What is Cannabinoid Hyperemesis Syndrome (CHS) with Dr. Rick Pescatore

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
I'm Brandon. And I'm Jesse, we're cannabis
school. Having cannabis infuse
conversations. With everyday.
People. Cannabis companies.
Celebrities. And your mom?
Welcome. To the sesh, an outsider, he
uses it, studies it, sees how itinteracts with anxiety,
appetite, sleep, hydration and the gut brain loop long before

(00:23):
someone hits the ER. So this is harm reduction
science and lived experience allin one conversation.
So let's get into it. Rick, you've treated hundreds of
CHS cases, but you're also a cannabis user yourself.
What pulled you into studying this so deeply in the first
place? Yeah, hey.

(00:43):
Well, so yeah, I've seen a lot of patients with cannabis
hyperemesis and, and, and I am acannabis user myself.
And to be honest, what, what pulled me into studying patients
with CHS really had little to dowith my own cannabis use and
probably had so much more to do with the profound prevalence of

(01:04):
CHS in emergency departments. And so I'm an ER doc, I've been
an ER doc my entire career. I'm kind of a full corroded ER
doc and CHS is kind of not very acute condition.
It's a recurring and sort of chronic condition.
And so the question becomes why is an emergency doc sort of

(01:25):
dealing with the chronic condition so much?
And the answer really becomes isbecause nobody else has.
And this is a problem that is everywhere.
We are seeing cavalry hyperemesis syndrome and related
conditions to the tune of nearly10% of all visits in the United
States emergency departments today.
It's a real issue. And I grew up learning from the

(01:49):
Titans of emergency, most of like the, the absolute, the guys
wrote the books and they, they spoke all the time about how
emergency medicine was built andpeople falling through the
cracks of medicine. And back then it was gunshot
wounds and heart attacks and strokes.
And now it's not that it, it's people like you and me and and
people that we love who are being cast out into the cold.

(02:12):
And CHS is is at the is very high on that list with a number
of other conditions and so. 10%.It's a it's a big problem.
It's a big problem. And so how did I get to CHS?
It it, it was really like at a confluence of many things, but
certainly my own cannabis use, seeing it in the emergency
department, but then also seeingit as a broader symptom of a

(02:35):
broader problem. Yeah, so before CHS was a
headline term, what were those early ER cases like?
What made you realize something bigger was happening?
Yeah, We have seen patients in the emergency department with
this broader sort of concept of disordered gut, brain
interaction, bad bellies. We've, we've seen this for
decades. I've been practicing emergency

(02:56):
medicine for a long time. It's not a new concept that
people are showing up with terrible belly pain, nausea,
vomiting. It's a worsening concept.
And that really I think drives one of the principal things that
I like to preach and sort of hold high with cannabinoid
hyperemesis syndrome is that it's a real problem and it's
common, but it's also commonly misdiagnosed and over diagnosed.

(03:17):
It's part of a broad, broad misunderstanding and new
understanding of people with long standing bad bellies that
we can't seem to figure out whentheir lab tests are normal and
their CAT scans are normal. And certainly for patients who
have significant cannabis use, cannabinoid hyperemesis syndrome
as a real problem and real possibility at the same time,

(03:40):
cannabis can be a real savior and helpful medication.
But for people with quite the same problem.
So people experiencing cannabis hyper like CHS can actually
utilize cannabis to help deal with symptoms like symptoms of
CHS. Well, I'm gathering.
No, I'll, I'll back it up a little bit more.

(04:02):
You know, we, we look at cannabinoid hyperemesis syndrome
as a really diagnosis of exclusion right there.
There are poor diagnostic criteria for how you get labeled
with CHS. We use something called the Rome
Foundations, Rome 4 criteria. And while that sounds fancy, it
amounts to you're keeping your brains out all the time.

(04:25):
We can't figure out why. And you smoke weed.
That's the diagnostic criteria. That's what CHS pretty much is.
That's about it. That's the diagnostic criteria.
Diagnostic criteria that we throw onto it.
And then certainly we we we say it and then you stop smoking
weed and and you get better. OK, All right.

(04:45):
The problem is this, the problemis this, and it's an important
one, is that there is profound overlap with between that
diagnostic criteria and many others, including cyclic
vomiting syndrome in patients who happen to use.
Cannabis. And, and So what we've seen is,
is really a, a misunderstanding of what's going on here.

(05:09):
But that's, you know, the, the, the headline here is that this
is not unique to cannabinoid hyperemesis syndrome, but
cannabinoid hyperemesis syndrome.
And cannabis users are certainlyfeeling the effects of the lack
of knowledge around this. Yeah, definitely.
Most people think CHS is either you're puking or you're fine.

(05:32):
How do you explain that spectrumyou see in real patients?
I appreciate that question because I think that's really
where it begins. Is that an abnoid hyperemesis
syndrome, like all things manifest differently in
different people. We understand that in some
people is some morning nausea until they smoke.
We understand that CHS for some people is puking their brains

(05:56):
out and their potassium levels are so low that their heart
might stop. And So what we have done is
we've researched this right there are, there are fantastic
efforts throughout the country to understand this a lot better.
And we have conclusions from medical societies and from
others saying things like it's, it's a consequence of high dose

(06:17):
and high frequency cannabis, cannabis exposure.
It's a consequence of this and it's a consequence of that.
But at the same time, the best bench research we have, the best
sort of actual blood tests that we have in these individuals
actually points toward a geneticpredisposition.
And So what we have is a scattered data landscape, which

(06:41):
is frustrating, but but ripe forinnovation and ripe for
opportunity. And that sort of decimated sort
of field of evidence out there can be picked and and can be
identified that this is a multi factorial problem.
It is a consequence of high doseand high frequency cannabis

(07:01):
exposure. It is a consequence of genetic
predisposition. It's a consequence of a number
of other things as well. And I think that the important
concept is that we not limit it to a sort of narrow
interpretation. This is because you're smoking
too much weed. When in reality it's this is a
complex issue and there are a number of underlying components

(07:24):
and it could be that you're smoking too much weed.
It's probably more complex than that.
I find with cannabis that often is there's so many different
layers and every endocannabinoidsystem is so diverse from yours
to mine to Jessie's to anyone else's, that it's just, it's so
hard to have like a a standard data set across the board for

(07:47):
any of that. How would you see repetitive THC
exposure breaking down the body over time?
Does that affect it? Yeah, yeah.
Repetitive THC exposure changes cannabinoid receptor expression.
We know that. And we know that over time, the
effects of your CB1 expression to your CB2 expression and to

(08:08):
downstream other receptor expression.
And in the world of CHS, we lookat the niloid receptors, we look
at the effects of pyruvate, pyruvate dehydrogen.
Again, understanding that these things certainly can build up an
effect over time, right? And driving the the conclusion
that it's a, it's a consequence of repeated THC exposure,

(08:32):
absolutely. But if it's a consequence of
repeated THC exposure with downstream consequences that can
be directly fixed, that's something we should do.
Is there something that you've gathered or ways that you found
to navigate that in a healthy way that can help fix
symptomatic treatment of like CHS or?

