Decoding Cannabis with Dr. Staci Ann Gruber

Can cannabis really improve your sleep, help regulate your mood, and treat chronic pain? Neuroscientist Dr. Staci Gruber explains how cannabis works in the brain, what the latest research reveals about its therapeutic potential, and how different cannabinoids and delivery methods can make all the difference.

Links to resources mentioned in this episode: Women’s Health Initiative at Mind (WHIM)

Check out Sex Ed with DB on Apple Podcasts, Spotify or wherever you get your podcasts.

Note: In this show, we use “women” as shorthand for people with XX chromosomes. We understand sex and gender are more complex, and acknowledge the experiences we describe reach beyond that word.

 

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Episode Transcript

Speaker 1 (00:17):
Pushkin. Hi everyone, Doctor Poyter here, I'm popping in to
let you know that we're working on a special episode
of Decoding Women's Health. We're i'll be answering your questions
about one of my favorite topics, hormone therapy. If you've
been wondering about the different types of therapy, when it

(00:39):
might make sense to start possible side effects? Are really
anything else? This is your chance to ask. You can
leave us a voicemail at four FI five two one
three three eight five, or send an email to Decodingwomen's
Health at Pushkin dot fm and let us know if
you'd like to stay anonymous, or if you're up for

(00:59):
having your voice featured on the show. I'm so excited
for this one. Hormone support is such a misunderstood area
of medicine, and there's a ton of new and fascinating
research to talk about together. I can't wait to hear
what you're curious about.

Speaker 2 (01:14):
Our first paper. They said, aren't you worried that these
are people who are just looking to be high but
stay within the limits of the law. No, I'm not,
because most people that I deal with do not want
to be intoxicated. We have a clinical trial for endometriosis.
And the very first thing almost every one of them
has said to me is it's not going to get
me high, right, first thing, end of the box. Because
people have whole lives. They have work, they have children,

(01:36):
they have activities, they have partners, they have school lunches,
they have dinner dates, they have things. They don't want
to be high all day, every day.

Speaker 1 (01:46):
Welcome to Decoding Women's Health. I'm doctor Elizabeth Poynter, and
today on the show, we're talking cannabis. You know, medical
marijuana first came on my radar about ten years ago
when it first became legal in the states where I practiced.
That meant as a doctor and as a surgeon, I
had another treatment option to explore for my patients who
were dealing with pelvic pain, endometriosis, and other chronic pain issues.

(02:11):
The patients that I referred to medical dispensaries generally had
positive experiences, and over time, more and more of the
women I treated began sharing that they were using cannabis
for other conditions, not just for their pain, but also
for psychological issues like anxiety and depression. This was many
years ago now, and so much has changed. Access to

(02:32):
these products has exploded in recent years as more states
legalized both recreational and medical marijuana. So before recording today's interview,
I did some homework. I reviewed the latest medical cannabis
research from top journals, and for the very first time,
I visited my own local dispensary. It was totally overwhelming.

(02:53):
There were so many options. The sales representative or bud
tender as I learned that she was called, was kind
and tried to be helpful, but she seemed to struggle
to answer some of the more specific questions that I
had about what products might be the best for certain
symptoms and conditions. For many women, and exploring this world
for the first time, I can totally see how it

(03:14):
might be very difficult to know what to ask for
or how to proceed safely in a way that addresses
your individual health needs. Fortunately, today we have an exceptional
guide to walk us through all of this. My guest
is doctor Stacey Gruber. She's a neuroscientist and an international
expert on the health effects of marijuana. This made me

(03:36):
do a deep dive into the science of the connabinoid pathway.

Speaker 2 (03:41):
Super curious here and it's constantly changing what we know
today is different from what we'll know tomorrow. You know,
people used to think these things worked one way, and
they don't. So there's never a dumb moment.

Speaker 1 (03:50):
That's the great thing about science. If you believe in science,
I agree with you. Yes, yeah, that's a whole another episode.
Doctor Gruber is the creator and the director of the
Marijuana Investigations for a Neuroscientific Discovery, or the MIND Program,
at McClain Hospital. She's also in a so Sociate Professor

(04:11):
of Psychiatry at Harvard Medical School. The overarching goal of
her research is to understand how medical cannabis affects individuals
over time. She and her team study how cannabis use
influences things like anxiety, depression, sleep, chronic pain, and reliance
on other medications. They began observing people before they start

(04:35):
using medical cannabis and then follow their progress for months
and sometimes years to see how things change.

Speaker 2 (04:41):
In twenty fourteen, I launched the MIND Program because in
twenty twelve, Massachusetts was on the precipice of legalizing cannabis
for medical purposes, or I should say relegalizing cannabis was
legal in this country. Was part of our US pharmacopeia
it fell out of favor, became illegal, landed in the
most restrictive class of the Controlled Substance Act. But in
nineteen ninety six it was reintroduced in California for medical

(05:04):
purposes and reapproved. So in twenty twelve, Massachusetts was about
to approve cannabis for medical purposes, and I decided, let's
look at the literature and see what we know about
the long term effects of medical cannabis use. Scouring the literature,
I found almost nothing, and so that's why I launched
this program. There has never been a program dedicated to
looking at the long term impact of medical cannabis use,

(05:26):
despite the fact that it was relegalized in California in
nineteen ninety six. Almost everything we know about cannabis has
come from studies of recreational consumers, primarily young, healthy recreational consumers,
and that's a bit of a problem. In fact, it's
a huge problem. Individuals who are using for recreational purposes
by design, are looking for products with notable THHC or tetrahydrocannabinol,

(05:48):
the primary intoxicating constituent of the plant. In contrast, our
medical cannabis patients aren't necessarily looking for that same experience.
In fact, many will tell you I don't want to
be altered or high. As a result, it's very challenging
to really understand what the actual impact is on so
many of these indications and conditions that people will swear uptown,
left and right cannabis or cannabinoids are effect before. So

(06:12):
since twenty fourteen, we've spent a lot of time doing
longitudinal observational studies as well as some cross sectional studies
and some survey studies, but mostly focused on the what
is considered the holy grail getting to the clinical trial models,
which is where we are.

