Dosing with Nurse Susan

Dosing with Nurse Susan

Susan Marks, AKA Nurse Susan is an alternative healthcare educator and consultant. Susan received her BSN in Nursing from Mount Saint Mary’s University in 1984 and her Masters of Science in Nursing from Herzing University in 2019. She is a licensed Nurse Practitioner and Certified Family Nurse Practitioner as well as a Registered Nurse with the California Board of Registered Nursing. Susan discovered cannabis as a natural and safer means of treating her own neurological disorder known as essential tremors that cause her hands to shake uncontrollably.




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Full Transcript:

Levi: Welcome to Head Change, the podcast that puts you in a better headspace. I'm your host Levi Strom. In this episode I speak with Nurse Susan, that's Nurse Practitioner Susan Marks about proper dosing with cannabis. Susan I would love to learn a little bit more about your background and how you got involved with cannabis if you wouldn't mind sharing?


Susan: Sure, so I maybe had some cannabis when I was in college, but I didn't really like it, so I wasn't part of this whole culture, but I developed a progressive neurological movement disorder called essential tremor. And basically what that is is I have too many electrical impulses going off in my brain and it makes me shake. It's similar to seizure disorders. So they manage it using anticonvulsants pharmaceutical drugs. So, it got to the point where I was not able to do the most normal things whether it was, you know, clasping my necklace or buttoning my buttons or even drinking out of a glass I'd spill water everywhere, so I went ahead and I got onto the anti-seizure meds and they were horrible. Oh my god. Well, they're barbiturate anticonvulsants. So you can imagine what it does to your brain and it really scared me. So I was looking for an alternative because I just couldn't see myself, you know doing the route of Western medicine, which is basically as the condition progresses and the shaking gets worse they just keep bumping up the dose of the anticonvulsants and then once it gets to a toxic level, then they have to start with a different anticonvulsant and this is a condition that runs in families. My brother, who's 10 years older than I am, he’s 10 years ahead of me with this condition and he had gone through all of the available anticonvulsants and they just weren't helping him anymore. So he required brain surgery. It's called deep brain stimulation. It's basically where they put electrodes into your brain and then they have a it's like a pacemaker for the brain it has this thing that's under the skin that you can Just if you know you're shaking more than usual. The problem is that electrodes are so close to the speech center that if it gets to a certain point he's unable to speak. So it's not a perfect solution and I was trying to do everything I could to avoid that whole path. So I just you know, I'm a nurse. I've been a nurse for almost 40 years. And so I just started doing my medical research and I was shocked to tell you the truth to see all of this medical research on cannabis -- like medical medical research and all of the conditions that cannabis is able to address and you know affect the disease processes as well as dealing with the symptoms of the disease. So then I found out the US government had a patent on cannabis and I was like, okay what the heck is going on here. So the more I got into it and was learning about it the more I just felt like people need to know about this because this is really in my opinion a life-changing drug. It certainly was for me. It's a life-changing approach to managing health without the risk of pharmaceutical drugs. You don't need to take a separate drug for each separate symptom. Cannabis is so holistic and it affects, you know the endocannabinoid system which we can get into if you want but it allows your body to basically have the raw materials that it needs to heal or to mitigate the effects of disease. So, anyway after doing all of this research, I thought okay, this is worth a try. So as I started decreasing my dose of the anticonvulsant, I started increasing my dose of cannabis. My protocol is basically three main cannabinoids CBD is my foundational cannabinoid and then I use raw cannabis THCA and I use a little bit of THC because it's a neuroprotectant and you know, all of that stuff going on in my brain. There's a much higher incidence of Alzheimer's disease for people who have essential tremor. So anyways, I started decreasing my dose of anticonvulsants and increasing my dose of cannabis. I was getting better results than the pharmaceutical drug. So long story short that was about five years ago. I have been off my anti-seizure medications. I still shake, you know, if you were to look at my hands you can see that but it's absolutely nothing like it was before I can drink out of a class I can do the things that I you know that everybody kind of takes for granted until you can't do it, especially like if you're at a restaurant and you try to drink out of a glass in your hand is shaking so bad that the water spilling everywhere and you know, it conditions like that have and a lot of chronic conditions they have a psychological toll, you know, I started withdrawing I didn't want to go out to restaurants. I didn't want to be around friends because I was embarrassed and even out in public I would get looks like I was a drug addict coming off of you know something, so anyway to be able to find cannabis which, as you know, is so helpful in just wellness, you know, let alone managing diseases. It's such a godsend and it's so so natural and the side effects are absolutely minimal compared to most of the other pharmaceutical and over-the-counter drugs. So anyway, I just thought everybody needs to know about this. So I started doing presentations and working with patients because my friends and family saw that I wasn't shaking like I was before and they asked well, what are you doing? And I told them I'm doing cannabis. They were shocked first of all because I'm like the most conservative person in the world, the last person you would think would be, you know partaking. But anyway, they were like wow that's really fantastic. Do you think cannabis would work for me or for my mom or my dad or you know anybody so then I started working one-on-one with patients. I'm a nurse practitioner, so I'm licensed to prescribe and recommend and all of those things. So, anyway, I just started working with individual patients and doing a lot of educational you know events just to try to spread the word just so people would know because there is such a negative stigma around cannabis that is you know devious in my opinion when you look at the history of cannabis and the reason why you know, they took this medicine that had been, you know, the top prescribed medicine in the U.S. until the early 1930s and then all of a sudden politicians get involved and they want to push their agenda. So now they make it illegal and we've all had to, you know, kind of suffer the consequences of that. So anyway, I'm trying to unravel that a little bit to get people so that they feel more comfortable coming from a healthcare person. I do a lot of education for Physicians and other Nurses, and so hopefully I'm just kind of chipping away and helping people understand what it really is and what it might be able to do for them.


