Narrator:
0:01
Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts, powered by ENCORE Research Group and hosted by cardiologist and top medical researcher, Dr. Michael Koren.
Dr. Michael Koren:
0:16
Hello, I'm Dr. Michael Koren, and today Erich is joining me for our episode of MedEvidence. And I'm really excited Erich this episode, Erich, for a number of reasons. Erich and I have known each other for a long time and Erich has worked with us here in the Clinical Research Center and he's been a family physician in our community for a number of years and we've had cross-referral of patients Me as a cardiologist, you as the family physician so that's been a fun relationship. But Erich has gotten into the concept of understanding the use of cannabinoids or cannabis over the last several years and he's now dedicated his practice to help people by using this mechanism of treatment. So I'm really interested in learning more from you and really taking a deep dive into this so you can educate me and other members of the MedEvidence family about how to use cannabis and what you've learned and how we can share that information to help people in the community.
Dr. Erich Schramm:
1:11
Great, thank you.
Dr. Michael Koren:
1:12
And thank you so much for having me on, and we've collaborated since 2003, since I joined Clinical Research, so we've had a lot of great opportunities to talk about research and you're a fabulous researcher, and actually that's one of the reasons I'm really excited about this conversation, because the reputation for cannabis is that it's not always evidence-based, and you're going to help us understand that. So let's jump in. So let's start with the basic definitions for everybody we hear about CBD, THC, explain what that is to people.
Dr. Erich Schramm:
1:40
Great. So the cannabis plant. It's a very complex plant and has probably about 400 chemical compounds, but the important elements of the plant are , which is your THC, and cannabidiol, which is CBD. Now, a lot of times people say, okay, which part of that plant is the one that has the potential for intoxication? And I'll say, well, that's your THC component. The plant naturally makes one particular type of THC, which is Delta 9, but more recently now it is being able to be produced Delta 8. So it's kind of a very similar molecule, but those are the more potentially psychoactive compounds of it the CBD, the cannabidiol, is not associated with any potential for intoxication but has great potential benefits in terms of anti-inflammatory effect.
Dr. Michael Koren:
2:35
So just to explain, the Delta 8 versus Delta 9, this is not the Navy Seals, but it's actually what we call stereoisomers, and that means that it's the same molecule, but they can be mirror images of one another and I guess it sounds like they have different effects depending upon which of the mirror images it is.
Dr. Erich Schramm:
2:53
Absolutely correct. So it's just a very slight change in the chemical composition. The reason that Delta 8 exists is because it can be manufactured from CBD, and so it can be, as you can acquire CBD over the counter. This is possible to acquire Delta 8 over the counter without having to go through a medical marijuana solution.
Dr. Michael Koren:
3:14
So let's dig into that a little bit more so explain what is available over the counter versus what requires a prescription in the state of Florida. I know it's probably different in different states.
Dr. Erich Schramm:
3:23
Well, fundamentally, if you look at the potency of Delta 8, it's about half as potent as Delta 9 in terms of its potential effects in terms of intoxication. The reason that it exists and became about from CBD is because at one point in 2014, we passed the Farm Bill, which allowed for the CBD industry to be launched, and during that time and over those many years, we had a big glut of CBD on the market, and so those CBD manufacturers were looking for products that they could potentially produce, and Delta 8 was one of those products. So it evolved into that space because it categorically is derived from the hemp plant, which has, by design, much less THC than a traditional medical cannabis plant. So that was the big divider in the products.
Dr. Michael Koren:
4:18
Now, in this area we talk about terpenoids and flavonoids, so tell us a little bit what that means.
Dr. Erich Schramm:
4:24
Exactly so. A big one, important part of the composition and the effect of the plant relates to terpenes. Terpenes are found in all plants it's the oils that give it its scent and taste, and in medical marijuana it's important because the different terpenes are important in driving different functions. Different effects whether it's sedation or whether it's antidepressant effects or whether it's an anti-inflammatory effect can have profound effect on things like seizures, and so it has an important part in guiding the effects of the plant. It isn't just that we have traditionally what we thought of as a sativa plant, which is a little bit more of a considered cannabis sativa, more activating strain versus, say, an indica plant, which is historically more sedating and can be used for relaxation. So it's true that those plant types can affect certain effects, but at the end of the day, terpenes have a huge impact on how patients experience the cannabis.
Dr. Michael Koren:
5:32
So it's almost like wine making you have different types of grapes and the effects at the end of the day are somewhat similar, but a little bit different.
Dr. Erich Schramm:
5:40
Exactly. So here is an interesting one. You can go online and exactly you can decide what particular strains suits you, whether it's a dessert strain, or whether you know it's a gas strain, or they have all these different types of strains for different types of effects.
Dr. Michael Koren:
5:57
Does sativa go better with meat and go better with fish or vegetables? Yeah, I would. That would be a great pair. I would think that would be a great pair.
