Straight Talking Cannabis, Children, and the Government with Dr. Bonni Goldstein

John Malanca 0:02
Welcome back, everybody, John Malanca, with United Patients Group Be Informed. Be Well. and today I have a very special guest. Maybe you’ve seen her maybe you haven’t, but you’re gonna really enjoy this interview in this podcast. It’s my dear friend Bonni Goldstein, MD. How are you doing, buddy?

Dr. Bonni Goldstein 0:18
Doing great, john, thanks.

John Malanca 0:20
Always great to have you on and thanks for for what you’ve done for the industry, what you’ve done for criminai over the years and, and you’re continuing to do so. Can you share your bio, I mean, you have a pretty impressive background, how you become where you are and who you are here in this game, the cannabis industry and beyond.

Dr. Bonni Goldstein 0:39
So I trained as a pediatrician at Children’s Hospital a long long time ago Do I have to say how long ago was and then I went into the practice I did some critical care transport, which was a really fun, adrenaline filled job when I was very young after my residency. And then I went into pediatric emergency medicine. And I did that for almost 14 years. And then I left the practice just I was burned out. I was working a lot of night shifts. I had a young son at the time I was trying to balance motherhood and work and you know, I wasn’t sleeping for many years because I was working at night and I took time off. Just like a small I figured a few months leave of absence just to kind of regain my sanity and my sleep schedule. And during that time, a friend asked me about cannabis and that was kind of my introduction into medical cannabis. At that time, I knew nothing. I had not learned anything about cannabis during certainly not during medical school or residency, didn’t ever heard of the endocannabinoid system. And I started researching and I just couldn’t believe what I was reading. Like, how is it possible that cannabinoids kill cancer they’re potent anti inflammatories. They help with this Incredible, large array of symptoms. And yet here I am a doctor thinking I’m killing people and I don’t even know about this plant medicine even though in my state it had been, you know, legal at that point for at least 10 years for at least for medical patients. So I began the journey of educating myself and I went to every conference and I read every thing I could read and I started working in the field in 2008. And then was worked at a few different offices and then got hooked in with cancer centers. And then the this particular practice in LA went up for sale in 2011. And I purchased the practice and I’ve been there ever since. I really do have a passion for taking care of children, especially training as a pediatrician. So I’ve really focused the last, you know, five to seven years on pediatric pediatric cases children with treatment resistant epilepsy. Isn’t cancer, psychiatric illness gi illness auto immune? You know what you name it? If cannabis might be able to help the child? You know, I try to help them.

John Malanca 3:10
Yeah. And so your niche is, you know, I’m glad you said that has been. You have the whole gamut, but you’re really your niche he spent a lot of your time with and what you’re known for, especially in the is a pediatric room. And so thanks for doing that. And then the state you say your state, you know, for everyone money’s in in California. And but you do consult with patients all over the world, right. I know you’re

Dr. Bonni Goldstein 3:38
well, so the new rules are kind of you have to be a California resident. So I’m kind of sticking with the rules. And if somebody has California residency I do try to accommodate stick with the rules. Yeah, no.

John Malanca 3:55
Rules, a lot of rules.

Dr. Bonni Goldstein 3:57
Well, when you have a medical license, yeah, there is some somebody that’s handing you that and is watching you. Yes. And you are, which I don’t think it’s about thing. I mean, it’s, I have, unfortunately, does it have talked with adult patients and also pediatric families who have been getting advice from someone that I believe to be not only not helpful, but potentially dangerous, and there’s no accountability because the person is giving medical advice outside of an established, you know, relationship that is somewhat controlled. And what I always tell people is, you know, buyer, beware of someone’s trying to sell you something, be very careful. And I do think in a way that that’s a good thing. I don’t sell anything to my patients. And so there I do think that you know, like, when people ask me, what’s the best oil john, the best oil is the oil that works for you, are we whether it’s this company, that company or that company, everybody who makes a thinks that their oil is the best, of course. And I would be shocked if someone what didn’t take pride in what they do. When you grow these plants and make your products, you get very passionate about it. And I get that, but at the same time, we have to realize that it’s not one size fits all for all these for all these patients.

John Malanca 5:18
Yeah, I think you made a good point because that’s when printed, I started united patients group that was one thing we pride ourself on is, you know, you need to you know, talk about it. And by the way, you need this here it is and, and I think that’s why we’ve been brought into other states and our government talk because we’re not we’re giving just you helping the roadmap out on what questions to ask what to avoid, who to speak with, you know,

Dr. Bonni Goldstein 5:45
resources, sorry, resources, resources,

John Malanca 5:47
resources, and I think people that’s why people come to us a you know, because that that’s, that’s why we listen to we trust pandemic what’s happening with you, in this pandemic case it How is it? Well, let’s go back because the last have changed a lot. Man. I know you and I have talked about this. And I know a lot of people in industry have had gotten upset with me for saying this. But I, the reason I say this, it was voting this for adult use for 20 2018. Because I’ve I voted no current voted yes, because I’ve seen what it’s done to the true Cannabis Patient medical, since a true medical patient, but the medical patient wants guidance from a medical doctor, and you’re someone that had the effects of it hurt your business, right? I mean, it’s because people aren’t going needing wanting doctor recommendations anymore. And I’ll just go down there. And as you mentioned, getting some advice from someone else who really isn’t medical professionals. I’m a big fan of recommending a doctor should be involved.

Dr. Bonni Goldstein 6:50
Right. Well, you know, I think I fully believe that adults should have access to this plan. And I don’t think I just don’t think that the law that we passed was the right law. And part of that was because they included medical with the recreational and now medical patients are being taxed very highly. And I see that many of my patients cannot afford medicine from a dispensary. So I’m not against, quote, legalization or adult use. I’m over 21. I am against the way that our government lumped everybody together medical patients, you know, you do not pay tax on your Viagra, your Prozac or your antibiotics. Why should you pay tax on your medical cannabis? Many of the families that I take care of already are struggling. Financially when you have a child with special needs or a severe complex medical condition. It is very costly insurance doesn’t pay for everything. So now your child let’s say doesn’t respond to all these different medications at the doctor’s office. Describe and lo and behold, they respond to cannabis. So now you’re going to be dinged. Because that’s the one thing that your child responds to believe me, these families would love to go to the pharmacy and just pick up a prescription covered by insurance. They did not choose cannabis to be what their child responded to, it’s what their child’s responding to, and why not why that’s a good thing. It’s natural, minimal side effects and so on. But to tax these patients the same way in general, I mean, the tax is not that different between recreational use and medical use. And I think that’s, that’s count shame on California, shame on the legislature here and shame on the people who instituted that, that it’s a terrible way to treat sick people in our vulnerable population and think about elderly to fixed income. And you’re going in and your taxes are like 25%. That’s just ridiculous.

John Malanca 8:51
I remember the first time we went to Colorado, we walked in there and bought a few items. Next thing it was $125. And I said no, not well, he said They said tax is what’s attacked and it was 2120 thinking cat

Unknown Speaker 9:03
in Colorado is quite high as well but again on recreational and medical patients it’s about a third Yeah, but here in California it’s not that much different. But going back to your your statement about somebody in a dispensary giving medical advice Yeah. I have heard all kinds of things that families have told me or adults have told me about what they’ve been told in a dispensary and we have to remember that they are selling products they’re told to push products but also the people that work in dispensary Look, they’re all very nice people know, my bud tenders. Yay. But they are not qualified to treat me to give medical advice. When somebody says anxiety that is not it’s not one word. Why do I spend an hour with a new patient? If I if I just hear anxiety? Why don’t I just go here you go and be a five minute visit, but it’s not Like that we want, you want to get the whole story so you can understand this person, how they react to other medications, what they’ve responded to before, what’s been their experience with cannabis. What have they tried? What kind of dosing? What kind of timing? I mean, all of these are questions are extremely important because that helps me determine at least where to start. I once did a consultation for a woman is going back a few years, who was so very mentally ill in my office and I kind of after talking with her, I came up with a regimen to begin with knowing full well that we have to see her response. And then we make determinations of the next steps after that, like maybe if this doesn’t work, we try this. But she went into a dispensary and she, I guess must have said to somebody there Oh, Dr. Goldstein mentioned that I should try this ratio and the person behind the counter went for anxiety. I wouldn’t do That just completely undid my hour long intake. And all they heard was anxiety. That’s it. And so they didn’t know that she had 30 panic attacks a day, they didn’t know that she had already tried high dose CBD that did not do well for her. So the reason I gave her those again, it’s not one size fits all it was I based my recommendations on what she should take on this very in depth discussions. So to walk into a dispensary and say I have pain, what should I take? I mean, you may get lucky and it’ll work because cannabis works great for pain. And I hope hopefully people will get lucky but if you’re not getting anywhere, or you really have a serious condition, a medical condition and you’re thinking about weaning off other medication or you really want instruction, see somebody who’s knowledgeable in this. It’s It can make a big difference.