Levi: I think you really, I think stories like yours, you know, like a self-described conservative, you know, somebody that's not out going to Grateful Dead concerts wearing tie-dye and smoking blunts because everybody knows those people are into cannabis and it's going to cure everything under the sun. And so it kind of gets lost in translation, but for real medical professionals like you to come out and endorse I think is really powerful and there's so much I want to unpack. Your story's amazing. We know each other so I know a little bit about your story but this is a cool opportunity for me to get to know you better too. And there's so many things you just said, I'm really curious about when you first started treating yourself with cannabis for your condition. What were you using? Were you smoking it? Were you taking tinctures? I mean this was before legalization, so were you going to dispensaries? How did you go about getting your medicine?


Susan: Well, I went to dispensaries. I had a medical recommendation. There are a lot of neurological conditions that qualify people for a medical recommendation and mine was one of them, so I just started experimenting and this is really what most people have to do even with working with somebody like me, you know, I can pretty much narrow down the right cannabinoids the right dose all of that, but I don't know how that person is going to respond and I didn't know how I was going to respond. So based on all of the research that I had done I knew which cannabinoids I wanted to focus on and so I started going to dispensaries and buying tinctures. I wasn't into smoking. Smoking isn't the greatest thing for a chronic issue because you have to keep medicating and it only lasts for an hour or two. So this is, you know, a 24/7 condition for me. So I wanted to find the longest acting, most effective method of administration and that's why I use tinctures because they last for 6 to 8 hours.


Levi: Are you using oil-based tinctures or alcohol-based tinctures are glycerin or some combination? I'm just curious as a tincture maker.


Susan: At the very beginning I tried the alcohol-based, the oil-based, I haven't tried any glycerin, but I wasn't crazy about the alcohol-based tinctures. So I kind of narrowed it down to the oil-based tinctures and I tried a bunch of different brands which you need to do because every brand uses its own source of flower, and it will affect you a little bit differently, so when I work with people I have to explain. okay, so this is going to be a little bit of trial and error. I think I'm pretty close to the mark when we get started, but I just need to see how your body responds and if it responds like most people then we're pretty close to nailing your protocol. If you respond the exact opposite, we have to do some major tweaking.


Levi: So a lot of trial and error to find your own dose. You mentioned three cannabinoids specifically for your condition for seizures and neurological disorders: THCA, CBD and micro dosing THC.


Susan: Right.


Levi: So let's unpack those a little bit. CBD gets a lot of fanfare and what I know about CBD is that it is a very effective anticonvulsant. It is excellent for epilepsy. It is in fact the only right now, GW Pharma has the only FDA approved epilepsy medication Epidiolex, which is a CBD medication. I was listening so you and I both went to CannMed back in 2019 in Pasadena. I re-watched Dr. Raphael Mechoulam's keynote on CBDA, but in that he talked about CBD as well and he and his researchers in Israel did a study back in the 80s that showed CBD was a very effective treatment for epilepsy. It took 30 years for GW Pharma to finally do something with that research. He asked the question in that keynote. He doesn't know why it took so long because we could have literally, especially for children that suffer from these rare forms of epilepsy where nothing else has worked, and cannabis works. I get frustrated with this and I get emotional with this. Why did it take so long for our government and our society to allow you, people that aren't trying to get high, children that are suffering from chronic illnesses to get medication from a plant? I really don't get it. That's a bigger conversation piece that we're not going to solve today. But you know that question needs to be asked very loudly to society and we need to hold a mirror up to people and say -- look if we have these plant-derived compounds that study after study are showing are effective for a variety of conditions. We need to get these drugs to market. We need better research and we need to do the clinical trials, but there's an effective treatment for a condition we need to allow that avenue to happen and get the politics out of this because you and I know this is about politics. The reason why it's illegal has nothing to do with science. It has nothing to do with medicine so we know a lot about CBD and its properties for muscle spasms for anxiety. There's a whole host of issues. CBD is pretty well explored. But you mentioned microdosing THC and this is kind of something I really wanted to talk to you about because I think a lot of people have tried cannabis in the past, maybe in the form of an edible. They tried a brownie or cookie that somebody made for them, or maybe they tried to make it themselves based off of a YouTube video. They got way too high and then they're now too afraid to try cannabis again. What do you say to those people and talk about why microdosing? What is a microdose of THC and why was that effective for you?


