Medical Marijuana and Cannabinoids (and hemp seed recipes)

Marijuana and Cannabis

Cannabis sativa and cannabis indica are very versatile plants.  They have been used for thousands of years, not only for medicinal, religious or “euphoric” reasons, but also to make fabrics and eat the seeds (I love hemp seeds – see recipes at the bottom!).  The ancient cultures most known for cannabis use are Chinese and Hindu (the plant is indigenous to Central and South Asia); as well as Greek and Middle Eastern.  Within the last few hundred years, it reached the rest of Europe, as well as North America.(1)

Use of the cannabis plant has been recommended by physicians and medical texts throughout the ages.  A few of the traditional medicinal uses have been for chronic pain, seizures, spasticity, and nausea.(1)

Cannabinoids (the active compounds) from the plant were identified in the 1960s, particularly delta-9-tetrahydrocannabinol (THC) which is the psychoactive compound in the plant (no psychoactive or medicinal properties in the delicious and nutritious hemp seeds, sorry…).(1)

In the following years, concerns grew about addiction and other side effects, and cannabis’ medicinal value was questioned; which lead to legal issues.  However, there were always anecdotal reports of marijuana’s ability to help with many health concerns such as glaucoma and nausea/vomiting of chemotherapy.(1)

Note that from a strictly scientific perspective, anecdotes are interesting and can be a reason to begin researching something, but are not considered solid scientific evidence.  Even a massive number of anecdotes aren’t evidence.  This does not mean that they are invalid at all, it means that there is not enough research to start recommending something as a main treatment for patients.  We simply don’t know enough about the efficacy (how well it works for which conditions, how much it takes to work, etc.) and safety (who should avoid it, what it can interact with, what the long-term consequences are, etc.).(2)

The demand for marijuana continued, despite the legal challenges.  In fact, it’s the most popular illicit drug in the world (alcohol and tobacco are more popular, but legal).  At least one study shows that marijuana is 75% of the illegal drug trade in the USA.(1)

While smoking cannabis (as a cigarette or even in a pipe) is the most popular way to consume it, it can also be eaten, steeped and drank as tea, or taken as capsules.  It can also be taken as hashish.(1)

A theory of how addictions have evolved is that, those behaviours required for survival of the human species (such as eating food and sex for procreation) create pleasure.  They stimulate the brain’s “reward centre”.  So, in order to help ensure the next generation of people, we’ve evolved to naturally enjoy pleasure (as it can be synonymous with survival).(1)

However, other non-survival things (such as drugs) that can cause pleasure and affect the brain’s “reward” centre, can therefore become addictive.(1)

In the 1980s endocannabinoid receptors were discovered in the central nervous system, as well as the fact that our body naturally makes certain cannabinoid compounds that interact with those receptors.(1)

Research into the pharmacology and medical uses of cannabinoids continues to this day.

Cannabinoids: endo-, phyto- & synthetic

Endocannabinoids and the endocannabioid system (2-AG, AEA)

Endocannabinoids (eCB) are compounds our body makes that naturally interacts with the “endocannabinoid receptors” in our central nervous systems.(1)  This eCB system has been metaphorically referred to as a “microcosm of mind-body medicine”.(3)

The roles of the eCB system are to: “relax, eat, sleep, forget, and protect”.(3)

There are two different types of these receptors: CB1 and CB2.  The CB1 receptors are located mostly in our brains (hence the psychotropic effects of THC); while the CB2 receptors are located mostly on immune cells as well as in the gastrointestinal tract, and are involved in the inflammatory response.(1,3,5)

When these receptors are triggered (by a cannabinoid) it induces a “reward” feeling in the brain.  They also affect emotions, memory, and movement.(1)

At least one researcher has proposed a “Clinical Endocannabinoid Deficiency” (CECD) Syndrome that, when this system is not working properly, it can manifest as migraine, fibromyalgia, and/or irritable bowel syndrome.(4)  This was re-iterated by other researchers in 2014, in addition to the possible link to autism spectrum disorder as well.(5)  However, they do call for more research, especially clinical trials.(5)  Others have proposed that it might also be related to depression, schizophrenia, multiple sclerosis, Huntington’s, Parkinson’s, anorexia, and even possibly an infant’s “failure to thrive”.(3)