Speaker 1 (06:27):
So it sounds like patients originally led you to look
at cannabis. What particular aspect of it drew you into
looking at cannabis other than the kind of lack of data.
Was it you saw efficacy? Did you see people getting
better using recreational cannabis? What did you observe that drew
you into this area of research.

Speaker 2 (06:45):
So the first thing I would say is that going
back to the sort of recreational days when I was
still spending a lot of time in more general psychiatry,
I noticed a very interesting trend. We spent a lot
of time looking at patients with bipolar disorder, and I
would hear patients say, you know, when I feel like
I'm spiraling out of control, I take a few hits
and I feel better. On the other side, you'd hear

(07:05):
patients say, I feel so depressed and down. I take
a few hits. I feel better. I had never heard
of anything like this, and so this got me thinking,
so we did a study. I wrote a grant to
look at mood changes in individuals with bipolar disorder pre
and post cannabis use, and we gave people little devices
to chart their mood after every time they used cannabis
and three other times a day. And we found that
individuals with bipolar disorder who used cannabis actually had greater

(07:29):
mood relief, if you will, from their symptoms relative to
those patients with bipolar disorder who didn't use cannabis. What
I was hearing was really individuals saying that they felt
more stable.

Speaker 1 (07:39):
So it was working on both the manic side of
the bipolar and the depressive side.

Speaker 2 (07:43):
It seemed too for certain people. So that got me thinking,
how could something both provide relief from feeling hypomanic or
manic and give you more of a little bit of
a lift if you're feeling depressed. And I was desperate
to understand how both could be true, how can we
harness some of these things? And that's really how it began.
And the truth is, cannabis is a remarkable plant with

(08:04):
over five hundred compounds. You know, we have this tendency
to say cannabis and we refer to any and all
things the plant. But it's a missoe we shouldn't do that.
It's not one thing and it's not one size fits all. Yeah,
let's dig into that a little bit. Let's do cannabis
one oh one for our listeners. Okay, so, can you
just briefly explain the difference between cannabis and hemp, and
cannabis and cannabinoids and kind of the important components, and

(08:27):
just give us an overview of cannabis one oh one
what we need to know cannabis one on one. I
guess I would start by saying that Cannabis sativa l.
The plant is remarkably complex. It is comprised of over
five hundred compounds. Some of these are phytocannabinoids, things from
the plant that interact with our own system of chemicals.
Receptors throughout the brain and body the endocannabinoid system. These

(08:47):
are things like delta nying THHC or tetrahydric canabinol, the
primary intoxicating constituent of the plant that our recreational folks
are desperate to find. No judgment, We're fine with them.

Speaker 1 (08:57):
That's what makes us high, right, The THHC.

Speaker 2 (08:59):
That's what makes you high, exactly, So primary intoxicating constituents
of the plant. Cannabi diol or CBD is a primary,
but not the only, non intoxicating constituent of the plant.
Often touted for medical benefits.

Speaker 1 (09:11):
CBD is an anti inflammatory, right.

Speaker 2 (09:13):
CBD is touted for its anti inflammatory actions. It's also
got lots of other actions, but yes, it's one of them.
But there are literally dozens and dozens of other cannabinoids
that we spend time focusing on. There are also things
like terpenes, the essential oils that give cannabis its characteristic
scent and flavor profile. These essential oils, by the way,
present in every plant, have their own biobehavioral health effects.

(09:35):
As it turns out, flabinoids waxy penal. So the plant
is complex. It's not just THHC and CBD, as people
will often pretend a whole plant. Full spectrum product contains
everything from the native plant that made the product, so
that's THC, cbd, any and all cannabinoids, terpenes, flabinoids, everything.
A broad spectrum product is identical except that it has

(09:58):
no quantifiable amounts of THHC present, again the primary intoxicating
constituent of the plant. There are some people who, for
legal or health reasons, cannot have any exposure to delta
nine THHC, So broad spectrum products are like full spectrum products,
except they don't contain quantifiable amounts of THHC. Hemp is

(10:18):
a variety of cannabis with inherently low levels of delta
nine THHC. It's often referred to as industrial hemp because
it was used for industrial purposes. These are basically at
this point excluded from the Controlled Substance Act, which means
that products that are created from hemp are not under
the same federal jurisdiction. That is, they are not federally illegal.

(10:39):
If you will, as cannabis or quote marijuana is, can you.

Speaker 1 (10:43):
Speak to us a little bit about delivery systems, I mean, smoking, vaping,
edible vaginal suppositories for pelvic pain s.

Speaker 2 (10:52):
Yes, all the above. Root matters. Think of it as
a GPS like, it matters which way you go. So
the fastest way to get an effect from using cannabis
is or a cannabinoid based product is what I would
call a root of inhalation, right, so either smoking or vaping,
so we inhale, it goes into the lungs, into the bloodstream,
into the brain. That's what I would call moments to
minutes to get an effect. We use a sublingual delivery

(11:16):
system for all of our clinical trials because the area
just under the tongue, the salibary mucosa, is incredibly rich
and absorbent, and instead of waiting for you to swallow
something and digest it, which we're going to get to
in a second, with edibles, your body can actually use
it much more effectively, much more quickly. Edibles, whether that's
a brownie or a cookie, or a candy, or even
a beverage, although beverages are slightly faster anting than cookies

(11:39):
and brownies. So this is the type of product that
people are often very happy to explore. They think it's
going to be terrific and they eat it or they
drink it, and they wait what they feel is an
appropriate amount of time, they don't feel anything, and then
they have more. It takes a very long time, comparatively speaking,
for you to get an effect from an edible or
consumed product. That's because you have to digest it. Interestingly,

(12:01):
cannabinoids are processed then by the liver. Your liver process
is all compounds, all drugs, right, and things like delta
nine THHC. The primary intoxicating considering of the plant is
actually converted to something even more intoxicating, eleven hydroxy. I
always tell people hold on root of administration is important.
If you're eating it, you have to give yourself plenty
of time to feel the effect and to recover from

(12:23):
the effect. Isn't the same as smoking or vaping, where
it's almost immediate.