Dr. Erich Schramm:
6:05
Yes, so yeah, but the flavonoids, t hey give the color and they provide also, i t's very interesting because they can have anti-inflammatory effects. They tend to have anti-anxiety effects, and the purpose of all those compounds is basically they protect the plant against insects and so it's their self-defense mechanism.
Dr. Michael Koren:
6:25
All right, so let's talk about why it works, why it affects our brains, and this gets into some research that you and I have worked on in the past. I remember a number of years ago there was a product on the market called Ramonobons. Do you remember that? Yeah, and so that was a product that actually blocked a CBD receptor, and we all know that when you stimulate CBD receptors, you stimulate your appetite, right, and the concept behind this drug was to block that receptor and reduce your appetite, right, and it did in fact work to reduce appetite and, as I recall, people actually lost weight when they took Rimonabant. But it was actually taken off the market in many jurisdictions and I think probably all jurisdictions at this point, because people became depressed when they took this drug. So it gets into the concept that we have receptors that are able to process the chemical signal from cannabis and cause effects in our body.
Dr. Erich Schramm:
7:24
Right and I remember when I first joined in clinical research Rimonabant was, it was about the time that it looked to have great promise. Ultimately, that turned out to be quite disappointing because a number of people that had considered suicide worsening depression committed suicide and it really gave people a newfound respect for what the CBD receptors are doing, particularly in the brain your CB1 receptor, and so it in fact it was a THC variant, so it was THCV, and the question now is and as a synthetic it had had that problem. Now the question is well, if you get that from the naturally derived plant, is it possible that this in the future could be still looked at as a potential therapeutic product for weight loss that doesn't have the significant effects of mind altering or potentially, you know, mood altering disturbances, and that's hopefully they'll might reconsider that as a possibility.
Dr. Michael Koren:
8:22
Yeah, so explain CB1 versus CB2 receptors for everybody, right.
Dr. Erich Schramm:
8:26
So CB1 receptor, the most important place it's found is in your brain, and to have a THC have an effect on that receptor, you know it has to get through the blood-brain barrier and so that allows for, i f people are saying, well, how, is that going to, you know, affect in terms of causing people to get high or intoxicated or what have you, then that's the effect of THC on a CB1 receptor in your brain. Now we have CB2 receptors too that are found in the peripheral nervous system. We have CB2 receptors that regulate a big part of our immune system, which is, which is hugely important, because when people start looking at and say, well, how does you know CBD, you know how does it do so many different things Anti-inflammatory can help your mood, it can do anti-cancer effects and you're going to say, because it's reflecting its effect on different different CB receptors that we have all over our body. So we have CB1 and two receptors in the gut, and so there's recently some development coming along that looks like at a product that may be affecting CB2 receptors in the gut to decrease, you know, acid reflux, irritable bowel and you know, a pharmaceutical company just recently invested over $6 billion to get access to that potential product. So, it's very interesting where, how these receptors show up, understanding at what point that you know certain types of products have the potential for intoxication. I don't like to tell people that they're going to get high. People are like, hey, I talk about the possibility, as a side effect is intoxication, and so understanding where the receptors are and the skin has both CB1 and CB2 receptors, which makes the skin a great potential source as a therapeutic source.
Dr. Michael Koren:
10:14
Yeah, and for our audience. It's important for them to understand that if your body has a receptor, it can respond to that chemical signal. So our bodies are programmed to be able to respond to chemical signals and they're receptors for a lot of different things. You know, for adrenaline, for opioid analogs, and certainly we now know that there are many receptors for cannabinoids.
Dr. Erich Schramm:
10:37
Right and we have our own natural. We have two natural endocannabinoids called anandamide and 2AG, and Ananda is Sanskrit for bliss, and so they figured this out.
Dr. Michael Koren:
10:48
So, it's.
Dr. Erich Schramm:
10:49
We're hardwired for cannabis and to understanding what the why do we have an endocannabinoid system in the first place? And it's balanced right. So this system evolved to provide balance to your whole body, whether it was the physiologic stresses, illness, infection, and so when you look at the potential benefits for cannabis, it spans a whole wide variety of disease states. So that's that counts for the widespread receptor system. It's kind of the master, you know I call it. It's the like at the airport, it's the control tower. It's running everything and regulating everything downstream.
Dr. Michael Koren:
11:27
So, Erich, thank you for those wonderful explanations. I think I'm ready to pass Cannabis 101.
Dr. Erich Schramm:
11:32
Oh man, you are right on top of that, Mike. I love it Okay.
Dr. Michael Koren:
11:35
I'm ready for the exam. So let's take a quick break and then we'll reconvene and talk about this from a clinical perspective who are the patients and how do you approach them?
Narrator:
11:44
Thanks for joining the MedEvidence podcast. To learn more, head over to MedEvidence. com or subscribe to our podcast on your favorite podcast platform.
