Friday, March 27, 2020

CBD Series -- Part 2

The Endocannabinoid System-- How CBD Actually Works

Hang with me on this post.  It is going to be a brief lesson in neuroscience. It is a bit dry, but it gives you the mechanism of action for how CBD actually works.

Decades ago as a young scientist in Israel, Raphael Mechoulam longed to make an impact in research, but he acknowledged that he was in a small country with limited capital.  He decided to focus his interest on readily available materials that were not being studied by other major nations. Dr. Mechoulam surveyed his resources and ended up at the local police department.  He requested the hashish that had been confiscated during drug raids. This began the journey of the man who would become the father of modern cannabinoid research.

Dr. Mechoulam separated the components of hashish (compressed resin of the cannabis plant) and initially identified only one active component, tetrahydrocannabinol (THC).  He noted that THC seemed to have anti-anxiety and sedating effects in animal models.

In the mid 1980s, Dr. Allyn Howlett in the United States continued this research and identified the first specific receptor in the brain for cannabinoids.  She named it the CB(1) receptor. The CB(1) receptor had a specific affinity for THC, and CB(1) was found to be prevalent in the brain and the central nervous system.  This was the first momentous discovery of the endocannabinoid system because we now had identified a specific receptor for THC.

The next logical question was why would a receptor exist for an element of the cannabis plant in our bodies?  The answer had to be that we were already producing a form of THC internally. Dr. Mechoulam gathered his research team, and an American, Bill Devane, discovered the ligand anandamide.  This was the first isolated naturally occurring internally produced cannabinoid. So now we have both the receptor CB(1) which we can view as the lock on the membrane of the cell and we have the key--the endocannabinoid anandamide.  This was followed by the identification of the CB(2) receptor as well as other cannabinoid isolates.

Brain cells (neurons) communicate with the body and with each other by releasing chemicals called neurotransmitters to send messages from one cell to the next.  The neurotransmitter latches on to a receptor much like a runner passing a baton in a relay race, and the message jumps from cell to cell in this fashion. The endocannabinoid system (ECS) is different in that it communicates backwards.  When the neurotransmitter “hands the baton” to the next cell, cannabinoids are made on demand to act almost as a dimmer switch in the body, limiting the amount of neurotransmitters like dopamine and serotonin that are released. This has a significant impact on how messages are sent and received in the body.

The identification of the ECS shows that we truly are fearfully and wonderfully made.  We have an entire system designed to maintain biological harmony in response to changes in the environment, and this system is in all mammals.*  Cannabinoid receptors are found throughout the body. CB(1) receptors, primarily associated with THC, are found mainly in the brain and central nervous system while CB(2) receptors are found throughout the body: in skin, immune cells, bone, fat tissue, liver, pancreas, skeletal muscle, heart, blood vessels, kidney, and the gastrointestinal tract.

The clinical implications of this system are almost overwhelming.  In our next session, we will be discussing what this means from a treatment standpoint.

Bottom line:  We do have an understanding of the science behind CBD.  The endocannabinoid system has been found throughout the body, and CBD can act as a “key” for the cannabinoid receptor on the cell membrane.  For this reason, studies are being conducted with CBD on a number of disease states from anxiety and sleep disorders to the immune response of the body.  THC works on the CB(1) receptors and CBD targets the CB(2).  This is why the full spectrum CBD with the legal limits of THC will provide the maximum benefit.  More on specific diseases in next post! Stay healthy!

*De Laurentis A, Araujo HA, Rettori V.  Role of the endocannabinoid system in the neuroendocrine responses to inflammation.  Curr.Pharm Des. 2014; 20(29);4697-4706

Mackie K. Cannabinoid receptors:  where they are and what they do. J Neuroendocrinol.2008;20 Suppl 1:10-14.

Tuesday, February 18, 2020

CBD Series -- Part 1

Cannabidiol (CBD):  What is the real story?

John Hollis is an innovator.  He is always monitoring trends and new directions in pharmacy.  I am a perpetual clinical skeptic, always ready to question the latest brand new “thing.”  With CBD, we followed our patterns.  John began discussions with hemp farmers in Kentucky, one of the first states to legalize hemp production, back in 2015, long before CBD was introduced into the marketplace.  John drove out to hemp farms to watch the production and even critiqued the process by which CBD oil was produced, suggesting carrier oils that would provide the greatest bioavailability of the active ingredient.  John insisted on examining the source even before working with the product.  As CBD oil became available for use, John was ready to move forward.  I was, unsurprisingly, skeptical.  One afternoon, John was rushing out of the pharmacy, late for a meeting, and the lab was a mess of CBD soaked glassware.  I assured him that I would clean up and that he was free to charge forward.  During clean-up, I realized that CBD oil had spilled on my bare skin.  As a result, I could smell the CBD oil on my hands as I left the pharmacy, shaking my head, slightly irritated with myself (and John) as I knew it would be a long, aromatic drive home through Nashville rush hour traffic.  Much to my surprise, it was the easiest commute I had ever driven!  I was polite, even charming to other drivers.  The traffic was the same.  I, with the addition of CBD, was not.  This began my research into CBD.

