Dr. Patricia Frye: Cannabis and its Role in the Treatment of Auto-Immune Diseases

John Malanca 0:01
Welcome back, everybody. This is John Malanca. With United Patients Group – Be Informed. Be Well. Today we have a special guest today and she been on a few shows with me as well as spoken at United Patients Group conference in Baltimore, Maryland in 2017, as well as joined us in at United States Capitol in Washington DC for a day of education United Patients Group put on and this is Dr. Patricia Frye. She’s a founder and medical director of Tacoma south east, located in metropolitan area of Washington DC. Her integrative practice focuses on the use of cannabis, cannabinoids nutrition and lifestyle choices in the medical management of chronic conditions such as pain or autoimmune disease, neurodegenerative disorders, autism, seizure disorders and psychiatric illnesses. She’s professionally certified by the University of Vermont School of Medicine and cannabis science and medicine, and serves on the board of the Society for cannabis clinicians. As chair of the committee of education, Dr. Fry is an affiliate, excuse me affiliate for associate professor and medical cannabis science and therapeutics at the University of Maryland School of Pharmacy. She’s an international speaker sharing her vast knowledge and clinical experience in cannabis medicine with students, healthcare providers, patients, groups, policymakers, industry leaders, as well as government agencies. She is the author of the book The medical marijuana guide, cannabis and your health, which is an official reference resources the University of Maryland’s medical cannabis curriculum gratulations By the way, after completing her pediatric residency, she trained as an anesthesiology at Baylor University, excuse me, Baylor College of Medicine in Houston, where she gained experience consideration medic medical pain management, as well as pain management procedures. Dr. Frye also serves on the cannabis trade Federation’s Task Force on diversity, equity and inclusion and has testified on a number of panels addressing cannabis legalization, regularization, regulation scuze me and social justice issues on Capitol Hill as well as a 2019 democratic caucus issues conference. Welcome Dr. Brian, great to see you as always. Thanks for being on.

Dr. Patricia Frye 2:30
Thanks, john. Thanks for inviting me.

John Malanca 2:33
Yeah, we’ve done a lot over the years so I Thanks for always being open when I say with Yolanda Join me for this and so good relationship there. So thanks for that. You covered a lot I know you want to you do a lot with with pediatrics and you worked with epilepsy and I know you want to discuss autism. Now be another show. We just had someone on the show talking about autism. So I said what’s another topic that you Want to cover and you said, How about autoimmune diseases? And so I think that’s a big topic that’s affecting a lot of a lot of patients and people don’t realize autoimmune diseases, not just one disease a whole gamut, but can you share what is an autoimmune disease?

Dr. Patricia Frye 3:16
an autoimmune disease is an illness where the body responds to or the immune system rather responds to parts of the body as if it were a foreign object something that needed to be removed or eliminate it and and so it really is an overly active immune system attacking parts of the body in it and what parts are attacked. Depends on the illness.

John Malanca 3:48
It so when I you know when I mentioned I mean it, it Crohn’s is one of the most popular ones, MS, celiac disease, lupus Ultra Uc opha colloidal kaleidos slide Excuse me. And but when I found out too is type one diabetes, I didn’t realize that was part of that as well. And so, what are some common ones besides what I just listed there?

Dr. Patricia Frye 4:20
Those are common.

There’s rheumatoid arthritis is very common. psoriatic arthritis or psoriasis vulgaris, which involves the skin, Fibromyalgia line disease, mixed connective tissue disorder, poly myositis and closing spondylitis Mycenae Gravis, they, the NIH has bought that they’re just a lot more autoimmune illnesses and what we recognized Today

John Malanca 5:02
last thought here recently and we spoke about fibromyalgia and how many patients are affected by Fibromyalgia? How many affected by Americans are affected by autoimmune all together? I mean 10s of millions.

Dr. Patricia Frye 5:21
Yeah, at least the NIH estimates that they’re at least, all maybe 20 30 million Americans who are affected by autoimmune disease, it’s a very common condition is something I see quite frequently. And there’s prop there is the numbers probably higher than that.

John Malanca 5:43
And I rarely use the word cure, but are any of these curable kind of a Fibromyalgia is something that really isn’t you can use. We don’t

Dr. Patricia Frye 5:51
use the term cure as much as we use the term, getting patients into remission and whether they’re Symptoms come back, it’s a matter of time. Oftentimes we can get symptoms to quiet down. And there are a number of pharmaceuticals that are used that can do that. But they don’t work for every patient. And and sometimes we see it in cannabis. Case in point I had a patient with a very severe case of my senior Gravis who had been on a number of medications she had, she would have to be intubated, she had a feeding tube, she had so many chronic issues and after starting cannabis, things just started getting better to the point where the neurologist said I don’t use the word miracle very often but this is definitely in remission and she has been pretty much symptom free since since that time. So so it is possible to go into remission with an autoimmune illness.

John Malanca 6:58
here that is one That’s getting a lot of potential at my seat Gravis. You mean before not too many people even discussed about it not even people talked about, you know, cannabis. And so how did you let’s back up a little bit. How did you get involved with cannabis? Was it a personal story or did you do so many patients coming at you? You’re like, wait a minute, you know,

Dr. Patricia Frye 7:23
cannabis found me. I was I practiced in Southern California for many years and cannabis was just not on my radar at all. And it was moving back to the east coast. I was looking for a telemedicine job. And I was thinking more of an urgent care type job, but they called me about doing medical marijuana evaluations. And my response was I don’t know anything about marijuana. And they were like, Well, you know, why don’t you talk to the people that application was You didn’t have to know that much about it. I was curious. And I decided to do it. I learned so much from these patients. I was doing these evaluations three hours a day, almost every day and at the end of the year, I had evaluated maybe 2000 patients. And at that point, I it had the experience had definitely changed any preconceived notions I had about who used marijuana or and why. And I felt like this was a pretty remarkable plant. People should know about it, and people should have access to it. So I kind of came out of retirement and open to practice and continue to do evaluations but in person on the east coast.