(08:53):
Yeah, we, we, you know, I, we see patients all the time in the
emergency department with CHS and related syndromes.
And in the emergency department this has become a routine
approach. Patients receive almost
universally across the United States anti dopaminergic
medications. These are haloperidol and
droparidol, the IV medications used routinely in emergency

(09:16):
departments throughout the country.
They're used when the classic ondansetron Zofran just doesn't
cut it. She's also a common medication
that many turn to use. But universally the Haldol
androparidol work fantastically and to, to the point where we
treat patients and we send them home.
The problem being that we send them home with little more and,

(09:38):
and so I am the founder of a a biotechnology company and, and
we are excited to have a, a medication in development.
We we are running trials in Australia for medication to
submit through an FDA process for for treatment of these
patients. But along the way we've
identified there, there are waysthat we don't have to get that
far. These patients who are coming to

(09:59):
the emergency department if are receiving IV strong medications
to make them feel better also have a constellation of other
problems that speaks toward thisbeing a multi factorial problem.
And addressing those other problems along the way provides
an opportunity for keeping patients safe as well as helping

(10:19):
sustain sort of responsible cannabis use.
What are those, What are those problems?
What are we seeing and what are the common things we're seeing
in patients? At the top of the list is that
micronutrient deficiency. This is, this is, I think a
fascinating and important one. When I was growing up in
emergency medicine, one of the first things you learn as an ER

(10:40):
doctor is how to take care of patients who drink a lot, right?
Patients who who have alcohol use disorder and come to the
emergency department. And back when I was a young
doctor, we gave them all the, the coma cocktail, which
included vitamin B1, thiamine. We now know that there are more
daily cannabis users in the United States than daily alcohol
consumers. And, and we know as well,

(11:01):
there's a profound prevalence ofthiamine, vitamin B1 deficiency
in this population. And yeah, it's really
fascinating. And is there a specific like
diet or something that equates to that?
Has got you there. You know, the answer to that is,
well, it's all of our diets or we all in the United States are
sort of sit at the head of a pinwhen it comes to our

(11:24):
micronutrient status. And we've got some new
fascinating data about the type of thiamine that we use to
supplement. Tell me more.
Yeah, it's really, so it gets into the most fascinating and
nerdiest science that I've ever had the pleasure to engage in
and it looks at our true underlying metabolic processes.

(11:47):
We all know the mitochondria is the powerhouse of the cell.
We all know that how important that is.
And, and to that extent, we've seen a lot of eruption on social
media about the need for NAD supplements and and other
components to make you feel well.
And, and I think a lot of peoplehave engaged with that.
Some people have seen some benefit and some people haven't.

(12:10):
But it sort of begs the question, why do you need all
this NAD? And the answer really seems to
come back to this micronutrient deficiency thing that we're
seeing across the American population, enhanced certainly
in the cannabis using populationthat they don't have enough
thymine, not enough vitamin B1, because the vitamin B1 we use in

(12:30):
the food supply undergoes aqueous catalysis.
It goes into the cytoplasm, it breaks up and it doesn't make it
into the powerhouse of the cell because it breaks up in the
water of the cell. And so it can't work.
So even our vitamins are so overprocessed that they don't do it
exactly. Yeah, that's exactly, yeah.
And there are fascinating historical correlates here.
We we did, we've really dived into the literature.

(12:51):
It's been incredible. We see how in the 17th century
in Sri Lanka this happened, thatthe colonists created what was
called polished rice at the time.
They fed this hyper processed rice to their workers.
And they also, they suffered thecondition which we know now as
Berry Berry, which in Sri Lanka means I cannot, I cannot, right.

(13:13):
But we see this now in the American population.
We see patients who have a sub acute Berry Berry, a peri Berry
Berry. They have, they have an
electrical wiring of the belly system that's firing sort of all
awry. And in cannabis users in
particular, the added sort of insults CB, repeated THC

(13:34):
exposure, repeated terpene exposure can push you over the
edge. So it sounds like the gut brain
access plays a huge role here. Is there something that starts
going wrong before vomiting everstarts?
The, the gut brain axis is this new understanding that we've
done a pretty good job of the hardware of medicine.

(13:57):
We're pretty good at doing, I'm not pretty good at it, but some
guys are pretty good at doing brain surgery, right?
But and and we're pretty good atidentifying your pancreatitis or
your appendicitis, but the software problems of medicine,
the connection between your brain and your belly and the
understanding that 90% of the serotonin for which the SSR is

(14:18):
people are on and the dopamine which people are on 90, ninety,
95% of those chemicals are synthesized within and function
within the belly. We now understand that to be an
important component of the software of the human body, if
you will. And so there are signals that
that we are beginning to identify by looking at this

(14:39):
software, by mapping this software, the Pheno, by mapping
it, we are starting to tap into early warning signals of
degradation of software. We can see that patients with
cavenoid hyperemesis syndrome almost uniformly have a number
of symptoms that that sort of predict that they may become

(14:59):
worse. We we talk a lot about hot
showers making your symptoms better as being a strong side of
CHS. So we're talking a lot about
early morning nausea resolved with a smoking to be a sign of
CHS. But there are many more to begin
to detect until we can find it earlier.

(15:20):
And at the same time, we continue to have the need to
make it better. So for those who might be
experiencing that, it sounds like they're there's a million
different things that could be potentially causing that
multiple combined factors in that.
Is there something you would recommend typically for that?
Like is it dosing they could go off of more of a frequency of

(15:43):
cannabis use for someone specifically Is there, I mean,
it sounds like everyone's different with that.
So one factor might push someoneinto it that might not push
another into it. Yeah.
Well, yeah, that's it, right, everybody.
It's this hyper personal experience and that's important.
That being said, we have some data that shows that some people
are at higher risk, and then we've taken that data of those

(16:06):
people who are at higher risk and put together some patterns
as to why those people are the same.
So really fantastic. We have an academic partnership.
We've done some blood tests and we've identified for example,
what are called haplotype patterns between certain
individuals that there are certain simple genetic, not not
genes, but genetic patterns, sort of combinations of genes

(16:28):
that puts you into a category ofbeing at higher risk.
And then we can look at you and say we know you're at higher
risk, we know you're going to develop this.
So why does it seem that you aredeveloping this?
And so to that degree, we, we certainly do have some
information that tolerance breaks are beneficial.
We have some information that leaning more toward flour and

(16:49):
away from vapes is beneficial. We have an understanding that
waiting to smoke until later in the day is beneficial and these
things can be stacked, they can be combined and they can be
added to other preventative methods including
micronutrients, supplementation,taking your vitamins.
We 100% look at vitamin B1 as being critical and a lipid

(17:13):
soluble form. These are benefit time in TTFT,
Lithia, lithium and Alatyne. And I'm sorry, these these are
available all over and they're critical for the cannabis
consumer. Without question.
Magnesium supplementation we nowknow to be important for the
cannabis consumer. When we look at magnesium, we
understand that patients who consume cannabis have a number

(17:37):
of ongoing simultaneous problems, one of them being just
like micronutrient deficiency. Inflammation, gastritis and
stomach inflammation is a commoncomplaint among cannabis users
of smoking as well, and that inflammation contributes to mild
nutrient and micronutrient. Wow.

(17:57):
Yeah, that's a whole bunch of. It's a bunch of stuff, but the
what's really interesting is that the conclusion being is
that it's not because you smoke cannabis that you're getting
this, It's because you smoke cannabis and a lot of other
things that you're getting this.And so it's important for us to
recognize that for many people, cannabis is more than

(18:21):
recreation. And you know, I was medical
student once railing against benzodiazepine saying who would
prescribe that Xanax when I was a young medical student.
And I remember my mentor saying you can get rid of the Xanax,
but you better be ready for the 5th of whiskey and the revolver
at the night stand. And that was probably a little
too tongue in cheek at the time.But you know, harm reduction is

(18:44):
a lesson that we have learned the hard way again and again.
And responsible cannabis use is perfectly acceptable and
probably a salvation for many people, you and I included.
100%, yeah. And I would say that we have a
responsibility as physicians, asfellow cannabis users, to help

(19:06):
people understand that they can feel better with simple
interventions. Yeah, when it sounds like you
kind of gave a lot of the steps for someone who might be a heavy
user who doesn't want to quit. You know, you can do tolerance
breaks or, you know, smoke in the evening.
You know, wait throughout your day and not smoke first thing
when you wake up or wait till further in your day.

(19:29):
You know, maybe switch to flour instead of the concentrate or
something. Do you find the edibles and
tinctures also have the same risk profile for like a patient?
It does seem to be the case. Yeah, it does.
Certainly we see that patients who consume edibles only also do
suffer CHS. Generally, patients who consume
edibles only end up consuming higher doses over time.