While there is a huge amount of media attention devoted to CBD, the accuracy of information has been questionable.  New research has provided a clearer picture of how and why CBD works in the body.  We are beginning a new educational series on CBD, starting with understanding how CBD differs from marijuana, then moving to how CBD works on the Endocannabinoid system in the body, and finishing with information on using CBD in disease states.

To begin, CBD stands for Cannabidiol.  Like marijuana, the plant family is cannabis sativa; however, there are huge differences in CBD and marijuana.  CBD is derived from the hemp plant which is a cousin of the marijuana plant, and hemp contains lower levels of THC (tetrahydrocannabinol) which is the psycho-active ingredient in marijuana.  Hemp also contains higher levels of CBD than the marijuana plant, so the active levels of medication in the two plants are reversed:  hemp is high in CBD and low in THC, and marijuana is just the opposite.  By law, CBD oil has to have 0.3% or less THC.  CBD oil that contains THC is referred to as “Full Spectrum CBD.”  For reference, marijuana has from 5 to 28% THC, and the more THC, the more potent marijuana becomes.  Very importantly, CBD is legal in all 50 states. 

CBD oil is usually packaged in a 30 milliliter (or 1 ounce) bottle.  The amount of CBD listed on the label is the entire amount in the bottle.  It is not the amount per dropperful.  For example, if a 30 ml bottle of CBD has 2400 mg on the label, it means that there is 2400 mg per 30 ml or 80 mg per dropperful.  We will explore this at length along with dosing in a future post.

And now, does CBD work?  At this point, CBD has been promoted for an extensive variety of health conditions, and more research definitely needs to be completed.  CBD is being used to address anxiety and insomnia,* and may offer options for chronic pain and inflammation.**  We will address these disease states in upcoming posts.  The strongest evidence that CBD is effective comes from the FDA which recently approved the prescription drug Epidiolex (Cannabidiol) for the treatment of seizures in children.  

Side effects of CBD are mild and can include nausea, fatigue, and irritability.  The most important concern is that CBD does not currently fall under any regulatory agency, so evaluating the quality of CBD falls on the consumer.  Any reputable provider of CBD will have a Certificate of Analysis to prove that what you are buying contains actual CBD.  Each lot of CBD produced will have a certificate of analysis for that particular lot number.  The certificate of analysis is the official record that documents that a chemical contains what it is supposed to contain.  We always have our certificate of analysis per lot available and others should also.  Feel free to ask for this information when you purchase CBD oil.

The bottom line is that CBD is not marijuana.  CBD can potentially provide a safe and effective option for managing anxiety, insomnia and chronic pain.  It is important to read the labels carefully and to have information about the origin of the product, and to discuss CBD with your physician or pharmacist to make sure that it does not interfere with your current medication. 

Next time, we will discuss how CBD works in the body, so stay tuned!

*Cannabidiol as a Potential Treatment for Anxiety Disorders. Blessing EM, Steenkamp MM, Marmar CR. Neurotherapeutics 2015;12(4) 825-836.
**Cannabinoids and Pain:  Sites and Mechanisms of Action. Starowicz K, Finn DP, Adv Pharmacol. 2017; 80: 437-475.

Thursday, January 14, 2016

Upper Respiratory Tract Infections Are in the Air!

It seems like everyone is congested, coughing, hacking or sneezing! What can you do to protect yourself? We are going to review a few basics to keep you and yours safe:

1. Wash your hands. Often. Remember what your mother told you. It was good advice as this is the major way to prevent spreading colds and flu and other nasty things. Also, keep those hands away from your face!

2. Drink plenty of fluids. Staying well hydrated is important any time of the year. Currently, we are going in and out of buildings with heaters on, and this dry heat will suck the moisture right out of you.

3. Use a humidifier at night. Again, replace the moisture that you are losing from the heating system. Nasal passages that are dry are not as effective at keeping you healthy.

4. If you still refuse to use the Neti-pot, at least try a saline nasal spray. This will keep moisture in those nasal passages and keep everything "running" smoothly.

5. Repeat the basics: exercise, get enough sleep, and eat a healthy diet. All of these will boost the immune system. While the jury is out on how much vitamin C can help, it does not hurt to add an extra dose during cold and flu season. An extra 500mg supplement is sufficient.

6. And back to mom….chicken soup really does help. Warm liquids not only hydrate, but also speed the movement of mucous through the nasal passages, reducing congestion and increasing comfort.