Susan: Okay, so microdosing is just basically using a very small amount of THC somewhere around the range of 2.5. 5 to 5 milligrams. And so when you are using a microdose of THC, you don't need to worry so much about all the psychoactivity that can go with it. So THC is the only cannabinoid in cannabis that creates that euphoria, that high, and if you take too much it can cause a very uncomfortable experience. Where you can get paranoid, have severe anxiety, and once people do that and it's usually after having an edible and because what happens is when you take cannabis by mouth, it can take anywhere from an hour to two hours before you're going to notice the effects of it. So what happens is people who are naive to this will take part of a brownie or part of a chocolate bar and then like 30 minutes later, they're like, okay, I don't feel anything. There must not have been anything in that piece that I ate. So then they eat another piece. And what happens is when it hits it hits like a sledgehammer because they've taken way way way too much and one of the other characteristics of cannabis and of THC in particular when it goes through the liver the compound of Delta 9 THC gets converted to 11 hydroxy THC, which is more potent than Delta 9 THC. So not only have they taken way too high of a dose, but then that high dose gets converted into an even more potent effect, and they have a very bad experience. Nobody's ever died. You know, it's not like overdosing on any other Pharmaceutical medications, you don't need to worry about dying from it. You'll just be very uncomfortable.


Levi: You just might feel like you're dying.


Susan: Yeah, exactly and you'll never do it again, right that's the good news. I mean once you've done it once, you know not to do it again. Well, that's kind of the problem with Edibles and for people who are a little naive in this space. It doesn't help with uneducated budtenders so when the public goes into a dispensary the budtenders don't often times know the appropriate recommendation on dosage and so they think somebody starting with 10 milligrams of THC is going to be absolutely fine when they've never had it before and so that's the one problem and then the other benefit of micro dosing is you know I have no interest in being high. That's not what I do. It's for neuroprotection. So most of the clients that I work with are elderly they have pain issues. They have arthritis. They have depression, anxiety. All of these things. They are not looking to get high. They just want to get some relief and they don't want to have to keep taking all of these Pharmaceuticals. I mean some people are on 18 or 20 different Pharma drugs. So not only do you have the side effects of each individual one, but now they're interacting with each other. And people start developing these new illnesses in air quotes, which are really just symptoms of the side effects from all these different medications. So in order to be able to get the benefits of THC without having to deal with any kind of psychoactivity, if you microdose that little amount of THC is not going to make you high but it does affect the other cannabinoids and it boosts their effectiveness. And so by taking a little bit of THC with CBD or CBDA or any of the other cannabinoids, it's going to boost up the effect. There's something called the Entourage Effect. Nature put all of these compounds together for a reason and they work together. They enhance each other. Another example of this is if you take CBD with some THC like I said the THC will increase the effectiveness of the CBD and the CBD will decrease the psychoactivity of the THC. So there are ways to use cannabis, certain protocols that help people to get the relief that they need without having to be impaired in any way.


Levi: Are you a fan, speaking of the synergistic relationship between these compounds CBD and THC as an example, are you a fan of like ratio products, like 1:1 or 3:1? Do you have a particular ratio that you like for yourself?


Susan: For me I usually use the 1:1 and I love having all the different ratios because different medical conditions require different ratios. So for pain the 1:1 is the very best ratio and it is a wonderful formulation whether you're taking it by mouth or let's say you're going through chemotherapy. Now, there are some instances where I think smoking or vaping has its place and it's you know is a good approach, for example, if people are going through chemo and they have horrible nausea, and they're vomiting and they feel like crap and you can't take anything by mouth cuz you just throw it right back up. So by using a vape or smoking the flower you can get relief in about 15 seconds. And you know, all of that vomiting has its own detrimental effects on the body. It disrupts your electrolytes, it interferes with your nutritional status, all of those things. So just by taking a little bit of inhaled 1:1 where you getting the CBD and the THC it's going to drastically reduce your vomiting and your nausea. It will allow you to feel well enough to be able to take things by mouth. So if you do use the inhalation method to calm down that nausea, and then you take an oral dose, then you get that six to eight hours hours worth of relief without having to keep smoking and smoking and smoking. So yeah, there are a lot of different ways to use it. The ratios are different for people who need to work during the day, operate, you know a car or whatever. I would generally recommend a 18:1 or a 24:1, one of those meaning there's 24 CBDs to one THC. So it's very very CBD dominant. And so when you have to work during the day those kinds of formulas are fantastic. If you're dealing with some pretty serious stuff, then you go all the way down to the 1:1's. 


