Expert report regarding the clinical use of CBD

Robert Gorter, MD, PhD, is emeritus professor at the University of California San Francisco Medical School (UCSF), etc.

Robert Gorter:

“CBD is a powerful COX-1 and COX-2 inhibitor and therefore, in general, CBD is good to use where chronic inflammation reactions play an important role …”

Content

The Endocannabinoid system

Cannabis sativa L.

Cannabinoids

Cannabinoid receptors

Cannabidiol (CBD)

CBD in anxiety disorders and phobias

CBD in muscle tension and muscle pain

CBD in psychiatric disorders

CBD in epilepsy

CBD in Parkinson’s

CBD in Tumors

CBD at Crohn’s Disease

CBD in Dementia and Alzheimer’s

CBD in Diabetes

CBD in Sports

References

The endocannabinoid system

Endocannabinoids are important neurotransmitters that are mainly present in the brain and are involved in many cognitive functions. Endocannabinoids were discovered by the investigation of the effects of cannabis.

Cannabis

Medicinal cannabis is extracted from dried flowers of the Cannabis sativa L plant. Cannabis contains various components, the most important of which are tetrahydrocannabinol (THC) and cannabidiol (CBD). But while the effects of different cannabinoids are being investigated, more and more cannabinoids emerge which seem to have very positive physiological and medicinal effects. THC is usually the main component of clinical studies but also CBD has many activities, which are now being discovered and tested in clinical trials. The effects and side effects of cannabis are determined by the composition if the plant is given in tota to the patient. If cannabis is used for medical purposes, one talks about medicinal cannabis. These products must meet the highest quality requirements. (Cannabis Office, 2017) (NCSM, 2017)

Cannabinoids

Cannabinoids are divided into two categories: endogenous and exogenous

Endogenous are the body’s own substances. These substances are produced by our body. Endogenous substances regulate basic functions in our body such as various immune functions, sleep, hunger, mood and pain. They do this by generating reactions at the cannabinoid receptors (CB receptors).

Exogenous are substances from outside. Exogenous substances in cannabis include THC and CBD. These substances also interact with CB receptors. (Cassini, 2017)

Cannabinoid receptors

Two CB receptors have been identified so far, namely CB1 and CB2 receptors. Both receptors belong to G-protein-bound receptors (GPCR). These are the most common receptors. CB1 is mainly found in the central nervous system and is the most widespread GPCR in the brain. Activation of CB1 receptor protects the nervous system against activation or blocking by neurotransmitters.

CB2 receptor occurs in the white blood cells and is involved in the immune system. The function of these receptors includes modulation of the release of cytokines. Cytokines are responsible for inflammation and regulation of the immune system. CBD is a significant “COX-2 pathway inhibitor.” (Grotenhermen, Cannabinoids and the Endocannabinoid System, 2006)

Cannabidiol

By activating the GPCR, cannabidiol exerts a lot of effect. Natural cannabis products are normally inhaled or taken orally. Sublingual administration, transdermal delivery and eye drops have only been used in a few studies and have little relevance in practice. (Grotenhermen, Pharmacokinetics and Pharmacodynamics or Cannabinoids, 2012)

There are several scientific data that show that cannabis has a favorable effect in, among other things:

– Chronic, phantom and facial pain

– Muscle cramps and muscle twitching (in MS and spinal cord injury)

– Nausea, loss of appetite, slimming and weakening of cancer

– Hepatitis B & C, HIV / AIDS

– Therapy resistant glaucoma

– Duchenne muscular dystrophy (DMD)

– Malignancies (tumors)

– Chronic (but not acute) inflammations

More and more data are available on efficacy in other disorders, but these have not been proven in definitive clinical studies. But so many phase-1 and phase-2 studies have been published that one can assume that these indications are also correct:

– Crohn’s disease

– Ulcerative colitis (inflammatory disease of the colon)

– Epilepsy

– Itching / Eczema / Ectopic dermatitis

– Migraine

– Rheumatoid arthritis

– ADHD

– Parkinson’s disease

– Sleep disorders

– Menstrual cramps

– Asthma

– Alzheimer’s

– Anxiety disorders

– Psychological disorders

– Reactive depressions

– Significant improvement of DNA repair

(Cannabis Office, 2017) (NCSM, 2017)

CBD in anxiety disorders

For a long time it was thought that the use of cannabis as a soft drug could lead to anxiety disorders and schizophrenia. But cannabis also prevents anxiety and anxiety disorders. This appears especially in studies with CBD only in psychiatric patients with clinically relevant. One of the most common fears is speaking in public, or social anxiety disorder. Scientists have discovered after a study that CBD can effectively and safely inhibit this fear. (Gunduz-Cinar, Hill, McEwen, & Holmes, 2013) (Bergamaschi, et al., 2011)