Healthy living with John Hollis Pharmacy! Submitted by Cindy Franklin, staff pharmacist

Wednesday, December 2, 2015

Polycystic Ovarian Syndrome

Acne, weight gain, irregular periods, infertility after years on birth control pills….these are some of the symptoms associated with Polycystic Ovarian Syndrome (PCOS), one of the most common hormonal endocrine disorders in women. It impacts approximately 5 million women in the United States, with symptoms beginning as early as age 11. The cause is unknown, but genetics do play a role. PCOS cannot be cured at this point, but it can be managed. We are currently seeing more patients diagnosed with PCOS and we want to provide a brief overview.

PCOS is primarily a hormone imbalance. In healthy ovaries, there are tiny sacs of fluid called follicles (or cysts). The egg grows and the follicle builds up fluid. When the egg matures, the follicle breaks open and the egg is released and travels through the fallopian tube and into the uterus for fertilization. This process is called ovulation. With PCOS, the egg does not fully mature because the ovary is making too much testosterone. The follicles may start to grow and build up fluid, but since ovulation does not occur, the follicles remain as cysts. And since ovulation does not occur, progesterone is not made and the menstrual cycle is irregular or absent. For women who have been on birth control pills and have underlying PCOS, the condition is masked because it is managed by the hormone regulation of the birth control pills. Many women receive a diagnosis of PCOS after they stop taking birth control pills in order to get pregnant and then have difficulty conceiving. PCOS is the cause of approximately 75% of anovulatory infertility.

The second major hormone issue with PCOS is increased insulin, and this increased insulin can trigger even more male hormone production. The increased insulin exists because the body is not using insulin effectively: a condition known as insulin resistance. This is why weight gain can often be a problem with weight tending to accumulate along the midline. Experts are unsure of the reason for insulin resistance in PCOS, but about 40% of women with diabetes or glucose intolerance will have PCOS.

PCOS can be difficult to recognize because the symptoms can vary so much. Overproduction of testosterone can either spur or disrupt a growth pattern. Patients can be thin or obese, and patients can have increased hair growth on the face, chest, and other areas but thinning hair on the head. There is no specific diagnostic test for PCOS, but women will have one or more of the following: acne, weight gain, multiple small cysts in the ovaries, high testosterone levels, and irregular periods. Diagnosis can then be confirmed with ultrasound to visualize the ovaries and blood tests to measure hormone levels.

If untreated, PCOS can lead to diabetes, high blood pressure, infertility, or cardiovascular disease. This sounds frightening, but PCOS can be managed, and these women can go on to lead healthy lives and have families. The key is diagnosis and lifestyle management.

The first step of treatment is limiting sugar and processed foods and adding more whole grain, fruits, and vegetables into the diet. Exercise is a foundation as this helps with insulin resistance. The prescription drug Metformin has also been used effectively in some patients to improve the response of cells to insulin and it can even lower testosterone levels. Other options include birth control pills or hormone therapy to normalize levels, the prescription drug Aldactone to block male hormones, and managing symptoms with laser hair removal, skin lightening creams and specific vitamins. There are promising studies using magnesium, chromium, vitamin D, calcium and omega 3 fish oil to help with symptoms.

The bottom line is that PCOS can be managed. It starts with exercise and a healthy diet.

Healthy and more informed living with John Hollis Pharmacy! Submitted by Cindy Franklin, Staff Pharmacist

Wednesday, November 4, 2015

Marijuana: Real and Synthetic

Four states have approved marijuana for both medicinal and recreational use. More states seem poised to follow because of income potential. Colorado posted an extra $70 million in tax revenue for 2014 from combined medicinal and recreational marijuana sales. More states want to share the wealth; therefore, we want our patients and their families informed on the facts.

1. According to the American Chemical Society, the marijuana of today is not the marijuana of the 1970s. The marijuana produced today is much more potent, and the effects on the central nervous system will also be more pronounced.

2. No adolescents should be using marijuana for recreational use ever. Because of the war on drugs decades ago, all research on THC was stopped and we are now trying to catch up. We don’t know as much as we should, but we do know this: Marijuana changes the chemistry of the brain. The brain is composed of fatty tissue. Marijuana is a fat-loving (lipophilic) product. Does it make any sense to insert a lipophilic product into a growing brain? Ever?
3. The Archives of General Psychiatry.( 2011;68(6):555-561) state that marijuana is associated with an earlier onset of psychosis in patients prone to schizophrenia. Schizophrenia often manifests in the late teens or early twenties, and the later it manifests, the better the outcome as patients are old enough to learn coping mechanisms to help manage the condition. Early onset can have devastating results.

4. Your teen or young adult may tell you that marijuana is a natural product, so it is much better to use than alcohol. While it is true that alcohol is more of a neurotoxin than marijuana, "natural" does not always mean better. Arsenic is naturally occurring.

