Podcast Summary
Peter Attia's Podcast Runs on Subscriber Support: Peter Attia values trust and authenticity, and offers exclusive benefits to supporters of his ad-free podcast, ensuring they get more than they give.
The Peter Attia Drive, a podcast dedicated to optimizing performance, health, and longevity, does not run ads and instead relies on listener support. The host, Peter Attia, explained that he values trust and authenticity, and he finds it difficult to enthusiastically advocate for something he doesn't fully believe in. Instead, he has adopted a subscriber support model, offering exclusive benefits such as full access to show notes, Ask Me Anything episodes, and discounts on products he loves. The podcast remains free to all, but supporters receive additional value in return. Attia emphasized that it's his goal to ensure that supporters get back more than they give. The podcast features interviews with top performing individuals and covers various topics, including a recent discussion on THC, CBD, hemp, cannabis, and related topics, which Attia admitted he found confusing but found valuable in preparing for the podcast.
Exploring the Complexities of Cannabis as a Medicinal Option: Experts Deborah and Steve, an anesthesiologist and scientist, discuss the varying effects of THC and CBD on the body, their personal motivations for studying cannabis, and the evolving policy landscape surrounding its use as a medicinal option, while addressing safety concerns like the vaping epidemic.
Cannabis is a complex plant with various compounds like THC and CBD that work differently in the body, and their effects on the brain and other parts of the body can vary. Deborah, an anesthesiologist, and Steve, a scientist and former FDA attorney, have dedicated their careers to understanding cannabis as a medicinal option. They met through their shared interest in cannabis as a potential alternative to pharmaceutical drugs. Deborah was driven by the loss of her mother, who could not try medical cannabis due to its illegality during her time. Steve, on the other hand, was inspired by friends with PTSD and cirrhosis of the liver. Together, they have spent decades studying cannabis as a medicinal option and are now involved in a company that develops cannabis formulations. The discussion also touched on the evolving policy landscape surrounding cannabis and the safety concerns, including the ongoing vaping epidemic. While this podcast doesn't cover every possible question about cannabis, it provides valuable insights from experts with a deep understanding of the topic.
A brief history of cannabis as a medicinal plant: From ancient use to modern research, cannabis has a rich history as a medicinal plant, with various forms and uses throughout history, but its legality and public perception have fluctuated significantly.
Cannabis has a rich history as a medicinal plant, with use dating back over 5,000 years. It was consumed in various forms, including topically for horses and as a beverage in India. However, its public perception and legality have fluctuated throughout history, with it being scheduled as a narcotic drug in the 1930s under the DEA. This made it difficult for research and medicinal use. The popular image of marijuana is often associated with THC intoxication and smoking, but its uses and forms have varied greatly throughout history. Today, companies like the one Steve and Deb are part of aim to create safe and effective forms of cannabis delivery. Despite its long history, cannabis is still a complex and evolving topic in the realm of medicine.
Cannabinoids and Their Interaction with Receptors: Cannabis' medicinal properties come from THC and CBD, which interact with CB1 and CB2 receptors to provide pain relief, memory extinction, immune system modulation, and non-intoxicating benefits like inflammation reduction and appetite stimulation.
Cannabis, specifically the flower, contains the majority of its medicinal properties due to the presence of cannabinoids like THC and CBD. THC interacts with CB1 receptors in the brain and peripheral nervous system to produce intoxicating effects and provide pain relief, memory extinction, and immune system modulation. CBD, a non-intoxicating cannabinoid, interacts with CB1 and CB2 receptors to offer various medicinal benefits, including pain relief, inflammation reduction, and appetite stimulation. The rapid rise in CBD's popularity is due to its non-intoxicating effects and potential therapeutic applications. Understanding the complex interplay between cannabinoids and their receptors can lead to innovative treatments for various conditions.
CBD and THC: Different Impacts on Endocannabinoid System: CBD doesn't directly bind to CB1 and CB2 receptors like THC, instead it interacts indirectly or with other receptors, leading to a synergistic effect. Hemp, with less than 0.3% THC, is a distinct cultivar from cannabis and is now legal for cultivation and production of CBD products in the US.