(19:53):
And that leads to that, that cannabis receptor dysregulation,
but at the same time also exacerbates the micronutrient
deficiency and the inflammation that that contributes to all of
this. And then what's more, we find
that this is a, this is a kind of recent and fascinating
innovation almost, but almost step back at the same time.

(20:16):
As I said earlier that we look at hot showers and resolution of
symptoms with hot showers as a, as a high frequency sign of CHS
and that's in fact published by the American Gastroenterological
Association, right? This is, this is codified in
guidelines that if patients get better with hot showers, ask
them if they smoke weed and thenpoint the finger at them.
Well, and we've assigned that mechanistically to a receptor

(20:41):
called TRPV. One what we, what we found out
in the past month or so is that just repeated acts of vomiting
cause the same mutations in TRPV1.
So patients with cyclic vomitingwithout cannabis use have the
same underlying pathophysiology in response to shower hot
showers. So someone almost with like a

(21:03):
bulimic or an anorexic type of response could almost have that.
Exactly. So it takes the specificity of
that sign which people have beenhanging their hat on that sign,
it takes the specificity of thatand it throws it out the window.
Yeah, it's more of a symptom treating at that point of like,
hey, this symptom is showing andhere's how we found that
treating this symptom works. And well, if you're using

(21:25):
cannabis, shame on you because it's that's what's causing it
versus the other. Exactly.
Listen, if, if, if, if the finger can be pointed away from
the initials at the end of the name, people are going to take
that opportunity. But at the same time, while it's
kind of disappointing that this kind of that this specific thing
is gone, it informs the kind of broader narrative that that this

(21:48):
is part of a broader family of disease, a broader family of
misunderstanding of disease thatwe can intervene upon.
So what's the biggest myth aboutCHS online that hurts others or
confuses them? It's a good question.
I think the biggest myth about CHS online is that this is
somehow your fault. I think that there is a such an

(22:12):
incredible stigma about CHS thathas seeped its way throughout
emergency departments in the United States and from there on
to social media and it's terrible.
We, as we said earlier, how manytimes need we learn this harm
reduction lesson? And patients who come into the

(22:33):
emergency department in the throes of any type of syndrome,
much less CHS don't need blaming.
They, they need help. And so that's the number one.
And then to follow up from there, I'd say that absolutely
we know that if you have CHS, abstinence can make it better.
If you don't have CHS, abstinence is not going to make

(22:57):
it all the way better. And those who can't do
abstinence. I think anal is the other A
that's supposed to be approved. Exactly, exactly right.
You know, we, we have to understand that it's not an
option for people, some people. And and so treating the
pathophysiology incurred by the cannabis use, treating the

(23:17):
problems and helping people continue to consume cannabis
correctly, helping them consume cannabis safely is our job.
Jesse has entered the conversation.
Jesse Yeah, guys, sorry about that.
It's the big wreck on the freeway.
Normally I'm home way before this time, but it was not.

(23:38):
It wasn't in the cards. All right, mid break here real
fast. What's everyone puffing on this
evening? I have a sativa concentrate that
I picked up from the dispensary this morning and I'm using a pen
despite just just just sort of just talking crap on pens.
Just do you know which sativa you're rocking today?
It's a blueberry something. Oh, is it a lot of the flavors

(24:02):
of blueberry? No, it's not really, to be
honest with you. I've just had some really good
experiences with some of the blueberry strains and then some
like yeah, it just. I don't.
I don't like when they're sometimes they're harsh.
I think the blueberry strains, Ifeel like they're peppery and I
don't like, but this is a fruitier one, which that's what
I like. Yeah, I'm rocking some cheetah

(24:24):
piss tonight. And the bomb mag loud.
Nice. Yeah, I am.
I think what I'm smoking, what am I smoking?
I'm smoking some some Sour Diesel the wind way you can cut
and I'm smoking it in the Dynavape.
Now for those of you who don't know Dynavape, this is the

(24:45):
coolest vaporizer I've ever usedand it's it's super killer.
We'll review it really soon, butI love this little vaporizer.
This has been my go to. I was using those.
Yesterday I'm. Surprised.
They're so cool. Yeah, I know.
Hey, yeah. I'm so glad that we're going to.

(25:05):
I came right in at this time on CHS because there was a little
while back that I thought I was coming, that I was suffering
from it. And I would wake up and I would
be nauseous and. And I couldn't explain why.
And then I was constantly looking for like what's causing
this? And then I would have my morning

(25:27):
toke. And you're exactly right.
I what I needed to do was have abstinence, but I was able to do
it in a way where it was triggering in the morning where
it became dependency. And when I was wake and baking,
I was just probably doing too much.
So I saved my wake and bakes forthe weekend, kind of.
I do edibles throughout the day,but this step, you know, just

(25:51):
understanding that because I think there's a lot of people
out there that have that misconception that immediately
when they have like a symptom ofanything, which CHS could fall
underneath, right? If you've got a cold or upset
stomach or something, then immediately they go, oh, it's
because you're you're cannabis use because you smoke in the
pot. That's why it's so unhealthy for
you. Like, I'm sure you hear that a

(26:13):
lot. That's exactly what we hear.
We you know, there's a victim blaming mentality to it And and
I love how you mentioned that itcan be so different in so many
people because that's so exactlyright, right.
We see that 100 by the way, likeif you're waking up with nausea
and and you feel better after you smoke, like, yeah, you're
developing CHS absolutely. Like that's 100% something to be

(26:35):
concerned about. And like we talked about kind of
there's things you could do taking a tea break, kind of push
in your first smoke till later in the day, moving toward flour
and away from distillates. Those are really at the top of
the list. And and and micronutrient
supplementation very important. All these, all these, this
critically important. Go into that.
I'll go, I'll go into that. Yeah, micronutrient deficiency

(26:57):
is a huge problem. We in the United States, we have
a micronutrient deficiency problem.
We have a food supply system that I need not tell you sucks.
And we have a hyper processed food supply system that has
stripped the nutrients from foodsupply.
And we have data that shows thatabout 1/3 of individuals who

(27:18):
present to the emergency department, acknowledge and
vomiting have vitamin B1 level so low as to qualify for a
diagnosis called Wernicke's encephalopathy.
That their, that their vitamin B1 levels are so low, they're
going crazy. And and that's crazy.
And we know now that we're not even measuring the right vitamin
B1 levels, that the vitamin B1 levels were measuring our 1950s

(27:41):
levels that are of the wrong damn molecule and the wrong
numbers to look at. And we really have screwed up
again and again. But we're, we're, we're
understanding this better. We're understanding that, Yeah,
patients who have cannabinoid hyperemesis syndrome could be
smoking too much weed, probably smoking too much weed,
definitely have micronutrient deficiency, definitely have

(28:04):
gastritis and stomach inflammation, definitely have
10-15 other things to do with them, including perhaps perhaps
a genetic predisposition. And that genetic predisposition
leads exactly to what you said, a different manifestation in
different people. We've seen, we've partnered with
academic universities all over the country.
We see that people have similarities to mast cell

(28:25):
dysregulation and hives and rashes.
We see people who we've seen people develop wheezing as a
primary symptom of vocabulary hyperemesis syndrome that that
truly their asthma exacerbates with with that that concords
with their cannabis useful and they're edible consumers and so.