Speaker 1 (12:27):
Any damage to the lungs with us smoking. So you know,
there's a lot of dispute about this, and the twenty
seventeen Nason Report, the National Academies of Science Engineering in
Medicine looked at what indications or conditions there might be real,
substantial or moderately significant evidence for it with regard to
cannabis being efficacious, and they did review things like head

(12:48):
and neck cancers, and the rates were not significantly higher necessarily.
I think it's early still to figure that out. And
really most people acknowledge that the amount of cannabis that
people are smoking or vaping and the ways in which
they're doing it may be very different from things like
cigarette smoking, So maybe that's one of the differences. But
there's lots of debate about the carcinogenic compounds and what's contained,

(13:10):
so I think we don't know the whole story yet
for sure. But there are people who would prefer to
use a root of inhalation, so smoking or vaping. Dabbing,
of course, is another where people take a very very
concentrated Bullus concentrates are exactly as their name suggests, designed
to give the consumer or patient a big bang for

(13:30):
the buck. These are primarily THHC focused and start at
about forty five or fifty percent PhD and go north
of ninety nine percent. How do you dab?

Speaker 2 (13:39):
So, in the case of an actual quote dab this
little blob of very concentrated product, you actually need something
that you can get very very hot with a blowtorch.
It doesn't look anything like conventional cannabis.

Speaker 1 (13:49):
Use.

Speaker 2 (13:49):
Like when we think about people passing a blunt or
a spliff or a joint or something, or a bong.
You see people with a little blowtorch and a little
flat area. They get very very hot, and as soon
as they put this little tiny blob of very concentrated
product on it, they inhale. They get this giant bulus
all at once. Then we get to the you know
sort of we had the oromycoastal or transmucostal. So things

(14:11):
like suppositories vaginal or rectal people are using for more
localized relief, and they do seem to be efficacious for
some folks. For some things, we never see recreational folks
using suppositors. I will tell you if you had to
come across a recreational purssses, yeah, that's my favorite way.
Now nobody says that.

Speaker 1 (14:29):
No, how about for enhancement of sexual pleasure? Do you
see that? Yes, vaginal suppositories.

Speaker 2 (14:34):
I think vaginal suppositories began as a way of increasing
pleasure and increasing lubrication and decreasing discomfort from many many
individuals who are having any kind of discomfort around sex.
And it was also initially tattered as a way of
you know, sort of getting yourself in the mood. But
at this point we certainly see a number of products
in the marketplace designed to address or ameliorate symptoms relative

(14:57):
to meastural related discomfort or other types of discomfort, as
well as enhancing sexual pleasure. And then there's the daily
suppositories for women quote of a certain age. As time
marches on, right, lots of people experience the things like
vaginal dryness, so some of these oppositors are used on
a daily basis, or oils are used.

Speaker 1 (15:16):
So what are you finding And let's just speak a
little bit about midlife women, right, do you see a
number of midlife women using cannabis for medical reasons and
not recreational reasons? And if they are, what are they
using it for? Hot flashes, mood disruptions, sleep anxiety.

Speaker 2 (15:33):
So the answer to both those questions is yes, yes,
and yes. The top three indications for medical cannabis use
across the country are chronic pain, mood or anxiety, and
sleep disruption. Not surprisingly, these are the three top conditions
we hear about in individuals who are either perimenopausal or postmenoposal,
so that's not a surprise. Individuals are increasingly interested in

(15:55):
using cannabis or cannabinoid based therapies to help because they
have very limited treatment options currently and very limited clinical response.
As it turns out, those who get clinical response from
certain conventional medications often complain about side effects, and the
cannabis or cannabinoids they may be able to reduce or
completely eliminate that aspect from the equation, which is pretty amazing.

Speaker 1 (16:17):
So you started the Mind program, you have the Women's
Health Initiative within the Mind program. Can you tell me
what kind of questions you're trying to answer with that?
What are your goals? Where are you moving with that?

Speaker 2 (16:31):
I didn't realize what a vastly understudied population we are.
I didn't. I really didn't. I didn't think about it.
You know, in psychiatry we think about things that are
disproportionately higher in women than men, like anxiety disorders. Right,
things like dementia occur in women more often than in men.
We have all of these things that we need to
be mindful of. Guide Ecologic pain, by the way, affects

(16:52):
over one billion with a b B one billion, and
we do relatively little, or we've had relatively little in
terms of these giant discoveries in terms of allowing people
to be better and not just feel better, but actually
be better. Women or the Women's Health Initiative at MIND
was a program that was dedicated to looking at conditions
or disorders that either disproportionately or exclusively affect women or

(17:15):
some non binary folks. Because there's so little work.

Speaker 1 (17:20):
In this area, Stay right there. We've got lots more
from my conversation with doctor Stacey Gruber. Coming right up,

(17:42):
Can you describe a little bit about the endocannabinoid pathway
in the human body and how cannabisc and CBD are
impacting these pathways?

Speaker 2 (17:51):
Sure, I would say it very sort of. The overarching,
you know, ten thousand foot summary is that every mammal
has an endocannabinoid system, highly understudied, highly undervalued, and its
whole purpose really is what we call homeostasis. We're keeping
things in balance, in check, mood, appetite, pain, all of
these things are impacted by the end cannabinoid system, and

(18:13):
it's comprised of these chemicals and receptors. And for chemicals,
they're our own cannabinoids. En do cannabinoids, and we have
receptors including CB one and CB two receptors. CB one
receptors primarily throughout the central nervous systems, CB two receptors
throughout the periphery. And it appears that THHC is really
a very very strong agonist, that is, it binds very
effectively to CB receptors.

Speaker 1 (18:35):
So the CB two receptors are all throughout our body, correct,
not just our central nervous system.

Speaker 2 (18:39):
Throughout the periphery, right, So you know, you see CB
two receptors sort of everywhere else a few in the brain,
but not like CB one receptors, And that may be
one of the reasons that initially people were rather stunned
to see that things like Crohn's disease, INFLAMMATORID bowel disease
were responsive to different types of cannabinoid based therapies. Not all,
not all cannabinoids are created equally, and we have to

(19:02):
be mindful with some actions come reactions, and so it's
very important to know which cannabinoids for which types of indications,
in which patient populations. And until relatively recently, we were
under the impression that cannabidial or CBD also must exert
its effects through the CB one and CB two receptors.
As it turns out it's not true. It appears that

(19:24):
CBD modulates its effects through five ht one A or
serotonin receptors, other chemical and receptor systems. So it's really
very easy to understand then how you get a bigger
bang for the buck with more quote players on the field.
If you're involving more than one receptor subtype and chemical
messenger system, you're going to get more of a response.
Right and medical school, we don't spend a ton of

(19:47):
time thinking about the endocannabinoid system. Nobody hears about it,
but it turns out to be incredibly important. Again, when
I think of it, I think as keeping everything in balance,
your ability to keep things at status. Quote, that's its
entire goal. That's the endocannabinoid system.