John Malanca 12:02
It can’t you know, because people always call, you know, this work for my family member, you know, I want the same thing. And I said, it’s not a one size fits all. And that’s why I truly believe in a medical professional should be involved to spend an hour, you know, take that intake, what what, why is it maybe you can say, you know, are you not sleeping, let’s work on your sleep, and maybe the sleep will be the domino effect of helping your sleep, your depression, anxiety, anger, stress. I want to talk about COVID and see how that’s affected your business. But both Let’s go there because I want to talk about we’re talking about insurance now and I wanted to get into epidiolex as well, for patients that are going to have but but COVID I mean, we’re all sitting at home. You know, doing this at home is how’s it affected your personal life has it affected you or your business?

Unknown Speaker 12:54
Well, I’m a homebody anyway, so I think personally, it hasn’t affected me that much except for you know, being a Being able to visit family professionally. A lot of the conferences that I had planned for this year in fact, all of them were canceled and have gone, either virtual or rescheduled, which, in a way has been kind of nice to not travel as much and to just be a little bit more of a homebody we’re, we are working on the garden in the backyard and I just got my greenhouse delivered and we’re setting up a greenhouse. Oh, very excited about that. In terms of my practice, everything’s just we switch to telemedicine and we’re just going to be doing it either, you know, through zoom Skype or phone, which I think, you know, look, I cannot have patients coming into the office and potentially getting sick because my population I take care of is highly vulnerable. Lots of cancer patients, kids with epilepsy, kids with autism, again, also adults that have medical conditions, autoimmune and so cancer. I don’t want anybody getting sick in my waiting room. I don’t want them in the elevator in My building that elevator freaks me out. I just think we have to rein it in. And so that’s how, you know, I’ve been affected I think in for some people, you know the cost of cannabis has become prohibitive if they’ve lost their job and they’re just trying to pay for their rent and their food. Again, going back to that high tax in California, I know that those taxes are driving the underground market for sure. I think we all all of us in the industry know that there’s a pretty healthy underground market still flourishing because of those taxes. But I’m hopeful still that one day cannabis will be covered by insurance. And we just also have to have the ability to study it because we really have the freedom to study it. And again, if people don’t know it’s still all cannabinoids, including CBD, are still schedule one. epidiolex got a different schedule. So it CBD from the bottle of epidiolex. That’s on it. Different Schedule A doctor can write a prescription for that however, still all the other cannabinoids are still a schedule one. And unfortunately schedule one were prohibited from studying the benefits.

John Malanca 15:13
Can you talk I always say that about 140 cannabinoids and you hear everywhere right? Hundred 20 to 160 are you You and

Unknown Speaker 15:20
140 or so? Sure.

John Malanca 15:22
Can you share a little clip note version? What a cannabinoid is because you people are like cannabinoids what is right,

Unknown Speaker 15:30
so we talk about different cannabinoids So endocannabinoids are the cannabinoids right that our humans and other creatures make our cells make. What we call endo and dough from within endocannabinoids are you know for lack of a better term inner cannabis compounds? There’s one called inanda my there’s one called to ag five have been determined to exist We think actually there’s about 13 or 15 different compounds in our body that act like endocannabinoids. And these compounds exists to help ourselves and balanced messages. Then we have Phyto cannabinoids pH yto, Phyto cannabinoids come from the plant. So the cannabis plant specifically so we’ve got THC and CBD and CBG and thca and THC V and cbdv. And I could go on for 140 of them. But those compounds exist in the plant and they’re mainly in the plant as deterrents to anybody that might want to prey on the plant like insects and deer and so on. So they play a role for the plant. Our endocannabinoids play a role for us in terms of helping us to maintain balance. So let me give a good example of maintaining balance. If you get a head injury, we know that your body In your brain releases Endocannabinoid so like if you get a big clunk on your head like a football player getting hit really hard. There’s an impact that causes inflammation and your body goes into protective mode and endocannabinoids are part of that protective mode where they’re released. So that there’s less inflammation. There’s more antioxidants to pick up free radicals. Right. And we know that in cases of people who have let’s say, you’d be have the beginning of Parkinson’s, your body kicks in some endocannabinoids. In cases of cancer, we know your body kicks in endocannabinoids to help fight cancer. It’s really a your endocannabinoid system is this protective, physiologic system. And it’s crazy because it was only discovered in 1988 1992 was the birth canal Benoit receptor was discovered in ada 1992 we discovered the first scientists discovered the first Endocannabinoid. Think about when your doctor that you go see trained. Did they learn about this? Well, it’s still not being taught in medical schools but like I was already through medical school when this came out. I didn’t learn about it till years and years later, as I mentioned,

John Malanca 18:14
I don’t think they’re learning about it and some are learning about it. Even now.

Unknown Speaker 18:17
8% of medical schools actually teach about the endocannabinoid system. Like, I do think that the new kind of crowd of doctors that are coming out of medical schools or their Look, they live in a world where most states now have some form of a medical cannabis law, whether it be CBD only, or like California full medical and full adult use. And it behooves all doctors though, to learn about these things, and to be aware of it so that as far as I’m concerned, it’s just another tool in the toolbox. It should not be a last resort medication. But certainly when we make it costly and out of pocket, sometimes that’s what ends up happening. But anyway, so we talking about these cannabinoids, there’s also we have to remember synthetic cannabinoids. Those are made in a laboratory. They can be whipped up. If you are good chemist and you know what you’re doing you can put together some carbon, some hydrogen and some oxygen and create some synthetic cannabinoids. They’re mostly used for research. Some are on the mark on out like spice or kaitou which are synthetic cannabinoids that we

John Malanca 19:26
consider. Marinol, synthetic

Unknown Speaker 19:29
Marinol is a synthetic cannabinoid, it is lab developed. Yes. Now epidiolex as you’ve mentioned, so if people don’t aren’t aware of what epidiolex is, it’s an FDA approved. CBD rich basically 99% pure CBD, product, pharmaceutical product, it was developed by CW pharmaceuticals, they began researching GW sorry, GW, they began researching in I want to say around 2012 ish 2013 Maybe a little bit even before that I think was on the horizon and then went into clinical trials here are for severe pediatric epilepsy these two conditions were initially approved and then another third was just approved. So those two first two conditions are what’s called drew Bay syndrome is severe genetic epilepsy. And then the second one is called Lennox gasto syndrome, which is a condition usually diagnosed on certain criteria on the eg these are severe. These are kids having 1020 3050 seizures a day. Usually in a month time thousands of seizures possible. It’s extremely difficult condition for families to live with the children suffer terribly terrible burden on the family. And now the latest condition that was approved was tuberous sclerosis, which is a condition where benign tumors develop and if they occur in the brain, they can cause Severe seizures. Yes. So it was also approved for that and basically what it what that what the product is is CBD. It’s plant derived though so they extract CBD from the plant and then they put it into like a package a pharmaceutical package. Initially, I wasn’t thrilled that it had sucralose and some denatured alcohol in it.

John Malanca 21:23
rubbery flavors that

Unknown Speaker 21:24
are very flavoring. I mean to make it palatable, though, you know, I have lots of patients taking yucky tasting oil without any difficulty. Um, I do think that there are certain patients that respond well to it. And for those patients, I’m on board and you know why? The financial burden is lessened? Yes, someone went in I posted something when it first came out on my Facebook page. And someone responded with Why are you promoting this crap? And I thought, you know, that’s really interesting that somebody would ask me that. Anything and everything should be on the table for A child who is suffering cannabis does not natural whole plant cannabis does not work for every single child. I have some family spending close to 30 to $50 a day on cannabis medicine that is very hard to sustain. I don’t care how rich you are, that gets really pricey. And people say well, why are they spending so much? Because some patients need very high doses of CBD in order to stop seizures in fact, so one young man I’m helping right now we just increased his dose to 900 milligrams a day. That’s what keeps him seizure free when we go under that he has seizures. And by the way, that’s in conjunction with two drugs that weren’t working and when CBD was added in, it definitely helped. Now we’re seeing seizure freedom. Yeah, that’s really important. It’s not

John Malanca 22:57
again, not a one size fit. It

Unknown Speaker 22:59
is not There are some patients who are seizure free at the other end of the spectrum and then everybody in between. But my point being with epidiolex is that it’s at least worth a try. If you’re not if you’re unable to escalate your dosing or in a child’s case, a child’s dosing because of finances, right? I do have some patients taking epidiolex as their base. So they have a certain amount of CBD and then we give whole plant oil on top of that, and that combination has worked really well for some of my patients, but allows the family not to have to sustain have to hold up that big financial burden.