John Malanca 8:46
Yeah, it’s funny the very first time I went in to get a medical cannabis recommendation here in California, I think it was 2010 and I walked around thing and who’s going to see me walking into this place, you know, it’s kind of You’re breaking the law. And I walked in there. And I saw everybody in every game and there was a sign up on the wall, that this is what your typical Cannabis Patient actually looked at the science of this what your typical stoner looks like. Add a picture of a police officer, a teacher, a doctor, a parent, a mom, you know, and I am looking around in the in the waiting room, that’s exactly what I saw. And so, from 2000 now to 2020, you’ve also been seeing this this wall go down of what this plant can do. And even when I present I’ll put up there on the on the slide and I’ve talked about this my show, I’ll put a slide up there that has a roll of duct tape in the audience looks to me like I think the other up the wrong slide up there. And I say, actually, when people ask me, does it work for this or does it work for that I say I don’t want to it’s like it like it’s a duct tape. But when you really get down to it It has so many benefits. I never want to say I like you. I never use the word cure. But but it’s not. It’s not a one size fits all. And so it’s not just because someone has you know, Fibromyalgia doesn’t mean every single fibromyalgia patient is treated the same way or rheumatoid arthritis or Crohn’s patients and so can you talk about that what you look at when you do have an autoimmune patient that comes into your office and what do you what are the things that you look at and what can you share from our some of our listeners that probably are going through this and really know nothing about the cannabis plant how it works?

Unknown Speaker 10:41
Well, I’m basically looking at alleviating symptoms that bring the patient and there are a certain number of symptoms that are very common in autoimmune illness. Pain is a is a major factor and that could be joint pain. It could be chronic headaches, it could be my official pain like in fibromyalgia. So, um, or abdominal pain from inflammatory bowel disease or celiac disease, so I’m usually focused on alleviating a symptom. So sometimes it’s pain most of the time pain is involved. Other times it may be chronic fatigue, it could be brain fog, insomnia, and then anxiety and depression are very commonly seen in patients with autoimmune illnesses. And a lot of that is just I think just the stress of being sick all the time of not feeling well. And dealing with chronic pain we just with chronic pain for other for other reasons, we often see anxiety and depression. And then if all if the anxiety and depression aren’t addressed, there’s no way you can get up under the pain because the those emotions actually signal the Release of inflammatory mediators which add to the inflammatory response. So it’s not just that people feel worse when they’re depressed or anxious that those emotions are actually stimulating or are starting pain or making the pain that’s there worse and it’s not their imagination.

John Malanca 12:19
It’s almost like a domino effect because I’ve spoken to a lot of patients over the years and you know, sometimes if you relieve the the, I guess the insomnia and the sleep issue kind of everything else falls in I mean, when we all don’t sleep for a day or two for whatever reason, you know, stress next morning, you know, you you’re not sleeping, it affects you and next thing you know, you’re you’re kind of spinning out your anxiety goes up your your your depression falls in. Is this something that a lot of patients are born with? Is this something is genetics is tied to this or

Unknown Speaker 12:54
I think there’s a people are warned to be susceptible to it. Yes. There is there’s definitely a genetic component to it. It doesn’t mean that every child that’s born into a family where they have autoimmune illness is going to have an autoimmune illness. But very frequently, when you see an autoimmune patient, there’s a strong family history or at least there’s some people in the family usually in the somewhat immediate family, there are a parent, or brother or sister who has an autoimmune, autoimmune illness. So there there are certain genetic markers that they can look for. I don’t know the names right off the top of my head. But that’s there’s off more times than not there’s a familial component to this.

John Malanca 13:45
Gotcha. And then what’s the difference between an autoimmune disease and an autoimmune disorder is that

Unknown Speaker 13:52
they’re interchangeable. There really is no difference in the words. We just use the word disease, for some disorder just seems to have latched on to other ones. But I look at the word diseases, dis ease. And when you’re at ease, everything is in balance and homeostasis. When there is dis ease, that’s when things are out of balance out of homeostasis and you have symptoms that are, for the most part unpleasant. Yeah, and in going back to sleep, I want to just point out how important getting seven to nine hours of sleep is. There’s so much that the body does based on your circadian rhythm that if you’re getting fewer than seven hours of sleep, there are a lot of hormonal shifts a lot of inflammatory mediators that depend on you being asleep. At night when when the sun is down when there’s no light in the dark and people cut Can underestimate just how important sleep is in managing pain and those emotions. It is

John Malanca 15:09
your I started doing because I could go to bed at two in the afternoon or two in the morning I’m still going to wake up at 530 in the morning. And lately when I say lately like in the last three months, four months since this whole cry thing in the middle and I leaned over and I grab eyemask and I put it on, you know it, it’s kept me in bed until seven 730 sleeping. So the darkness really, really helped and I would at first it was just, I can’t sleep with this hang on you know and, and but it is so so important. You talk about homeostasis and balance. Can you talk about how cannabis works in the body and with the endocannabinoid system and how it does bring the body back to balance.

Unknown Speaker 15:56
Well we have this endocannabinoid system that it’s an neuro modulating system it’s an everything from jellyfish to humans. And the whole point of the system seems to be to keep everything in balance and interacts with almost every other neurotransmitter system. It interacts with our immune system and interacts with almost everything. And so when we don’t have enough of a neurotransmitter or too much of a transmitter, that endocannabinoid system plays a role in either increasing the release of certain nerve neurotransmitters, or cutting other nerve, some neuro transmitters off so say in in pain. an atomizer which is one of the cannabinoids that our bodies make. Once the, the second part of that nerve fiber gets the signal that there’s there certain calcium ions that are coming in, there’s maybe glutamate and cytokines, which are inflammatory mediators that stimulates the production of these endocannabinoids like an and amide, or to AG, that travel retrograde back to the first part, you have this these two parts to the to the synapse, and it shuts it down as sort of the body’s way of saying, Okay, we got the message. There’s a problem. You can, but you can stop now we get it. So acute pain is necessary for survival, because it’s, it’s letting you know that something’s wrong. Chronic Pain is maladaptive in it because you already know that something’s wrong or something was wrong and it’s long healed itself. And there’s really no reason to be sending the signaling. So the endocannabinoid system plays a role in that and when it’s not doing its job, that’s when you get To this chronic signaling that causes pain and discomfort, same thing with anxiety and depression, the endocannabinoid system modulates how these neurotransmitters are, are released and and activate other types of receptors, let’s say stress for example, people, we need stress to survive if there’s an emergency, we need to, we need blood in our arms and legs so we can run fast. Just like a zebra, we need to outrun the lion will know we just need to run faster than another zebra. But the whole point is to get away from the lion. And so run faster than who you’re

John Malanca 18:45
running next year. Right?

Unknown Speaker 18:47
Exactly. It’s like it. Like my husband says you don’t have to run faster than the bear. You just have to run faster than the other guy.