Speaker 1 (20:03):
Can you just give us a broad overview of how
cannabis is impacting the brain for an axiolytic effect or
a pain of fact and that type of thing, like
what is it actually doing in the central nervous system
to help our anxiety, to help our pain?

Speaker 2 (20:17):
I think that the jury is absolutely still out with
regard to the specific absolute mechanisms, because so many different
types of products wind up being efficacious, and those different
types of products have different constituent profiles, and so you
can't necessarily know exactly. Okay, well, we know it's this
receptor system in this one of this one, and I
tend to think of us as being comprised of dials

(20:37):
and not switches, right, what we really want to do
in individuals who are anxious, and I will tell you
in general, when we can allow people to take an
emotional breath dial down that master gain. Everything begins to
fall into place. And so I think of all of
these things, whether it's anxiety or some of the other
mood related symptoms, but particularly for anxiety, it would appear

(20:58):
that higher levels of CBD being administered in our case
sublingually where people are holding for two full minutes, that's
the secret two full minutes multiple times a day, very
low to no levels of depending on what we're doing,
we do tend to see this down regulation right of
this hyper responsive activity. The real data will come when

(21:20):
we can actually look at the underlying change in what
we call endocannabinoid tone. So when you can take samples
of individuals before they use these products and then follow
them over time and look at how that changes, we'll
have a better sense of exactly what's happening, but I
like to think of it as again turning down this
unbelievable response system. And people with real anxiety will tell

(21:42):
you it is paralyzing. They can't get out of it,
they can't stop ruminating, and so this ability to sort
of allow them to shift cognitive set is hugely life changing.

Speaker 1 (21:54):
I'm definitely going to steal that we're made of dials,
not switches, because I think in modern medicine and pharmacology,
we think we're going to turn this pathway off or on,
flip it off or on, and it's not. It's an
adjustment in multiple pathways and dials. I would like to
ask you about cognitive health because that is one of
the concerns obviously with younger individuals who are using cannabis.

Speaker 2 (22:14):
Those are the kinds of questions we started off asking.
I was very interested in understanding the cognitive changes that
we might see in individuals who are using medical cannabis.
We spent decades documenting cognitive decrements associated with recreational cannabis use,
particularly in those who began using cannabis regularly or consistently
early prior to age sixteen. Not surprising because again, the

(22:37):
brain is nerd, developmentally vulnerable, or as I like to
say to my cannabis audiences, half baked. Right, the brain
is under construction, not vulnerable just to cannabis, but to
other substances alcohol, injury, illness, just vulnerable. And my question
was for those who are beginning medical cannabis use, who
are adults beyond this period of vulnerability, would we see
the same decrements? And I will cut to the chase

(22:59):
and give you a spoiler alert and tell you absolutely
we do not see that, which is amazing. It is
not what people think.

Speaker 1 (23:05):
So the brain develops to what age like, where are
we most vulnerable to alcohol and cannabis?

Speaker 2 (23:11):
Yes, Interestingly, we used to think that the brain was
quote done by the time we hit puberty. This is
long ago and far away, and we now know that
the brain continues to develop throughout the second and into
the third decade of life. And so when we see
individuals who are using cannabis regularly that are you know,
let's say, age fourteen or fifteen, that may wind up

(23:32):
looking very different in terms of a cognitive profile, maybe
a clinical profile for sure, in terms of brain structure
and function relative to someone who began using much later
in life. That's a really important finding.

Speaker 1 (23:43):
What's the data on cognitive health and older individuals and
brain health in terms of cannabis use.

Speaker 2 (23:49):
We're just starting to get some of that data on individuals,
let's just say from midlife on over the age of
forty forty five. And you know, I used to move
that line depending on where the number was and where
I was just kidding, But the truth is, it looks
very different if you begin to use cannabis later in
life as opposed to when you are again neurobiologically or
or neurodevelopmentally vulnerable. Our data suggests that in individuals that

(24:12):
we see over the course of one year, and we
take people again, we look at them at baseline and
we give them a whole neurocognitive battery, and we do
the same thing at three months, six months, twelve, fifteen, eighteen,
twenty four, and now we go out for years and
even just looking at baseline to one year. When we
think of recreational cannabis ues and what we know, especially
from young folks, we generally see these frontal executive decrements,

(24:34):
so the ability to inhibit an inappropriate response, for example,
the hallmark of somebody who is let's say mature versus
somebody who is not When we're coming along and we're
in our teens. Unfortunately, our frontal cortex isn't necessarily online
as we age. That's the first part to go. That's
why babies and old people have trouble with inhibiting, right,

(24:54):
So they just blurred things out. There was a pre
clinical study that was done years ago in free groups
of mice that was really quite stunning. A group of
juvenile mis let's think of them as adolescents, outperformed middle
aged and older mice investigators that inserted a tiny little
pump delivering only THHC. And now the adult let's just

(25:17):
say middle aged and older adult mice outperformed the young
mice and the young mice when exposed to THHG in
the tournament. So the brain is vulnerable to certain types
of cannabinoids. It doesn't appear that it's the same case
necessarily for things like CBD, which has been touted as
potentially neuroprotective. So it's important to understand that age matters.

(25:41):
What you do and when you do it makes a difference.
And our folks certainly are not demonstrating decrements across the
board in frontal executive tasks. And from a brain imaging perspective,
you know your brain is comprised of gray matter, white
matter and CSF and gray matters are hard working neurons.
White matter, you know, this is what connects brain region

(26:01):
to brain region for good communication. And you want white
matter to have what we call high integrity or coherence.
We did a study our medical cannabis pations and what
we found was that, and again we compare them to
treatment as usual, folks. What we found is relative to
baseline with no cannabis on board, we don't see changes
or decreases in white matter organization or coherence. Over time,

(26:21):
we see increases that stunned me. Our studies of recreational consumers,
younger cannabis consumers had lower levels of white matter integrity
or coherence. We do not see that in adults who
begin using in midlife. In fact, we see increased white
matter coherence. This is perhaps the most surprising thing for

(26:42):
most people.