CBD and THC, two main components of cannabis, work differently within the endocannabinoid system. While THC binds directly to CB1 and CB2 receptors, CBD does not. Instead, it interacts indirectly or with other receptors, leading to a synergistic effect. CBD occurs in varying concentrations depending on the plant strain, and hemp, defined by less than 0.3% THC, is a distinct cultivar from cannabis, which historically had higher THC levels. The 2018 Farm Bill legalized hemp cultivation and processing in the US, paving the way for widespread production and use of CBD products beyond cannabinoids, such as hemp seeds and fiber, in various industries.
Hemp: A Versatile Plant with Industrial and Medicinal Applications: Hemp offers various industrial uses including plastic and concrete replacements, clothing, and more, but its expensive processing hinders widespread use. CBD's medicinal properties and high demand make it financially viable. The FDA is regulating CBD use, while studies show promise in pain relief.
Hemp has the potential to replace various plastic and concrete products, as well as being used in the production of clothing and industrial uses. However, the expensive machinery required to process hemp fibers is currently hindering its widespread industrial use. CBD, on the other hand, is currently more financially viable due to its medicinal properties and high demand. The FDA is still in the process of regulating CBD for use in consumer products. In a recent study, a water-soluble CBD was found to effectively reduce pain in a group of 16 patients with mild to moderate pain, but the study lacked a control group. CBD and THC differ in their mechanisms of action, with CBD interacting with the breakdown products of endocannabinoids and enhancing the effects of certain neurotransmitters. Unlike the reductionist allopathic view, hemp is a complex botanical medicine with over 100 cannabinoids, over 80 terpenes, and possibly other undiscovered constituents.
Turpians have natural benefits for plants and humans, THC has minimal toxicity and no reported lethal doses, but individual responses can vary greatly.: Turpians have natural anti-inflammatory and pesticide properties for plants, THC has minimal toxicity and no reported lethal doses, but individual responses can vary greatly depending on the dose and setting.
Turpians, found in various plants and foods, have natural anti-inflammatory properties and function as a natural pesticide and antioxidant for plants. When it comes to THC, while it has minimal toxicity and no reported lethal doses, individual responses can vary greatly depending on the dose and setting. Unlike other substances like alcohol, THC does not have a known upper limit of toxicity due to the absence of CB1 receptors in the cardiorespiratory centers of the brain. It's important to note that while THC may cause anxiety or psychotic events, it does not have the capability to cause death from a cardiorespiratory standpoint. Additionally, THC does not have the same level of toxicity as commonly consumed substances like alcohol, and its effects are generally known and acknowledged by users. The toxicity of a substance is not just determined by its lethal dose, but also by how far it is from the therapeutic or use dose. For example, acetaminophen, which has a relatively low LD50, can cause severe liver damage even at therapeutic doses.
Narrow therapeutic index of alcohol and prescription drugs: Mistakes in prescribing or consuming alcohol and certain prescription drugs can lead to serious harm due to their narrow therapeutic indexes. Societal acceptance and historical context play a role in the legality and perception of these substances.
The therapeutic index of certain substances, such as alcohol, can be very narrow, leading to potential toxicity and harm even with small dosing errors. For instance, a simple clerical error in prescribing Ativan led to a patient's respiratory arrest due to an overdose. The therapeutic index for alcohol is similar to that of prescription drugs like Valium, but alcohol is more socially accepted despite its toxicity. The prohibition era saw alcohol's return to favor due to societal needs for release and the difficulty of enforcing prohibition, whereas cannabis remained largely illegal due to its association with certain groups and lack of societal acceptance among those in power. Regarding the gateway drug argument, while cannabis was once considered a gateway drug, recent evidence suggests it may lead to healthier choices rather than drug addiction. The legalization of marijuana in states like Colorado and Washington has not resulted in significant increases in the use of other drugs.
Marijuana and Opioids: Connection and Complexities: Access to legal marijuana may reduce opioid prescriptions, but more research is needed to understand potential risks and benefits, especially for young people. THC, the psychoactive component of marijuana, has lower addictive potential than opioids and may help overcome addiction to other substances.
