Friday, August 11, 2017


This post is preceded by 2 posts on sleep. These three posts are designed to be viewed together.

I started to get interested in medicinal marijuana about five years ago. There were a few examples of ME/CFS patients who used various marijuana medicinals for pain, inflammation and sleep.  Most resided in states where medical marijuana was legal or about to become legal.

Cannabis has over 70 cannabinoids of which the most well known is THC, the psychoactive part of the plant.  A second component or cannabinoid has recently received a good deal of attention. It is CBD or cannabidiol. CBD is believed to have various medicinal activities.

The Federal government continues to list marijuana as a schedule 1 drug. One very great consequence of this is that research into marijuana is severely and intentionally restricted. With more states legalizing marijuana, the bigger states are starting to do some research into this plant. Research continues in Israel, Spain, UK and Italy, but it is, predictably, underfunded.

Anyone who wants to engage this subject is going to have to proceed on their own, guided by trial and error.

In reality there are two allied plants, cannabis and hemp. Cannabis is loaded with THC, while hemp has very little. Both have a great many other cannabinoids including CBD, CBN, CBG, and CBDa.

CBD from marijuana has always been touted as the gold standard of CBD. Some propose that in order to be effective CBD needs to have a certain amount of THC with it. Marijuana CBD is restricted to states where marijuana is legal. It appears that Mary's Medicinals makes good products. 

About five years ago, there were only a few companies that produced CBD from hemp. These CBDs were legal, but their quality was challenged by many, including the marijuana CBD makers. Also the FDA objected to the claims of some of these hemp CBD producers.

It remains to be determined if hemp CBD is as good as marijuana. However, certainly things have radically changed in the last few years; there has been an astonishing amount of sophisticated hemp CBD that is available through the Internet. Hemp CBD is legal in all 50 states.

There is a growing body of positive anecdotal information of hemp CBD use, but there is very little of what one might call real science. This might change but I wouldn’t hold my breath. The main claim for both forms of CBD is that they reduce pain and diminish anxiety. Hemp CBD has been called “calming drops” by my own daughter.

The question remains. Will CBD be useful to ME/CFS patients? We are about to find out, as more patients are giving this a try. As with almost everything with this illness, the process is wholly trial and error. Additionally, every treatment must be individualized.

The present choice in high grade, organic hemp CBD is quite surprising. At one end one finds Mary’s Nutritionals pure CBD. This has been heated and refined to take all terpenes and additional cannabinoids out of the solution, leaving only pure refined CBD oil. This oil is at the expensive end of the spectrum. One can find similar CBDs at RSHO with their RSHO-X - no trace of THC, pure organic hemp CBD.  At the other end of the spectrum is raw unadulterated, unheated hemp CBD, also organic, some grown in the US.  A good example of this can be found at Nu-Leaf. These products have CBDa and CBD along with terpenes and all the cannabinoids in the hemp plant, producing what is referred to as the "entourage effect". The entourage effect is the supposed but unknown interaction of all the cannabinoids and terpenes working together.  In between, and cheaper, is a heated, partially refined CBD that can be settled on in various places. Read about this at Endoca.

As there are arguments as to whether THC is necessary to make things go, so there are arguments between the use of pure refined hemp CBD oil versus the raw plant oil with all the terpenes and host of cannabinoids that work together to create the “entourage effect”. The positive way to look at this is that there are many options to try.

In addition to oil, there are pastes, extracts, pills, crystals, gels and suppositories. This industry has exploded. Put a Google alert on hemp CBD and start reading.

The rationale for using CBD in ME/CFS lies in the thought that ME/CFS might be connected to an Endocannabinoid Deficiency. Here is an article on the Endocannabinoid system. Here is another one. Finally, here is an interview with Dr. Ethan Russo on CBD and Endocannabinoid Deficiency.

The study of the Endocannabinoid system can be said to have begun by the Israeli scientist Raphael Mechoulam with the discovery of the psychotropic cannabinoid THC in the mid-1960’s. (Dr. Mechoulam remains the foremost marijuana researcher in the world.) Further research identified the brain receptor CB1 in the early 1990s, quickly followed by the discovery of a second receptor CB2 located throughout the human body. With these discoveries the Endocannabinoid System was identified, leading to discoveries that this very system helps regulate a host of processes in the body - and the awareness that deficiencies might have some connection to chronic illness. 

With so many dysregulations and disconnects in this strange illness of ME/CFS, it is worth considering that these patients suffer also from Endocannabinoid Deficiency System. The supposition is that these deficiencies, these Endocannabinoid deficiencies, can be corrected – with CBD or other cannabinoid items. Certainly the symptoms of Endocannabinoid Deficiency seem to shadow ME/CFS symptoms.

There is additional study and use of other cannabinoids from hemp and cannabis for seizures, sleep, pain, anxiety, migraines, wound healing, and the rest. You name it and some cannabinoid is reputed to help treat it. THCa is in the raw cannabis plant. If one heats THCa it converts to THC. The straight marijuana plant can be treated in a cold fashion (unheated) - and the THCa preserved. THCa is a non-psychoactive compound, which is reputed to have many of the qualities of CBD. CBN is another interesting cannabinoid. CBN can be increased in the marijuana plant material by aging the main product, exposing it to sun and light for a long time – months. Converted into a medicinal, either a tincture or a salve, CBN is reputed to have high sedative effects. Others say that the sedative effect of this aged product comes from the aged terpenes. CBG is another cannabinoid that is gaining interest, also for the same properties – its calming and sedative properties.

My main interest at the moment is in these various cannabinoids as sleep enhancing agents. Not to beat a dead horse, but a good sleep sensor is very helpful in seeing changes wrought by different compounds in different arrangements. A pulse and oxygen saturation monitor also could be helpful, in conjunction with low-dose oxygen. A sleep sensor can separate out and determine sleep initiation, sleep duration, length of sleep entirety or sections of sleep. This can be immediately obvious and adjustments made based on the sensor readings.

So the world is working its way back to cannabinoids, which does not make everyone happy. There is a great battle going on, and it is not difficult to identify its outline and terrain. Where this will go we do not know. The surprising thing is that cannabinoids have been used as medicinals for thousands of years before being put out of business in the US in 1934 and then really put in the slammer by Richard Nixon in the mid-1970s.

Both ME/CFS physicians Paul Cheney and John Chia have used CBD with their patients. 

Here is an additional blog that has information on CBD.

What is written about is educational in nature. It is not medical advice. Please consult your physician (if you have one) for medical advice. 

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