Speaker 1 (26:43):
So, if a woman wants to explore using cannabis to
help her health and well being, what are some guidelines
for her? What should she be aware of? What should
she ask if she goes into a dispensary, what kind
of questions? What should she look out for?

Speaker 2 (26:58):
I would say the overarching things to be mindful of,
like what are the top things you say to people?
Start low and go slow. As an obvious one, here's
the thing that people don't know about cannabinoids. Necessarily, you
can always add, you can take away. Never Once it's in,
it's in. You can't really throw it up or poop
it out like it doesn't work that way. It's in, okay.
And so what we want to be mindful of is

(27:20):
the root of administration and knowing that you can always
add to what you've taken. So it's better to err
on the side of less rather than more until you
know how you're going to respond to different products, and
they are different. A gummy created for sleep versus pain
versus anything else, even by the same company, may very
well affect you very differently because the constituent profile is different.

(27:43):
What works for your best friend, your husband, your girlfriend
may not work for you. That's the other thing to
be mindful of. Be mindful of the here just try
this phenomenon.

Speaker 1 (27:52):
Eh.

Speaker 2 (27:53):
I had one patient who said her husband said, oh,
this is exactly what you need right now. And he
gave her something that was the equivalent of about fifty
milligrams of THHC. Look didn't dend well. Low doses of
THC are generally considered for many people angxiolytic. That is,
they can help reduce anxiety for the majority of individuals,
and in fact, at certain levels everyone, THHD can be exogenic.

(28:13):
That does, it can create or worsen anxiety. So you
have to be very very careful. And to me, a
quote small dose is not what other people's small dose is.
Five miligrams is not a small dose. That's a full dose.
Governor Hickenlooper and Colorado back in the day twenty twelve,
proposed ten milligrams of THC per serving. That was dropped
by Nora Walkoff, the director of NAIDA, the National Institutes

(28:34):
on Drug Abuse. So what's a small dose in my world?
Less than one milligram? And people laugh, they go, oh,
come on, you can't get anything. No, I can get
activity at a receptor, which is what I'm looking for.

Speaker 1 (28:45):
And then you have to be careful, like if your
gummy is that ten milligrams are five milligrams and you
cut it up, you have to make sure it's a
homogeneous gummy, right, because some of them are not so homogeneous.

Speaker 2 (28:55):
Edibles are the most challenging products in terms of dozing,
in terms of making sure that you know, if it's
a batch of brownies that a well intended manufacturer has created,
does the brownie on the bottom left have exactly the
same profiles a brownie in the bottom right, I don't know,
And it depends did you tip the pant? All these
things matter, and so not to scare anybody, but again,

(29:17):
start with something small, smaller than small. Start with a
quarter of what you think you should have, and then
add don't go the other way because unfortunately I get
the calls in the middle of the night where people
are in the emergency group, and that's decidedly unpleasant and
should be avoided.

Speaker 1 (29:31):
So start low and go slow. And what's right for
your friend is not right for you, and you've got
to figure it.

Speaker 2 (29:36):
Out your own. Metabolism affects things. What other products or
compounds are on board will affect things. Alcohol on board.
So here's another important fact. We know that in a
quote fed state, that is, with food in your system,
cannabinoids have much higher bioavailability. That is, the ability for
your brain and body to use these compounds. So somebody's

(29:58):
going out to a club with their friends and they pregame,
so they're going to drink at home. So what do
they do. They have like a half a cheese pizza, right,
something in the gut to help absorb, so they're not
out of their minds. When you do that with cannabinoids,
you actually make get I had a much bigger signal
from the connappenoids, so it's the opposite.

Speaker 1 (30:14):
It's so interesting.

Speaker 2 (30:15):
So when people said I had a full stomach, I'm like, oh, oh.

Speaker 1 (30:18):
Yeah, So more food equals more effect.

Speaker 2 (30:22):
You may get more effect. Yeah.

Speaker 1 (30:24):
I want to pause for a moment here to talk
more about what we know about mixing cannabis and alcohol.
Researchers have found that using the two together can worsen
their effects on thinking and coordination, and alcohol can significantly
increase THHC absorption. This combination is also linked to more
risky behaviors. Overall, there hasn't been a lot of research

(30:47):
in this area yet, so we don't fully understand all
of the implications, and of course the effects can vary
a lot depending on how much alcohol you're drinking and
what kind of cannabis product you're using. So we've talked
about THC five milligrams being on the low end standard dose.

Speaker 2 (31:03):
Yeah, what about CBD depends on what you're using it for.
So for some people, at our first clinical trial of anxiety,
we pitched very low. I based it on a product
that was being used in San Francisco in the Bay
Area that had great response, and it was somewhere between
ten and twelve milligrams per mil of CBD, but a
whole plant ful spatrum product and very low tcy like

(31:25):
less than point three milligrams, So it wasn't going to
get you high necessarily, and that was what I was
aiming for. But the amount of CBD that you might
think about using is really dictated by what ails you
for a mood. You might need less than you would
for chronic pain. Ourre chronic pain studies start significantly higher.
Most of my studies now use a whole lot more product,

(31:48):
a higher concentrated product.

Speaker 1 (31:49):
So it depends back to some practical advice. For a
midlife woman who may be having perimenopausal symptoms issues or
menopausal issues worse than perimenopause, many times, start low, go slow.
What would you recommend to start with.

Speaker 2 (32:04):
I would say systemic administration is generally better. A lot
of times people are caught up in the topical or
dermal realms. You know what, I have cramps. I'm just
going to put some of this salve or this lotion
of systemic application. Something that you take is likely to
give you the best response. A root of inhalation is

(32:24):
the fastest way of getting response, but it's not generally
the way that most patients want to take quote their medicine.
Not generally, so I would say again, if you're looking
to address things like chronic pain, I'm a fan of
sublingual solutions as opposed to other things, and you really
want to make sure that whatever you're using. In my

(32:44):
humble opinion, whole plant broad or whole plant full spectrum
products are highly efficacious For many things. The individual constituents
within the product dictate the outcome, So if you're having
trouble with sleep, might look for something with higher levels
of CBD and not a huge amount of teaching necessarily,
sometimes a little is fine.