(28:46):
They're edible consumers and their asthma gets exacerbated.
Yes. And the, and I'll tell you why.
There's there's something calledan HLA subtype, there's
something called human leukocyteantigen subtype comes from the
major histocompatibility complex.
And what does that all mean? That you can have a
constellation of genes that putsyou at higher risk for

(29:08):
autoimmune dysregulation in the setting of cannabis use.
That your that the cells that drive not your allergic
response, but your inflammatory response and the the things that
cause you to itch and the thingsthat cause you to get a rash.
Those cells themselves can be more likely to lay out their

(29:28):
itchy stuff because you have a certain what's called haplotype
and you happen to smoke. Dude, that's why I have friends
who go, oh, I'm allergic to cannabis.
Not very many, yeah. It's a thing.
It's. Very small subset.
It's a thing on chromosome 6. There are groups of genes that

(29:49):
for certain people, yeah, allergies are fair enough word.
It's a, you know, there's, you know, if we were going to slice,
you know, yeah, make you itchy from cannabis use and and how
about that, right? God, does anyone, like anyone
listening, have that drop in thecomments below?
That sounds terrible. Is there something that you can

(30:10):
navigate that? Is there a type of cannabinoid
or way to consume that without having that type of reaction?
Well, yeah, I mean, yeah, yes and no.
I, I mean, the, the, this sort of HLA grouping, this, this
group of genes, yeah. It has been identified as, hey,
if you have this group of genes,the likelihood of you having

(30:33):
cannabinoid induced dysregulation of this entire
cascade is pretty high. It's pretty high.
And, and so doing the things to avoid that dysregulation is
better for you. And so you're going to benefit
even more from all the things that we've said, right.
At the same time, also understanding that probably
you're going to benefit from things like antihistamines

(30:54):
because of the, the kind of chemicals that are happening
here. So you take an allergy pill
every morning is probably good for you.
I have a buddy here, live in Utah.
The air is pretty dry and he haspretty bad asthma.
The only time he ever smokes is with me, but that's because I

(31:15):
will. Interrogate him and force him to
do it. He I have alpha Pinene and he's
like oh this is a bronchial dilator.
So when I put this on the bud, this actually makes my asthmatic
reaction way less intense. And so he chooses to smoke when
he comes over because I have that as a separate terpene.

(31:35):
And so he'll go, Oh yeah, I'll put that on.
It's a dropper. And he'll just add that on to
the top of whatever bowl we're doing.
And he goes, all this makes my like, my ability to enjoy this
like it changes the experience for him.
He can actually join that. I'm like, it's really weird, but
I'm glad you can enjoy it. So it's a rarity because he

(31:57):
doesn't smoke much, but even drier vaporizers and that like
with the volcano, we're droppingalpha pining and that on there.
So wow. I mean, that's responsible
consumption, right? That's, you know, listen, I the,
the last thing I want to do is compare anything to anything,
right? That's all.
That's the the first, first timeI go down a bad way.

(32:18):
But, you know, many years ago I was involved in the public
health response to the opiate use disorder epidemic.
And just as we handed out naloxone, one of the things we
did in the emergency department was educate about the infections
that came alongside people. People would lick their needles
and that would be to a specific type of heart infection, right?

(32:40):
So holy shit, big problem, right?
But all we had to do was tell people not to lick their
needles, right? And rather than rather than make
you shouldn't do drugs, they're like, yeah, great, super
helpful. So how do we solve this problem
that Utah is experiencing? I heard that we had the first
armpit STI's at BYU because they're not sure what to do

(33:02):
aside from docking. Can you help from a medical
perspective find a solution to this?
Man, man, you know, I yeah, I was on a panel today of science
editors. I, I, I had a big medical
journal. And so I'm on this panel.
And the question posed to the panelists was RFK Junior says

(33:23):
that you're all bought and sold by far, but what do you have to
say? And so one by one, these people
answered, you know, fuck RFK, right?
I don't care what he says, Bah, Bah, Bah, Bah.
And my answer was, listen, people think what they're going
to, right? Like, like, you know, we have
to, no matter what, no matter how much we want to throw this

(33:43):
off people, we have to meet people where they are.
And so if it's, you know, herpesof the axilla, that's one thing.
If it's cannabinoid hyperemesis syndrome and you need a vitamin,
that's another thing too. Yeah, what do you wish people
would do differently long beforethey ever think this might be
cannabis hypermesis syndrome? I think First off the the thing

(34:06):
to do is people need to heavily take appraisal of their
symptoms. I have seen surgical emergencies
diagnosed as cannabid hyperemesis syndrome.
I have seen people diagnosed with CHS and come back 12 hours
later and be under the knife. So the first thing people need
to do when they're feeling abdominal pain, nausea,
vomiting, any symptom whatsoeveris not automatically ascribe it

(34:30):
to their cannabis use and take areal analysis of their health on
a broad, broad basis. Cannabis, broadly speaking, is
very safe medication, but that is used broadly in medicine to
great success. That being said, we're seeing
problems with its use. And so if patients begin to
experience frequent nausea, if they begin to experience pain,

(34:50):
if they begin to experience symptoms that they think might
be related to their cannabis use, patients do a pretty damn
good of job of assigning that themselves most of the time.
And if that becomes the case, I think doing a little bit of
education is top of the list. The American College of
Gastroenterology has a lot of resources.
I know you guys have resources as well.
And we basically would encouragepeople to understand that it's a

(35:13):
multi factorial thing. Spacing out use is top of the
list. Taking tolerance breaks, moving
toward flower and away from distillates and then
supplementing with micronutrients, whether that be
vitamin B1, magnesium, as well As for many people in allergy
pill top of the list. Yeah, yeah, yeah, that's
interesting cuz it's like, you know, when, when we start

(35:34):
thinking about it, it's really looking at cannabis a little bit
further away from the rec side, which I'm I'm totally for as
well. But what you're describing is,
is just it it it's it's irresponsible cannabis use.
So what I meant about that is that if you're just consuming to
consume and not really, really understanding the weight, the

(35:57):
grams that you're being able to take, the milligrams, how it
affects you journaling, like Brandon's really deep into the
journaling as well. Like that's kind of how this
show started. We would like go off, we would
smoke a vape cart and then we'd write stuff down like we're
entering into a general. Oh, Sally, I just really like
this stray. Makes me feel real giddy.

(36:17):
Yeah, I mean. Our whole start of the show, we
didn't even use the actual strain at the time that we were
doing. It was like, yeah.
But I mean, that was the thing like when other people would do
it, we didn't want to come across as Stony.
We wanted to come across as informed.
And and that's the thing where it's evolved And, and I love
where you're at because you're at the forefront of educating

(36:39):
people in a way that makes more sense to them.
They have a difficult time beingable to trust their uncle or
their brother that's always wearing flip flops year round.
They're like, well, don't listento that guy cuz he's a fucking
loser. No, it's, it's it's focused on
like, man, when you see somebodysuch as in your position, it's
easier for them going a yeah, you know, cannabis is not a bad

(37:01):
thing. And they go who said that shit?
Oh, oh, hey, what's up, man? Yeah, yeah.
You would, you would know, you would know.
And that's we've over time been able to get to that point and
we're there kind of now. But it's so great because now
we're being able to meet individuals such as yourself
that can speak from that clinical side saying, hey, this

(37:22):
is the things that we're being able to see.
This is just common like with any other supplement being
abused, right? If if somebody was like, oh,
well, this guy's got a horrible disease.
What is it? This fat ass keeps eating
hamburgers like morning, noon and night.
Well, OK, let me tell you where your problem is, asshole, right?
It's it's not that anymore. You're you're really being able
to take something so diverse as cannabis and really make an

(37:46):
impact where it needs to be. Well, I, you know, I, I think
that cannabis in particular has really gone through the gamut in
our country and how it's treatedboth clinically, legally,
recreationally, and every possible way.
And a lot of the problems that we've seen in the failure to

(38:07):
fully comprehend how it impacts people are rooted in, just as
you said, looking at people backAnd screw this guy.
I'm not. Yeah, he looks like a loser.
I'm not going to listen to what he says.
And, you know, we've learned that lesson the hard way, that
we need to listen to these people, that people's inputs
here are not only important, butoften transformational.

