This transcript is customized from CannMed’s weekly podcast, hosted by Ben Amirault, who lately interviewed Bonni Goldstein, MD, one of many nation’s most revered and skilled medical hashish physicians. Dr. Goldstein has handled 1000’s of sufferers with medical hashish. She is the medical director of Canna-Centers Wellness & Education and the medical advisor to Cannformatics. She can be the creator of Cannabis is Medicine: How Medical Cannabis and CBD are Healing Everything from Anxiety to Chronic Pain. Dr. Goldstein will likely be main the Medical Practicum at CannMed 2023 (Might 15-17), the place she may even be talking about CBG and different minor cannabinoids throughout the primary session.
Ben Amirault, CannMed: I needed to debate one of many so-called minor compounds that you simply’ll be overlaying throughout your discuss at CannMed this month. You’ve gotten mentioned that cannabigerol, or CBG, is certainly one of your favourite cannabinoids. Why?
Dr. Goldstein: It seems that CBG does numerous issues that THC does and numerous issues that CBD does — however perhaps even somewhat bit higher. It’s sort of a bridge between THC and CBD. CBG is just not intoxicating or impairing. It appears to be efficient at decrease doses in comparison with CBD. And it does seem to deal with among the important points that folks flip to hashish for — irritation, ache, nervousness, sleep issues, despair, and most cancers. So, prefer it checks all of the bins, particularly for individuals who don’t need to get excessive and who don’t have the flexibility to pay for very excessive doses of CBD.
CannMed: It’s fascinating that you simply say CBG is a bridge between THC and CBD. Is that as a result of CBG is a precursor for the opposite plant cannabinoids?
Dr. Goldstein: CBG’s dad or mum compound, cannabigerolic acid (CBGA), is sort of often called the mom of all of the cannabinoids in that it’s the compound that’s present in immature hashish flower. After which, based mostly on the genetics of the plant and the enzymes that it’s uncovered to, CBGA modifications into CBDA and/or THCA, which flip into CBD and THCA when heated. CBGA hasn’t actually been studied very a lot. I’d say it’s extremely understudied. However I think that we are going to ultimately discover out that CBGA has some very fascinating anti-inflammatory and anti-cancer properties. We don’t know actually know but. However at the very least CBG is being studied. I always take a look at the scientific literature, and simply this yr there’s a research revealed from Israel on how CBG could also be useful for a number of sclerosis. And there’s one other research that checked out CBG’s mechanism of motion when it comes to the way it works for ache and irritation. So, there’s numerous curiosity in CBG, which is basically thrilling.
CannMed: For what situations do you assume CBG has essentially the most promise? What are you most concerned about?
Dr. Goldstein: I feel CBG holds numerous promise for individuals who wrestle with irritation, ache, and temper problems, like nervousness or despair. Ethan Russo, together with different researchers, lately did a survey of CBG customers. About 70 p.c of individuals mentioned CBG was superior to their typical treatment. It was extremely rated for nervousness, ache, despair, and sleep issues. I don’t know that it’s a direct sleep agent, however if you find yourself having much less nervousness and fewer ache you possible will go to sleep somewhat bit simpler and perhaps sleep higher. It’s noteworthy that a lot of this anecdotal knowledge is supported by findings from preclinical analysis.
CannMed: Within the survey you talked about, was that CBG being taken by itself or together with different cannabinoids?