Speaker 1 (33:08):
After the break, we'll get into safety issues to tell
how much THHC is really in a product, regardless of
what the label says, We'll be right back looking for
another great podcast that decodes women's health. I am so

(33:30):
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(33:53):
the biggest questions in sex, intimacy, and pleasure, and we
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(34:16):
by searching sex ad with dB, or find the link
in our show notes. So, for a woman in midlife
who wants to maybe you feel better, maybe better cognitive function,
get better sleep, is there an advantage of going to
a medical dispensary versus going to a recreational dispensary?

Speaker 2 (34:35):
Very often medical products have a significantly lowered tax rate
associated Very often the same products the plant doesn't care
what you use it for. By the way, plant doesn't
care at all. Right, Cannabis is cannabis, But the products
themselves are tax very differently, and there may be a
different fund of information from the quote patient care advocates
or bud tenders that you're talking to. So there are

(34:56):
different types of products that people should probably be exploring
if they're interested in having let's say, better sleep versus
addressing things like chronic pain or motor anxiety. Sometimes it's
a question of dose with the same type of product,
and sometimes it's a whole different set of players we
want on the field. So there are some constituents that
people don't talk about too often, although now we're seeing

(35:17):
them more often, like CBN or cannabinol. Actually THHC degrades
over time and we get high levels of CBN and
old weed. But CBN has been remarkably effective for some
people with regard to decreasing sleep latency, so time to
fall asleep and the ability to have better sleep coherence
or staying sleep. I think of CBD is helpful for
coherence and CBN is great for latency, but high CBN

(35:41):
levels are often helpful for people with sleep disruption and
it's not really generally considered intoxicating. So different combinations of
these types of compounds are making their way into the
marketplace now, which makes me very happy. And it's what
we do in our clinical trials. We try to create
products and formulate them so that they're optimized to address
these different conditions and indications.

Speaker 1 (36:01):
So it sounds like this where is like hypothesis generating
and then you move into making your own product. Do
you have your own tinc sure that you're making or
have made? Is that correct?

Speaker 2 (36:11):
A number of different clinical trials, Each clinical trial generally
uses a different type of product. If you're looking for
something for sleep versus focus or concentration versus chronic pain,
they're going to look different. In our group, we spend
a lot of time I custom formulate all of our
products to capitalize on that idea.

Speaker 1 (36:29):
How do women begin to what are safety concerns that
women should have? What do they need to ask, what
do they need to what do they need to look
for to be safe about this? If they want to
explore using cannabis to relieve some of their symptoms.

Speaker 2 (36:41):
So yeah, for symptom relief, And if that's really clear
I always tell people no, before you go, be honest
with yourself and ultimately the people that you're talking with
or dealing with about what your real goal is. And again,
no shame in Ah. You know, I'd like to take
the endge off with my partner on Friday. Fine mazzle,
but very different from I have this intractable pain. I
can't move. I really I can't get off the couch.

(37:02):
I'm really uncomfortable. So label claims have been reported to
be both under and overstated. So sometimes product will say
that it has a whole lot more of let's say
CBD in it than it does, which, by the way,
is really heartbreaking when you're talking to somebody who's seventy
eight years old on a fixed income and has spent
ninety six dollars on a one ounce bottle of something

(37:24):
that's supposed to be fifty megs per mel and it's three.
That's a problem. Sometimes they're understated with regard to things
like THHC, where the individual is going to be exposed
to a whole lot more THC than they might have anticipated.
The only way to know really what's in your weed,
or what's in the product you're using is to ask
your dispensary or the point of sale if you're buying
it online, or a certificate of analysis to ensure that

(37:48):
the product is what they would like it to be.
Dispensaries have to have them by law, and most reputable
manufacturers and sellers online will also have coas for all
of their products by batch, not just the general one
that sort of represented what they made long ago and
far away, but the actual product that you're using. You
should be able to match the batch and look at

(38:10):
the CoA that will tell you exactly how much of
each of the compounds is in your product. I would
remind people that it is not necessarily without its own
associated concerns or risks. So we think about things like
drug drug interactions. This is what I call the least
popular girl at the dance phenomenon. When I bring this up,
people say, oh, with that already. So here's how it goes.

(38:32):
Your liver processes all drugs and so. As it turns out,
cannabinoids impact the liver's enzyme systems. The cytochrome P four
fifty enzyme system highly impacted by cannabinoids, and in fact,
CBD affects more of them than DHC so as a result,
we are very careful with individuals who are on certain
types of medications because you could wind up inadvertently increasing

(38:55):
or decreasing the serum level of certain drugs that you
would not want to do that with. For example, an
ANTIICOI got a blood fitter. It's not so great to
increase the amount of blood thatitter coursing through your body.

Speaker 1 (39:07):
No, thank you.

Speaker 2 (39:07):
Women should be mindful of that. It's not completely benign.
You have to be careful.

Speaker 1 (39:12):
So a number of midlife women may be on SSRIs
or even hormone replacement therapy so or I call it
men a puzzle hormone support. Sorry, not HRT. That's old fashion, right,
we don't say that anymore, right, therapy support? Is there
any interaction with cannabis.

Speaker 2 (39:28):
So there are some to be mindful of. The best
thing to do is to go online and actually look
for the drug drug interaction calculator, and you can put
in anything you're using. And the reason I wouldn't be
specific is because then you could misinterpret what I'm saying
and take it as postulate, and so we don't want
to do that. But to your point, generally, there are

(39:49):
a number of conventional medications that are not a concern,
and then there are a handful that are, and some
of them appear in certain classes like SSRIs for sure,
benzodiazepines for sure, anticoagulants or blood thinners, So we want
to be mindful of that. Hoomone replacement not generally an issue,
but always best to check with your PCP. But you

(40:09):
can look at a drug drug int Reaction tool online,
which is incredibly helpful because sometimes people aren't always forthcoming
about what they're using. That's the other thing. They don't
necessarily want to tell their treat that they're using cannabis
or cannabinoids. And I say this to you if you're
one of those folks, don't be afraid. If your doctor
isn't open minded and willing to listen to why you're using,

(40:32):
what you're getting from it, and your rationale, you may
want to consider talking to someone else. Let's talk about
physician education.