(38:29):
And to that, to that end, cannabis users have really been
thrown to the wayside in this group and cast out to the cold.
And, and we spoke earlier about emergency medicine being
specialty that was designed to catch people falling between the
cracks. And people at CHS really fit
that bulb. So you're pretty open about
being a cannabis consumer. How does that change the way

(38:51):
that you diagnose, teach, or talk to your patients?
Yeah, consuming cannabis definitely helps me speak with
patients about their cannabis use and I think to a large
degree understand the likely impact it of it upon their
diagnosis. We all know that there's a
difference between somebody who consumes cannabis every once in

(39:15):
a while and somebody who spends their day consuming cannabis.
And those obviously are going tohave different effects upon a
patient. But then to lump them into the
same category makes absolutely no sense whatsoever.
But that's what the diagnostic criteria does, right?
If you smoke a joint once a week, we make no distinction
between you and the person who is sucking down of eight 24/7

(39:38):
and so and so it seems like it seems like a pretty obvious.
Distinction word, yeah. Yeah, but but you'd be shocked.
It's like one glass of wine versus like a bottle of tequila
every night. These are clear.
Distinctions these are. Different things, but then at
the same time, listen, if you'redrinking the bottle of tequila,
not only do I know what to do for you because I learned

(40:01):
specifically about it in medicalschool, if you're drinking
bottles upon bottles of tequila,we have entire system.
Of care designed for you, right?We have entire hospitals and
specialties of medicine designedfor you, right?
And yet for the cannabis consumer, which by the way is
more common than that person, now we've got nothing, right?

(40:22):
And so now we've got something we're starting.
To build, What do you think you have learned from your own
cannabis use that you might not have learned or read in
textbooks a lot. How to how to see the world but
a little more clearly, maybe. I'd say, you know, my cannabis
use started. I was older, I, I was a naval

(40:42):
officer. I went to Military Academy.
Yeah, you went. You went to organize chicken
shit. Organize chicken shit.
No, no, I, I O. CS.
I went to the boat school and. OK.
And we, you know, we were tested.
I was poor Navy, so awesome. Excellent.
Yes, that's right, I do, yeah. And and you know, we were tested

(41:04):
all the time. So I I never consumed cannabis
until I was much older. And so my instruction of
cannabis was older and helped meunderstand very much how
patients use a large variety of things to help approach the
world in a better way. Whether it be whether it be the
patient who drinks a beer every day or a couple beers on the

(41:26):
weekend. Whether it be the patient who
runs too many marathons a year, or whether it be a patient who
has a vice or pursuit or utilization of anything that
helps them handle the world in abetter way.
I think that help give me that perspective.
A little more fairly. Well, we know CHS cases just

(41:47):
keep rising nationwide. What needs to change in a
cannabis education so people understand this without getting
scared away from the plant? Yeah, you know it's interesting
in many states in the country it's unlawful to sell non
cannabis products in the dispensary, right, which is

(42:09):
fascinating because it is the law in some states that when I
prescribe an opioid, I prescribenaloxone alongside it.
And and so right away we can putharm reduction materials.
Into place. In dispensers all over the
country, whether it be supplementation, knowing again
that most of these people, many of these people are vitamin B1

(42:30):
and magnesium deficient, whetherit be under that a nationwide
campaign at the dispensary saying, hey, a lot of you guys
might benefit from a Zyrtec every once in a while.
These aren't these aren't heroicmeasures, yet they can be
profoundly impactful. You know, when I was a much
smaller, much better looking medical student many years ago,

(42:52):
I wrote a paper about alcohol use disorder in my country and
the profound economic impact it had downstream.
And back then, I swear to God, this was 10 years ago.
I wrote an article about how at that time, thymine
supplementation in in patients with alcohol use disorder could
have an effect on the global, onthe nation of national economy

(43:13):
to the tune of billions of dollars because of the
downstream effects of of these deficiencies and what they do.
And that holds only more true today.
And speaking as a physician, speaking as a cannabis consumer
and speaking as the former chiefphysician of a state's public
health apparatus, let me tell you one of the simplest and most

(43:33):
effective public health interventions we could do today
is provide at least awareness, if not Co administration
micronutrients supplementation to patients who consume
cannabis. Yeah, and you know, and that
I'm, I'm super glad that you actually talked about that.
That's my world now is healthcare and understanding

(43:54):
that like I, I've kind of laughed about it because, and
Brandon and I talk about this all the time, I would see that
if people are able to be able tointroduce cannabis in one way
form or another, not always psychoactive, but any type of
cannabis used on a regular basis, I tend to see these
people have lower body mass. I'm way more fit now.

(44:15):
I'm almost 50 and I'll tell you right now that I feel and look
better than I did in my 20s and I have better mental clarity and
acuity. My memory is sharper, but more
importantly, man, like I don't get sick right Brandon?
Like when we rarely get sick in.Comparison.

(44:37):
It's weird. I feel like maybe once every
couple of years usually, yeah. Like I can.
Shoot, they're lucky. I as a as an emergency
physician, I get to be exposed to the Petri dish of the
Constipation on a Richie. Oh yeah, I spend my life with a
low level upper respiratory dry infection.
Yeah, yeah. But that's, have you seen that?

(44:59):
Have you seen any type of, I mean, this is definitely like
correlation, not causation by any means, but I'm just finding
it very odd that cannabinoids being introduced into your
endocannabinoid system, right? Crazy concept there.
But if people started to be ableto use this in one way or
another, I could see this dramatically having effect on

(45:22):
healthcare as a whole. Because right now, like
everybody's complaining about, oh, Healthcare is up because
this person said this online or this politician did this and he
was like, it has nothing to do with that.
And a lot of it has to do with this, the usage of medicines and
the and the and the mis usage oftheir benefits.
If people just got checked out, were able to come and talk to

(45:44):
you saying, hey, I'm going to behonest about something here.
They always feel like I used to lie to my doctor all the time.
Like, hey, you taking care of yourself.
Yeah, the weights and I do the funny things and they're like,
oh good. Do you ever use anything?
No, never. Why am I lying to this person
that can help me? That just seems ass backwards
and. Yeah, you're absolutely right.

(46:06):
And right, you're you're hittinga nail in the head in that, you
know, institutional medicine lost the war long ago.
And we lost the trust of the patients that we were meant to
take care of. We held no space for nuance.
We held no space for advice. We held no space for individuals
to explore who they were and what they wanted.

(46:28):
And it's no secret that the gap between patients and physicians
has never been wider. And I'm very hopeful that this
inflection point of artificial intelligence is what changes
that. And there's going to be plenty
of doctors who dig their heels in and, Oh, yeah, they don't
want to do this, just like they don't want to understand the

(46:49):
world. Cannabis and patients out.
Yeah, they're going to pitch andscream, but they're going to
lose because AI is going to helppatients like you, Gates, to
help patients do exactly as you say, understand why they feel
better. And does cannabis play a role?
Do other things play a role? Using the data that's all around
us, that's used against us rightnow, using those data with AI to

(47:10):
help patients get better, That'swhere we're going.
And I'm very excited about that.Yeah, that's really exciting to
have a better understanding and how it can really impact and
just on a more granular level. So you guys, when you and your
wife came through and drove out to Utah, you were talking about
where your. State, by the way, my God, can I
tell? You.
We're chess. We went.

(47:34):
To Zyadid. Gas station mushrooms in Zion.
It was great. It was great, but.
How are the gas station mushrooms they were?
Fantastic. But but well, they were a
little. Yeah.
I get nauseous by anything, let me tell you.
But they were pretty good. But what a beautiful.
We don't have that kind of stuffout here where I am.
We don't have the beautiful and the sky.
The sky. I could just.

(47:55):
That's why I was there and I goteverything I wanted.
It's beautiful. I good to.
See you, of course. Yeah, it was amazing.
I had such a blast and the conversation like you guys are
such fantastic people. Where is it that you guys are
going now in your direction? You'd talked about right before
we jumped on you have an app that's coming out.