John Malanca 23:38
You know, I was I was probably like the person that wrote into you because I was like, you know, and Sativex came on the market, also from GW pharmaceutical.

Unknown Speaker 23:48
Not in the United States, so

John Malanca 23:49
not in the United States. And so everybody started, no one will replicate it. 2.75 cb 2.5 milligrams of THC. It’s a one to one ratio, and so a lot of companies replicated and and had sex with sex with that. success with that. And then EPA dies came on I said, Ah here we go you know the pharmaceutical companies are involved. So a friend of mine, her daughter is they’re down in Southern California near you and she is the daughter’s 20 but a functioning autistic but with epilepsy. You know they tried the cannabis plant for the past year because of conversations like this. And they were hit and miss. You have the same company different matches so like this this is I hope one day it’ll get to the point where you know every time you take this like pharmaceutical or Tylenol or going to certain restaurants you know every time you word that same exact day, same exact thing and reach and result. And they weren’t having that it was up and down, up and down. So they every I think twice a year they go to UCLA for their neurologist and she gets hooked up and has her sleep patterns. And they asked about that Doctors said, Well, I’m not convinced cannabis is is is the answer because of federal illegal? And she said epidiolex. And he said, What’s that? It’s a it’s a federally approved, right? You write us a prescription, if you’re into that if services, so she made them write a prescription covered by insurance, and I think she was able to get it hundred percent covered by insurance. And it’s working. Yeah. And so you know, and I became a believer that, like you said, if something works for a child or an adult,

Unknown Speaker 25:32
right, do it, right. And one thing we know, though is, and I’ll tell you, it’s coming from plant based medicine. So I know, look, people want, everybody asked me and people want long term studies. Well, we have thousands of years of people using cannabis and nobody’s really dropping dead. Okay. The question is, is if I give it to a child, yeah, what are they going to look like in 20 years? Well, we don’t know. But I do know what prolong seizures does to a child’s brain or to an adult brain That it seizures versus cannabis. I am I am. Look my it’s a guess. But I’ll I’ll go for cannabis every single time be in the safer bet over seizures. And by the way, this idea of long term well we don’t know long term they approved epidiolex without long term studies, period period we know so clearly they’re okay with that. Right and part of that is because of the history that we have as humans on this planet alongside the cannabis plant, knowing that there are, you know, thousands and thousands of cases of years of cases of people using cannabis long term Look, I talked to people who, yesterday I did a renewal for an older guy who’s a Vietnam veteran. And he said I’ve been using it since the war. You know, he’s fine. He has no medical conditions. He’s in his want to stay late. 60s and he doesn’t take any pharmaceuticals, or is he’s doing really well. At this point, I think that we would see something. If there was something to see. And again, it’s not perfect. But why is cannabis being asked to be perfect when we have this whole medical community filled with pharmaceuticals that are not perfect?

John Malanca 27:20
It’s I’ve had the Matic family, Casey Maddox, and his family and their son Sawyer, and they’re from Georgia. And they contacted kryptonite years ago and their son has doose syndrome, and that’s another rare disorder. seizure disorder. I think about 250,000 children in the US habit every year

Unknown Speaker 27:42
very rare. Yeah, you’re

John Malanca 27:43
and he was having 200 plus seizures a day and blown up like a Pillsbury Doughboy helmet, bruised everywhere, and the whole house was padding. Yeah. Anyway, they contacted us and they shouldn’t you know, California, come out here at that point. Meet with a doctor become a legal patient. To make a long story short, they became a cannabis refugee, but it was working and so their doctor back in Georgia said, there’s no proof. There’s no studies. And Casey said, Look at my son. He’s running around. He’s playing baseball. They live in California, Santa Barbara area. He’s top of his class. He has friends, right? life. He has a life and they just say he always laughs He says, I told my my kin back in Georgia, John Malanca Rivers come you better over here always. He says, you know, but it just see that like, there’s there’s no there’s no proof. There’s no studies like look

Unknown Speaker 28:36
at my son. Yeah, we can be what we call the end of one. Another one and unfortunately, kind of the pharmaceutical model the business model for for drugs in this country. Cannabis doesn’t fit it. It just it’s it’s poly pharmaceutical by by design by by Mother Nature. You know, when somebody says to me, I bought this bottle And it’s stopped my child’s seizures or it stopped my child from being aggressive or an adult says my chronic pain is gone. And the bottle says THC and CBD, let’s say in a one to one ratio. There’s also hundreds of other compounds in that bottle as you know, right whole plant. So we don’t really know what’s working. But does it matter? If somebody’s better as somebody who’s able to wean off? How is it that we stopped looking at? You know, how patients respond. I was at a conference where a doctor spoke after I spoke, who said, patients, patient reports are not evidence. And I will tell you at that point, she did not have any friends in the room and I understand what she’s saying from a purely scientific standpoint. Yeah, that I get what she’s saying. It’s still anecdotal, but the N of one has to be part of the way we assess cannabis. And it has to be part because we do not have the time in our lifetime to take Every compound out of cannabis to see what it does and test it on a whole bunch of people. If we’re talking about generations of research that first of all we’ve been held back from doing but even if we started doing it today, it would take years and years and years and why do I have to show that when I’ve got little kids walking around where a parent says my child went like I have one family just checked in with the child went she was born with a brain malformation. She’s never gone longer than I think three weeks without a seizure. We’re at we’re at two months right now. Beautiful something to be celebrated. I don’t know how long it will last. I don’t know if she’s on the right oil yet. It’s a journey. It’s not a here you go and it’s magic miracle medicine. It’s not that but how is her going two months. The longest she’s ever gone. Even though she’s been on seven or eight previous medicine. She doesn’t know what she’s getting. Is that not evidence?

John Malanca 31:01
Yeah. You made a great point not magic Mehta medical evidence pill. You know, I share shares because everyone thinks I, I’ve seen it work and I see it not work. So I want people to think this is the golden pill, the magic medicine and I never used the word cure and I’m not a doctor. You know, I say healing and helping and benefits and, and bringing back the life. You know, do you You must get that every day, please.