Speaker 1 (40:38):
So I'm a pretty curious physician, early adopter of medical
marijuana twenty twelve, twenty fourteen in New Jersey, New York.
Good for you, And Demetriosi is pretty curious but know
very little about this. Know a lot more now, But
what is the average physician, what is their participation in
knowledge of these pathways and the impact that cannabis and

(41:01):
the utility and benefit that it can have for women
or just patients in general.

Speaker 2 (41:06):
Generally, people are underinformed and they are overwhelmed by the
headline that will tell you cannabis is terrible for this
and awful for that, And it's so important to understand
once again, cannabis is not one thing. It is a
multi compound plant, so to refer to anything that comes
from it is foolish. It is also really unfortunately true

(41:26):
that most don't have the time to educate themselves about
where it may be most effications, where it may be
most concerning, or how it may differ from their firmly
held beliefs. Our patients require it, I mean, really, they
are looking to us to help make good, sound decisions.
Those decisions should be based on real data, real science,
and not rhetoric or your own personal beliefs. I think

(41:48):
that more and more physicians are interested in understanding it
because it's coming through the door every day now, and
it's usually because one of their quote more responsible patients
has raised the question, and so now they're going to
dig into it they had a handful before, But you know,
those people were probably just looking for a legal way
to be high. I was told the same thing when

(42:09):
we first started this program. We created a metric in
our lab called can account, and it allows us to
quantify the amount of individual cannabinoids that people are exposed
to on a weekly basis, whether you're using a tincture
or flower product, or an edible or beverage. There are
ways that you can calculate it based on both what's
on the label and a certificate of analysis, how long
it takes you to use it, how you're using all

(42:30):
these things. And the truth is when we look at
the data at three months, six months, and one year,
overwhelmingly just looking at CBD and THHC levels, CBD is
exponentially higher than THHC, underscoring the point that these people
aren't really chasing a high. So it's important for physicians, caregivers,

(42:50):
healthcare workers, legislators, everybody to sort of let go of
what we think we know and allow ourselves to be
open to what the science and the data tell us.
It's really important to remember and to remind people who
see patients every day all day to have dialogues and
not monologues with their patients. This is supposed to be
a conversation, not me telling you what to do. And
I think for a long time and still today, people

(43:13):
are very concerned about losing their license if they were
to perhaps consider writing a certification for medical cannabis use.
It's not by prescription. You can't get a prescription for
scheduled drug, right, So these things are recommendations or certifications.
And the number of folks that I see who say, yeah,
I'm not getting into that. I don't want to lose
my license because when things invariably come around, I don't

(43:36):
want to be in the crosshairs. So I think a
lot of it is fear, a lot of it is
misperception and a lot of misinformation. What do women need
to know about drug testing? There's definitely professions where there's
drug testing involved, and you may be using a high
CBD product that does have some THHC in it. What
do we need to know about that? We need to
know a bunch of things first and foremost. When people

(43:56):
hold up a bottle and they say to mean, look,
this is just CBD, it's almost never just CBD, and
that's Okay, from a clinical perspective, we don't want it
to be just CBD. Whole plant full or whole plant
broad spectrum. Botics are more efficacious. However, at our very
first clinical trial that I developed for folks with moderate
severe anxiety was basically a whole plant full spectrum product

(44:17):
and it was sourced from cannabis. However, that particular chemo
ar cultivar that made the base that I then created
the product from would be termed hemp today. I could
have used ten times the amount of THHC that I
had in that product and still been within the limits
of the law. It had point to two milligrams per
millileter very low. And what we found was after four

(44:38):
weeks of a relatively higher CBD containing compound and very
low THHC, half the sample was positive for THHC after
four weeks, so they would have filled a drunk test.
And so people say to me, but Doc, you know,
it's just this hold on broad spectrum. Products are designed
to eliminate that possibility from the equation. So civil servants,
people who are in jobs where they really can't take

(44:59):
the chance, or who are uber sensitive to THHC. And
there are many people who are hyper sensitive to THHC
and very very small amounts are still too much. So
that's something to be mindful of. Please be mindful of
what you're using in When it doesn't list how much
THHD is in the product, ask for a CoA. Any
and all amounts of THC can aggregate in the body,

(45:21):
and they do, and you will potentially have a positive
drug screen.

Speaker 1 (45:25):
How long is the drug string positive for if you've
ingested some THC.

Speaker 2 (45:28):
Depends on what you're using, how often, and how familiar
you are with cannabis. So some of our more routine
users in the old days, the recreational studies that we did,
these were what I would call heavy hitters. These are
people who are using multiple times a day. We had
some folks who are still positive at for forty some
odd days.

Speaker 1 (45:45):
Do you have any personal experience in improving your own
health with cannabis? If you do use it, do you
have any any surprising effects or so?

Speaker 2 (45:54):
I would tell you that not all people have a
positive relationship with THHC unfortunately, and I'm one of them.
Is like the plumber whose house has a leak in
the basement, Maybe THHC and I have a detuont other
cannabinoids that are non intoxicating. I'm fine with. Some people
are very very slow metabolizers of certain consiguents like THHC,
and a very little bit can go a very long way.

(46:17):
So you have to be very mindful. If I try
something and it's absolutely fine for me with like one
milligrammar or a milligram and a half of PC and
I don't feel altered, no one's going to feel altered
because it takes very very little. I'm a cheap data.
As it turns out, if.

Speaker 1 (46:31):
You had to tell women or advise women, what would
be the one thing that you would say about cannabis
use and how cannabis can impact their health?

Speaker 2 (46:40):
I think I would probably say that there is unprecedented
promise with regard to cannabis and cannabinoids for many many
indications and conditions that affect us. That said, you can't
believe all the hype, and you have to really educate
yourself and ask questions. In my very humble opinion, people

(47:02):
are exploring cannabis and cannabinoid based therapies to reduce their
use of conventional medications, to sleep better, to have less pain,
to have better mood and also to have better day
to day life. If we think of things as a
natural anti inflammatory or ways of improving your own immune system,
people are adding these products to their daily health and

(47:22):
wellness regimens. There are certain cannabinoids likes for sure, CBD,
but so many others that are the unsung heroes that
are actually more effective as anti inflammatory or neuroprotective agents
or all sorts of things we don't have time to
get into, and so you can create these compounds that
you might take on a regular basis or have other
people do it and feel a whole lot better than

(47:43):
you might otherwise. I've been in situations where I didn't
recognize the patient when I walked into the waiting room
because they looked so different from the way they looked
a month prior. I think we're at the very, very
beginning stages of what will ultimately be an absolutely unprecedented revolution.
I mean, we really can change some of the ways
that people are living. And I had this last week.

