https://www.lymedisease.org/med-marijuana-lyme-kinderlehrer/

Medical marijuana for Lyme symptoms? A doctor’s perspective.

Kinderlehrer-headshot-300x300

by Daniel A. Kinderlehrer, M.D.

I have a confession to make. I proposed a talk on medical marijuana at ILADS because it would force me to learn everything I could on the topic. I live in Colorado where it seems there is a dispensary on every corner, and many of my patients have been using medical cannabis. But the huge assortment of products is confusing, and I wanted to give specific recommendations to help patients get the most benefit. Here is what I learned.

Marijuana has 483 phytocannabanoids, which are naturally occurring compounds that can affect many body processes such as appetite, mood and sleep. Most people have heard of one of them—THC, or tetrahydrocannabinol—the psychoactive component of marijuana. THC can make you high, giddy, or euphoric, and provide seemingly awesome universal insights that may appear quite trivial the next day.

Some strains of marijuana now available are not your father’s weed—they have a much higher THC content. It’s important to choose the appropriate strain for your needs, and some people may want to avoid THC entirely. However, it has been clearly established that THC is quite beneficial for pain, sleep, nausea, appetite, and PTSD, so there are medically valid reasons for choosing it.

Most of the non-THC phytocannabanoids fall into the category of cannabidiols, or CBDs. CBDs were once considered to be physiologically inactive unless paired with THC, but it turns out that is not the case. There is compelling scientific research documenting its independent activity, and now there is extensive clinical experience as well.

Did you know that we make our own CBDs? All vertebrates going back 600 million years on the evolutionary tree have an endocannabanoid system, which modulates immune and nervous system function. CBDs are potent anti-inflammatory agents, they regulate neurotransmitters, and they may enhance immune competence. CBDs decrease neuroinflammation and are neuroprotective. They can significantly reduce pain and anxiety.

Marijuana is not the only product that supplies CBDs. Hemp, a variety of cannabis that is used to make rope, fabric and paper, contains CBDs. Hemp has less than 0.3% THC, and is not psychoactive.

There are two strains of cannabis: indica and sativa. Indica has a high proportion of THC to CBD. It is great for pain but is sedating, so it is best used at night. Sativa is CBD-dominant. It is activating, can increase energy, and is better suited for daytime use. There are also a number of hybrid strains now available that essentially cross categories.

If your problem is pain, consider taking CBDs in the form of hemp oil in the daytime. My patients have had excellent responses to a liposomal sublingual extract (taken under the tongue), and it is activating, not sedating. In the evening, you can take a marijuana extract with equal parts THC and CBD, since these together will have additive pain-relieving effects. There are a number of delivery systems available, including smoking, vaping, edibles and sublingual extracts. I recommend the extracts since the onset is reasonably quick, usually in about 30 minutes, and the dose can be easily titrated by adjusting the number of drops under the tongue.

Both hemp-derived CBD and marijuana are available as balms that can be applied topically to relieve pain. Whether taken systemically or applied locally, these products can help many patients significantly decrease their need for pain medication. In fact, states that have legalized medical marijuana have experienced a 25% decrease in opiate overdose deaths. That’s right. This scourge, which took 42,000 lives in 2016 (66,000 including all drug overdose deaths), was significantly reduced by the availability of marijuana.

For sleep, take a THC-dominant indica strain. THC is not only sedating, it increases the time spent in the deeper stages of sleep, so sleep is more restorative. If your problem is difficulty falling asleep, use a short-acting vehicle like vaping, which kicks in within 15 minutes. Vaping is high-tech smoking without the ill effects of the smoke. Alternatively, use a sublingual extract, which has an onset within 30 minutes. Both of these will hang around for up to an hour.

If your problem is staying asleep, then take an edible. It takes 60-90 minutes to get into the circulation, and hangs around for an average of 3-4 hours. I don’t recommend cookies or candy, as they usually have a lot of junk in them—you can take pure THC tablets. The average dose is 10mg, but start with 2.5mg to see how well you tolerate it.

If you have problems with both sleep initiation and maintenance, you can take sublingual extract or vape to fall asleep, and a THC tablet to stay asleep. The table below includes some considerations for choosing among the available options.

TIMING 

  • Daytime CBD from hemp oil  for pain, anxiety, energy – because THC can cause sedation & alter cognition
  • Evening Marijuana with THC:CBD ratio around 1:1 for pain & relaxation – because
    THC and CBD combination yield optimal analgesic benefits
  • Night THC dominant indica strain or edible THC for sedation, improved sleep, architecture – Vape or SL extract for sleep initiation; Edible for sleep maintenance

While THC is only available in states that have legalized medical marijuana, CBD from hemp oil is available everywhere—although the attorney general in Nebraska seems to be confused about that. You can buy it on the Internet, travel across state lines, and I have even taken it out of the country when I traveled to Israel to visit my daughter.