Usually these types of disorders are treated through cognitive behavioral therapies. However, this does not always help as these fears often have a hormonal cause too. To treat this, anxiolytics (anxiety inhibitors) are needed. However, this type of substance is harmful and in itself addictive and not always effective. (Bergamaschi, et al., 2011)

An important relationship between fear and CBD is the amygdala. Amygdala is an area in the brain that links information in the senses with fear and emotions. This part also provides the so-called fight and flight response. A study showed that CB receptors are located wide-spread in this part of the brain. The same study also revealed that stress reduces the natural production of endocannabinoids in our body. (Snyder, 2014)

CBD has an anxiety-inhibiting property. A group of scientists from Brazil investigated the impact of CBD on public speaking and performance. (Bergamaschi, et al., 2011)

The study showed that the group at which 600mg CBD was administered per day significantly reduced anxiety and cognitive impairments. It was also tested with a placebo group. This group felt less at ease. So from this concluded that CBD has a fear-reducing effect on people with a social anxiety disorder. (Bergamaschi, et al., 2011)

CBD in muscle tension and muscle pain

Dyskinesia is the involuntary muscle movement that occurs when treating Parkinson’s disease. The symptoms of dyskinesia can occur when uncontrolled pulling or shaking. This can, with time, ensure that people cannot move extremely slowly or even at all. A specific form of dyskinesia can occur in Parkinson’s patients receiving long-term treatment with Levodopa. This form is called Levodopa dyskinesia. This form can ensure that patients move their hands and feet in a dancing form or have persistent contractions of muscles. Several studies have shown that the activation of CB receptors by administration of CBD, levodopa-dyskinesia and other motor problems can greatly reduce. (Susan, Henry, Hill, Crossman, & Brotchie, 2002)

A 2014 study showed improvements in shake, stiffness and slow movement. There was also a significant improvement in sleep and pain scores. This study was conducted in patients who made long-term use of Levodopa. (Lotan, Treves, Roditi, & Djaldetti, 2014)

Cannabis (CBD) is the most effective drug according to patients suffering from fibromyalgia. Fibromyalgia is a disease that causes severe muscle pain and pressure sores all over the body, leading to sleep disturbances, fatigue and headaches. This condition cannot be cured and is difficult to treat. A study in the US showed that CBD is actually effective. 62% of people who use CBD for their condition indicate that they are fighting the symptoms very effectively. More than 60% of patients, Duloxetine (one of the pharmaceutical medications, administered in fibromyalgia) indicate that the drug had no effect, only 8% find the drug effective and 32% indicates that it helps a little. (National pain report, 2014)

Positive results emerged from a survey conducted in the US. This is the largest research on cannabis use ever. If we delve deeper into the section on CBD, we see that no less than 80% of the respondents indicate that it is very effective. 54% of the respondents used CBD for joint pain, 35% for muscle tension with cluster headache and 32% for chronic pain. 66% of Respondents indicate that CBD is more effective than the medications prescribed and 42% of these have replaced their prescribed medication with CBD. (Brightfield Group and Hello MD, 2017)

CBD in psychiatric conditions

In Canada, the scientists found results, for which they had not designed a study with CBD. The study was focused on chronic pain. It was to their surprise that CBD has an effect on both physical and psychological / psychiatric symptoms. The group, which received CBD during the study, experienced significantly less pain and indicated that they had an increased quality of life. The participants actually surprised the scientists more with the fact that they had less anxiety, depression and fatigue. (Ware, Wang, Shapiro, & Collet, 2015)

Schizophrenia is a serious psychiatric disorder. Medications for this condition usually have many side effects such as liver and kidney damage, muscle spasms, restlessness, tremor and dizziness. Previous studies have shown that CBD can be an alternative to schizophrenia. CBD also has a very positive influence on learning ability, memory and attention. This means that the medicine could help with the symptoms without causing any harmful side effects. (Osborne, Solowij, & Weston-Green, 2017)

Depression is a very common condition. There are few drugs that help against depression. Antidepressants need a long time to prove efficacy. However, there are more and more patients who indicate that cannabis helps against their condition. It also appears from a study performed on mice that hyperactivity was reduced within thirty minutes of administration. Hyperactivity (mania) is a symptom of anxiety and depression in humans. (Linge, et al., 2015)