Levi: And I know for people that are listening that are new to cannabis or maybe want to try it for the first time. What they really want to be looking for with dosing is the THC amount because the compound that's that's going to potentially get them high and potentially they might not want to get high so you're recommending around two and a half to five milligrams of THC as a beginner dose. Does that sound about right?


Susan: Yeah, I would start with 2.5 and then you know, like I was saying if you take it by mouth, make sure you give it at least two hours before you expect to feel anything and then really pay attention to how your body is responding to it. It and do that keep it that dose for about three days. And then if you feel like you know what it's not as much as I need then go ahead and bump it up to five and see how that goes. Do that for three or four days. So it really is a kind of a step increase in dosage. It's not nothing you want to rush into.


Levi: Yeah, start small and increase dosage. And that's one of the things that I love about an oil based sublingual tincture is that you can literally titrate your dose down to the droplet, so you can find you know, hey, I really like, you know, three droplets under the tongue. Talk to me a little bit because you know, I'm not a scientist, I'm just a guy who makes and uses cannabis products, but when I use a sublingual even the THC when you absorb it under the tongue through the sublingual duct, my understanding is that it goes immediately into your bloodstream and bypasses the liver. Is that your understanding of it too?


Susan: Yeah, so when you swallow it, so what I tell people is if you use a tincture just put it under your tongue and leave it there for about 30 or 60 seconds or longer if you can and then swallow it so you have a lot of blood vessels underneath your tongue. So you will get some immediate absorption and don't have to wait for the hour, two hours for it to go through your stomach which then goes through your liver which then converts everything and by the time you start to feel something an hour has passed.


Levi: So there's a big difference between eating an edible, ingesting a cookie or a brownie or a gummy and versus smoking or taking a sublingual product, the sublingual application absorption through the mucosal membranes in your mouth and the sublingual duct is going to kind of mimic smoking is that is that accurate in terms of its bioavailability or no?


Susan: No, not really usually because our lungs are so vascular and the oxygen is so close to the blood capillaries. So when you smoke it, you're going to feel it in about 15 seconds full on. With sublinguals it doesn't work like that. You don't get that immediate result so to speak to that degree, you know, you can take a hit off of a vape pen or you know, however you want to take it and you can feel it.


Levi: Sublinguals in my experience take probably general rule of thumb about 10 minutes to really feel the effects versus an edible that takes usually fifty minutes is when you start to feel the effects and it can even take longer depending on you know, is it a heavy brownie or a light gummy so that you're right that that that's what can really sneak up on people is they'll take a little bit, they don't feel it and then they compound it and then they get too high. So that's something that people are I think really need to pay attention to is if you're going to ingest cannabis and even if you're taking it sublingually, you know set a timer, you know for I would say set a timer for three hours before you take another dose just to really make sure. And probably do it at night, especially for the first time so you're not driving or doing something where you could become impaired. I mean these compounds are very powerful and a heavy hit of THC ingested, If you're not used to it can be pretty scary. I mean even me, I'm a stoner and also sometimes eat too much of an edible and it's like whoa, I need to be alone for a while and just kind of process this.


Susan: Exactly.


Levi: You know, I think it's important for the industry to really let people know that dosing is not the same for everyone. You know, it's okay to start with a small amount and even these other compounds. I want to talk about some of these other cannabinoids besides just THC, but THC is the one that gets most of the attention and it's the one that I think people either seek or are afraid of and actually seek the opposite, you know, the hemp products that virtually have zero THC or trace amounts, I know from selling products into both the legal cannabis space and the legal hemp space. There's a lot of people that want to see 0 THC, 0 Delta-9 on the lab test results. And for those people there is the hemp market. Now the problem with the hemp industry is it's unregulated so lab testing is not required. The good brands do the lab testing and post those results publicly, but that's something that people need to be aware of as well, when you go into a dispensary at least in California, those products are lab tested beyond belief. I mean, it's incredible the degree to which we're testing these products for pesticides, microbial contamination. No other food product is held to that standard. So I think people can be pretty confident that when they buy a legal cannabis product in California, and I'm sure other states like Colorado and Oregon have similar practices, they can be pretty sure that what they're seeing is true in the dosing is true, too. There's a ten percent variance that the state of California allows. So if you say that something has 10 milligrams of CBD, they allow you to have 10.9 milligrams or 9.1 but you have to be within that ten percent variance. So it's fairly accurate. On the hemp side, the opposite is true. And in fact journalists have boughten a bunch of hemp products on Amazon lab tested them and like a third of them don't have any CBD at all, another third are like way off, you know, they'll say they have ten and they have one or they have a hundred, and then Third of them are accurate. So you really need to be careful. If you're going to buy hemp online. I think it's great that we have the U.S. Farm Bill and it's expanding cannabinoid products to a larger audience, but people need to really be careful about the products they're buying, make sure that it's from a reputable brand and make sure that there's a lab test results from a real third party lab, you know, you have to do a little bit of homework, but it's your health and your well-being at stake, so it's worth it.