5. While there are patients for whom medical marijuana is indicated, we cannot be an advocate of recreational marijuana when more research needs to be done on both acute and chronic effects of marijuana use. For every study that shows benefit, there is another showing detriment. The jury is out, and in that case, caution is advised.

And now there is synthetic marijuana! Also known as K-2, Spice, or Moon Rocks, synthetic marijuana is being sold on line and in convenience stores nationwide as potpourri or incense. A random herb is sprayed with a chemically produced form of marijuana, and the results have been frightening at best with patients presenting in the emergency room with agitation, vomiting, hallucinations, seizure, stroke, psychosis, and death.

While marijuana binds to cannaboid receptors in the brain as a partial agonist (meaning not completely covering the receptor), synthetic marijuana binds as a full agonist meaning that it is much more efficient, so smaller doses produce more dramatic results.

Also, the body does not remove synthetic marijuana from the body easily, and the metabolites can bind to receptors in the brain. Because there is no regulatory agency monitoring production, quality control is non-existent and pesticides can be part of the package.

Talk with your teens about drugs, preferably before they are teens while they are still good listeners. They have friends telling them that smoking once or twice a week can’t hurt them. The truth is that each person responds differently and there is not enough information on safe amounts, especially in an adolescent. The stakes are too high to gamble when dealing with brain function.

Healthy, informed living with John Hollis Pharmacy from Cindy Franklin, staff pharmacist

Tuesday, September 29, 2015

Allergy Season

Fall allergy season is beginning. If you are prone to autumnal allergies, please do not wait until you are sniffling and sneezing to start an antihistamine! The time to begin is now so that the antihistamine can be in the system when it is needed. Remember histamine is released by the body when it perceives a threat (like pollen or mold). Histamine attaches to receptors on cells and a series of events is triggered, and the result is the swollen nasal membranes, itchy eyes, and mucous production associated with an allergic event. Antihistamines attach to these same receptors on the cells forming a protective barrier to prevent histamine from triggering the allergic response. If the antihistamine is not in the body before pollen or mold hits, then the antihistamine has to work double time to find cell receptors that have not been impacted. An antihistamine is much more effective if it is in the body before pollen comes along.

Also, for those of you who have to use prescription inhalers: there are usually two kinds of inhalers. One is a rescue inhaler which is used to provide immediate relief, and it usually contains some form of albuterol. The other type of inhaler is a steroid inhaler. These stabilize membranes in the body and decrease swelling of membranes. This inhaler can take up to three weeks to work, so it must be used before there is an immediate need. Make sure that you discuss with your doctor or pharmacist the type of inhaler that you have so that it can be used appropriately.

Non-prescription nasal steroid sprays are also very useful as these can decrease swelling of the nasal passages. Because of the minute amount of steroid that is absorbed into the body from nasal sprays or oral inhalers, these may both be used at the same time without harm.

Healthy living (and limited sneezing) with John Hollis Pharmacy by Cindy Franklin, staff pharmacist.

Wednesday, September 16, 2015

Two More Medicinal Teas!

Continuing our focus on proactive natural healthcare, we are introducing two more medicinal teas!  Remember that our teas have no "filler" items and all ingredients work together to benefit health.  The first is Immuni-tea and it is just in time for the upcoming cold and flu season.  We have used Elderberry as a primary ingredient as this is a Native American plant that is rich in antioxidants and prized for its healing properties, especially in the upper respiratory tract.  It provides a naturally fruity flavor.  To this, we add Echinacea and Goldenseal for the immune system and for inflammation of mucous membranes.  When combined, these two herbs have a synergistic effect.  Cat's Claw and Astragalus are added to boost the immune system, and we finish with Rosehips for vitamin C and Chamomile to soothe the system.  We recommend steeping this tea for 10 minutes to maximize the herbs, and increasing the acidity of the tea with a squeeze of fresh lemon may enhance the beneficial effects.

To support the immune system, we suggest one cup daily in the morning during cold and flu season.  This may be increased to one cup every two hours as needed.

We have also added ZZZ-tea to our collection.  This was a fun but difficult tea to finish as we had to be careful not to conduct our testing in late afternoon...we did not want any drowsy drivers!  ZZZ-tea has a non-caffeinated rooibos base that acts as a potent anti-oxidant to help promote the natural recuperation that occurs during sleep.  Chamomile has a featured role as it is the superstar of night time teas for soothing and calming, and then we add lavender and lemon balm to promote relaxation and hops to help with anxiety and sleeplessness.  Each individual has a unique response to herbal blends, so we suggest not using alcohol or sleep aids in addition with ZZZ-tea.  ZZZ-tea is best enjoyed one hour before bedtime.

We have these available now as the weather is cooling and perfect for hot tea.

Healthy living with John Hollis Pharmacy from Cindy Franklin, staff pharmacist.