Unknown Speaker 31:31
Yeah, well, so recently I got an email. So it’s your last chance to save our child. And so that’s, you know, I don’t know that cannabis is going to help we’re going to try. There’s nothing wrong with trying. That’s what they did for this child with chemo and with various types of surgeries and whatnot. The way I look at cannabis is just like any other treatment in that is you give it a try. If it’s and again Benefits risks to me. Yeah, except in certain cases, the benefits usually outweigh the risks. The one thing I know about cannabis is even if I accidentally overdose you, you’re gonna be okay. It’s just a matter of a few hours for to wear off. And in general, we’re not really doing any harm. Now, one thing that people should be very aware of though, is that CBD does interact with numerous other pharmaceuticals. CVD is processed, metabolized, broken down in the liver, at what’s called the cytochrome p 450. systems. So we have this enzyme system in our liver that takes drugs and breaks them down, right. So a good analogy. So if you take if you drink a lot of alcohol, your liver breaks down alcohol, but it can break down into this compound that builds up if you drink too much, and that’s why you have a hangover The next day, right? So Some drugs are broken down in what into what we call inactive metabolites and then your body just gets rid of them. But CBD is broken down at this one couple of particular enzymes and about sick, you know various numbers 60 to 70% of other pharmaceuticals are broken down at the same enzyme. So they’re competing. Here’s the barstool, the last one left in the bar and you’ve got CBD aiming for it. You’ve got a drug aiming forward who gets the barstool. So what can happen is that CBD can either speed up the metabolism pushing that other drug to be cleared out of the body, which means then it’s not as effective because there’s less in the body. And the analogy for that is women who take birth control pills are told if you’re going to take antibiotics, antibiotics, make those hormones clear out of your body quicker. You can get pregnant while you’re on antibiotics because your birth control is not as strong. Yeah, okay, that makes sense. So that’s the analogy of the speeding the drug out. And I’ve seen that with certain immunotherapies these new immune treatments for cancer. I have a patient who was taking an immunotherapy and they told the family expect X, Y and Z side effects the child got none of them. So when I looked at when the mom called me and said, Hey, you know what I’m expecting to see a rash and to see this and that and I don’t see it. Do you think the CBD could be attracted when I looked it up? Yes, they compete. We stopped the cannabis and lo and behold, within two days, she had all the side effects. So clearly CBD was clearing that drug out of her system. People might say, Well, you know, why are they using cannabis only? Well, we’ve been using it for eight years and we’ve kept the tumor from destroying this child’s life. Yeah, but here’s a drug that might work. It’s shown some good results. If the family wants to try it. Let’s try it without cannabis in the way it goes back to my favorite saying rule it in or rule it out. All right, so we took her off cannabis as much as I want her on cannabis to be protective. She now her last scan showed 50% reduction of the tumor, which cannabis never achieved for her for whatever reason. It helped no question allow her to have a good life and I think it did help shrink the tumor to a point. Now we can look at the other side. What else does CBD do to drugs CBD can cause the drug to not clear out in the way that we expect and then it builds up and if you get that buildup you can get toxicity from that drug. And that can be as from blood thinners to chemotherapy to immunotherapy. So it’s important anybody taking any medication really should have kind of look and see if there’s a drug interaction. And I just did a lecture on last week. I was invited to speak at a virtual conference for A group of cannabis pharmacists, and let me tell you, they are wicked smart. They know their stuff that people that are really interested in this whole cannabis and drug kind of interaction while they’ve created databases and so on and so this information is available. Yeah, just as patients, you know, have to know who to ask. And certainly,

Unknown Speaker 36:24
it should be something that everybody does before they just go haphazard on cannabis. Now again, I just want to point out, usually the drug interaction with CBD is of cbds at a relatively higher dose. It’s not on low dose THC, low dose CBD.

John Malanca 36:38
It I’m glad pharmacy was involved. And you remember you spoke at one of our conference? Yes, out of pharmacy school. I think it was back in 2015 or 16. And they’re one of the first and i and i like I’m enjoying seeing these pharmacists finally coming on board and doing it thanks for talking about the drug degenerate drug interaction. What do you say for the patients that say, you know, I want to try this? And if this does not work, then I’m going to go, then I’ll try cannabis.

Unknown Speaker 37:10
I think that’s, I think that’s a reasonable approach. I think, again, anytime you have a you’re facing a medical condition, whether it be mild, moderate or severe, you know, having information is is power. So you kind of have to have an overall view of, you know, what is conventional allopathic medicine recommending for me? Okay, is that something I’m willing to do? Is it something I’m not willing to do? What does cannabis allow? Right? And so as you know, I just rewrote my book, cannabis revealed and it’s coming out next month is called cannabis is medicine. And the publisher is little brown sparks. I’m very excited about that. But in that book I talk about this is the latest science on this condition. What what studies Do we have because everybody’s wires? Oh, there’s no research. There’s not enough research. There’s a ton of research. But the whole point is what does the research show? Is the research meaningful? You know, there was a study where they gave people with schizophrenia, one dose of CBD to see if it did something. Well, since when does one dose of medicine fix things? I mean, here and there, I suppose, but rare. So to me, that’s a silly study. Sorry, that’s my opinion. I don’t expect one dose of CBD to do anything to anybody. Right? But they did that study. What about the other studies for that, let’s say for schizophrenia, what do those studies show? The studies show that high dose CBD is an anti psychotic. It can help patients with delusions with hallucinations with clarity of thought, with enjoying life with having positive emotional feelings. I’m Helping a family right now with a young adult who, who unfortunately had a psychotic break when he was 16, which is on the younger side. And we’re now about four years into using CBD high dose expensive. What’s

John Malanca 39:14
high dose you like you said 900.

Unknown Speaker 39:17
He’s taking 100 milligrams a day. He’s on 800. Yeah, he takes 400 in the morning and 400 in the evening, and it has changed his life. Now, he still takes one other anti psychotic, because he found that that help, but we got him off. He was on four medications when we met. He’s off three that he hated. And his parents hated giving to him because you know, when you read about the side effects and so on, but he also remember a lot of people who have this condition, they feel better on the medication and then they start to say, Well, I don’t I feel better, so I’m good. And the side effects I don’t like so I’m going to go off my medicine because I feel better. Good now. And then what happens is they end up in the hospital. And then they end up back on medication. And it’s this terrible cycle. This young man, I’m happy to say has not been hospitalized for I think two and a half years, which is the longest he’s gone since his diagnosis. I am so pleased with that. And we really believe CBD has played a big role in helping clarity of thought, and the anti psychotic benefits and so on. I can’t remember why I brought him up. But my point is, is that you have to look and see what does the research say if the research is bad research, it is what it is. We can’t use it. But we try to glean from the research what you know, may translate over to human you know, actual human response. A lot of the mouse read, you know, research in mice and rats and so on. It’s so all this animal data, it’s very intriguing with cannabis, right and then Question is, is can you translate it over and again, for patients that are in desperate situations, I always say it shouldn’t be last resort but I do look at it as if we’ve know it’s safe. And you’re being medically supervised by a fairly I’m still even though people say oh, you’re a pioneer and all this. I’m a conservative physician. I’m careful I look at everything that the patients are dealing with and try to make the best possible the safe decision. It may not work but I know it’s going to be safe under my medical supervision to try so why wouldn’t we try it?

John Malanca 41:35
You nowadays everywhere you turn, everyone’s talking about CBD. And you’re you’re doing that here as well. But I know that you also recommend THC and I don’t want

Unknown Speaker 41:47
Oh, absolutely. Absolutely. Hundred percent. Sure. Well, I think those two conditions I mentioned john, so epilepsy and schizophrenia are two of the conditions that need that have shown response. to high dose CBD again not everybody look I’ve got some patients with epilepsy who are, you know, I still follow many of my adult patients from years ago. They have a vaporizer they take a few puffs of THC, they don’t have their seizures THC is an anticonvulsant now for a severe pediatric like a specific kind of epilepsy it may not be the right medicine and again, even under the umbrella of epilepsy under the umbrella of cancer. under the umbrella of mental illness, you’re going to find different red cannabis regimens are required for different people. We can’t go like you said we can’t go by the condition. We have to go by the human who has the condition and their response.

John Malanca 42:45
Talking about that all the I’ll say 140 cannabinoids and you you it’s funny I always my brothers in the wine business, we’re in California and so for you to use that example of the barstool with the CBD medication. I try laughing because internally I was laughing at you because I always use that in as you know you can go out and drink three bottles of wine and of course you’re gonna get like you said you have that hangover and you know the build up and deliver and and you’re going to be totally intoxicated drunk throwing up in most cases or you can add your sip of wine and enjoy it and the same thing with TC more is not always better. So can you talk about sure?