Unknown Speaker 18:55
person you’re with. But so the area of the brain that That controls this the amygdala is usually in a quiet state, and it’s in a quiet state because of inanda mide. So when there is a lion, our FDA enzyme, which is the FDA enzyme is what breaks down an and amide. It increases so that it decreases the randomize so that we can have a stress response and send a signal to the hypothalamus to the dreams, and we can run and we do everything we need to do to survive. Once that’s over, that thought enzyme is supposed to go down so that our inanda my levels can come back up and put that area of the brain called the amygdala in a quiet state. When that doesn’t happen, we get into chronic stress. Chronic stress leads to a lot of other ways to call and mental problems

John Malanca 19:49
in with with these illnesses, stress, chronic stress. Do a lot of autoimmune patients that have this Are they more often getting sick than than not?

Unknown Speaker 20:04
Absolutely. Stress plays a big role in people’s state of being be at well being or being in a state of dis ease. So it’s very important to try to to control stress or at least to cut that stress signal off when you’re not if you’re not in a state where you need to run for your life. stresses is is causing problems it affects how we metabolize glucose it affects how we metabolize lipids it affects how we our energy expenditure it’s impossible to maintain the say a healthy body weight if you’re constantly stressed, at least for some, for a lot of people cortisol levels go up. It causes our insulin to be less effective. That’s how people develop things like type to diabetes it can be a problem.

John Malanca 21:03
And so with this that you’re seeing your practice with all these different types of I guess autoimmune diseases and it’s affecting them the immune system because of the stress and are you seeing a lot of this more so in your practice right now even with what’s happening right now with COVID not only in your in your practice, but in your circulate with your family as well. Family and friends guy. I’m seeing more people are getting into walking and stretching and meditation and Tai Chi mom’s evening and I said, I think it’s a great mom to let’s just keep keep keep the stress level down. Are you seeing that?

Unknown Speaker 21:42
Absolutely. I am since COVID, though I have been doing telemedicine but it’s pretty consistent. I hear that patients anxiety levels are definitely higher than they were pre COVID there are They’re stress of daily living we have people all in sometimes there’s a little too much togetherness everyone’s home 24 seven you have you know couples that are not you know, spent day after day after day without you know, some kind of break the children are going to school so everybody’s a little stressed out more more so than usual. But at the same time, most of the patients that I’m seeing happen using cannabis and have been watching what they eat and trying to get their exercise and get that that restorative sleep that’s necessary to keep those stress levels and to keep that anxiety from wrecking havoc on their well being.

John Malanca 22:46
With with cannabis, can you talk how you treat show at ease. And for our listeners, this is not to replace a one on one with your medical professional and so I would always recommend having a one on one with your medical professional or scheduling a consultation with Dr. Fry. She was mentioning but can you talk about some of the benefits how cannabis works with the body and treating a lot of these autoimmune diseases,

Unknown Speaker 23:14
yet well, both CBD and THC are immunomodulating meaning that they there are some inflammatory mediators that go up in when these receptors are activated. There’s there are others that go down. But at certain doses, particularly with CBD, when we get into some higher doses, we sometimes see what what we believe is more of an immunosuppressive action, and that’s basically mimicking what a lot of the pharmaceuticals try to do. Most patients who have active disease with autoimmune disease, if they’re on biologicals or other medications is usually to try to calm the immune system down. And so with autoimmune illnesses, I generally start patients on rather high doses of CBD with the with the hope that it will calm the immune system down and let it readjust. And once we see that some symptoms are starting to improve and that they’re feeling better, then I take those doses down out of that range, that I would anticipate the art and immunosuppressive and more to just keep those inanda my levels and those tg levels to the to the extent that they’re able to activate these receptors and alleviate a lot of the symptoms they’re having. So I generally see patients have decreased pain they have definitely decreased anxiety and depression because they the THC in particular is mood elevating Those who have a muscle spasm particularly in something like multiple sclerosis. The both of these cannabinoids are muscle relaxants, so we see improvement. They’re both cannabinoids can help with sleep. A lot of times these patients aren’t sleeping well because of pain. Or because of anxiety, anxiety can wake you right up out of a deep sleep. And so we see better sleep we see reduced pain, we see improvement in mental clarity. And I think I get but it’s like almost anything else in nature. It doesn’t work for everybody. But when it works, it works in a big way.

John Malanca 25:46
You talked about cannabinoids and so a lot of you know the buzzword right now that everyone’s hearing out there is CBD CBD CBD. You mean you can go to your gas station, get CBD and so you know Be careful what’s out there because you’re putting this into your body. You know, make sure whatever products you use are tested. Are you? I’ve heard a lot of your talks and I know you’re you’re pro CBD. He talks about the other cannabinoids, ytc even minute somatic THC would work. Do you get this because I always hear this. I want them. You know, I want the medical portion of the cannabis plant. You know, not the

Unknown Speaker 26:29
medical, they’re all medical. All of the compounds in the plant are probably medical, even the ones we haven’t we have yet to identify. And I very rarely The only time I recommend CBD all by itself is for a patient who’s working who is at risk of random drug testing because even the small amount of THC and some of the products that are over the counter could be enough to trigger a drug test and it could jeopardize their employment, but I am of the belief that these cannabinoids work better together. And I generally start with high CBD ratios to THC so that the patient because I see a lot of cannabis naive patients that have never there, they’ve never used cannabis. And THC can be disconcerting. For some patients it can be dysphoric. It’s not always euphoric. So dysphoric means that you, it makes you uncomfortable, you’re edgy, it can increase your anxiety. So I always like to use CBD and THC together and starting with higher doses of ratios that are higher in CBD than THC so the patient can get used to it and if they do well with that ratio, we stay there. But if we’re not getting the effect we need especially with pain, then we gradually increase the THC so that the patient can become accustomed to it. So they can use it without the intoxicating effect because patients need to drive and they need to go to work and go to school and it’s not it’s not so great to be intoxicated when when you have those things to do. And by using CBD and THC together we can get the benefits of the THC in terms of activating those pain receptors and and not have the intoxicating effect the CBD will kind of knock the THC off of the receptors in the central nervous system. So a lot of patients can get the benefits of the THC with without being stoned for the you know common term. But there that’s not to say that these other cannabinoids aren’t important. I use a lot of CBD a CBD as an RA plant. It’s an acid. I use a lot of thca it’s a good pain reliever. It’s not intoxicating. We have we use CBG sometimes a lot of these other cannabinoids have actually more anti inflammatory effect than CBD or THC. So I use them all

John Malanca 29:15
in your in your description. How many can ammonoids because you hear I always say plus or minus that you hear everything from 120 cannabinoids to 160 cannabinoids and right now I’m at 140. Mark, right? I’m splitting it down the middle. Are you around there cuz I’ve even heard people say 300 because more are being introduced each and every day. And they all had as you mentioned, they’re all medicinal,

Unknown Speaker 29:42
medicinal, and I stay around the hundred 50. And yeah, the 150 I was like, because that’s what we know. Um, I think they’re more. Yeah, but right now I just said, Well, you know, we know that they’re probably at least 100 50 compounds in the plant that are particular to the cannabis plant, and so I, what the real number is, I think we we just know the tip of the iceberg when it comes to this plant. You know,

John Malanca 30:18
there’s so much we don’t know. And so what do you say for patients that are listening that unfortunately don’t live in a legal state and have legal access to a product?