Susan: Exactly.


Levi: So a couple of things you've talked about I think are important. I'd love to pick your brain about, one is THCA. Let's talk a little bit about raw cannabis because that's my jam. And then I also want to talk about the Entourage effect and I want to unpack that a little bit and talk a little bit more about terpenes. So THCA, you're taking THCA for your condition. So it sounds like THCA is similar to CBD and its therapeutic input at least for epilepsy and muscle spasms, is that accurate? 


Susan: Yes


Levi: What does it do that's different than CBD, why not just take CBD, why take both THCA and CBD?


Susan: Well, they're two different compounds. They're two different molecules. So the primary thing when you're using raw cannabis likeTHCA, CBDA, all of the compounds that end in A, that means it's the acidic version, it has not been heated. So thca is how the plant produces the cannabinoids and the reason why people smoke cannabis or they cook it is because when you apply heat to thca it converts to THC and that's where the psychoactivity happens. There's no psychoactivity in the thca but there are a lot of medical benefits for example, thca is fantastic for autoimmune disease it has a direct effect on our immune system to kind of you know, put it back into balance. So for people who have inflammatory bowel disease or MS, lupus, all of those autoimmune diseases, if you employ thca it's not only going to reduce the inflammation, but it also has an effect on your immune system in terms of becoming hyperactive, which is basically the case with autoimmune disease. Now CBD doesn't do that, CBD will reduce inflammation at the site of the inflammation, but it really doesn't have the kind of effect, you know from the source of the inflammation, which is our immune system, so those are two primary differentiations between your thca and your CBD. You wouldn't want to take thca for a seizure disorder, which is where CBD, that's like CBD's superpower, THCA's a superpower is autoimmune disease and helping to down regulate or up regulate your immune system depending on what your issue is.


Levi: So I want to talk a little bit about and this is, I'm going to speak anecdotally okay. This is not I don't have any science to back this up, but in my experience ingesting large amounts of these cannabinoids, which I've done mostly for pain and as an anti-inflammatory for when I broke about 10 years ago, and I've used cannabis, like you, instead of pharmaceuticals and that's how I really that's when the lights which went on for me. And this was back in 2011. And I found two things, similar to you, I found that micro dosing THC was actually very effective for me for pain management. There's a therapeutic window with THC where you can actually take too much THC and it begins to have an adverse effect. But a small amount can actually be very productive for anxiety, pain management and a lot of other ailments. But thca I seem to be able to ingest endless amounts of THC a with zero side effects may be the only side effect would be at super high doses, when I say super-high dose I'm talking like 600 milligrams, I do start to get, it can make me a little bit fatigued, but barely. As opposed to CBD, I've taken six hundred milligram doses of CBD and I pass out. I mean it's like heavily sedative. I don't know if that's just my experience in my physiology or if that's an experience that you've encountered treating people, but it seems like the raw cannabinoids from a raw full spectrum whole plant source seem to just interact with the body with no toxicity where the I know there is toxicity to the liver with THC and from what I understand with large amounts of CBD. Is that true?


Susan: Yeah, you know, there's a general approach of more isn't better. So CBD has a lot of very beneficial aspects in terms of recognizing and killing cancer cells, all kinds of different beneficial effects and wellness effects, but when you take too much of it or even with the THC you start to have kind of a different response. So it's called biphasic dosing. Whereas you increase your dose over time. There's going to be a tipping point where if you increase it anymore, you're going to start feeling dysphoric. You're going to be maybe having a little anxiety. And so if you do notice that you just back up your dose to what it was before without those kinds of feelings. So yeah any time you're anytime you're dosing you need to consider what cannabinoid it is you're taking. So the reason why you're probably having such a strong reaction to high doses of CBD is number one CBD is a muscle relaxant as well as an antidepressant and anxiolytic meaning it reduces anxiety. So these are quote unquote psychoactive effects because it does come from the brain, but it's not the same kind of psycho activity as THC. So if you take a large amount of CBD, you know, it's other muscle relaxants, for example, Valium, Ativan, Xanax all of those things just make you crash. Right? Well, that's the muscle relaxant effects of those drugs. CBD is also a muscle relaxant. It doesn't have the same overdose profile. In other words. If you take too much of the Ativan or the Valium you could die. You will not die from taking too much CBD but it will have a profound effect on you. It can make you very lethargic, sleepy, tired where you just don't want to move. That won't have that scary feeling that you get with too much THC.