**My note:  Hemp Oil has little THC.  Go here to read about the differences** https://healthyhempoil.com/hemp-oil-vs-cannabis-oil/

CBD can lessen anxiety, without any of the psychoactive giddiness of THC. CBD is anti-inflammatory—it not only decreases pain, it can improve energy, cognitive function and general well being. When I started selling it in my office, it went flying off the shelf. The full effects of CBD from hemp oil do not kick in for two to three weeks.

While properly administered marijuana has been extremely effective in helping people with PTSD, in some people it will make anxiety worse. Similarly, THC can help depression in some people, but in others can make depression worse, particularly if it is abused by chronic users. If you develop tolerance to the benefits of cannabis because of chronic use, it is important to take a drug holiday. Pregnant women should not take marijuana.

The legal status of marijuana is dicey. It is unjustifiably classified as a Class I controlled substance by the Food and Drug Administration, in the same category as heroin, and the Obama administration declined to enforce federal laws regarding marijuana in states where it was legalized and properly regulated. The current administration is trying to change that, but I predict it will be like trying to put toothpaste back in the tube.

The analgesic, anti-inflammatory and neuroprotective properties of cannabis make it extremely valuable as an adjunct to the treatment of tick-borne diseases. There is a lot of research available on the medical uses of cannabis. A couple of good resources are listed below.

Kowal MA et al. Review on clinical studies with cannabis and cannabinoids 2010-2014. Cannabinoids 2016;11(special issue):1-18

Project CBD, User’s Manual: https://www.projectcbd.org/guidance/cbd-users-manual

Dr. Daniel Kinderlehrer specializes in the treatment of tick-borne disease in Denver, Colorado. He has found that properly administered medical marijuana and CBD from hemp oil have been extremely beneficial for many of his patients.

______________

**Comment**

Helpful and practical article by Dr. Kinderlehrer.  Recently, I posted an article by Dr. Amen that serves as a caution in regards to the THC in marijuana:

https://www.linkedin.com/pulse/does-cbd-oil-cause-brain-damage-dr-daniel-amen/ “Although marijuana doesn’t necessarily pose the same immediate, life-threatening dangers as alcohol, we have seen that chronic, long-term use does cause significant brain changes—chiefly, slowed activity in the frontal and temporal lobes; areas of the brain involved with focus, concentration, motivation, memory, learning, and mood stability.

Just published in the most recent Journal of Alzheimer’s Disease,  https://www.j-alz.com/content/new-study-shows-marijuana-users-have-low-blood-flow-brain the research finds that, after studying imaging of 1,000 cannabis users’ brains, there were signs of noticeable deficiencies of blood flow. The study, which included 25,168 non-cannabis users, and 100 healthy controls, shows a scary and obvious difference in blood flow levels for those that used cannabis.

Additionally, those that used marijuana showed a significant lack of blood flow in the right hippocampus, the area of the brain that helps with memory formation. This part of the brain is severely affected with those that suffer from Alzheimer’s disease.”

The Amen Clinic Uses SPECT imaging and as they say, “A Picture’s worth a thousand words.”  http://www.amenclinics.com/blog/amen-research-marijuana-affects-blood-flow-brain/

marijuana-8x4

Like everything else it’s important to read all around an issue, particularly when you are considering it as a treatment and it’s going into your body.  As always one must weigh the risk vs the benefit.  I know folks who swear by medical cannabis and that they wouldn’t be alive without it.  I also know of folks who swear by Hemp CBD oil as well.

For more on Cannabis:

https://madisonarealymesupportgroup.com/2017/01/23/nasem-report-on-cannabis/

https://madisonarealymesupportgroup.com/2017/10/05/marijuana-chronic-pain-q-a-with-dr-david-barton/

https://madisonarealymesupportgroup.com/2015/05/19/marijuana-the-miracle-herb/

For more on Hemp-derived CBD:  https://madisonarealymesupportgroup.com/2017/09/28/cbd-for-pain/

https://madisonarealymesupportgroup.com/2017/10/19/november-madison-lyme-support-group-meeting/

https://madisonarealymesupportgroup.com/2017/11/14/hemp-oil-presentation/

If you are having trouble sleeping, immune dysfunction, inflammation, & PTSD,  read about LDN:  https://madisonarealymesupportgroup.com/?s=LDN

Trouble with your gut, detoxing, inflammation/pain, and allergies?  Read about MSM:  https://madisonarealymesupportgroup.com/2018/01/03/the-invisible-universe-of-the-human-microbiome-msm/