Unknown Speaker 30:28
Well, though most states almost every state they have legal access to CBD, or CBD with up to 2.3% THC, which is by definition hemp, and a lot of patients will have a good response to CBD, especially autoimmune patients because that CBD is it’s activating these other receptors that are that are so involved in the immune system. If they have pain, and they don’t respond to what’s available. With the small amounts of THC. I generally write a prescription for a pharmaceutical THC and add it to that CBD. And I’ve had nurdle. Yeah, I’ve been using Marinol for about four years and I started using it before Maryland got their dispensaries. I use it a lot in my Virginia patients because their dispensaries haven’t opened. But for chronic pain patients, I generally will combine the Marinol with a vetted CBD product and I have to I cannot overemphasize how careful you have to be with CBD. I would I have gotten to the point now where I just if your doctor recommends it if they have a brand that they have investigated. If it’s a you just have to be really careful because even with these certificates of analysis, a lot of them are adulterated. There’s a lot of junk out there. There are products out there that have no CBD. I was in a store kind of a healthy, you know, wholesome, healthy store, very small chain and they had CBD products that were made from hemp seed. While hemp seed doesn’t have CBD, there’s no CBD in the seeds so it’s it’s hemp seed oil, there’s no CBD in it than they would have had to have added CBD. Or I saw one product that said the CBD came from orange peel. I’m not aware of any CBD that comes from an orange peel and I was you know, kind of wagging my finger and said you know you shouldn’t be selling this and marketing this as CBD people need this as medicine and there’s no CBD in orange peel there may be Wyman name and that that’s a good analgesic and it’s anti inflammatory that It’s not CBD. So you have to be careful about the CBD products wherever you are. And there’s certain brands that are absolutely top notch. But there’s a lot of junk out there too. So you have to be careful

John Malanca 33:15
not to question just because also too, that it’s in your doctor’s office, your chiropractor’s office, your dentist office, your massage therapists, your acupuncture office, doesn’t mean that it’s the top call I, you know, I just came back from my chiropractor’s office and I was kind of blown away this stuff they had in there that they’re selling and so a lot of people are jumping on the CVD bandwagon. So to ask questions, you know, make sure that they do have lab results test results, but unlike like Dr. Fry was mentioning, you know, some of these labs, you know, are aren’t really testing for what else is in there. You need to be careful for mold, pesticides, metals, toxins, besides the Canna cannabinoids, if it’s coming from an orange or Or the

Unknown Speaker 34:00
carbons some some of these products they tested out and found synthetic cannabinoids in them. And periodically I’ll send a batch off to get tested myself. Because that’s that’s the only thing and I there’s one lab that I trust and I send it and get it tested

John Malanca 34:17
that northern Northern California. Is that in north of you there?

Unknown Speaker 34:21
Yes. I have to say it’s in Massachusetts.

John Malanca 34:23
Okay, good. You talked about limonene and the benefits of and for our for our listeners. You hear the term stop and smell the roses. Got

Unknown Speaker 34:40
to be away from people that some of the dispensary is used to guide patients to a particular plant. They said well just smell it and if it appeals to you, if you like the smell, then that may be what your body needs. But yeah, the linemen mean I generally use the names of the plants. So what is lemon or sip some kind of citrus the name, oftentimes it’s going to have a lemony aroma and that means that the lemon name may be higher in that particular variety.

John Malanca 35:11
And you go into what terpenes are, because that’s exactly what the terpene is, is what you’re stopping and smelling. So, you know, I’m smelling a lemon smelling a pine cone, shell, you know, that’s the essential oils, excuse me, and those are terpenes and can you go into terpenes and how they’re also part of feeling.

Unknown Speaker 35:28
terpenes are the compounds that are found throughout the plant world that give plants their medicinal and their aromatic benefits. So Lima Nene is anti inflammatory, its pain relieving its mood elevating. It’s found predominantly in citrus run. Beta carry awfully in is found in a number of plants. It is also good for pain. It’s found in I believe it’s founded in black pepper hops which is a cousin of a cannabis of the cannabis plant. There’s pining that gives a pine forest it’s Piney aroma. It’s it has antibacterial and antiviral properties. It’s a bronco dilator cannabis used to be used to treat asthma back in the turn of the century, going from the 1800s to the 1900s. So, so that we can use cannabis even to treat something like asthma. So there there, oh, there are a lot of terpenes myrcene is muscle relaxing, it’s relaxing little it’s found in lavender and it tends to be higher in the keema bars are the varieties of cannabis that we find to be more effective for treating things like anxiety or seizures, even nerolidol is good, it’s sedating. So a lot of these Cannabis varieties that are are known to be good for sleep for helping with sleep, maybe hot, maybe high in nerolidol or myrcene or linalyl some of these more relaxing terpenes. So these terpenes and cannabinoids all seem to work together and what the the scientists who first discovered these, the THC well first really isolate it THC calls it a entourage effect. So that’s why sometimes when we see these CBD isolates or THC isolates where it’s just the CBD or just the THC, that they may not work as well or you mean it may need higher doses of those types of products, because they’re not getting the benefit of all these other compounds like these terpenes kind of massaging how Your how that that plant is going to affect a patient. So I, I’m a big believer in the whole plant concept, I just find that that I can I can have patients who are having pain levels of eight to nine to 10 out of 10 A respond to two and a half five milligrams of THC because the THC is in a product that has all of these other compounds, whereas if they’re using isolette, they would need much higher doses of that. That same cannabinoid

John Malanca 38:33
you brought to me before I go into the dosing and I’m glad you brought that up. I love Colin’s description with the entourage effect. It’s like baking a cake and leaving out the eggs or the flour or the water something’s missing. The combination of everything and you know everything all the cannabinoids and the terpenes are very benefit beneficial in bringing the body back to balance as well. That was my next question. You know a lot of patients Probably not as many today as they were I remember I used to speak Korean I would speak at events. And I would ask like at senior communities and that asked the room, how many people think the only way to consume medical cannabis is via smoking? And you would have half the room that would raise your hand then we go into the different products and so with your patients fighting these autoimmune diseases, what are you recommending? Is it a tincture? I know a lot of patients I’ve worked with krones have taking a heavier oil or vaporization. And so what are you seeing with your patients and more is not better. And I’m glad that you you talked about the two milligram the five milligram