Levi: Gotcha. The other cannabinoids that you didn't mention the makes me think of the antispasmodic, you know, kind of sedative muscle relaxing properties is CBN. Is that another cannabinoid you'd recommend? What is CBN good for? And I know that people use it for sleep. That's how it's marketed, but oftentimes I don't trust all the marketing hype. What do you know about that compound CBN?


Susan: Yeah, so I've read both camps: one camp says CBN really doesn't help with sleeping. Another Camp says, oh, yeah definitely works with sleeping. So CBN is basically the compound that is the result of aged THC. So, for example, if you have a bag of flower an old bag of flower that you found at the back of your drawer and it's been there for, you know, a couple of years and you go to smoke it, don't expect to get that high. You know, the euphoria thing is probably just going to put you to sleep right? Because the THC has been converted to CBN in the aging process or if it's been exposed to light or anything like that. So now they're making CBN available in tinctures, edibles. They market it as something that's good for sleep. I use it quite a bit in my practice and primarily for people who do have an issue sleeping. I usually use it in conjunction with some sort of CBD or you know, sometimes it comes with CBD, you don't want to take it as an isolate because you're really not going to get that great of result, but for some people it works great. They're like Hallelujah. I'm sleeping again. This is fantastic. They wake up. They have no kind of after effects and other people are like I didn't really feel anything. So again, you have to see how each person responds.


Levi: Yeah, you know CBN's never done it for me, you know, it's like the old bag of weed when you smoke it you just fall asleep, you know and maybe sometimes that's what you want. But any time I've taken large amounts of CBN, I do feel hungover the next day. I feel pretty groggy but it's an interesting compound. This is the new frontier right is finding what molecules for what condition and what amount and what combination of these molecules. You'd mention you said a word that is a big cannabis industry buzzword, but I don't think a lot of people really understand it, so I want to unpack it with you and that's the Entourage Effect. My understanding of what the Entourage Effect means is, specifically the interaction of cannabinoids and terpenes found in the plant and maybe even broader with flavonoids and other phytoactives, but primarily the interplay between terpenes, which are the aromatic compounds found in cannabis that make it smell like gas or orange or pineapple and how those hydrocarbons engage with these various cannabinoids and can really impact the effect. I know if I take a dab of THC distillate, right and distillate has had all the terpenes removed. It's just a purified, you know cannabinoid, or an isolate, it's a very linear experience, you know, I feel the effects of THC, but then if you add the terpenes suddenly it can be that energizing feeling or that couch lock feeling that people talk about with Indica, hybrid, sativa. When people say Indica -- THC is the same in an indica or sativa. It's really the terpenes that are driving the effects. Can you explain that a little bit to people that are totally clueless about this and I'm largely clueless about this myself to be honest. I know I like good weed when I smoke it, but I don't always exactly know the exact terpenes and how they’re influencing the experience. What do you know about this?


Susan: So terpenes have a huge effect on people's experience of cannabis and the effects of whatever product they're taking, so terpenes, as you were saying, are basically the essential oils. So that's why cannabis has such a strong odor where people recognize it in a second? And so the terpenes are the essential oils. Some common ones are, pinene which come from pine trees, myrcene which comes from mangoes, and limonene. All these different kinds of essential oils. Now some essential oils are sedating, some essential oils are uplifting, so there needs to be a little bit better consensus and nomenclature when it comes to the cannabis space because they talk about oh, well, that's an Indica that's a sativa or that's a hybrid. So Indica basically is what you want to look for if you have a lot of pain and you need some sleep. Sativas are more energizing, a lot of times people who are artists or you know, they want to get into the groove, they will reach for a sativa because it's more energizing and and they can get creative and you know, or just get the house clean and have a good time while you're doing it, but then the hybrids which are a combination of both. So when you have the terpenes like you are saying, the molecule of THC or the molecule of CBD is the same in both of those different varieties. So if you have an Indica something that's labeled Indica, if you look at the lab report you're going to see the essential oils of myrcene, linalool, you know, the very sedating, calming types of terpenes. If you reach for a product that is labeled as a sativa and you look at the lab results, you're going to see different terpenes. You're going to see pinene, you're going to see limonene, you're going to see all of these other kinds of uplifting and energizing types of essential oils. So the Entourage Effect is basically that, so the essential oils, even though you have the exact same amount of THC in one plant or in one product as you do in another, it's the essential oils that will determine that product's effect on you. So it's a very good idea like you were saying don't use anything that's not lab tested. Do your homework, look at the lab results and like you were saying when you find a cannabis that you like then look at the profile of that cannabis and see what the terpenes are in there. See what the percentage of the cannabinoids are because what I have run across when I'm working with patients is products come and go. You know a product that I had been using for years with somebody may not be available anymore. So I just take the lab results of the product that worked for them and I try to find another product that has a very similar profile. So it's important to know what it is your body responds to so that you aren't locked into just one product if that product goes away. You can very easily and seamlessly go into another product and be able to continue your treatment of it.