While there is ongoing debate about the relationship between marijuana use and the use of more harmful substances like opioids, there is evidence suggesting that access to legal marijuana may lead to a reduction in opioid prescriptions. However, it is important to note that correlation does not imply causation, and more research is needed to fully understand the potential risks and benefits of marijuana use, particularly for young people whose brains are still developing. Additionally, THC, the psychoactive component of marijuana, has a lower addictive potential than substances like alcohol, tobacco, and opioids, and there is ongoing research into the potential therapeutic uses of marijuana and its constituents, such as CBD, in helping people overcome addiction to other substances. Ultimately, the decision to use marijuana, especially for medical purposes, should be made on a case-by-case basis and with careful consideration of the potential risks and benefits.
Understanding the complexities of THC inhalation: THC's intoxicating effects require specific conditions and can be delivered through inhalation methods like smoking or vaping, but these methods have drawbacks like inconsistent dosing and potential health concerns
While THC is known for its intoxicating effects, it requires specific conditions to produce those effects, including the presence of receptors and sufficient drug concentration. The inhalational route of administration, such as smoking or vaping, allows for quick engagement of the active ingredients with the receptors but has drawbacks like inconsistent dosing and potential lung health concerns. The vaping method, in particular, has recently raised safety concerns due to reports of severe respiratory distress, likely caused by contaminants in the refined oil used in cartridges. The use of inhalational methods for medical cannabis is a complex issue that requires careful consideration of the patient's condition, route of administration, and dosing consistency. From a chemical perspective, vaping works by heating the substance at a lower temperature than traditional smoking methods, and new inhaler technologies aim to provide more controlled dosing. However, the safety of vaping, especially with THC products, is still a topic of ongoing research and debate.
Vaping Crisis: Complex Issue with Unknowns: The vaping crisis highlights the need for clearer regulations and oversight in the industry to protect public health, as the use of certain additives and lack of clarity in FDA's regulations can lead to unintended consequences.
The current vaping crisis is a complex issue with many unknowns. The use of certain additives like PG and PEG, which were thought to be safe for consumption but not for inhalation, may be contributing to the health issues. However, the FDA's regulations regarding GRAS (Generally Recognized as Safe) substances and their use in new products and methods are not clear-cut. For instance, the FDA may regulate individual components of a product, but not the overall product when used in a new way. This lack of clarity can lead to unintended consequences, as seen in the vaping crisis where thousands have been hospitalized and dozens have died. Furthermore, the FDA's oversight does not extend to all actors in the industry, leaving room for unregulated production and potential harm. The cause of the crisis is not yet clear, with no definitive evidence of manufacturing, loci, or etiology. The FDA's role in regulating the plastic containers of jelly beans as GRAS substances also highlights the complexity of the issue. While the FDA regulates individual components, the implications of using those components in new ways, such as inhalation, are not always considered. Overall, the vaping crisis underscores the need for clearer regulations and oversight in the industry to protect public health.
Navigating the complex and evolving regulatory landscape for cannabis vaping: Despite cannabis remaining federally illegal, safety regulations are primarily at the state level, leading to inconsistencies and challenges in ensuring product safety and efficacy. Concerns about acute toxicity have emerged, and manufacturers explore ways to improve product safety, such as changing the method of cannabinoid administration.
The regulatory landscape for cannabis products, particularly those involving vaping, is complex and evolving. The discussion highlighted that cannabis remains federally illegal, which means that safety regulations are primarily at the state level. This can lead to inconsistencies and challenges in ensuring product safety and efficacy. The conversation also touched upon the difference between acute and chronic toxicity, using examples like tobacco and alcohol. While the chronic toxicity of cannabis vaping is still uncertain due to the relatively recent popularity of the practice, concerns about acute toxicity have emerged. Manufacturers are exploring ways to improve product safety, such as changing the method of cannabinoid administration from fat-soluble to water-soluble. The conversation also touched upon the differences between edibles and other forms of cannabis consumption, with edibles requiring heating to activate the THC and produce intoxicating effects. Overall, the discussion underscored the importance of ongoing research and regulation to ensure the safety and efficacy of cannabis products.
Factors affecting THC dosage in edibles: Edibles can provide long-lasting relief for chronic pain, but inconsistent dosages due to individual digestive processes make it difficult to achieve reliable results. THC gets chemically converted into a more intoxicating metabolite when ingested, leading to unpredictable effects. Best use cases are for chronic pain and sleep disorders.