Dr. Goldstein: Within the survey, I feel they tried to type that out, and it was individuals taking plant CBG that they purchase within the hemp market as a result of most CBG merchandise which might be in the marketplace don’t comprise a major quantity of THC. They’re coming from hemp vegetation, so they’re available on the hemp market. I’ve seen it as flower, I’ve seen it as topical, which has anti-bacterial and anti-psoriatic results. Psoriasis is a widely known situation the place individuals get not solely joint ache however additionally they get these thick pink patches and scales on their pores and skin. It may be a really troublesome situation. And CBG has been discovered to have anti-psoriatic properties. It acts on the pores and skin cells themselves and inhibits the build-up of these scaly patches. I feel this simply goes to point out that the functions of cannabinoids are actually wide-ranging. Individuals typically ask: How is it doable that these compounds can accomplish that many issues? Nicely, they’ve a number of targets within the mind and physique and that’s what makes them so superb. Keep in mind, the pharmaceutical mannequin is “this drugs addresses this particular goal.” Whereas cannabinoids are what we name promiscuous – they go to numerous targets.
CannMed: How does CBG differ in its targets from different plant cannabinoids? Does it work on the identical receptors with related mechanisms of motion?
Dr. Goldstein: There’s overlap with among the actions of THC and CBD, for instance. However then there are additionally some reverse reactions. CBD and CBG have reverse reactions at a particular serotonin receptor — 5HT1A — the place CBD binds to it and CBG blocks it. They each act at that receptor, however in numerous methods. CBG additionally overlaps with CBD by binding to what we name PPAR receptors [on the surface of the cell’s nucleus]. And each of those plant cannabinoids work together with TRP [ion] channels to assist with irritation and ache.
CBG is the one cannabinoid that has been discovered to work on the alpha-adrenergic receptor, which mediates ache notion and irritation. There are prescription drugs for ADHD or behavioral points, for instance, which goal this receptor. CBG is all the time a compound I take into account when treating youngsters who’ve both conduct or different kinds of difficulties. I’ve used it in a few of my sufferers with autism. Some households report their baby is calmer, has higher focus, even speech is enhancing in among the youngsters with autism who’re non-verbal. However different mother and father report that CBG makes their baby manner too hyper. That could be a dosing difficulty. Why not strive it? We all know that it’s secure. And it’s beneath medical supervision. We begin with very low doses in order that we will management what’s happening and naturally there’s numerous oversight. The mother and father are watching, I’m watching. We’re simply making an attempt to make it possible for we do no hurt. Up to now, I’d say about 60 p.c of children that strive CBG appear to get some profit from it.
CannMed: I’m glad you introduced up ADHD. Full disclosure: my son has been recognized with ADHD. I used to be shocked to study that CBG may be useful for that.
Dr. Goldstein: We don’t have medical trials to say, sure that is definitively useful or detrimental for youngsters. However we could also be on the cusp of getting these trials, which might be very thrilling. In my follow, which is in California, I’m allowed to work with mother and father to strive totally different cannabinoids to see what may assist. We do it very methodically. As I talk about in my ebook, we have now a saying, ‘Rule it in or rule it out’. We begin low dose, and we titrate up. We deal with one compound to see if there are advantages. And bear in mind, too, that generally after we’re seeing a profit it might be as a result of the kid can be on CBD — and perhaps that mixture is working effectively. For those who add a compound and see enhanced advantages, you don’t know if it’s working due to that exact compound or the mix of the 2 in the event that they’re already on one thing else. There’s numerous trial and error concerned, and it takes time to type it out. I all the time inform households after I first meet them that we’re going to be working collectively for fairly a while. It’s not like we simply choose one thing and it instantly works nice. We’d get fortunate. That occurs, however that’s not the standard case.
CannMed: One other factor that stood out to me was this concept of CBG enhancing the physique’s perform. I used to be questioning in case you may converse a bit to that.
Dr. Goldstein: Various endocannabinoids, together with CBD and CBG, delay the breakdown of our endocannabinoids. Keep in mind, our endocannabinoids are our interior cannabis-like compounds, which our physique releases on demand in response to a set off, often one thing that’s stressing us, whether or not or not it’s an sickness or a traumatic insult or an an infection of some type. Your physique cranks out these endocannabinoids to assist preserve steadiness amongst all the assorted messages that our cells are always sending and receiving. The endocannabinoid system is a physiological regulator, and it’s serving to you keep in steadiness. We are able to improve our personal pure endocannabinoid system with plant cannabinoids, which delay the breakdown of endogenous cannabinoids in order that they last more. It’s sort of like the way in which some anti-depressants work by rising how lengthy serotonin is hanging round.