Levi: This is really the argument for whole plant products. You're getting not just a single molecule or two molecules, you're getting hundreds of phyto-actives, cannabinoids, terpenes, flavonoids that are all interacting with one another and not only influencing one another but actually amplifying the effects, like I know in the stoner world, you know myrcene, which like you said comes from mangoes is legend to increase the high which is, I don't know if you know this, but a lot of people because there's a whole YouTube thing, you know, like you eat a mango before you smoke weed and you get like 10 times higher. I've tried it. It's real. I don't know if it's just the power of suggestion, but the myrcene really is amplifying the effects of THC. So you're getting, if you find the right product that's whole-plant you're getting something that's vastly more valuable than a single molecule product. Although, like you said, you might not know exactly what's working someday, the pharmaceutical industry will probably pin it down to, well for this type of epilepsy we need CBG CBD and THC with myrcene at this quantity, but we're light years away from that at this point. So kind of the best shot people have is to find a whole plant product that's coming from a really good flower that's being extracted well, and not with a bunch of residual solvents left over and then look at the terpene profile of that product so you kind of know what's working for you in case they go out of business, which happens a lot, and then you can find something similar. I think that's why these strains of cannabis, Blue Dream, OG Kush kind of do have these followings, like there are literally people in SoCal that will only smoke kush, you know, and then there are people up north that will only smoke Jack Herer, you know, they have these these cult-like followings because people have found what works for them and it's the terpene profiles of those strains that work for you. So, you know for me it's like, you know it I like to mix it up to you know, I don't like to just take the same product. I think it's important to have diversity and to allow your body to experience these different compounds and they might affect you differently on different days depending on what you've been eating that day or the amount you've been exercising and there's a lot of variables. There's no there's no cookie cutter answer here, but I think I'm always a believer in working with the plant and trying to utilize it in its most natural state because you are getting all of the the real potential of the plant and you might find something that's a home run for you, that makes you feel good,  doesn't have toxicity, you know solves at least a lot of your issues and I think right now, you know, we all need like a little bit of stress relief and anxiety relief in probably boredom relief too and I think cannabis is amazing for all three of those, so I think we have a really bright future in this industry. Really amazing stuff. I mean, I would like to bring you back on the show to talk about the endocannabinoid system, because I don't think we have enough time today to really cover that but I think it's important for people to understand at least generally the endocannabinoid system. So let's just take a minute on it and we can go into it in great detail another time, but basically from what I understand, I'll give you the layman's version and then you can fill it in, there's primarily a CB1 and a CB2 receptor. There are more ways that cannabis interacts with our system, but when we're talking about the endocannabinoid system, if you Google endocannabinoid system, you will see CB1 and CB2 receptors. Can you explain what those two receptors are and how they interact with these cannabinoids?


Susan: Sure, so when scientists were studying cannabis, they were able to basically make the compounds radioactive and then they would follow them to see, okay, so how is this working? Because they wanted to know how we are getting these effects? And they discovered that we have cannabinoid receptors in our brain and in our spinal column. That's the CB1 receptor and then we have CB2 receptors basically everywhere else. So the CB1 receptors, those are the receptors that THC really interacts with so when you consider that it's in the brain and the spinal column and you get all the psychoactivity, it's kind of you know, it makes sense then your CB2 receptors are everywhere else, all in your soft tissues in your in your skin and everywhere. So the CBD compound is what really interacts with those, it doesn't attach or anything else, but if it affects, it modulates those receptors. So basically we have these receptors, so when we ingest cannabis in whatever way we do it they go to those receptors and then they create a response, a bodily response. So when you have the CB1 receptors, so, you know, for example any of the other well your example of the myrcene, it's not a wives tale. They know that myrcene reduces the blood brain barrier for these cannabinoids. So you get an even greater input of THC into the CB1 which is in your brain and in your spinal cord because the myrcene has opened up that barrier that kind of keeps your brain separate from everything else in case you have a toxin and you know bacteria or whatever. So these CB1 receptors have an affinity for particular cannabinoids which then we get the effects of those cannabinoids. So what else can I tell you about the CB1 and CB2? I think that's really about it, you know, and for example like CBD you were talking about when people take too much THC and they get very very uncomfortable. It's because the CB1 receptors are open and getting flooded with THC. CBD can block that. So if you get very high and you take an isolate of CBD because you don't want to take any more THC, you can take an isolate it's going to block those receptors and it's going to bring you down.


Levi: Interesting. So every stoner, everyone really generally should have a pure CBD product on hand in case they get too high and they can actually bring themselves back down. That's really interesting.