Of course, even if more research confirms CECD, there is more than one way to treat it.  Consuming cannabinoids is just one possibility.  Other possibilities include stimulating the body to make more eCBs, or even slowing down how the body uses eCBs so they stay active in the system for a longer time.  While, there are several lab, tissue and animal studies published, more clinical trials are needed.(2,3)

The endocannabinoid 2-AG (2-arachidonoyl glycerol) interacts with GABA and other neurotransmitters to help modulate pain, cognition, movement and emotions.(1)

Anandamide (AEA), another endocannabinoid, reacts more with the CB1 receptors, and its actions are similar to THC.  Cannabidiol (CBD) interacts with anandamide to help increase its activity, rather than directly with eCB receptors.(1,4)

Phytocannabinoids – compounds derived from the plants (THC, CBD, etc.)

Marijuana (as with all plants) is a complex living organism, and chemical analysis shows dozens of compounds within it.  THC is the only phytochemical in cannabis that has psychoactive properties.(5)  Many non-psychoactive compounds are also found in it, such as cannabinol (CBN) and cannabidiol (CBD).

THC can be extracted from the seeds, stems, leaves, flower or oil.  Its psychoactive effect makes people feel euphoric and relaxed, and can increase appetite.  It’s also been known to induce anxiety, depression, and hallucinations, as well as tolerance and withdrawal syndromes.(1)

NOTE: I will go into more detail about the side effects and toxicity in a future blog post.

The potency of THC in marijuana and cannabis products has increased over the years.  Back in the 1960-70s it was about 1-2%, now it can be found at levels of up to 22% potency.(1)

THC enters the blood stream very quickly when smoked (3-10 minutes), as opposed to an hour or more when eaten.  It is metabolized in the body, and the most active metabolite is 11-OH-THC, which can get to the brain easier than THC itself.  THC is stored in the fat tissue and is metabolized by the liver.  It is slowly eliminated from the body mostly in the feces, and some is excreted in the urine.(1)

Cannabidiol (CBD) can reduce some of the psychoactive effects of THC, including anxiety.  CBD has also been shown to have anti-convulsant, analgesic, anti-inflammatory effects and help reduce vomiting as well.(1)

Synthetic cannabinoids (medications)

Nabilone (synthetic CBD known as Cesamet) is similar to THC, and is approved for use in Canada and the USA.  Nabilone is more potent than dronabinol, and so is more tightly regulated.  It is approved for use for nausea and vomiting due to chemotherapy.(1)

Dronabinol (synthetic THC known as Marinol) is sold in sesame oil and is approved for use in the USA.  It is also approved for nausea and vomiting due to chemotherapy, but in addition, is approved for HIV-associated anorexia.  It acts like THC because it is metabolized to 11-OH-THC, the same active metabolite as that from natural THC itself.(1)  Dronabinol was also approved in Canada, but it was withdrawn from the Canadian market in 2012.

Nabiximole (known in Canada as Sativex) is a blend of the two phytocannabinols THC & CBD.  It is thought that the CBD helps to reduce the psychoactive effects of the THC.  Sativex is an oral spray indicated for cancer pain, spasticity, as well as neuropathic pain related to Multiple Sclerosis.(1)

Even though there are just a few approved uses for these medications, sometimes they are prescribed for “off-label” use, which means for other non-approved conditions.  This can be helpful to many patients, and the risks need to be weighed against the benefits.(1)

I’ll get into the side effects of these medications in a future blog post.

On the other hand, there are also some synthetic “designer” cannabinoid drugs (AKA “new psychoactive substances” NPS or “smart” drugs).  These “cannabimimetics” are sometimes sold as air fresheners with the warning “not for human consumption” and can have up to 10x the strength of THC.  They are designed to have a stronger effect on the CB1 and CB2 receptors.  They are sometimes marketed as being “safe” because they are technically tobacco and cannabis-free; however, they have a long list of side effects including anxiety, hallucinations, seizures, paranoia, psychosis, kidney injury, and death.(1)

Medical Uses for Marijuana and Cannabinoids

While there are many people who have experienced medical benefit with marijuana use, and there are a few cannabis-based medications approved and available by prescription (see above), the scientific evidence is lacking in many areas.

The use of marijuana and cannabinoids for medical purposes is still being researched.