The production of THC, the active ingredient in cannabis, requires both time and temperature. However, when it comes to edibles, the experience can be unpredictable due to various factors such as individual digestive processes, body mass, and personal feelings. This makes it difficult to achieve consistent, reliable dosages. Additionally, when THC is ingested and goes through the liver, it gets chemically converted into a more intoxicating metabolite. Some people who are experienced with inhalational methods of THC find edibles to be too intense. The best use cases for edibles are for individuals with chronic pain, especially those who have trouble sleeping, as they can provide long-lasting relief. It's important to note that THC, like opiates, can lead to tolerance and potential hyperalgesia, where pain is enhanced rather than decreased. While opiates also require time and temperature to be effective, they have a much stronger and more rapid effect on the body, leading to a higher risk of addiction and dependence.
THC interacts differently with individuals and substances, causing varying effects: THC can have negative effects on certain individuals, but combining it with CBD may be beneficial for pain relief and reducing opiate use in hospitals.
THC interacts differently with the central nervous system depending on the individual and the presence of other substances like alcohol. While small amounts of THC may not cause intoxication and can be used for medical reasons, high doses can have negative effects for certain individuals, especially those with psychiatric conditions. However, the use of other cannabinoids like CBD in combination with THC may be beneficial. THC has shown to reduce the need for opiates in pain relief and has been used in hospitals for chemotherapy-induced nausea and vomiting since the 1980s. The future of THC and CBD in post-op surgical patient care is uncertain but promising.
Exploring CBD's potential for sleep benefits: CBD, a purified cannabinoid, shows promise for improving sleep quality and reducing seizures, but more research is needed to confirm its safety and effectiveness in larger populations.
While THC can be uncomfortable with its side effects like increased heart rate, dry mouth, and agitation, CBD, a single isolated and purified cannabinoid, shows promise for various uses including sleep. CBD, which has a purity of over 90%, has been effective for some in reducing seizures and improving sleep quality, although high doses can have side effects. The mechanism of action for CBD's sleep benefits may be due to its central activation of the GABA receptor, which can help reduce anxiety and promote sleep. However, more research is needed to fully understand CBD's impact on sleep architecture and to confirm its effectiveness and safety in larger populations. The restricted legal environment surrounding cannabis research limits the amount of scientific investigation into CBD and its potential uses.
Companies are funding their own cannabis research and development: Companies are innovating water-solubilization tech for faster, more effective cannabis absorption, allowing sublingual administration and bypassing liver metabolism for optimal dosages
Despite the growing interest and potential benefits of CBD and THC, the lack of federal funding and the long-standing illegality of cannabis have hindered research progress. Companies like the one discussed are filling the gap by funding their own research and development, including the water-solubilization of cannabis molecules for faster and more effective absorption. This innovation allows for sublingual administration, bypassing the first-pass metabolism in the liver and increasing the amount of active drug reaching the bloodstream. The optimal dosage for sleep, for instance, may involve a combination of CBD and THC. While research is ongoing, this approach is providing new insights and potential solutions for various health conditions.
The complexities of researching cannabis: Researching cannabis involves overcoming challenges beyond standard safety, efficacy, and effectiveness phases, including route of administration, chemical composition, and cocktail effects. Seek public support and funding, collaborate with a team, and manage hype to maintain credibility.
The entourage effect, which refers to the synergistic interaction between various compounds in cannabis, is a well-known concept in the cannabis industry but also applies to medicine in general. Researchers, including Deb, an anesthesiologist, have observed the same effect through clinical trials using multiple drugs. However, for a company focused on mapping and understanding the complexities of cannabis, there are additional challenges beyond the standard safety, efficacy, and effectiveness phases of clinical research. These challenges include the route of administration, chemical composition, and cocktail effects. It's important to consider seeking public support and funding for research, as the public's appetite for this area is strong. The work being done is valuable, but it may be beneficial to collaborate with a team rather than going alone due to the complexity of the issue. Additionally, managing the hype and potential stigmatization is crucial, as anecdotal stories, while sometimes true, can damage the credibility of research when absurd claims are made.
Cannabinoids and Cancer: Personal Stories and the Need for More Research: While anecdotal evidence suggests benefits of cannabinoids in cancer treatment, lack of clinical trials and regulatory approval hinder their use. Personal stories of success don't replace rigorous research. Pursuing research on THC, CBD, and related products is crucial, with INDs playing a key role in bringing new drugs to market.