(48:04):
I had a woman say to me, I am for
the first time in nine years, I'm considering not having
a hesteractomy because I now know what it's like to
live without chronic debilitating. I'm at an eight or nine
out of ten pain all day, every day. What do
you do with That's that's amazing right.

Speaker 1 (48:24):
Researchers like doctor Gruber are learning more every day about
how to use cannabinoid based therapy safely and effectively, but
for now, there are a few key things to keep
in mind. Start low and go slow. Begin with a
small dose, even just a quarter of what you think
you might need, and increase gradually. Be clear about what
your goal is. Low doses of THHC, the primary intoxicating

(48:48):
part of the plant, may help with anxiety, but be
careful because higher levels often trigger anxiety in many people.
Cannabinoids like CBN and CBD may be helpful for sleep.
CBD may also be helpful for things like anxiety and inflammation,
and also has potential neuroprotective qualities. Doctor Grueber has noted

(49:12):
that there are other cannabinoids that have shown promise with
regard to anti inflammatory and neuroprotective properties, including CBG, CBC,
and THCHCB. Look for full or broad spectrum products. These
formulations take advantage of multiple cannabinoids working together. Full spectrum

(49:33):
products contain the naturally occurring range of cannabinoids, including THHC, CBD,
and other minor cannabinoids. Broad spectrum products are similar to
full spectrum products, with the important distinction that they are
intended to have no quantifiable amount of THHC. So doctor
Gruber suggests looking into broad spectrum products if you want

(49:55):
to avoid feeling altered or high, or if you work
in a field that drug tests for THHC, and remember
always check the products certificate of analysis to get more
accurate information about the compounds that are included in it.
For interactions. If you're taking other medications, use a reliable
drug drug interaction tool online to see if cannabis might

(50:18):
interfere and be honest with your doctor. Let them know
what you're using or considering. If your provider isn't receptive
or informed, consider finding someone who is. There are plenty
of clinicians out there who are curious and excited about
the medicinal potential of cannabis and who can help you
figure out what's right for you. Coming up on the

(50:42):
next episode of Decoding Women's Health will be diving into
the world of glp ones, a class of drugs that
has completely changed the conversation around metabolic health and weight loss.

Speaker 3 (50:54):
In the past few decades, we've only been pushing this
narrative of eating less and moving more, which is oversimplified
and not the right message. And I think what has
transformed the landscape of weight management is that now we
have tools to revillly dress the biology.

Speaker 1 (51:14):
Decoding Women's Health is a production of Pushkin Industries and
the Atria Health and Research Institute. This episode was produced
by Rebecca Lee Douglas. It was edited by Amy Gaines McQuaid,
mastering by Sarah Buguer. Our associate producer is Sonia Gerwit.
Our executive producer is Alexandra Garreton. Our theme song was

(51:35):
composed by HANNS. Brown. Concept creative development and fact checking
by Shavon O'Connor. A special thanks to Alan Tish, David Saltzman,
Sarah Nix, Eric Sandler, Morgan Rattner, Amy Hagdorn, Owen Miller,
Jordan McMillan, and Greta Cohne. If you have a question

(51:56):
about women's health in midlife, leave us a voicemail at
four F five two O one three three eight five,
or send us a message at Decoding Women's Health at
Pushkin dot FM. I'm doctor Elizabeth pointer and thanks for listening.
Until next time.

Speaker 4 (52:23):
Welcome to sex Ed with dB. I'm your host, dB.
Let's get into it. Hey everyone, welcome back dB here,

(52:46):
your favorite sex educator and pleasure expert, and today we're
talking about cannabis and sex. Now, maybe you've heard people
say that we'd make sex amazing, or maybe you've tried
it and thought was that hotter than usual? Or was
I just way too invested in the way my partner's
hair smelled because I was super high and it smelled
so good. Either way, there's a lot of hype and

(53:07):
a lot of myths around getting high and getting it on.
So today we are breaking down on what the science
actually says. As usual, we'll talk about how cannabis might
affect desire, arousal, and orgasm, why dose matters more than
you think, and then not so fun side effects that
you should know before you try it. We'll even dig
into what researchers have discovered about weed's role in pain
reduction and sexual satisfaction. And if you've ever wondered whether

(53:30):
cannabis could take your bedroom game higher or if it's
just smoke and mirrors. Oh sorry, it's such a bad pun,
but it's so good you are in the right place.
So first up, are people who use weed really having
more sex?

Speaker 2 (53:44):
What do the data show?

Speaker 4 (53:46):
Back in twenty seventeen, researchers at Stanford looked at over
fifty thousand Americans and found something kind of interesting. Daily
cannabis users reported having more sex than non users. Women
went from about six times a month to seven point one,
and men went from five point six to six point nine. Now,
before we start just kind of handing out blunts as

(54:08):
relationship therapy, here's the thing. This is self reported. It's
not proof that weed causes more sex. It's just that
people who use it tend to say that they have
more sex. Could be the weed, could be that people
who are more open to cannabis are also open to
other sexual activities. Hard to say, but interesting nonetheless, And
that leads us nicely into this pleasure piece because even

(54:28):
if frequency isn't directly caused by cannabis, plenty of people
swear that it changes how sex feels. In a twenty
twenty three study with around eight hundred people, over seventy
percent said that weed made sex better, more desire, more
intense orgasms, and touch that felt off the chart good.

(54:49):
Let me repeat that eight hundred people were in this study.
Over seventy percent said that weed made sex better. So fascinating.
Hello dB here, thank you so much for listening. If
you liked what you heard in this clip, you can
find the rest of this episode and more by searching

(55:10):
sex ed dB on your podcast app of choice, or
by heading to sex edi dB dot com.