sleep Center at UCSD so now we have patients going in for a sleep study before and after starting the cannabis so we're gonna really start to get some better data the studies that have been done we're on sleep apnea and so that can be a central affect from opioids it can be you know a mechanical one where your airway is just collapsing and causing snoring but either way we there was improvement shown with THC 2.5 to 10 milligrams at night and again using that slow upward titration to get the effect you're looking for without you know grogginess in the morning awesome okay we've got Allison who asked I'm in the UK and half Parkinson's and epilepsy how do I gain marijuana here to help me and I think this can stretch into a broader question of what do people do when they're somewhere where it's not available I'm sure it's available but it's not legal in any capacity what recommendations do you have for those people well in the UK there is sativex so you know that's a drug that's available by prescription and it was approved for multiple sclerosis and not Parkinson disease but I don't I don't know if it's easy or difficult to get in in the UK or if they can use it for different indications the same pharmaceutical company GW Pharmaceuticals has another drug called epidural X which is a pure CBD preparation and that's specific for treating epilepsy it just got some approval here in the United States for certain intractable epilepsy but sometimes when those drugs are on the market doctors can use them you know off-label for other symptoms you know and if you want to go with something that's more of a whole plant you know people are just finding local networks and it's it really seems to be exploding all over the globe honestly I get I talked to people everywhere I had a visiting doctor from Peru last week and it was being legalized for medical use in Peru beginning this week and you know already the patient connections are there and the growers are stepping up and there's product available even though the country has an sanctified it or you know created the regulations around it that's good super super information hopefully Allison that answers your question let's take that guy down so that is all for our questions and so Michelle I wanted to say thank you for joining us and appreciate you going a little bit longer than we planned can you maybe tell people where they can find you or I know you do telemedicine consultations I know you can't take people on who are outside of California as patients but you do have some ability to consult on the topic so where can people find you if they want to learn more why my website I have a Facebook page Michelle Sexton inde you can go like me on there and keep track and then my website is m sexton n decom so that's nd for naturopathic doctors and you can schedule directly on that site for telehealth consultation and/or you know give the office a call if you have other questions or want to do a brief 10 minute question-and-answer session it before deciding if you want to schedule perfect all right well you guys use her website and if you're watching and you're having trouble keeping track of all of this information you can find links to all the resources that we mentioned in the description depending on where you're watching above to the side or below this video and I would love to know for all of you out there what you think you know what have you learned has you changed your opinion about using cannabis or medical marijuana in your Parkinson's plan of attack are you already using it and would have been your effects I would love to hear and I'm sure Michelle would - in the comment section below and as always if you found this beneficial you can go ahead and like and share this video with anybody who you think would benefit from learning more which we all have an endo kanae and avoid cannabinoid system I couldn't do it at the end and so we would all benefit right from learning this information so again Michelle thank you so much for joining us I really appreciate all this information and for all the work that you're doing to just improve transparency and decrease those myths that are out there so thank you so much for joining us you are welcome and thank you so much for having me and I hope out you know I'd love to learn from patients so you know communicate me with me on Facebook message me if you have a different experience because I don't know everything and the patients are the teenagers that's so true there are my best teachers - alright everybody we're signing off here so until next time keep moving and I'm sending you lots of big hugs all right bye-bye

Channel: Invigorate Physical Therapy and Wellness

Views: 29,616

Rating: 4.7304583 out of 5

Keywords: medical marijuana for parkinson's disease, CBD Oil and Medical Marijuana for Parkinson's Disease, medical marijuana for parkinson's video, medical marijuana for parkinson, cbd oil and parkinson’s disease, cbd oil for parkinson's patients, cbd oil treatment for parkinson's, parkinson's cbd oil, cannabis and parkinson's video, cbd oil for parkinson disease, cbd oil for parkinson tremors, dr sarah king parkinson's, invigorate parkinson's, cannabis and parkinson disease

Id: xMeRwPDTQhw

Length: 81min 25sec (4885 seconds)

Published: Thu Sep 26 2019