CBD in epilepsy

Several independent studies show that CBD has a beneficial effect in different forms of epilepsy. The patients treated with CBD saw a clinically relevant decrease in the number of seizures. The patients had reported side effects that they were suffering from, so patients with high doses of CBD suffer from transient dizziness, fatigue, loss of appetite and constipation. (Vries, Ramcharan, & Lebbink, 2016) (Cannabidiol option in epilepsy, 2016)

CBD in Parkinson’s

A clinical study by the University of Sao Paulo in Brazil showed that the daily use of CBD significantly improved the quality of life and well-being of Parkinson’s patients. To measure this, the Parkinson’s Disease Questionnaire-39 (PDQ-39) was used. This is a questionnaire in which patients answer questions about, for example, daily activities, emotional well-being, social support, mobility and physical discomfort. (Chagas, Zuardi, Tumas, Pena-Pereira, & Sobreira, 2014)

Scientific research CBD in malignant tumors

Both animal and clinical studies have shown that CBD stops the development of tumors in breast, lung, brain, prostate and intestines (and probably all malignancies). CBD stimulates cell death in cancer cells and counteracts the multiplication of the diseased cells. The authors of the study concluded that on the basis of these results, evidence emerges that shows that CBD inhibits both the growth and spread of cancer. This is also easy to understand because CBD is a strong COX-2 inhibitor. (Pharmacol, 2016) (Massi, Solinas, Cinquina, & Parolaro, 2012)

CBD at Crohn’s Disease

According to a 2014 study, half of the patients with Crohn using cannabis were fully remitted. This study was conducted in patients with severe form of Crohn’s disease. The results of the study showed that the anti-inflammatory property of CBD is responsible for alleviating the symptoms. (Naftali, et al., 2013)

CBD in Alzheimer’s

A study at Stanford University in California proved that a deficiency of endocannabinoids may be the cause of Alzheimer’s development. The active substances from cannabis have the same effect as the body’s own signal substances. (Orr, et al., 2014)

THC + CBD and CBD only in aging processes of the central nervous system

THC and THC in combination with CBD improve the learning process and memory in older mice and large clinical studies with people have just started. The first data of these studies have been shared in oral presentations.

Researchers at the University of Bonn (Germany) gave a combination of low-dose THC in combination with CBD to mice of different age groups. Compared with many younger mice, who received nothing, it was possible to document that the treated much older mice received the same mental performance (for example, with problem solving) and memory as the young mice. The conclusion was that smaller amounts of THC with CBD restored the cognitive functions of older mice to those of younger mice.

As a result of aging, the quality of the endocannabinoid system, also in the brain, decreases considerably and as a result moods, memory, problem solving and pain sensation are negatively affected. By giving THC with CBD in small amounts daily, the whole endocannabinoid system can be restored to a normal level. (Andras Bilkei-Gorzo, et al. University of Bonn, Germany, 2017-2018

CBD in (extreme) Sports

Athletes’ bodies take a beating. Regardless the sport, an athlete’s body goes through significant sums of pain each practice and game. And as the studies around Chronic Traumatic Encephalopathy (CTE) have shown, the pain can be life-long. Other life-long pains have crippled or deteriorated the quality of life for most sport stars. Those pains extend well beyond retired and current sports elites. It can even happen to children.

Nine in 10 NFL (rugby) players told The Washington Post that they played hurt during their career. This comes as no surprise as the league’s depth charts are highly competitive. A starting spot can be lost in an instant. And in a sport where contracts often fail to reach their actuality, players are released and may never see another opportunity. So, how can players maintain their careers and quality of life?

Multiple observations by trainers and doctors who are specialized in extreme sports medicine as well as by self-reported data by professional sportsmen and women document several positive effects on increased strength and endurance as well as a general improvement in mood and behavior.

Dr. Gorter: “After years of guiding myself participants in extreme sports like wrestling, martial arts, body-building and athletics, I came to the conclusion that CBD has many beneficial effects leading to significantly improved performance; often leading to medals in national championships and Olympic Games.”

www.independent.co.uk/…/cannabis-thc-memory-learning-improvement- benefits-mice-study-university-bonn-nature-medicine-a7724701.ht …

https://www.sciencedaily.com/releases/2017/05/170508112400.htm

https://www.youtube.com/watch?v=Lc-unovivRU

CBD in Diabetes

A study, published in the American Journal of Medicine, showed that active cannabis users have more productive carbohydrate metabolism compared to non-users. Patients who use cannabis process carbohydrates better than non-users. Carbohydrates cause the rise of blood sugar levels. The body of CBD users breaks down sugar in the blood faster. (Penner, Buettner, & Mittleman, 2013).

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Expert report regarding the clinical use of CBD

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