(48:15):
Shit. Tell me more.
Let me tell you what we're doing.
I'm very excited about what we're doing.
We are. What we're doing is called
mapping the human phenome, right?
So there are data, data everywhere and whether it be
your phone that knows how long you sat on me John today to you
telling me that you're feeling alittle nauseous today to me

(48:38):
knowing what you ate. The data is all around us and to
the extent that you'll share it with me.
We are creating your me know, your private.
This is on your phone, your digital manifestation of self
and what it is, is really the synthesis layer between digital
experience and human understanding.
We focus very much on this government axis of people's, you

(49:01):
know, how they feel is influenced very much by this
evolving science. It's very important we use these
genomic inputs, the data all around you to help you draw your
map of why you feel the way you do.
Because maybe you do feel betterand not get Uris because of your
cannabis use and maybe your datawill support that.
But maybe for me, I, I get sick because my Christmas tree is

(49:27):
here. I don't know, right.
And everybody's different. And we use the, we use the
ambient and active inputs all around us to drive that
discovery. And for you, it drives you, you
draw your map, your feet, your, your menub.
And if you choose, you can shareyour de identified data included
de identified to for the we knowthe global map of discovery and

(49:48):
we use that global map of discovery for lots of stuff.
But principally, we use it to drive drug discovery for people
who are suffering from really hidden and unseen illness,
illness that manifests only in your Menom, how you feel holy.
Shit, that's awesome. We're very excited.
We're going to, we've got a drug, we've got a drug where we
give it to some people and they're feeling a lot better.

(50:09):
We we've got some partnerships with the largest companies in
the world, with NVIDIA and Amazon.
We've got partnerships with the most incredible academic
institutions, George Washington University.
And what we're going to do is, you know, we decoded the genome,
right? And it drove forward a decade of

(50:30):
drug discovery by mapping the phenom, by taking this first
step into what will ultimately become many years from now,
comprehensive digital, that's where we're going.
But by taking this first step, but anchoring it in experience,
I I'm excited. I'm excited for the the right
ahead. That's cool.

(50:50):
So in in essence and, and let mesee if I'm summarizing this
right that you've created something to be able to instead
of designer medications, you're creating designer patients for
medications that are available. Exactly right.
And that's exactly right. And we, we look at where we are
right now with Frontier AI models and with just where we

(51:13):
are with technology as it stands.
And the bottleneck is not turning data into drugs.
It's not. The bottleneck is knowing which
data to turn into drugs and by starting with asking the
patients. That's a good.
What good place to start? You know, one of the problems
with with with medicine and and with with science is that so

(51:38):
much of it is rooted on the bench in the ivory tower, in the
Petri dish, under the microscopeat the top of a mountain.
And I am an ER that has trained and worked in the urban streets
of cities all across our country.
And that science on top of the mountain under the microscope is

(52:02):
not finding its way to these streets.
And so by starting down there and we're going to make people
feel better faster. Hopefully reduce way more of
symptoms and stuff that they don't need and or they're like
throwing things and seeing what sticks.
Well, and yeah, and, and avoiding polypharmaceutical

(52:22):
prescription drugs, I mean, too often where you'll see a
physician, they'll be like, well, we'll give him this and
we'll give him this. Why?
Well, he said these two symptoms.
So I want to treat each symptom,but not knowing that there could
be an adverse effect. Like I worked in the, in the
field of psych and psychiatric care for 10 years of my life and

(52:43):
I got to learn all about these medications that they're given
these SSRI's. And it's not on top of that,
your antipsychotics and then allthe other medications that are
on top of it. You're, you're playing with the
body and it's a lot of guessing games.
So your product would actually be able to help physicians and
clinicians make better diagnosisand better and better pairing of

(53:06):
medications, which could introduce ways to be able to
introduce how cannabis is used medicinally as well.
I mean, am I? Am I far off?
You're exactly right, right? Understanding that everything
touches everything, right? When you put a drop into the
ocean of the human body, it doesn't stay where you put it.
It affects everything. And understanding, you know, we,

(53:30):
we've done a reasonable enough job in medicine of understanding
if I give you this drug, this, what is what will happen to your
lab work, right? But we have done a pretty crappy
job. This is how you feel and and and
so understanding how you'll feelmapping your experience is the

(53:50):
first step toward improving it. Now you had said that was maybe
like a week out from launch. I know you were still had a
couple things. So maybe in the next week.
It's always the juggling act, Yeah, yeah.
And and it's an iterative process.
We, we have spent the last year building the back end for this
the, the bedrock HIPAA secure guard, right?

(54:13):
We're not messing around with people's data here.
And so we've got a janky front end we'll put out next week and
then we'll start making it what it needs to be.
We'll make people understand that what we're gonna give them
as their mean we're gonna give them this little Berry, my God
shoulder that's gonna be taking notes on everything that's going

(54:36):
on and taking notes just like your TikTok algorithms taking
notes and taking notes just likeyour Facebook algorithms taking
notes, but. Not every other app that you use
exactly. But those notes are for you.
Those notes are for you to draw a map of why you feel the way
you do. And we would love if you'll take

(54:56):
the de identified patterns and contribute them to the We know
because it helps us help others.But it is in no way a
requirement and it is for the first time and making the data
work for you. That's going to change medicine.
It's going to change the way, I mean, you know, working on the
insurance side. One thing, it's extremely
frustrating. There's this TikTok doctor, he's

(55:18):
an eye doctor and he makes fun of like the healthcare system.
It's hilarious because it's like, yeah, so I want to make
this, this diagnosis and I want to prescribe them a treatment.
But I got to check with the insurance agency first to make
sure that I can actually do this.
But that that doesn't make any sense.
That means that the insurance agency is practicing medicine,
and they can't practice medicine.

(55:40):
So it's this weird, convoluted snake eating its own tail.
But with your system, man, you're going to fix a lot of
the. I mean, malpractice is going to
go down, right? Overconsumption of certain
medications, being able to have an expiration date on
medications going, yeah, if yourbody's doing these things,

(56:00):
you're going to feel better. And then we can taper off of
them instead of somebody going. How long you been on that SSRI?
What year is that? You know, I mean, it should be
utilized. Medication should be utilized
the way it should be. And you know, and that's one of
the things I was and I'll shut up here.
Damn, this thing's got me all chatty.
Brandon apologize, but. Good stuff.

(56:21):
Dude, it's good. It's good, it's always good, but
it's thinking about like how to be able to bridge that gap now
where the patients can now finally feel like they are part
of their actual treatment plans.Like not just kind of trusting
the doc going, well, the doc gave me this medication.

(56:41):
Like you're the doctors are going to get way more data all
the time, not just based off of lying to your doctor.
You don't need to like it's going to follow you and you're
going to be able to get so much more out of this.
And we're going to learn that you know what, you probably
don't need to be on blood pressure medication because
we've noticed these things over here.
So we need to introduce these modalities and maybe this type

(57:04):
of dietary regime and then thesetype of medications that are not
as long term, you know, side effects.
Whatever it is, man, it's going to change everything.
I mean, my high ass is just thinking this one.
Tell me I'm wrong. I mean you and.
It's all science fiction. You're speaking towards so many
key components of our healthcaresystem.
Polypharmacy is a gigantic problem, and we know 100% that

(57:28):
AI can be used to identify opportunities for Glee
prescribing. And so you're absolutely right.
We, I want to destroy this system of medicine.
I hate this system of medicine. I have been, I've been the
director of the emergency departments of emergency
medicine services, of state public health systems.
I've worked in emergency departments all over the

(57:49):
country, all over the world. And I'll tell you very clearly
that our health care system sucks.
It leaves everybody behind. But at the same, as much as I
want to destroy it, I unfortunately understand that
that's going to happen, come with it.
And so you're absolutely right. We have a patient facing
component, the mean, but the we gnome faces doctors as well.

(58:11):
And so patients have the opportunity very much as you
said, to link up with their doctor here and their doctor
receives the information and it's synthesized through the,
the, the, the big, the big, the big colleges of gastroenterology
and the big gastro psychiatry associations.
All of this information is threaded through that lens so

(58:32):
that the clinician does receive it.
And the clinician has the ability to get this information
about the patient so that it's not a 32nd visit of, oh, you got
some belly pain, why do you takeanother drug?
But it is in fact a much more holistic and informed view of
the patient. Dude, you better get some good
security too. Big Pharma coming for you bro.
Big pharma's coming for me. It's like that one kid.