Unknown Speaker 39:36
right, um, I don’t I’m not a big. I don’t think inhalation is necessary for most things, especially for chronic illnesses. Because while inhalation is like taking cannabis IV, you’re going to get a higher plasma level and it’s going to get in faster you’re going to start feeling the symptomatic relief quicker. It only lasts two to three hours. So to treat a chronic problem that’s present, you know all the time, inhalation is a very inefficient way of, of treating it. I I like tinctures because the the onset of action isn’t that much longer than than inhalation it might take 20 or 30 minutes to start working. But when you put the tincture under your tongue, hold it there for not too long, maybe about a minute or so and then swallow it where it has to go through the intestines and through the liver, you’re going to get a much longer duration of action so that you could get five to eight hours of action from that dose. So I do think inhalation has its place for treating an acute problem or a severe problem where you need something in quickly. You’re having severe pain your back seizes up severe muscle spasm you feel A migraine coming on. Or if you just need something very short acting, you wake up at three o’clock in the morning and you know you have to get up at six. That’s not enough time to really take a tincture for it to get through your system so that you’re not groggy so a puffer two is really helpful. It can be really helpful for getting back to sleep, or a patient who has trouble falling asleep but doesn’t have any trouble. Once they fall asleep. They stay asleep. They don’t really need a tincture, so inhalation can be very appropriate for that. inhalation is great for it for sex, you know, you may just want just a little bit just to kind of get things going but you may not need that effect for five to eight hours. So inhalation can be you know, very helpful for that. So I I tend to mix it capsules, I tend to reserve For my gi patients, because the GI absorption is rather unpredictable that that’s actually a benefit for patients with inflammatory bowel disease because you have a lot of medicine that’s staying in the intestines, the intestines is filled with immune receptors and are receptors that are part of the immune system. And I just find that if I have a patient who takes a capsule with CBD or CBD and cbda that they just get better results. So I I use different modes of delivery depending on the patient depending on the condition, but for treating a chronic problem I do strongly recommend using tinctures if they have a problem with a tincture and I’m sort of okay with something that will hang out in the mouth like a trophy or a gummy. But I tend to steer away from some of those products when I think some of them are kind of strict. down, and then a lot of them have sugar. A lot of them have these emulsifiers and things which have their they have other problems. There are other problems to some of these additives. So the old fashioned tincture is probably my favorite.

John Malanca 43:17
It’s funny, my mom the other day said, Did your CBD work on arthritic? I said, Oh, yes. You don’t have arthritis. Why do you ask me? She’s Oh, her girlfriend said she just watched a show. I love Dr. Oz, but it was a dr. oz show about and he was recommending gummies Oh, she said do gummies gummies work for CBD gummies were for arthritis. And I said, Why are you asked that question? So she sent her friend and she said she saw it on the show. And I said Mom, you know, it’s really disappointing about that is Yeah, it would probably work but sugar is probably the worst thing in arthritic patient could use Yeah and and I said this is the stuff that just just disappointing of the Miss Miss there’s some great information out there but there’s a lot of misinformation out there and then when main media gets involved like this, you know that everyone follows and if my mom didn’t talk to me or someone else who knew something about about cannabis, you know, her girlfriend probably would have run out and stocked in these gummies that are loaded into sugar and stuff like that are you finding with all these different ailments that we’re talking about in the autoimmune I mean the list goes on and on and on. Are you finding certain things work best for each because it’s not a one size fits all are using a combination of THC CBD works better with with fibromyalgia patients? Are you seeing you know, high CBD works better for Crohn’s, lupus etc.

Unknown Speaker 44:52
Yes. And this is just the patients that I see. It’s all observational that I find that the inflammatory bowel patients Do best with CBD and CBD a and that’s not to say that THC is not helpful for a lot of patients, but most of my patients do very well with CBD and CBD a and I tend to use capsules or if they’re using an oil that has a fair amount of CBD a and for fibromyalgia patients, I find that they do they, they they have more pain issues. And the THC does seem to be more helpful, but it’s rare that I add that I have patients that need more than let’s say a one to one ratio of CBD to THC that seems to be quite effective. And again, most of my patients, you know, or at least pre covid were driving and needed to be at work and and couldn’t, you know, could not risk of being

Unknown Speaker 45:59
impaired.

John Malanca 46:00
You know, yeah. What was your? Well, I miss you. You said,

Unknown Speaker 46:04
I said that they they can’t take the risk of being on their job and appearing to be impaired.

John Malanca 46:12
I say talk to you right when you said impaired I didn’t hear you.

Unknown Speaker 46:16
My other words, yeah.

Unknown Speaker 46:19
impaired and intoxicated is great if you had a terrible day or, or you just want to unwind and you’re in your home, you want to get some relief. Sometimes, you know, sometimes that intoxication can be so therapeutic it’s almost a respite for patients who don’t feel good and or who have pain and sometimes they’ll say, Oh, well Doc, it doesn’t take my pain away completely. But when I’m when I use it on I just don’t care. That’s the beauty of the THC. But a lot of patients can’t be that way and be at work and not get in trouble.

John Malanca 46:55
A and you run into that and that’s a question that comes up you know, I have to work it. Can’t or I work for a company that that randomly drug tests? what I do and so, in situations like that, do you ever recommend and I don’t know if your practice still practicing where you’re writing prescriptions for pharmaceuticals? Are you finding calm? Are you working with any patients that combine? The reason I say that I’ve worked with fibromyalgia patients for quite some time and they are finding success by having small amounts of pharmaceutical with cannabis. And that is their sweet spot. And it’s something that they, I mean, some of these patients wake up at three to get out of bed by six. I mean, I’m very fortunate knock on wood. You know, I don’t experience that and

Unknown Speaker 47:43
that is stiffness. That was what stiffness is another common symptom with a lot of these autoimmune illnesses. If they’re on a non steroidal anti inflammatory, they can often get better pain relief by combining cannabis with With something like ibuprofen, or Meloxicam, they tend to work with the same endocannabinoid system if they’re on an opioid cannabis, part of the beauty of cannabis is that it automatically increases their sensitivity to the opioid by cross talk between these cannabinoid and opioid receptors. So when I have patients that come in on opioids, I can almost immediately cut their opioid dose in half if not by 75%. And they will get better pain relief. Because unbeknownst to a lot of patients chronic use of opioids causes a condition called opioid induced hyperalgesia. So that the more you take the opioids the more pain you’re going to have, your more sensitive you are to pain by cutting that dose. You have kind of alleviated tolerance to the opioid. You’re kicking out the opioid induced hyperalgesia and patients can get them a lot more comfortable on a much lower opioid dose than they would if they were not using cannabis.