Susan: Yeah, you can do it with peppercorns. Peppercorns have a compound called beta-caryophyllene that does a very similar effect on the CB1's. So if you get too high just chew on like 4 or 5 peppercorns and it will block your CB1 receptors.


Levi: I did not know that and that you know, that really makes my favorite, I love all weed, had I'm such a stoner, but really if I could only smoke one type of weed for the rest of my life, it would be Kush, and the reason why is because Kush gives me therapeutic value. It's a great pain reliever, but I don't get paranoid, I don't get too high and it must be the beta-caryophyllene because beta-caryophyllene is the dominant terpene found in Kush, or one of the dominant. So that's, I did not know that, that's fascinating. Like literally, it's like -- eat some black pepper?


Susan: You need the peppercorns to get the active beta-caryophyllene.


Levi: So literally what you eat while using cannabis could impact the medication and this is probably true for any medication right that you're taking, these plant compounds. So the endocannabinoid system, I want to kind of finish with this because I think this is really important for people to understand, because oftentimes we see cannabis as this foreign thing, but the body has receptors, because the body produces cannabinoid like molecules called endocannabinoids. 


Susan: Exactly.


Levi: So THC and these other molecules just look enough like these molecules that we already produce in our body. So it binds to these receptor points. The human body doesn't make molecules for no reason. We're a very efficient operating system. So these endocannabinoids obviously have a function and I got to tell you quickly about my experience with endocannabinoids. So I've started running recently. And recent research has shown us that the runner's high that people talk about is literally an endocannabinoid production. So when you run long distance and you have to run for like 30 minutes apparently to really produce large amounts of these endocannabinoids, but you literally get high. It's like it's literally the natural high from running and it's amazing, anybody that runs. Anybody you know that's a runner, they're always in a good mood, they're like annoyingly happy because they're high all the time (Laughs).


Susan: (Laughs) That's exactly right. Yeah, I love Raphael Mechoulam has a great way of saying it.. He said "the body doesn't produce receptors hoping that the human will ingest something outside of it." It produces receptors because the body produces its own substance to interact with it and that's exactly right. So those are our endocannabinoids which are the two primary ones are anandamide and 2ag and they're similar almost identical to THC and CBD.


Levi: I know from Mechoulam there are a lot of endocannabinoid like compounds that the body produces too that are like the next wave of research that's going to be mind blowing, there's probably just like they're a hundred over a hundred known cannabinoids in the cannabis plant, phytocannabinoids, there's probably over a hundred endocannabinoids that the body's producing, I'm just guessing, but there I imagine there's dozens if not over a hundred that we haven't even scratched the surface of understanding yet. So yeah, a lot of research to be done.


Susan: It's very exciting. It really is. I mean from a western medicine steeped practitioner, this is like, so exciting to be able to have a whole new frontier for finding ways to help people and not only deal with disease, but prevent it to begin with. You know that the patent that the U.S. Government has on cannabinoid specifically states that it prevents Alzheimer's, Parkinson's disease, all these neurodegenerative diseases, which I am totally in your camp with wanting to ring the necks of these people who keep it away from people who could really benefit from it, it just it makes me crazy. So and that is a discussion for another time, but you know, it's very exciting to be a health care person with an open mind that can see the potential of this and know that research is happening and we have everything in the world to look forward to and it's not with just knew, you know side effect pharmaceutical drugs. You could grow it in your backyard. It's fantastic. 


Levi: I think you just hit the nail on the head there because the pharmaceutical industry doesn't want people to know that, that you can grow your medicine in your backyard, and I can show you how to make really great topicals and tinctures from that.


Susan: I love your topicals!


Levi: Thank you. Well Susan, thank you so much. I think we got some really great stuff here. I think the work that you're doing is so important. Keep doing it. You know, I'm so glad that you found cannabis that it took you down this path and that it brought us together. And I know you've been a supporter of what I've been doing for years and you know right back at ya. I think it's you know, it's going to take it's going to take people like me from the industry, old stoners and growers to network with medical professionals and scientists that have you know, the have the right and you know letters at the end of their name so that people are going to listen to them. So thanks for being an activist. I know it's not easy. I know there's a lot of you who don't learn about the endocannabinoid system in nursing school, or at least you know you touch on it briefly. So a lot of the doctors and nurses out there, they just don't know. So like people, you're going to help educate people in your field, which is crucial. We're never going to advance cannabis therapeutics without getting doctors and nurses on board, has to happen. So thank you for all the work you're doing. I really appreciate you having you on Head Change, my first guest. This was great. Let's do it again soon.


Susan: Absolutely. This is really fun. It's so good to see you again.


Levi: Thank you for joining me on Head Change, the podcast that puts you in a better headspace. I've been your host Levi Strom. Be sure and join us next time for another episode and until then, peace.

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