(58:54):
Have you ever seen that? You ever seen that kid, Brandon?
I don't know if you've ever seenthis guy, but he's a he's a kid
and he figured out how to take plastic and turn it into diesel
fuel. Brilliant fucker.
What? Yeah, he's a kid, too.
He did this in his house. He's this kid from the inner
city, this killer black kid. He came up with this formula and

(59:15):
he takes like all this like shredded bottles and stuff like
that, and then he puts it through some type of pressure
system and he produces his own diesel fuel.
But that's use for all of our shitty waste of plastic around,
like, right? That's brilliant.
And then he started getting shithappening to him and he found it
like the lug nuts on one of his wheels were completely taken

(59:38):
off. So he went into highlighting for
a while, got a bunch of funding and now he's starting to come
back out. But man, it's this and I'm not
saying like on this, but I'm I'mreally excited to see where this
goes. I.
Got to check my lug nuts. I know, right?
For sure shit, dude, I mean, butit's like I I love what you're

(59:58):
doing because it's disruptive and you're doing it.
I mean honestly, I'm going to say this.
A lot of this shit probably camefrom this amazing plant because.
Like that's honestly like when you were talking about.
It just started clicking into place like a fucking Rubik's
Cube where you're over here going, yeah, this is what it
does. And my mind's like, oh, we could
do these things and it fixes these issues.

(01:00:20):
You're able to start lowering healthcare.
I hope a lot of people listen tothis.
You will lower healthcare costs if you use something like this.
Like this is this is crazy. This is crazy.
We're the. Thrilled we, you know, we, so we
have a responsibility to do thisvery much in the right way and,
and good FDA rules. And still we're, we have

(01:00:42):
clinical trials, we have partners with strong research
organizations throughout the country and we'll continue to
sort of evolve these data alongside patients
transparencies at the top of this list.
And as we learn how to do this responsibly, we are going to
just do it out in the open. We're going to do it with people

(01:01:02):
and do it out in the open and all together.
We're going to figure out how tostop misunderstanding, what it
means to suffer, you know, and try to.
Amen. Some better insight and way for
us to talk about the language ofpain and suffering.

(01:01:22):
Have you found there's a broaderacceptance at all within the
medical field with cannabis at this time?
Yeah, for cannabis for sure. I think it, I think it's, it's a
much broader acceptance. You know, back in the there,
there are some physicians who have really led the charge.
Peter Grinspoon, You know a number of other names that are

(01:01:42):
just at the top of a group of individuals who have made sure
that cannabis as both a therapeutic as well as a
recreational option are considered across the board in
medicine. There was Once Upon a time where
everybody got Marinol, right? That was what we gave everybody
in the ICU to get it eating again.

(01:02:05):
And that I think helped doctors understand that it's a perfectly
reasonable medication in some ways.
And if we can just get over thishump of kind of trying to blame
it for people, people with theirbrains out, I think we can be in
a better place. No, Jesse doesn't agree.
He's shaking his head. He's like, fuck that, I don't
agree. I think that's just, you know,

(01:02:25):
I, I, you know, I agree. I mean, I'm just trying to, I'm
shaking my head because I'm like, don't talk too much
anymore, Jesse, because you justgot to go off this, this shit.
I just smoked another one and I'm just like, why did I do
that? Why did I do that?
Because it was tasty. I was calling your name.
I was like, Jesse put me in. Your mouth quick plug dynavate
dude, these are probably the most cost effective.

(01:02:47):
These things are bitching. These little one hitters we got
to get have you? Have you seen those, the Dynavap
ones? They're these little metal ones
and they're it's like A1 hitter,like steel or something.
And you just put the tiniest bitof flour in the end and then
they send out a lighter with it and you heat it up and it will

(01:03:07):
click when it's to the temperature and you inhale.
And I think the guy from the company said how fast or how
hard you inhale depends on how much smoke you get.
Makes sense, yeah. And it, it allows you to micro
dose. And that's one thing that
Brandon and I have always been like, you know, we're big
proponents of dab for new users.And the reason why is that you

(01:03:29):
can do micro, micro doses where you can get more.
I mean, we we love flour, but flour is for more of a middle
ground type of user because theycould go, Oh yeah, I like flour.
And then smoke a joint like a friend of mine, he's like, yeah,
I smoked a joint yesterday. How did that go?
And he goes, it was not a good idea.
And I'm like, yeah, know your limit.

(01:03:50):
Was it the full one of the wing wing sour diesel?
Nah, it was the Cowboy Kush. That shit's good.
Dude, that would do it too. Yeah, it would, it would.
He was like I was staring at theTV and my wife comes in and
goes, are you high? And he goes what?
She's like, it's like if my wifecomes out and sees me over
there, she just looks at me. She goes, he's probably high.

(01:04:12):
Then she just says it to herselfand she's like, but he's nice
now. So we're OK.
But oh man, I I am just like this this thing, dude, it's so
cool because you get like you save a lot of of flour and I
think this is really good for dosing.
And so this would be my second choice for people who are
getting into flower would be this type of device.

(01:04:35):
It's cost effective. It's super discreet.
They sent us the wand this that disappeared.
Yeah, I Spires dabbing wand for dab rigs.
Wow, that's. Beautiful.
But it fits perfectly inside it.Yeah, you heat, you turn it on
and it turns. Out of here.
That's cool. So then you go drop it in.
I want this temperature set it to the exact temp that looks

(01:04:57):
like. An ink pen I could keep on my
desk that looks. Just send it in the whale pull
it out. Excuse me Sir, this needs to.
Be written in green. You know what, Doc?
We're going to cut, We're going to reach out to him.
We're going to have him send this out to you because.
This on my desk like an ink pen.It will.
Be dude, this this is super cool.
It's like one of the big. I mean they should use this for

(01:05:18):
their marketing out there. They were so kind to send this
out to us. I have loved this and I don't
like any of these things and I love.
I stopped using my electronic vaporizer because I love this
thing so much. I praise for real.
I mean, and I love, I love my stores in Bickel.
I do. But at home, yeah.
Yeah, I like stores in Bickel. I'd rather than you check that

(01:05:40):
out. Very cool.
Yeah, I think it's probably the best.
I love my stores in Bickel like I.
Right. But this like I thought about it
like this, the pen is so tiny, like you, even if you took it on
the go, they have this little tiny container that it comes in
that fits the lighter and that throw that in your pocket or
something. It's super.

(01:06:00):
Go hiking and you don't have to roll a bunch of joints, you just
take a couple tubes with you. No, I'd still roll a bunch of
joints because then I have enough for the.
Joints. They're pretty good.
That's way too much work for me to have to go, but I want to
keep smoking I. Do that's what I love about
this. What was that?
It's like the middle of the day escaped 10 minutes between

(01:06:21):
meetings. Yeah, yeah.
It's just like a quick look, perfect puff.
Oh my. God, I got another meeting in 10
minutes. Right, kind of step out real
fast. Take this, I'll be back in.
All right, man. Dude that's so cool.
If you could leave every cannabis user with one rule to
protect their gut, their brain, and their relationship with
cannabis, what would that rule be?

(01:06:43):
My rule would be to use responsibility.
It would be to recognize a multifactorial and dynamic nature of
cannabis. Just like everything else you
do, right? Just like what you eat, what you
drink, and what you scroll. All of these things play a
complex, dynamic and interrelated role in how you

(01:07:04):
feel, and in cannabis you use inparticular, we who are starting
to feel not great, whatever thatis.
We've identified that tolerance breaks, moving toward flour,
moving your first smoke later inthe day, supplementing with
vitamin B1 and magnesium, and taking an allergy pill all seem

(01:07:26):
to be very high on the list of ways to help you continue
responsible cannabis. That's what I was going to ask
you. I had a question that popped in
my head. Have you, I'm sure you take the
vitamins like magnesium and the vitamin B.
Do you notice a difference with how cannabis feels when you have
that in your system versus not? Absolutely.