Unknown Speaker 43:28
Yeah, so THC is a is a great compound there isn’t a good cannabinoid, a bad cannabinoid, as Dr. Russo says THC is a cannabinoid, it is what it is. And it has its role. There is no question that it is for many patients who have suffered with chronic pain that it is necessary to get a good result. I can’t tell you how many people have come to me and said, well, I’ve tried really everything under the sun in the CBD market. The strain, not strain this product high dose, low dose My pain is still there, it’s not working and it’s because they probably need a little more THC in the mix to help. Studies show that the combination of CBD and THC in in kind of you know lower ratios seems to help nerve pain much better than all CBD or all THC. The biggest problem with THC is that there are some people who do not like the intoxicating effects and they just assume that if they take THC, they’re going to be intoxicated. That is a myth. There are many patients who take low non intoxicating doses of THC who reaped the benefits, it’s a matter of finding your dose. Everybody has what I call a ceiling dose of THC and that is the dose at which they’re intoxicated. Some people like that feeling some people don’t. But if you know that, let’s say seven and a half milligrams gets you to your ceiling. You want to stay under that. And if you said to me while I take six and a half milligrams of THC in it doesn’t help me Then I would say add in another cannabinoid looking for what we call that entourage effect or synergy. Recently, there was a study in mice that showed that the combination of THC and CBD a the raw form of CBD before it’s heated up so you have a genetically dominant plant with that genetic I’m sorry CBD dominant by genetics and in the raw form if you make a powder out of it or a good oil, juice it whatever don’t heat it up, it will stay as CBD a they showed in this study that a what they thought a therapeutic dose of CBD a would do. A therapeutic dose of THC a would do but when they did combination, sub therapeutic doses of CBD a combined with sub therapeutic doses of THC helped those animals with pain. And that’s interesting. Why would the combination Well, they’re sitting They’re right and remember there’s there’s it like I use the analogy of tug of war I either can have the largest biggest bodybuilder guy one guy or I can have a bunch of kind of not so strong but a bunch of guys on my team or gals I should say. And so when you have the synergy of the Phyto cannabinoids and also the terpenes that are present, you can see a benefit at a lower dose and so it’s important to understand that THC should always be part of somebody’s regimen and in general if you’re using whole plant you know from a dispensary or or even if you buy online now a lot of things do say THC free, there may be a reason that you have to do that. Maybe you get drug tested. Maybe you remember a bad response from way back when to THC or something like that. But in general, a little bit of THC usually, you know, a milligram, two milligrams milligram is not really going to harm anybody and not really cause an intoxicating effect. And I have found that having that little bit in there even in someone who says I really don’t want much THC, just having that little bit in there can be very helpful for pain, chronic pain, anxiety, sleep and so on.

John Malanca 47:19
Can you talk about that how they all each have a role in that? That’s interesting that I’m starting to see a lot of products out there. It’s with the two acid CBD A and T.

Unknown Speaker 47:31
Yeah, so we have to remember that CBD and THC are the two most studied Phyto cannabinoids. So we can say a lot about those anti inflammatory antioxidant anti cancer anticonvulsant you know, helps with pain, nausea, vomiting, appetite and so on. Okay. When we look at some of these other compounds CBG there’s not a lot of studies. There. There have been a handful but it’s not a tremendous and many of Maybe there have been done in the lab or in animals and we don’t really have CBG and studies in humans. But CBG we know is an anti inflammatory. It’s an anti depressant. It’s an anti anxiety. It’s an analgesic. And so the big question is, does that translate from those studies where we, where we make these claims, you know, claims, okay, in this study, we found X, Y and Z. does that translate to humans? Right? And sometimes it does, and sometimes for some people, it doesn’t. What’s interesting about CBG is that I have given it to children with autism and or recommended it to children with autism and we’re seeing in those kids significant anti anxiety effects. Now, not all of them for some kids, it’s overstimulating and aggravates their anxiety. I’ve seen some kids where parents have said they started CBG and they’re not previously nonverbal child started putting words together better, better, and the question is, is okay, Is that good? developmental is it just happening or is it really correlate to the CBG and there are family saying correlates to the CBG. There are other cannabinoids like we talked about THC a raw form and then I’ve already mentioned CBD a. Those are potent anti inflammatories, they’re potent anti nausea. What’s interesting about the raw forms that have the A at the end is that they appear to be very potent in low doses. So they found that cbda is has, like let’s say a one milligram dose is equal to about 100 milligram dose of CBD for nausea. In and out, wow, yeah, so CBD a has this incredible potency compared to CBD for nausea. Again, in an animal model, wouldn’t it be nice to get adults who have nausea as their one other issues and and test them and we could do a trial to see how CBD a is necessary to help with nausea. You know as it is I have recommended it and I’ve had patients respond to CBD a and thca in low doses usually under, you know 20 to 40 milligrams. Remember we’re talking about CBD I’m talking about sometimes hundreds of milligrams. THC is very interesting. It just has a pretty narrow window of, you know, before you hit that and talk about, you know, to intoxicating effect. CBD has this really wide range therapeutic effect, you know, and I usually say 10 to 20 milligrams all the way up to hundreds and hundreds, as I’ve mentioned. So CBD can be frustrating because we start low, and then you have this huge range of dosing. No wonder it takes a long time and I’ll share with you john that like 99% of people who come to my office and say, CBD didn’t help me. I dial in on what they took and how long they tried it and they took a low dose and they only tried it for a very short time and there is no question that CBD you have to go if you don’t feel anything you didn’t take enough. One thing people should realize is we only absorb about 40 20% of these cannabinoids if taken sublingually or swallowed, ingested. Okay, you’re taking THC oil and you take 20 milligrams, you’re only getting about somewhere between four and 20% of that 20 milligrams. That’s a teeny tiny dose. So remember, just

Unknown Speaker 51:24
like the rest, you’re doing just, you don’t

Unknown Speaker 51:26
Yeah, it’s just passing through. Right? Yeah. So that’s what we call bioavailability is what a bit what is available in the body. And what most people don’t realize, though, is that we do not absorb these there are products on the market that have claims they usually say nano technology or something like that, where the molecules been wrapped somehow for better absorption and so on. My thing with those is that there are families of mine who take you know, give those products to their children because it kicks in quicker. The big question is is, you know, let’s compare Let’s at least try to do a study so we can see what are the levels in the bloodstream in the same human. Right? So if we test it on five people, so Oh yeah, it worked quite a quicker that is not a study so we really should do a study on that to see if that is something because those those products are usually slightly more expensive but they also have more ingredients and I did have a child have a severe allergy, like hives head to toe after trying one of those nano products and we don’t really know what it was that caused the allergy so we just have to be careful if we’re going to make claims like that.

John Malanca 52:35
speak about hives. You know, a lot of a lot of people not just kids are allergic to strawberry. Why would epidiolex go with the strawberry flavor?

Unknown Speaker 52:45
Yeah, yeah, I asked him about that.

Unknown Speaker 52:47
You know, they really didn’t have any

Unknown Speaker 52:50
real strawberry though it my dad,

John Malanca 52:52
I mean, their answer was taste for the kids can take it mentioned, hey, I’ve got other other patients that are you know, can can stomach the taste of of cannabis. I, you know, we’re a few more minutes here and I know you’re talking about CBG and anxiety. A lot of patients that I’ve talked to are very sensitive to CBD and sometimes you see that in induces anxiety and some of your patients

Unknown Speaker 53:19
well, so CBD is not known to cause anxiety and so usually what I will share with people is that that might be if they’re taking it for anxiety, it may be that they’re just having their typical anxiety and their anxiety is untreated. Yeah, um I usually will tell people if you are taking CBD and not getting a the anti anxiety effects, you are not taking enough, okay, that’s the first thing. So you must, again to my favorite statement religion or rule it out. You need to rule in or rule out higher doses. It either works or it doesn’t. So you should titrate up on your dose. However, there can be what we call bi phasic, or bi directional response with phytocannabinoid. So what does that mean? That means that at low dose and at high dose you can get a completely opposite effect. So THC and low dosing can be very anti anxiety. But as we know, if you get too much you can be really anxious, paranoid and hide behind your couch for half a day waiting for it to wear off right? CBD is also by phasic. In low doses, CBD can be overstimulating CBD is an alerting compound. It is an upper in low doses. So people who say I took 10 milligrams of CBD and went to sleep, that is a placebo effect. I mean, I never say never, but I’m pretty sure that’s a placebo effect because first of all, the amount you’re getting is only at best 20% of that dose, but also a very tiny dose, it should be alerting it should not be sedating. See that.

John Malanca 54:59
That’s right. I felt falling asleep is so important to me. And one time I didn’t take enough CBD at night, you know what? To have the morning way,

Unknown Speaker 55:09
right, by the way in higher doses. So remember that my favorite low doses alerting higher doses more calming and sedating. And so and again, where’s the line? Well, that’s very individual. Your line may be 50 milligrams, my line might be 200. It just depends on our chemistry. I don’t know how much you’re absorbing. I don’t know how much I’m absorbing. So we have to, you know, look, we have to be free to study this so that I have the answers right to these questions. But at the same

John Malanca 55:38
token, I had a late dinner, you know,

Unknown Speaker 55:41
like did you eat something with like high fat food has been shown to enhance absorption. So if you take a scoop of peanut butter, when you take your cannabis oil, you will likely get a little bit more in your bloodstream. I love it. You are fasting, right? If you’re fasting, we know that it can kick in a little quicker. But it won’t get as hot in terms of your bloodstream. So there’s all these little nuances to it all and so it’s it’s lots of variables that we’re working with and again, it’s not one size fits all. But we have to remember that if I always tell people if you take cannabis whatever you’re taking THC CBD CBG thca cbda and you don’t feel the effect as you’re taking it, bump up the dose and you know, our dear friend Dustin souillac Dr. souillac in Maine, he says start low and go slow and don’t be afraid to push it. Don’t be afraid to go all the way push the dose. The only compound that might make you feel badly is THC. So with THC just take it easy. I tell people to increase in it for adults in increments of two and a half milligrams. So two and a half. Five 7.5 10 and children. We do one milligram two milligram three milligram for milligram because we don’t want to add escalate and again, it’s a narrow window, you’re eventually going to find your ceiling dose very easily and probably sooner rather than later but CBD is different with that big wide therapeutic range.