John Malanca 49:11
If you mentioned steroids and you a lot of fibromyalgia patients are using a type of a steroid to battle their autoimmune disease. And so how do you see steroids, steroids and how do they compare to CBD or the cannabis plant?

Unknown Speaker 49:30
Yeah, steroids are nothing but a way of suppressing the immune system. That’s what they’re used for as an immunosuppressant. The problems with steroids is that you have adverse effects from so much steroid in your in your system that you have issues with weight gain and, and irritability, increased anxiety. Some patients don’t tolerate steroids HS they become so irritable Patients, it’s not unusual to gain 20 or 30 pounds on steroids. And steroids can impact the they act just like that cortisol from chronic stress is that they increase insulin resistance. So if you’re on steroids for an extended period of time, especially high doses, as a really, really easy way of developing a type two diabetes, so you have none of that. with cannabis, you get the you can get an immunosuppressive response. If you dose it properly. That’s why I do those high doses of CBD for a couple of weeks and then bring it down. But even at the high doses, we don’t see if anything, CBD can help with glucose metabolism and limit metabolism. It’s actually an appetite suppressant. You don’t get to see the weight gain, it can actually help both CBD and THC can can actually rev up energy expenditure but that’s why chronic cannabis users for the most part have lower lower prevalence of obesity because even though their caloric intake may be a little higher than those who don’t use cannabis, at least a THC, they’re going to burn those calories. A lot of them burn the calories more efficiently so you just don’t see the weight gain that you would think you know knowing that THC in particular is an appetite stimulant.

John Malanca 51:31
It carry x i know crew that was one thing Chris said. I don’t want to do that because when I tried cannabis in college, I ate and I ate night. Want to go back there and so that’s what a lot. A lot of patients I talked to Am I going to get the munchies but in the case of Kevin’s father when we went through this and then we’re going all over the place here. We didn’t know the benefits of cannabis and we knew that it was an appetite stimulant and I came across a study that showed 40% of cancer patients passing malnutrition before the cancer takes over. It’s we said, okay, you know, he had a two week life expectancy and they say, you know, let me you know, pass peacefully compared to just wasting and wasting, wasting and it was the complete opposite. Yay. Energy came back his complexion came back. So we’ve seen we’ve seen the benefits of this plant. For our listeners to when you’re talking about steroids, it’s not injectables, what you’re hearing about in the news,

Unknown Speaker 52:36
these aren’t just steroids for muscle building muscles. These are those are anabolic steroids. They’re completely different. The generally patients with autoimmune illness might be on something like prednisone or dexamethasone not not.

John Malanca 52:53
Is that a topical?

Unknown Speaker 52:56
No, they would be for severe autoimmune illness, they would be taking them Oral a now if they have you know a rash particular say with let’s say psoriatic arthritis, oftentimes those patients will have skin and belt ball movement and have psoriatic plaques. Those patients would more than likely being a topical steroid. And you have to be careful with those. We use topical steroids to treat things like psoriasis and eczema. But too much steroids over too long period of time can actually thin the skin and leave some marks in the skin. And not surprisingly, topical CBD works really well for eczema, psoriasis, insect bites, itching, damage from the sun, it reduces inflammation in this skin. There are a lot of benefits

John Malanca 53:56
back to the duct tape, roll the duct tape because I’ve spoken to parents in this industry actually parents and their kids are, you know, at camp, you know, not, of course not this summer, but they send their kids off with a bottle of CBD for suntan burns or sunburns, as well as insect bites. And it’s like, you know, it’s 1,000,001 uses two. And so what are you seeing some of the major side effects of autoimmune disease that are happening to patients? You know, are there any long term besides depression and everything else that comes along with not being 100% balance?

Unknown Speaker 54:41
Well, it depends. I mean, that’s that’s a really hard question to answer because autoimmune illness isn’t just like one thing. So so the something like let’s say multiple sclerosis, you are you may see a decline and in function and mental function you have D myelination of the nerves, which is progressive. So the the so the effects of that disease are going to be different from the effects of let’s say some someone with inflammatory bowel disease who may have chronic pain, chronic inflammation, so much diarrhea that they are malnourished, they have a malabsorption syndrome, or they develop fistulas. These little tracks that aren’t supposed to be in the intestines, they can perforate the intestines and have a bacterial infection that gets into the blood. So you can’t really answer that question because autoimmune illnesses just not one disease or one disorder. It just depends on what the illness is and what it’s what it’s affecting some things like lupus, that affect the kidneys, somebody might develop chronic renal failure from from lupus. So it’s that’s a really hard question to, to answer we would have to be talking about one specific illness for me to go into detail

John Malanca 56:12
more cases of autoimmune diseases now than when you first became a medical doctor and why why is that?

Unknown Speaker 56:19
Well, I think they’re more. When I first became a doctor, well for part of my career, I was in PD, I was doing pediatrics and then I was doing anesthesiology and anesthesia is mainly helping people go to sleep waking them up and month in managing pain, but I that I actually see more autoimmune disease now that I’m practicing cannabis medicine because it helps so much. And yes, I think there’s an increase in autoimmune disease. I think there are a lot of exposures. We see certain foods that are highly inflammatory Things like the way they’re they’re grown like wheat you know with the incidence of of gluten sensitivity is astronomical compared to 30 years ago. We were rarely saw celiac disease or anything that that even remotely mimicked celiac disease now, it’s highly it’s highly

Unknown Speaker 57:26
probable to see

Unknown Speaker 57:30
gluten sensitivity which is what we call an IGA g sensitivity because of the way things are grown and a lot of these pesticides and herbicides and fungicides that are used on on foods like corn and soy and and we they negatively impact the endocannabinoid system. So I you know, there are a lot of foods that I get patients to avoid even emulsifiers like poly sorbate ad and lecithin they’re finding that these impact insulin sensitivity and energy expenditure and the microbiome, your bacterial balance, the meat that we have is not the same meat that we had in the 50s. These animals this feed lot. They’re fed enormous amounts of omega six rich grains so that they gain weight quickly and I don’t care what you say. They say they don’t give them hormones, but I’ve never seen a chicken with a wing that big in my life ever. Seeing chickens and living in rural areas.