(01:07:47):
What a great question. You know what, there's a,
there's a phenomenon among people who they begin taking
high dose of what's called TTME,special form of thymine, where
they experience something calledglycogen shock.
And it's because they're basically their metabolism
starts working so well that their bodies like whoa.

(01:08:08):
And, and, and the, the thrust ofthis being that patients who are
healthy will experience the euphoria and effects cannabis
better, right? So patients who are optimizing
their metabolics and underlying your underlying inflammation
will have a better experience with GABS.
That's kind of like the entourage effect where it's more

(01:08:29):
of a complete better experience.And I kind of wondered if adding
in those other vitamins was kindof that similar effect, just on
a deeper range. Absolutely.
I mean these vitamins and not just vitamins, right?
Like you said, you have the right terpenes, right?
These things function synergistically.
We know. We know it to be true from the

(01:08:50):
genetic apple type. We know it to be true from the
fact that patients have multi receptor dysregulation.
But many of those receptors haveshared underlying problems, and
so addressing those underlying problems makes them all work
better. Yeah, well, take that.
I had a question and just ran away.
Yeah, because the marijuana. I know like.

(01:09:12):
Damn you marijuana took away my brain.
No dude, I I you what you got Lemon Haze?
Yeah, well, I switched from Cheetah Piss midway to Lemon
Haze because it just sounded so good and I was like, why not?
It's here. Wow.
Super lemon haze, man. Oh, delicious.
Yeah. Oh, I had yo go.
You had it go. Do you have a brand or a

(01:09:35):
specific type of magnesium or vitamin B1 that you recommend or
use yourself? Well, I think that the top of
the list here is patients need alipid soluble form.
We people are at particular riskin our country because the type
of thiamine we use in our food supply breaks up in the cell.

(01:09:55):
And so there are different typesof lipid soluble thiamines out
there. There's been so TMN there,
DENFOTIMINE, that's the most common, a lithium and TTFE,
those are other ones that we see.
So I think that's important. Magnesium's an interesting thing
because there is First off, like75 different types of
magnesiums. And the thing about magnesium is

(01:10:17):
the type of magnesium you use isreally important.
Magnesium citrate is what we give to people to evacuate their
bowels, right? Magnesium 3 and 8 is what we
give to people with palpitations.
So those are different. Things.
So be very careful. Which one?
Yeah. You gotta be careful, right?
Like and. You might be shitting your

(01:10:37):
brains, yeah. You gotta be careful, right?
So like, don't take magnesium citrate if your goal is not to
shit your brains. That's what literally what we
use it for in medical school. You learn the effect of
magnesium. I swear to God in the book that
we all use for is that it causesis a maximum amount of these,
right? I swear to God that's the
mnemonic. And so don't use the wrong

(01:11:00):
magnesium, right? So magnesium malate is what like
Olympians use for like muscles, right?
We see that patients with belly problems.
So we're talking about cannabinant hyperemesis.
You know, magnesium glyconate really is at the top of this
list. There's also a magnesium bisque
glyconate. They're kind of the same thing.
So yeah, magnesium glyconate's the one that you want if you got

(01:11:20):
a bad belly. All right.
That's. Cool.
That's, you know, hydrate. Yeah.
And if you want to pull some pranks on someone, maybe slip on
some of that. Yeah, it comes in a big glass
bottle. You don't want it.
Is that what they send you home with before you get a
colonoscopy? No, that's a different thing.
Yeah, that's that would be. Here's your bottle though.

(01:11:43):
Lightly, you'll feel better. Soon.
That's what I was about to say. It is the most horribly named
thing over there. I think the guy who was a better
than going, it would be funny ifthey called it go lightly
because that's the last thing you're going to do.
Actually, the name of it, yeah, that's messed up.
Dude, when I worked at the statehospital, I worked at state
hospital for 10 years, man. And patients would have to go to

(01:12:05):
the guts and butts doctor. So they give him this like
gallon. It looked like, it literally
looked like windshield wiper fluid.
It was like this big old jug. And they would drink it and you
couldn't. And it would just, they would
just sit on the toilet and they would make their insides look
like brushed brass. It was just like.

(01:12:26):
And then they get there. Yeah.
I mean, it was horrible. That sounds rough.
I don't know. Yeah, I don't know.
Not my cup of tea. No.
Well, you don't want that in your tea, Brandon.
You don't want that in your tea.No, no, this has been great.
I appreciate you hopping on, man.
This was a blast. It's always good talking with

(01:12:48):
you. I appreciate you guys having me
on to the chat, you know, Yeah, there's a whole community out
there that's searching for people to teach them, and you
guys are really spreading some important information.
Man. Are you?
Appreciate that. Doing conferences and that
around or what are you? What am I doing?
I'm I'm all over the place, man.Yeah, we're doing.

(01:13:09):
I can't see. I can't see what it's something.
But like we we got some conferences coming up.
We what's, what's my big thing? We're launching this app.
We want people to get on this app.
We want people to engage with it.
They don't have to. They can turn it on in the
background and it'll work for you.

(01:13:30):
The more that you help it map your experience, the more that
it'll help map your experience, right?
And then it'll drive a new drug discovery, right?
That's where we're at. We're looking.
Do you have a name? Oh well, our company's name.
Oh, for your app, what do they look for when it's called?
Meno, Meno. Yeah.
You're going to map your me? No, please jump on.

(01:13:51):
And we'll get the links from youwhen it's live, and it'll all be
below in the show. Oh yeah, we'll we'll share the
hell out. And thank you.
Yeah, we, we're. So it's gonna give people, you
know, one of the complaints thatwe hear all the time is this
sort of gaslighting in medicine that has become the norm, that
if, if my lab tests say you're normal, then you can't possibly

(01:14:13):
be in pain or discomfort. And, you know, it turns out
that's not right. And so this will finally give a
language to that that's unassailable, UN gaslightable
and for a lot of people. And we're certainly focused on
this group of individuals with bad bellies, people with
cannabis, hyperemesis, IBS, cyclic vomiting.

(01:14:34):
And that's our primary group that we began with.
But it's grown to so much more to that.
It's grown to people with a whole host of hidden and unseen
illness. It's grown to people with, you
know, just the daily experience of what it means to be
functioning. Yeah.
And if it needs, if it needs a label, so be it.

(01:14:54):
But what we do know is that it it's time to begin to map the
pheno. That'll be really interesting My
I'll be curious to see how that plays out.
Long run, my grandma's side on my dad, her half her family died
from a specific heart disease. It's crazy rare in the US.

(01:15:16):
They came out and did blood draws of so we had probably only
like 70 people in the family at that time, but they had all 70
of us go to my grandparents. They had doctors and nurses come
do blood draws on every single person in the family.
Yeah, down to like 6 month old like infants and stuff because
it was that was such a rare disease and there's like they

(01:15:41):
don't live long people who have it and my grandma down no one in
our family has it, but her sisters like half of her sisters
passed from her her parents likeall of that line.
It's and I can't even think of what it's called right now.
Oh, that's. Yeah, wow.
Holy. Moly But yeah, I'd be very
interested to see like how even those types of things play out

(01:16:05):
with like really more in depth data that we just truly don't.
We can't. We can't help people with these
small data sets, right? We can't.
It's terrible. And I could wax poet forever
about how we did this to ourselves.
We set an EBM barrier that was rooted in bastardized

(01:16:25):
understandings to what it means to be a position.
We could preach that all day long, let me tell you.
But you know, ultimately, you'reexactly right.
There are rare diseases all overthe world that we hope to gather
more information about what it means to live with that rare
disease, and perhaps what it means to live before that rare
disease. Yeah, I'll, I'll ask them when I

(01:16:48):
see them this week and I'll textyou what it is.
So please do. Yeah, yeah.
Hey, thanks so much, Rick. This has been amazing everyone
at home check out ricks links below download the app and
figure out Jeremy now tune in the next week so.

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