CannMed: Now right me if I’m flawed, however bodily train is one other method to spur your physique into creating endocannabinoids?
Dr. Goldstein: Sure.
CannMed: Would supplementing with CBD or CBG be an efficient method to maintain anandamide within the system and get extra advantages from our pure cannabinoids?
Dr. Goldstein: Theoretically you possibly can take a look at it that manner. I don’t know that there’s a direct correlation, as in take a dose and now you could have additional anandamide. However I do assume the literature helps this entire concept of cannabinoids being anti-inflammatory, antioxidant, neuroprotective — and one dose is just not going to do the trick. It’s useful to assume when it comes to a wellness routine that features cannabinoids, after all, along with different wholesome issues that you have to be doing to reinforce your endocannabinoid system – nutritious diet, train, good sleep, actually making an attempt to manage your stress.
CannMed: Might you converse to how CBG may improve the consequences of different cannabinoids or conditions the place you assume the mix is beneficial?
Dr. Goldstein: There’s a 2019 animal research that confirmed the mix of CBD and CBG decreased neuroinflammation. They had been trying particularly at neurodegenerative problems with dementia, what we name Lou Gehrig’s Illness or ALS. And it confirmed on this preclinical research that CBD and CBG labored collectively and gave higher outcomes for shielding in opposition to neuroinflammation. This ties into the idea of the entourage impact, whereby combos of cannabinoids and terpenes seem to reinforce the advantages, the optimistic outcomes. One other current research confirmed that CBG along with THC and/or CBD has anti-cancer results in check tube experiment taking a look at sure mind tumor cells. When a few of my most cancers sufferers come to me with superior most cancers, very poor prognosis — and I’ve been doing this now for a variety of years — I add CBG into the combo. To me there isn’t any hurt in doing so. It doesn’t trigger the impairment that anti-cancer doses of THC can generally trigger.
CannMed: What different eventualities or conditions do you encounter the place you assume CBG is both the proper instrument or may be a superb companion when you’ve got already began a hashish routine and also you’re not getting the proper outcomes?
Dr. Goldstein: I feel that in case you’re making an attempt to deal with nervousness, ache, irritation, and you aren’t getting nice outcomes with both THC and/or CBD, which, after all, are the 2 commonest cannabinoids getting used proper now, then definitely the addition of CBG is value a strive. Keep in mind too, that if you mix cannabinoids generally you will get away with a decrease dose of both or each, whereas getting an enhanced impact from that entourage. As a result of there are research that present sub-therapeutic doses of cannabinoids — which means doses not anticipated to do something clinically — when mixed will work higher. For lots of people excessive, excessive doses are simply not financially possible. And generally that mixture of small quantities of two compounds really is simpler. As for what I’d advocate CBG for — nervousness, ache, psoriasis, I take advantage of it in my sufferers with autism, I take advantage of it in my sufferers with most cancers. As a result of it’s secure, and if any person’s struggling and standard drugs is just not serving to them or it is just serving to to a degree, I don’t see any motive, particularly beneath medical supervision, to not strive CBG and different cannabinoids when there’s compelling preclinical analysis that begs for medical trials.
CannMed: It looks as if CBG could be very effectively tolerated by sufferers, however are there opposed reactions that you simply’ve run into?