John Malanca 58:41
I was oh, by the high school. I mean, I graduated high school. I was a late bloomer, I graduate high school. Five, six. I’m six one now. I see high schoolers, freshmen that are six, four. They look like they can play in the NFL and I’m thinking what’s what what chickens are they eating? No,

Unknown Speaker 59:00
that’s right, there’s um, and omega six is actually important. Omega six is an important fact to have. It’s a precursor to a lot of the near neurotransmitters, even our endocannabinoids. But the ratio of omega six to omega three should be about four to one. And in this country, it’s 16 to one, all this omega six, also down regulates the endocannabinoid system, so that it isn’t able to do the job it’s supposed to do of keeping these things in balance and keeping that immune system and check. our immune system is supposed to protect us from invaders and once it’s done, its job is supposed to settle down just with COVID. That the devastating part of COVID is that you have this crazy immune response called cytokine storm, where you just have a flux of all of these inflammatory needs. mediators so it’s the damage that’s done by our immune system and it’s very much like an autoimmune illness but at a much higher level

John Malanca 1:00:10
geesh talking about this you talk about diet with with all your, with your patients and can diet help.

Unknown Speaker 1:00:19
One of them? Yes, indeed, I have a list of foods that I call the I refer to as The Hateful Eight. And these are the foods that are most commonly implicated in ag sensitivity, where you have these molecules that get into the system through the intestines through what they call leaky gut, and you have you don’t have tight junctions, these molecules get in and stimulate the immune system to cause all these problems. And it’s, uh, let me see if I can remember them all as wheat or gluten, soy, not necessarily unfermented soy, so temp and tofu are okay that we have gluten soy, corn, eggs, chicken eggs so if you’re gonna eat eggs just a few of them are tried duck eggs are they they seem to not be as inflammatory tomatoes tomatoes may be more because of the night shade issue where these alkaloids are can stimulate the immune system and some people shellfish grapefruit and I’m, there’s one I’m missing but these are these foods are very commonly implicated in an abnormal or chronic immune response and if patients will eliminate these from their diet, they often find that there’s their brain fog goes away, their joint pain goes away. I also sugar is a big problem. It’s inflammatory. There’s sugar and a lot of process Foods there emulsifiers in these processed foods, a lot of the stuff that’s in processed and packaged foods is really making people sick.

John Malanca 1:02:09
Have you changed your diet over the years?

Unknown Speaker 1:02:12
I have. I have. I was a big I was a big beef eater. And I have to say that I usually ate good beef already beef like from the farm down the road where I knew people and I knew these animals and they were grass fed and, and well cared for maybe a little grain finish at the end, but I’ve pretty much eliminated beef from my diet. Most meat I can’t say that I’m vegan. That’s something that I’m kind of working my way to but I have definitely increased the plants in my diet. Most of us don’t eat enough that yes, yay says four or five servings maybe three or four servings you really need like nine to 10 servings because a lot of the vegetables and fruits are micro nutrient depleted. From the farming techniques, so we need more to get those micronutrients that really help us be healthy at a cellular level. So it’s it’s something that has evolved over the last few years I think of seeing patients seeing patients chronically ill, a lot of obesity and how these things have are just making people miserable and it’s, it’s affected me and I definitely have changed my eating style.

John Malanca 1:03:29
You know, Korean I always ate healthy and but this past January, I went vegan. I said, Let me try it out. And you know, I’ve sleeping better. There’s a first time I I feel like I don’t have any inflammation on the inside, and pretty good feeling. There’s a crinan I watched this movie, a documentary few years ago called the second brain in the kidney and the brain brain in the gut,

Unknown Speaker 1:03:56
bacteria, the enteric nervous system. Yeah,

John Malanca 1:04:00
makes sense. I mean, even when we’re off, you know, in your gut, you’re off, you know, eat too much of anything, you’re like, Okay, well, I won’t do that again.

Unknown Speaker 1:04:11
And they show that

Unknown Speaker 1:04:11
animal protein. When you look at animal protein versus plant protein, that animal protein absolutely changes the microbiome, and you have much more a higher counts of the more pathogenic bacteria than the beneficial bacteria. And that when you switch to a plant based diet, that you get a much better balance of beneficial bacteria to non beneficial bacteria. They actually even using cannabis actually shifts that microbiome to a more beneficial so even people who don’t really need cannabis for a chronic problem, I say this available, but little pinch of it in your smoothie, you know that cbda that thca other compounds in that plant? is you just for well being they can it can be very helpful.

John Malanca 1:05:11
I’m glad you said well being so would you recommend a healthy bodies or disease bodies at disease? Do you recommend cannabis? Excuse me on a daily basis?

Unknown Speaker 1:05:24
Well, certainly if they’re symptomatic, I recommend on a daily basis once they’re no longer symptomatic, and I usually see patients who are sick. That’s just the nature of my practice. They don’t come to me for wellness, then they can they can because cannabis is expensive. And I don’t think that all the benefits go away in a certain number of hours. Once things are back in balance, then sometimes I’ll recommend just then

Unknown Speaker 1:05:52
just

Unknown Speaker 1:05:53
a small dose, maybe two, three times a week just to kind of remind that Endocannabinoid system and, and

Unknown Speaker 1:06:02
and certainly when they are feeling better,

Unknown Speaker 1:06:04
and if they enjoy the euphoria or if they experience euphoria from the THC that if that’s a good way to unwind and relax, you know, it adds more benefits than then a martini.

Unknown Speaker 1:06:21
So you know, why not?

John Malanca 1:06:26
What do you recommend for patients who are cannabis naive or just getting into this industry? Or to see this as another option, but are afraid to have this discussion with their doctors or want to have this discussion with their doctors and what do you Where would you What would you recommend them starting to kind of chisel away this this stigma that’s in this industry?