John Malanca 57:11
Do you know what Sativex is? Yeah. guide of dosing. It’s, it’s pretty much like that go low start low go slow.

Unknown Speaker 57:17
bartlow. Yeah, yeah. trade up little by little. And one of the biggest things if I could share with people is Be patient. I said this to somebody yesterday. This is not a harsh pharmaceutical. This is not magic. This is going to take time. So if I’m out of shape, and I hit the gym tomorrow, am I in shape tomorrow? No, I buy time I noticed muscles. It’s going to be at least six weeks. By the time somebody else notices it’ll be three months. We’re asking a plant to to help with what ails us. And sometimes those are very serious ailments. And yet we have this expectation that’s going to do it like immediately and it takes time. To find the proper product that fits your chemistry to find the proper combination of cannabinoids that works

John Malanca 58:08
and how you can you talk about even how you bring it into your body. Some people have success with vaporization Sure, like,

Unknown Speaker 58:15
try different ways. Absolutely. And when people say well what’s the best way to take it? Well again, it’s like the best oil what suits you some people find that inhaling is the only way that works for them. I have other patients that say, you know I take like five MLS, which is like a teaspoon big dose of THC and I don’t feel it, how come? You may be a poor absorber? Right? It’s not getting into your bloodstream. So it’s important for people to understand that when you venture into a into the cannabis medicine and into a regimen, that likely what you’re starting with, unless you’re really lucky is not what you’re going to end up on. And just to accept the fact that you’re going to try different things. If you will. If you really want to give it a go, you got to be willing to try those different products and you also have to be willing to give it time. I wrote a story in my book about a patient who actually is someone in my personal life she’s in the book and she suffers with severe autoimmune disease as was diagnosed with IBS, fibromyalgia, migraines, you name it, hashimotos thyroiditis, all this stuff. She, it took about eight months, took about four months for her to say I feel better and took about eight months or say, Okay, now I feel like how I felt before I got sick. That’s a long time but remember her endocannabinoid system after 10 years of chronic illness was completely out of whack. And it’s not going to snap in like this. Now, if you’re lucky, it might. But for most people, it takes time and that’s the one thing I was I try to tell people is this is not magic. It’s science just like everything else. You have to give your body a chance to respond. And it’s got its natural. It’s from Mother Nature. It’s going to take time.

John Malanca 1:00:08
I wanted before I want to get into COVID as well. Talking about, you know, you this patient you were just mentioning, I’m sure she was on a bunch of different pharmaceuticals as well. And, you know, that’s one of our gut is a major body and country you talk about you talk about natural, right body back to balance Weiser II takes longer for other others,

Unknown Speaker 1:00:30
right. So the food you put in your body is crucial to your health doctors. I will just share with you as an MD we learn nothing about nutrition, nothing. I mean, maybe some people younger doctors have learned a little bit but I literally got in four years of medical school a half hour on vitamins, and that was it. Nobody ever talked about anything. The microbiome the the environment of your gut is crucial to your health. There is no there’s now even A specialty called nutritional psychiatry, because the food you eat affects your brain, okay? The gut and the brain are connected. They are not, there’s not like, there’s a line here,

John Malanca 1:01:14
documentary called the second brain.

Unknown Speaker 1:01:17
There you go. And I actually might be the first brain, right? So to really put into your body matters, the food that Americans eat is, as you know, terrible. I myself have had to make some big changes because I was starting to get some medical conditions for which I could start pursuing. But they’re all conditions for which there really is no, quote, easy treatment, and I figured why would I go do that if I can control the food that I put in my mouth, and it’s not easy. I’m gluten, dairy egg sugar free, it is not easy. Sometimes I open the refrigerator and I close it back up because I can’t I deal with, okay, I got to come up with something to eat. It’s not easy. However, all of my conditions have subsided. And so or Well, I should say my symptoms. And so it was, and again, it took a few months of going through the course of you know, making sure that and look, I tried cannabis first and cannabis didn’t reverse it. And part of it was because I was still putting the offending agents into my body. That’s the one thing if I’m poisoning myself, I have to stop poisoning myself. So the microbiome is incredibly important and remember that we our gut is filled with cannabinoid receptors, the intestines

Unknown Speaker 1:02:40
have a very

Unknown Speaker 1:02:44
they are a very good target for cannabis treatment. And I include for people who are dealing with like autoimmune leaky gut, that kind of thing you must include some of the raw cannabinoids so you can get all those great turns. Beans before they’re cooked out. And not to mention thca and cbda, which target some of those, some of those receptors in the gut. It’s really important that that people realize that they kind of go hand in hand. Yeah, no count. Like it’s just enough What are doctors now finally saying eat more plants? Well, here’s a plant that you should include, but also include a lot more plants and try to minimize really the processed food. It’s, you know, if you read a label, and they’re like, they say if there’s something on there you can’t pronounce you probably shouldn’t put that in your body. Because it’s disrupting it’s disrupting the balance in your gut, which is is key to your health.

John Malanca 1:03:44
cannabis is a daily supplement, putting into your body you talking about you you had, you know, short course and in medical school, do you recommend patients taking this as a daily submitted daily by anyone

Unknown Speaker 1:03:58
you know, so The way I look at it, john is this plant was taken away from us back in the 1930s and 1940s. And it was, you know, made illegal and it was vilified. And it created fear in the last number of generations that are here on earth with us. And I just look at it and say we, if, if that didn’t happen, where would cannabis be right now? We all be growing it in our backyard. In our kale smoothie and

John Malanca 1:04:28
our new greenhouse, what are you doing?

Unknown Speaker 1:04:32
But, like think about everybody’s walking around with these green drinks. Well, why isn’t aren’t there cannabinoids in there, they’re good for you. Now, you may not need a whole bunch of them. If because if you’re not don’t have a severe illness or a medical condition to treat, but on a daily basis, they augment and supplement your endocannabinoid system and I believe to help keep your endocannabinoid system kind of balanced and Remember that anytime we have chronic stress hello everybody out there right now right? Your Endocannabinoid goes out of balance those all those bad nights that you don’t sleep those tip out of balance the food that you eat that’s not healthy you tip more out of balance right? So to me, I do think it is worthwhile and if people can grow their own and juice it and drink it, that is a great way to supplement your endocannabinoid system I know that’s not easy to do. Because it takes time and effort and even though they call it weed to grow good cannabis can take a little bit of effort but at the same time, you know to get a bottle of of a some company so a mixed like very low THC with some CBD THC a CBD a mix, blend. Sure a score to that every day. I don’t think it’s going to harm you. I do think it might help your endocannabinoid system kind of stay in a balanced way. What other things can you do you Yoga, massage exercise. We make our own endocannabinoids from healthy fat. What if doctors been telling us not to eat for the last 30 years until the ketogenic diet kind of became popular or paleo became popular? We were substituting fat with sugar. Then what do we get hypertension, obesity, heart disease, all kinds of diabetes, the whole thing. And now we’re be saying, Oh, I’m doing a ketogenic diet. I’m Palio, and I feel better, I lost weight, my blood sugar’s better. You’re also supporting your endocannabinoid system by providing your body with healthy fat that your cells can then take use as ingredients to make your endocannabinoids. And so all of those things kind of together. Are there to me, they’re all puzzle pieces to good health.

John Malanca 1:06:51
Good. Good. Go into COVID All right, get in on this year. You know,

Unknown Speaker 1:06:58
I’m going to share some research. If that’s People are

John Malanca 1:07:00
going through some some major things right now. I mean, it’s affecting mental health. I think everybody’s going through, you know, being quarantined, not being able to get out. When they do get out. It’s high stress, depression, anxiety, anger. And so can you talk about and I don’t know if your studies you’re going to talk about cannabis and and COVID or what what are they?