Dr. Goldstein: I haven’t actually seen numerous opposed reactions, apart from a couple of particular ones associated to the inhabitants of kids that I deal with. In some youngsters with autism, it’s simply too overstimulating. It makes conduct go off the charts. So, I warn the households about this earlier than we get began. It could be a dosage factor. Dosing could be very, crucial. Decrease doses could also be overstimulating. If that’s the case, we’d strive increased doses. However that’s particularly associated to a sure inhabitants. I’ve not noticed or heard of too many unwanted effects from adults taking CBG. Some sufferers say that CBG is considerably alerting, which means it feels somewhat up. So, you wouldn’t need to take CBG proper earlier than bedtime. You determine the way you reply to it, after which don’t use it at evening if that’s the impact you get. Then again, some individuals say it helps with sleep. Perhaps it’s serving to with sleep as a result of it’s calming and reduces nervousness. When a physician palms you an antidepressant or an opioid, no person is aware of the way you’re going to reply in case you’ve not taken that earlier than. It’s the identical factor with CBG. There may be all the time an opportunity if you take a brand new treatment that you could be be the one that doesn’t reply very effectively. Otherwise you may be the one that will get an amazing end result.
CannMed: CBG remains to be one of many lesser-known cannabinoids. How simple is it to entry CBG merchandise?
Dr. Goldstein: Within the video that I put up on YouTube, there’s a slide that reveals among the CBG merchandise. You will get it as flower if you wish to vaporize it. You will get it as a topical, as I’ve talked about. Principally I’ve seen it in tincture kind, which suggests an extract in a bottle the place you could have somewhat eyedropper or syringe and also you measure out your dose and squirt it beneath the tongue. I don’t endorse any firm, however definitely a fast Google search will lead you to the place you could find CBG. And naturally, all the time, all the time earlier than you buy something, you need to ensure you get a Certificates of Evaluation (CoA) so that you see what is meant to be in that bottle before you purchase it. And if a CoA isn’t out there or not readily clear, transfer on to the following product.
CannMed: We really did a podcast with a laboratory skilled who was speaking about how some producers will even falsify their CoA’s. She had some good suggestions for having the ability to spot the actual ones and the much less scrupulous ones. So, Bonni, earlier than I allow you to go, I need to thanks a lot for speaking about CBG with us. I sit up for listening to your discuss on among the different cannabinoids at CannMed 2023, the place you’re additionally going to be main our Medical Practicum, together with Dustin Sulak, Kevin Spelman, and Eloise Thiessen. Might you give us a sneak fast preview of what individuals can anticipate on the Practicum and why you consider it’s essential to have occasions like this to teach clinicians and laypersons about hashish drugs.
Dr. Goldstein: It’s essential as a result of for well being care professionals there isn’t any full board coaching program, no residency or internship that focuses on hashish therapeutics. The suggestions we’ve gotten is it’s very useful to listen to immediately from clinicians who’re really working towards one of these specialty and who’re exploring the nuances of hashish drugs. The practicum is a full day of training. We begin off with endocannabinoid system physiology, the physiology of the cannabinoids and different constituents of the plant. Dr Kevin Spelman, who’s a superb botanist and herbalist with a few years of expertise, is without doubt one of the academics. His lectures are superb. Particularly coming from my world as an MD, an allopathic world, it was an enormous change for me to grasp botanical drugs. Having him on board actually helps bridge that hole for these of us who’re coming from the allopathic subject. In the course of the practicum, we additionally undergo medical functions for hashish, particular concerns for geriatric sufferers, continual ache therapy. I’ll be speaking about pediatrics, my space of specialty. After which there will likely be sensible panels the place we’ll be giving case studies and recommendation on assist your sufferers choose the proper drugs. It’s actually a full day with a number of data for anybody who desires to advance their data. I actually take pleasure in it. It’s nice to be round like-minded individuals, and it’s nice to listen to about different individuals’s experiences. I all the time study one thing from my colleagues at CannMed, from individuals within the viewers, and from the opposite audio system.
For extra data on Dr. Goldstein, go to her YouTube channel Bonni Goldstein MD. She sometimes posts on Instagram, and he or she can be on LinkedIn. To listen to the complete CannMed podcast with Dr. Bonni Goldstein, go here.