Unfortunately, at this time, there is a need for more scientific evidence showing the safe and effective use of marijuana and/or cannabinoids for:

• cancer treatment;
• epilepsy;
• pain and chronic pain (I will go into this in a lot more detail next week on the blog);
• neurological conditions (Tourette’s, Huntington’s, Parkinson’s);
• neuropsychiatric disorders (addiction, schizophrenia, anxiety);
• glaucoma;
• sleep disorders;
• gastrointestinal disorders.(1)

There is a very powerful quote, which was the last sentence in reference (4) that says:

Our insight into these possibilities is dependent on the contribution of one unique healing plant; for clinical cannabis has become a therapeutic compass to what modern medicine fails to cure.

And on a different note…

Hemp Seed Recipes

Sorry, there is almost no active compound (THC) in the seeds of industrial hemp, but they’re delicious and nutritious.

Here’s a picture of the nutrition facts table on my bag:

And you can buy it here:

Manitoba Harvest Hemp Hearts

Hemp seeds are a unique plant. They are high in protein (about 25% protein). And they’re one of the few plant proteins who can boast “nutritionally significant” amounts of all amino acids.(6)

They also contain the optimal ratio of both essential fats. Humans need both omega-6 and omega-3 fats, and hemp seeds not only contain them both – but in the ratio of 2:1 to 3:1.(6)

To top this all off, hemp seeds contain vitamins, minerals and fibre.(6)

If you don’t have any, here are dozens of awesome ways to eat (and drink) them.

Breakfast

ShiftShape Coconut Yogurt Parfait – Shift Nutrition

Easy Overnight Oats – Naughty Nutrition

Delicious French Toast – Orgali

Hardcore Mom Oatmeal – Nutritionnaire

Grain-free Hemp Heart Porridge – Healthful Pursuit

Hemp Pumpkin Porridge – Aly Lewis

Mango Quinoa Breakfast Bowl – Richelle Ludwig

High Protein Vanilla Chia Pudding – Simply Quinoa

Grain-free Berry Granola – Healthful Pursuit

Drinks

Boosty Matcha Latte – Gastro Senses

Chocolate Hemp Shake – Healthful Pursuit

Spicy Hot Chocolate with Creamy Hemp Milk – Joyous Health

Creamy Cherry Hemp Milk – Sexy Food Therapy

Creamy Cashew Hemp Latte – Food 52

Vanilla Nut Hemp Milk – Healthful Pursuit

Soups & Salads & Spreads & Snacks

7-Seed Bars – Nutrilicious

Chocolate Hemp Butter – Nutritionnaire

Beat The Blues Hemp Salad  – Julie Daniluk

Citrus Hemp Seed Dressing – Pop Sugar

Maple-Cinnamon Superseed Almond Butter – Oh She Glows

Multi-Seed Crackers – Deborah Kuhnen

Cauliflower & Hemp Seed Soup Recipe – Joyous Health

Mains

Black Bean Hemp Burgers [Vegan, Gluten-Free] – One Green Planet

Super Seed Buns – Nutritionnaire

Fettuccine with Artichokes, Basil and Sun-Dried Tomato Hemp Seed Alfredo – Connoissaurus Veg

Desserts

Hemp Chocolate Tahini Coconut Bars – Nirvana Cakery

Heavenly Hemp Butter Cups  – Julie Daniluk

Chocolate Protein Spread – The Naked Label

Dehydrated Fruit and Nut Cookies – Deborah Kuhnen

Gluten-Free Black Bean Hemp Brownie  – Julie Daniluk

Convinced to try (or stock up) on these nutritional powerhouses?

Here’s the link again:

References:

(1)  Cannabis: The never-ending, nefarious nepenthe of the 21st century: What should the clinician know?

(2)  A Rough Guide to Types of Scientific Evidence

(3)  Care and Feeding of the Endocannabinoid System: A Systematic Review of Potential Clinical Interventions that Upregulate the Endocannabinoid System

(4) Clinical Endocannabinoid Deficiency (CECD): Can this Concept Explain Therapeutic Benefits of Cannabis in Migraine, Fibromyalgia, Irritable Bowel Syndrome and other Treatment-Resistant Conditions?

(5)  Clinical endocannabinoid deficiency (CECD) revisited: can this concept explain the therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions?

(6) Callaway, J.C. (2004). Hemp seed as a nutritional resource: an overview. Euphytica 140, 65–72. 10.1007/s10681-004-4811-6