Unknown Speaker 1:07:23
What? Well, the studies that I’m going to mention there’s three particular studies that shows the preliminary evidence supports the use of cannabis Phyto cannabinoids to help fight COVID and so I’m not saying that if you get COVID that you should go to your doctor and say, I’m not going to do what you tell me to do. I’m going to do cannabis instead. I’m just saying that these preliminary studies support further research. And certainly people who are already using cannabis if you are I have heard of people saying oh, I stopped using cannabis because I’m afraid that I might catch COVID I understand. So smoking and vaporized Right now I definitely smoking should be minimized or eliminated so that your airway immune system is remains intact to be able to fight any viral particles that you may come in contact with. But let me just share with you so in 2015 at the University of South Carolina School of Medicine, there, some research is being done there on the anti inflammatory and the effects of cannabis, meaning THC and CBD and also looking at how cannabinoids affect human immune system or I should say, animal immune system because they’re not allowed to study in humans, but, but they’re ready to study it in humans if we could get the get scheduled one status change. So in 2015, they took mice and they gave them a bacterial toxin that triggered what’s called a cytokine storm. A cytokine storm is when the body goes in. To this massive inflammatory immune cell response where the immune cells are releasing all these chemicals that create inflammation to help fight the infection, but it’s like an over response and it actually can harm the host. Okay, so a cytokine storm that sounds what it says what it sounds like, which is like oh my gosh, crazy out of control immune system cytokines, those pro inflammatory compounds, which then leads to a condition called AR DS, acute respiratory distress syndrome. That is what people who end up on a ventilator, who have covid that’s where they that’s why they end up on a ventilator, they have a RDS. Okay, so cytokine storm leads to a RDS This is a well known process from not only COVID, but from other conditions. So they gave mice this bacterial toxin that induced a cytokine storm. By day five, all of the mice that were untreated. Develop RDS and by day five, they were dead hundred percent mortality. Then they had a group of mice where they gave them the toxin. And they gave them intravenous THC, which you can really only do in the lab, but they gave them a dose of THC on day one, day two, day three, day four. And on day five 100% of the mice were not dead 100% of the mice were alive. When they looked at the my sacrifice the mice and looked at them, they had less cytokines in their bodies and in their lungs and they had less inflammation. We know cannabinoids are anti inflammatory. I’m not surprised by this research. So now the question becomes is if somebody who is quite ill with covid, can we prevent cytokine storm which then ultimately prevents ardf? And I don’t know, but certainly that study gives a hint to it. Now there’s another study what

John Malanca 1:10:54
what doses were that anyway that

Unknown Speaker 1:10:56
they were they a relatively high dose in mice like 20 milligrams per kilogram through an IV which though there’s always a, there is a translation to human but of course I would never recommend anybody that do not inject THC. It’s not sterile. Don’t inject it. This was laboratory sterilized isolated THC. So it’s that is not available to people right. Now another mouse study just published last month, they found CBD to minimize the cytokine storm and that basically protects the lungs and it reestablishes like it. What it does is it takes this hyper immune inflammatory cytokine storm and just brings it back down. So what did I say in the beginning cannabis helps maintain those cellular messages, stop sending so much cytokine stops don’t send the message of inflammation. Okay, and so, and I’ll just read you their quote, potential for CBD a potential purchase. active role for CBD during AR DS that may include CBD as part of the treatment by reducing the cytokine storm protecting pulmonary tissues and reestablishing inflammatory homeostasis. Okay. And remember these are preliminary studies.

Unknown Speaker 1:12:16
These are not that also IV and was that also in?

Unknown Speaker 1:12:19
You know what I’ll have to check? I don’t think so. It might have been I have to double

John Malanca 1:12:23
check it also in in, in South Carolina School of Medicine in South Carolina.

Unknown Speaker 1:12:28
I know this is different. This was from another group. And then there was a study from Israel that came out this month, which is actually I don’t even think published yet. It was just reported in an article and I sent you those links, so you can share that with your listeners. CBD plus a specific terpene combination treated life threatening cytokine storm it was more effective than CBD isolate, going back to our synergy and entourage, right. And also more effective than have a steroid, a pharmaceutical steroid commonly used for that condition. So that is very again very preliminary evidence but why are we not allowed to study this so that we can come up with dosing? When would you need to start treating? How long would you stay on it right? Like all of these questions need to be answered. But the bottom line is, is that cannabinoids no question may play a role in helping to protect people from the full blown COVID but also potentially with recovery. Remember, we’re talking about these people that are they’re calling long haulers. Now people who have months they test negative but they’re still very ill. Maybe some anti inflammatory phytocannabinoids are indicated in those cases.

John Malanca 1:13:44
It’s tough you know, I don’t know if you you know Dr. Chu Sharma. He’s also a medical director of of hospital out in Maryland. And he was the same thing he we don’t know the long term effects. You know, we don’t know, he does. We’re seeing so many different types of blushing,

Unknown Speaker 1:14:06
excuse me.

John Malanca 1:14:08
So many different types of patients and what they’re coming in into the hospital experiencing some have, you know, a light fever, they test coverage, so don’t have a fever, but they feel

Unknown Speaker 1:14:21
and some people are getting gi stuff some people are getting skin everybody disappears is getting heart problems. I mean, it’s, there’s it’s this extensive range of disease being, you know, long term disease being caused by COVID. You know, the clotting problems. We’re only at the beginning of understanding COVID so we don’t really know yet what this disease we do. We have not witnessed the full dizzy course of disease for COVID. And that’s something that we definitely have to know in order to be able to be to make the proper decisions. Right now I err on the side of caution. Why wouldn’t you it just seems silly, not to Yeah, I mean, I have a cousin who’s devastated survived COVID eight weeks in the hospital is very, very ill still, he’s about almost eight weeks out from being home. Yeah, he’s still very, very ill I do not want this disease I do not want I am not interested in this. For anybody I love much less any of my patients or even anybody out there, because you just don’t know if you’re the one who gets it. You don’t know how you’re gonna react to it.

John Malanca 1:15:28
You know, there’s recurrence. I was talking to Sean yesterday and someone at their at their kids school has had it twice.

Unknown Speaker 1:15:34
Yeah. I mean, that’s, and that’s one of our questions, too, is now they’re saying the antibodies are there, but we don’t know how long they last. Again, we do not know the full course of this disease. yet. The only way to know the full course of a disease is to live through it and to gather as much data and thank goodness for all the scientists and researchers that are frantically working 24 hours a day to try to figure out so that they can give those of us Who are waiting on them? Good advice. And I’m going to share look, we’re going to see, like conflicting

Unknown Speaker 1:16:09
advice coming out. But remember,

Unknown Speaker 1:16:11
we’re going to we are not we’re

Unknown Speaker 1:16:13
already seeing it. We can only go by what we know as of today, and somebody may have a discovery tomorrow. That will change what we did today. We have to go with the flow with that. It’s kind of like saying and us use the cannabis analogy. Do I know everything about cannabis? cannabis? No, there’s like this much to know. And I think we know this much because research has been prohibited. And we do the best we can. When people come to me with with cancer. I cannot say if cannabis is going to help them or not, I don’t know. Because I don’t have enough research to say 95% of patients with this kind of cancer who get cannabis get this result. We have no idea. So, you know, it’s the same thing right now with COVID.

John Malanca 1:16:56
I appreciate that.

Unknown Speaker 1:16:59
Would you wear a mask

Unknown Speaker 1:17:00
I wear a mask Yes.

Unknown Speaker 1:17:03
I wear a mask in my when I leave my house when I go to the grocery store when I go into my office collect charts. I again, I do not want this illness. And that is to me is, look, my colleagues in the hospital are wearing masks for 18 hour shifts. And if they can do it, I can do it to go into the grocery store and grab what I need and get out of there. Yeah.

Unknown Speaker 1:17:27
That’s my opinion.

John Malanca 1:17:28
Nice shave. That’d be really nice talked about. I talked about math, and I’ve written about math, and I have reached people have written back, you know, why are you putting false information I should listen, if it’s gonna help, you know, why not wear a mask

Unknown Speaker 1:17:41
why and until we know for sure, we should err on the side of caution. I don’t think there’s really anybody out there that wants to knowingly spread cannabis to somebody else who could be quite ill or die

Unknown Speaker 1:17:53
spread cannabis or

Unknown Speaker 1:17:55
COVID sorry.