Unknown Speaker 1:06:51
Well, I encourage patients to talk about it with their doctors and the response they get varies widely I have patients whose doctors say, Okay, well that sounds like a good idea. Or, you know, or I don’t I don’t do certifications. But here’s the name of a doctor who does who could go see. And then that there are others are like, they don’t want to talk about it, they cut the patient off. When when this a doctor like that if you’re not, if you’re not glued to that doctor for some come by some contract, then that might be time to start looking for another doctor, somebody who’s a little bit more open, because generally the doctors who are very rigid and you have a patient who is not responding to conventional therapy,

Unknown Speaker 1:07:41
there’s little there’s little likelihood that

Unknown Speaker 1:07:44
you’re going to really get better because usually they have tried everything in their pharmaceutical arsenal. And if you’re not getting better than I sometimes I find that the deos are more open. The doctors of Osteopathic Medicine they’re trained is a little bit more focused on wellness than the medical and I’m an MD I’m an allopathic by training, but our training is more disease oriented, we’re very, we tend to be very rigid. If

Unknown Speaker 1:08:14
I just you know,

Unknown Speaker 1:08:17
every patients different in their relationship with their doctor is different, but I think if you have a serious condition and you are not feeling good, and you are not improving,

Unknown Speaker 1:08:28
that you can bring it up with their doctor and if they,

Unknown Speaker 1:08:31
if they react negatively, then that might be an impetus to find another practitioner because not every not all, not all indies are like that there. There are plenty who are open to the discussion. They may not know anything, but they should be open to you trying something and be supportive. You shouldn’t be scolded or penalized in any way for asking about the possibility of using cannabis for symptoms.

John Malanca 1:09:01
Do you ever have patients invite their other doctors in on the call with you and say, and have everybody on the same? I know you do. telemedicine

Unknown Speaker 1:09:09
That has never happened. I have. There are a few doctors in the area that tend to send patients to me when their patients ask. And some of them from May I major universities, major specialty groups, even spine and pain I get. I get patients from some pain management practices. I think what it is that a lot of doctors don’t want to talk about it. Why because they don’t know the plant. They don’t understand the plant. They don’t understand how you can use cannabis and not be at risk of becoming addicted or pothead or something. And they also for a lot of physicians, they don’t like the idea of sending their patients to a dispensary Erie, where they don’t have control over what the patient is advised to purchase where you have, you have some dispensaries where the guys are very knowledgeable despite not being healthcare providers and you have to remember that they are not trained as healthcare providers, unless you’re at a dispensary that has a medical director. But at the same time, you can get somebody who’s, you know, kid that’s just been there a week and you know, he’s 19 2021 years old and they don’t know anything and but they know kind of like, Oh, this will get you hired or this or like, you know, and so as such a range of what they’re exposed, their patients are exposed to that they really are very uncomfortable doing that. And even even though I give in writing my patients, what I’m recommending in terms of their approach in terms of CBD to THC ratios, what to start with how how often and by How much to titrate up because you don’t want to overshoot. Cannabis doesn’t work very well if you take too much, or it can cause your symptoms to increase if you take too much, despite giving every patient that in writing, I’m still faced with, but this isn’t what I, oh, I’m no better. They gave me this. I said that that’s not what I recommend it is Oh, they didn’t have it. And they said to get this one. I said, Well, no, another other dispensary would have it. So I’m constantly fighting that. There’s some states where they do have to follow the doctor’s suggestions. And then other states is like, if I go into CVS with your prescription for ibuprofen in the in the in the pharmacy tech says Oh, would you like a little morphine sulfate to go with? It’s Yeah, yeah. So a lot so we have no control and a lot of doctors Don’t like that at all. So they’re, they don’t want to consider it.

John Malanca 1:12:04
And I could see that totally makes sense. It totally makes sense. And so what I recommend to if if a patient and their doctor is not open or really doesn’t know much, don’t be afraid it’s not illegal ask the question, but don’t be afraid to ask him or her. Can you recommend somebody who may and I’m certain I’m always positive that they’ll know somebody in their circle. That is that integrative doctor and open minded like like Dr. Brian lot, a lot of the other doctors out there too. And so

Unknown Speaker 1:12:38
if I can put a plug in from society

Unknown Speaker 1:12:40
of cannabis clinicians that you can patients, you know, if they’re doctors resistant, go on the website, see if there’s a clinician in your area that these doctors are not just going to push cards out. They’re going to treat you like

Unknown Speaker 1:12:58
you Yeah.

John Malanca 1:13:00
They’re not docs and unfortunately there are a lot of them out there and laws are changing I should say that a lot of them out there but before in the day, you know, before it became recreation legal here in California was we always heard here’s your recommendation coming in a year if you want to renew and I think for cannabis naive patient who’s really trying to look for something to help with their autoimmune disease or any other type of ailment, you know, they do need that hand holding and so that’s why the middle of the show I should you know, make sure medical professionals involved you know, they look at age, the weight the current health condition that you’re in the sensitivities in other medications. More is not always better you might have success by always mentioning it two to five milligrams not 100 milligrams some people need

Unknown Speaker 1:13:47
some people need it but not many. Yeah, yeah.

John Malanca 1:13:50
So well, doctor for I can’t thank you enough for being on and and be supportive of what what I you know, we’ve been doing over the years. ears and an eye. It’s always great to see you. I’m glad glad that you’re healthy and, and always smiling. You’re always smiling when I see you. So thanks. Thanks. I’m gonna throw this curveball at You ready? All right, any closing words that you want to share with our listeners?

Unknown Speaker 1:14:18
My closing words, let me say What should I say? I would say that this plant has we’ve we’ve had an intimate relationship with this cannabis plant for probably more than 5000 years. And it’s been part of the medical tool box for hundreds of years that any concern about cannabis being an illegal substance you have to just remember that the reasons it was made illegal had nothing to do with science or medicine. And it was a strictly socio political situation that prompted This war against cannabis, that it doesn’t work for every person just like no medication, no pharmaceutical works for every patient. But when it does work, it works in a big way. And many, many, many people find relief and get better and feel better and are better because of this plant.

John Malanca 1:15:22
Well said, well said as always, how can they find you?

Unknown Speaker 1:15:28
I’m online, you can google me You can Google my name or Tacoma park or Tacoma southeast integrative care. You can Google my book, the medical marijuana guide cannabis in your house. It’s available in bookstores and Amazon. I do I’m licensed in several states. If I’m not licensed, I can do a an educational consultation. with patients almost anywhere, and I do, I’ve done those internationally. It’s not the same as a doctor patient relationship, but I can certainly review your your symptoms, your medications, and give you some guidance. Yeah.

John Malanca 1:16:18
And I can attest to that Dr. Dr. Fry, consulted for United patient group for years. And so give her a call and website. Can you mention your website to please?

Unknown Speaker 1:16:28
It’s www dot tecoma. Care ta K. Oh, ma ca r e.com.

John Malanca 1:16:37
So, Dr. Patricia fry, thank you for being on again. We’ll do more of this as well and everyone hope you have a wonderful day. This is John Malanca with United patients group, be informed and be well we’ll see you soon. Bye.