While there is promising evidence suggesting that THC and other cannabinoids can have a positive impact on cancer through mechanisms like apoptosis and neovascularization, there is a lack of robust clinical trials and regulatory approval for their use as cancer treatments. The speaker shares a personal story of successfully transitioning an eight-year-old girl with cancer from hospice to school using cannabinoids, but emphasizes the need for more rigorous research and cautions against unproven cancer treatments that may drain people's resources. The speaker also discusses the importance of pursuing research on THC, CBD, and their associated products, and the need for funding and incentives to drive this research forward. An IND (Investigational New Drug) is an essential step in the regulatory pathway for bringing a new drug to market in the US, allowing researchers to investigate the safety and efficacy of the drug before seeking FDA approval.
FDA Clinical Trials for CBD Products in Three Indications: Company collaborates with FDA for clinical trials in pain for dogs, osteoarthritis for people, and PTSD. Adheres to GMP for safety and efficacy despite state law exemption. Prioritizes indications based on testing ease, speed, and cost.
The company is working with the FDA to conduct clinical trials for their CBD products in three therapeutic indications: pain in dogs, osteoarthritis in people, and PTSD. The company follows Good Manufacturing Practices (GMP) to ensure safety and efficacy, even though it's not required by Michigan state laws. Creating a new drug through the FDA process is a lengthy and expensive process, taking about a decade and $1 billion on average. The company has prioritized indications based on ease, speed, and cost of testing. They have a successful business in Michigan, selling extracts, tablets, gummy bears, and vape cartridges in state-authorized dispensaries. They have grown to employ about 100 people, with a research team led by their Chief Medical Officer, Deb.
Navigating the legal framework for selling cannabis-related products: Federal approval through organizations like the FDA is currently required for selling cannabis-related products across state lines and internationally. The speaker believes that changes in federal status and use of existing regulatory frameworks may facilitate future sales.
The legal framework for selling cannabis-related products across state lines and internationally involves a complex process that currently requires federal approval through organizations like the FDA. The speaker, who has been involved in advocating for the use of these products for medical purposes, believes that the legal status of cannabis will change at the federal level, likely through the use of existing regulatory frameworks like the over-the-counter drug review. The speaker also emphasized the importance of the farm bill in decriminalizing parts of the cannabis industry and paving the way for further changes. Despite the challenges, the speaker remains optimistic about the future of cannabis as a legitimate medical option.
Protecting Yourself in the Unregulated Cannabis Industry: Buy from legal dispensaries, ask for certificates of analysis, consult with a cannabinoid medicine specialist, and be cautious of online or street purchases to ensure cannabis product safety and effectiveness.
The cannabis industry, while full of excitement and potential, requires caution due to the lack of standardized testing and regulation across states and even laboratories. This can put consumers at risk of purchasing products that may not be safe or effective. To protect yourself, it is recommended to buy from a legal dispensary in a state where cannabis is legal, ask for a certificate of analysis, and consult with a physician who specializes in cannabinoid medicine. The lack of federal regulation also makes it important to be wary of online or street purchases. The expert team being discussed in the conversation is dedicated to ensuring patient safety and advocating for robust testing and standardization at the federal level.
Understanding Cannabinoid Product Testing and Regulation: Decriminalization of cannabis has led to more rigorous testing, allowing for faster research advancements in the field of cannabinoids. Consumers should ask for certificates of analysis and educate themselves on safety and efficacy.
The field of cannabinoid product testing and regulation is rapidly evolving, with varying rules from state to state. It's crucial for consumers to ask for certificates of analysis and educate themselves on the safety and efficacy of these products. The endocannabinoid system was not traditionally taught in medical or chemistry schools, making it a challenge for physicians to keep up. Decriminalization of cannabis has led to more rigorous testing and destigmatization, allowing for faster research advancements. Despite confusion and complexities, the decriminalization of cannabis and ongoing research are leading to important discoveries and improvements in understanding these substances. For more information, visit peteratiamd.com/podcast. Remember, this podcast is for informational purposes only and does not constitute medical advice. Always consult a healthcare professional for any medical concerns.