Unknown Speaker 1:18:00
The hours make cannabis around.

John Malanca 1:18:04
closing thoughts I want you How can people find you one but I want you, you know Bonnie’s book is incredible. This is her second version. And but he talked about your book. You know what I want people to be able to find it pre order. How do they come they find Oh,

Unknown Speaker 1:18:25
yeah, they can go to Barnes and Noble or Amazon. I think there’s a couple other websites. I’m sorry I can’t remember the other two, but it’s called cannabis is medicine. It is available for pre order. I go through the physiology of the endocannabinoid system. I go through what? What’s in the plant. I go through the safety of cannabis. I go through a number of conditions for which you should be careful with cannabis and that’s of course pediatric patients, patients with any type of cardiac conditions, pregnant women, people who have may have another type of condition. So I go through that Then I do, I added a chapter. So again, this is like an 80% revision of my previous book. So some of it is a little overlap, all the patients that were in the previous book gave an update on there. So here you now have, you know, four or five years later of how they’re doing, which is very exciting for me, because that does show that patients can get long term benefits. I have a chapter on kind of the science of how CBD works like everybody’s raving about CBD. But can you tell me where it works in the body and what it does? And if you can’t, that’s what this chapter is about. And I go through every cannabinoid and what do we know about its interaction with receptors in the human body because remember, all these compounds work at the cabinet in within the cabinet, endocannabinoid system but they also work at external sites outside of the endocannabinoid system, and we have to be aware of that. So I put all of this kind of data that’s floating out there, and it tried to make it really organized and methodical in that chapter. And then there’s a chapter called How to use cannabis as medicine. How do I approach? My like? How do I know what products to try? How do I categorize products? So it’s kind of a roadmap. Yeah, without giving specific a person with Parkinson’s should take this dose because that is not okay for me to do because remember, and I’ll use Parkinson’s as an example. Parkinson’s starts off one way. And as a person with Parkinson’s progresses, their brain changes, their chemistry changes. And something that might be appropriate at the beginning of treatment, if you’re in the beginning of the illness may not be appropriate later on. So that’s something that people should be managing with the physicians help. But in that chapter about how to use cannabis as medicine, it gives you at least a methodical approach, rule it in or rule it out. How do I do that? How do I know when to say this product is helping isn’t helping. So I go through all of that. And then I have about 30 conditions where I go through the latest scientific information that either supports or doesn’t support the use of cannabis for those conditions.

John Malanca 1:21:13
Right, awesome. And so can you repeat the title and again, and

Unknown Speaker 1:21:16
whatever it’s called cannabis is medicine. And it’s available on Amazon for pre order and also Barnes and Noble.

John Malanca 1:21:25
And I know you’re busy. So are you still seeing patients?

Unknown Speaker 1:21:32
I am still seeing patients currently My practice is full. I am a bit overwhelmed. I am still taking pediatric cancer patients right now. Because unfortunately, by the time often they get to me that we’re, you know, we’re at a critical point where I feel that I might be able to help or at least but give improved quality of life. Right, but The practice is bulging at the seams. So I’m trying to as best as I can, if somebody calls our office or emails us, we have a network of physicians and as you do as well, so I sometimes even tell people to reach out to you if I don’t know of a physician in the area. We try to refer to other physicians who are doing what I’m doing. And luckily, there are now a handful of us across the country who are able to help patients and who understand cannabis and can least get patients started on a regimen that might be beneficial.

John Malanca 1:22:33
Do you want to get bombarded to share your phone or website or you on edge as

Unknown Speaker 1:22:37
well? So it’s Canada In Canada Sanders, calm, okay. And there was a Contact Us page there. There’s also I’m on Instagram, although I don’t check messages on Instagram, but if you want to follow us on Instagram, it’s Bonnie Goldstein, MD. And even though I have a Twitter account, I don’t use it and do not reach out through LinkedIn. I never check it you know, it’s just it’s there’s too many things for To be checking very low on the list. Yeah, yeah. So if but if you reach out I’m not allowed to give medical advice unless I’m established in a relationship with the patient. That’s the that’s the rules. I can’t just kind of give out what we call curbside advice. Yeah. And I’m, I’m Mike, the practice of my, of my medical practice is regulated by the medical board and I follow standard of care, which includes a history of physical, establishing relationship with the patient. And, you know, there’s only one of me and I wish I could help everybody. But there’s also Dr. Sue lac. Dr. Herman rather, in Northern California. There’s a wonderful doctor here in Santa Monica, Dr. Sherry yify. And there’s Dr. Patricia fry on the Maryland Virginia area. There’s some doctors in Florida that I know in Colorado, so you know, there there are other doctors out there. that are willing to help patients that are leading the way. And hopefully we can connect people.

John Malanca 1:24:06
And we can do that. And you can contact Bonnie, her law office or myself, I’m always reachable, and she’s always reachable, but I am reachable, approachable. Both Bonnie and I are approachable as well. And we’re more than happy to help you on your journey. Can you before we get on this, you’re talking about in your book about roadmap, and one thing a lot of patients are afraid to do is have this conversation with their doctors. Sure, can you can you just reiterate, it’s even if you’re in a legal state, it’s not illegal to have that question.

Unknown Speaker 1:24:37
That’s right. So there is a precedent case. If you want to look it up. It’s called conent vs. Walters, I believe. And it was a case where the federal government went after doctors basically saying you cannot have a discussion with your patients about a schedule one substance Because it’s in conflict with with the federal government. And the case erred on the side or like voted on the side of physicians having an open, honest relationship with patients. And it protects a physician speech. I have free speech when I’m talking to a patient. But under free speech, it includes that I’m not lying about it. I can’t say if you come to my office and your ball that cannabis is going to give you a, you know, beautiful long, you know, Farrah Fawcett hair, I’m not allowed to lie. What I can tell you though, is there is evidence that shows that cannabinoids might have an or have anti cancer properties, or there’s evidence that CBD can stop seizures, you’re allowed to have the discussion meaning physicians and other health care professionals it is protected speech. And the reason is, is because it’s a special relationship where I am not there for my benefit, I am there for the patient’s benefit and I am supposed to help that patient understand what their potential options are in the best course of treatment. If I if I want to talk about cannabis, but I’m afraid to I’ve not done my patient a service right, I have done them a disservice. So for what I tell patients is a good question to ask your doctor just to feel them out, especially if you’re nervous about it is what do you think about medical cannabis? And if the oh it’s a bunch of hooey and it’s garbage and so on, then you might not want to get into it with your doctor. What you might want to do is educate your doctor in a very subtle way where you don’t bruise their ego, what you might want to do is say, gee, you know, I found this paper on I have Parkinson’s and here’s a study that shows that CBD might help Parkinson’s. I brought it for you. I was wondering, maybe you could read it and let’s let me know what you think and just kind of leave it you know? Doctors and we have big egos and we don’t like patients, teaching us things we don’t know. We’re supposed to know everything. But the reality is, is that we have not been taught about this. And if a doctor hasn’t gone out of their way to learn about it, they’re coming from a place of ignorance, whether it’s willful ignorance are not I leave that to them. But it may just be they didn’t come across it. They want to know, but look, it’s hard to be a doctor these days. If you’re a cancer doctor, it’s so hard keeping up with all the drugs coming down the pike. How are you supposed to learn about the cannabis specialist in there as well? So the whole idea is, be gentle with your doctor, but try to help educate. I always tell people buy the book, give them my book or print something off the internet that talks about the endocannabinoid system and hand it to them. If your doctor says Well, now I’m open about it then you can have a conversation. They may not be able to advise you because you have to remember they don’t know very much and that is where if you are seriously ill or even you just want direction while getting into a relationship with a cannabis specialist, whether it be a doctor, a nurse practitioner, or an RN who has bothered or even a cannabis pharmacist who is bothered to learn about this, you will likely have a better experience.

John Malanca 1:28:20
I’ll shine Well said, Bonni Goldstein, MD. Bonnie, thank you so much.

Unknown Speaker 1:28:26
always welcome, john. It was a pleasure to see you.

John Malanca 1:28:30
And great seeing you as well. So, everyone, Bonni Goldstein, MD, buy her book is a John Malanca united patients group being formed and be well we’ll see you soon. Bye bye.