Aging

Psychiatric Disorders Reduce Survival Among Immune-Mediated Inflammatory Disease Patients

Psychiatric comorbidity increases mortality in immune-mediated inflammatory diseases

Summary Information:

A new study finds that a diagnosis of depression, anxiety, and/or bipolar disorder increases mortality rates for patients of one of three immune-mediated inflammatory diseases (IMID):

1) multiple sclerosis (MS), or

2) inflammatory bowel disease (IBD), or

3) rheumatoid arthritis (RA).

Depression and bipolar disorder can cause poor health behaviors in patients, as depression, bipolar disorder, and anxiety disorders are “associated with increased inflammation and immune dysregulation.” Suicide risk and attempts are increased among IMID patients with mental illness, compared with IMID patients who are not also suffering from one of these additional battles. Given that cannabis has shown promise in treating both inflammation and a range of psychiatric disorders, there is reason to be optimistic for further cannabis research to uncover multifunctional treatment options.  

Dr Caplan and the #MDTake:

Clinically, it’s rare to see medical patients who have only one concern. Sure, there are some who are hoping that cannabis will help them to treat seizures, headaches, anxiety, sleep troubles, or terrible back pain, but more often, it is a combination of several troubles that each add to a cumulative tipping point.

Naturally, very few individual systems act alone. When a body part is injured, sleeping (or not sleeping) effects the course of illness. Similarly, feeling less anxious, or improving sleep, may make symptoms of a struggle with consistent headaches seem more tolerable. Even when there aren’t direct connections between symptoms, a treatment which implements a systemic treatment can have multiplied benefits.

Many patients have found that cannabis offers them a way to attack more than one problem, with a single actor. Some with Diabetes are finding that some formulations are not only helping them reduce blood sugar levels, but also reducing appetite. Similarly, some patients with ADD are turning to cannabis options which may help them focus, without their ability to get to sleep at night.

To a related note, many elderly patients are treated with too many medications. Modern Western medical treatment often compels patients into silos of treatments by isolated specialists, who are not always monitoring the patient as a being beyond individual organ systems. Medications, such as cannabis, which have the opportunity to treat more than one system, without multiplying the risk of potential drug-drug interactions presents a much safer approach to care

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Benjamin Caplan, MDPsychiatric Disorders Reduce Survival Among Immune-Mediated Inflammatory Disease Patients
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Does Cannabis affect blood pressure, heart rate, brain blood flow?

Article title: Acute Cardiovascular Effects of Marijuana Use

The Review:

The authors of this systematic review combed through multiple previously published studies, looking at the short-term cardiovascular effects of THC on the body. The cardiovascular effects they covered included: changes in blood pressure, heart rate, and blood flow to the brain (cerebrovascular circulation).

This review showed that for blood pressure, the results were undecided, as some studied showed a drop in blood pressure, while others did not. For heart rate, the studies showed an increase after consuming marijuana, but quantity and duration were not mentioned. As for blood flow to the brain, only one study showed a potential decrease while the others found no change. The THC percentage of the products used (mainly inhaled ones) ranged from 1.2% to 17.5%.

Dr Caplan and the #MDTake:

This limited review aims to evaluate the effects of THC on blood pressure, heart rate and blood flow to the brain, but it has important limitations. In terms of how the changes were recorded in the studies and the relevant amounts (of what is changing) were not mentioned. For instance, while the study did show that THC may increase heart rate in the short term, it is not clear what the relevance is, what risk this may poses to consumers if any. Past literature has shown that heart muscle can respond to specific cannabinoids, both in the lab and in animals trails. Several case studies have reported individuals with grave reactions, although these concerns have yet to be replicated in a controlled manner, nor correlated with any specific circumstances or components of cannabis. Toward a goal of maximizing safety, caution is likely warranted for those consuming cannabis with known cardiac risk factors (including heart dysfunction, blood pressure concerns, rhythm abnormalities, and others) particularly with regard to the consumption of high THC products.

Clinical Impressions:

Clinically, there is a distinct trend of people who have found heart rate effects with their cannabis use, mostly increased heart rates at the beginning of use (both when first beginning to consume cannabis as well as early on during an episode of consumption.) There seems to be a tolerance to the heart rate effects because many report that this effect wanes over time. There are a clear group of patients for whom cannabis lowers blood pressure, but also groups for who it either has no effect or increases blood pressure. The long-term trend again seems that tolerance plays a role in bringing all extremes to the middle ground. Regarding blood flow, there seems to be a clear increase in local blood flow with topicals and, at least among CED Clinic patients, no observable relationship between cannabis use and blood flow, from a macroscopic perspective.

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Benjamin Caplan, MDDoes Cannabis affect blood pressure, heart rate, brain blood flow?
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CB1 and CB2 receptors play differential roles in early zebrafish locomotor development

Scientists found that blocking CB1 receptors and CB2-receptors in young zebrafish resulted in morphological deficits, reductions in heart rate, and non-inflated swim bladders. These findings indicate that the endocannabinoid system is pivotal to the development of the locomotor system in zebrafish, and that disturbances to the endocannabinoid system in early life may have detrimental effects.

The translation of these effects to humans is obviously not direct, but it is important for science to learn about safety and expected effects, to examine how chemistry interacts in petri dishes, how basic organic/animal functions are impacted in a living thing, and when the time is appropriate, to then assess any effects in humans

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Benjamin Caplan, MDCB1 and CB2 receptors play differential roles in early zebrafish locomotor development
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Surveys show medical professionals’ opinions clashing around Cannabis

Surveys on medical professionals’ opinions on medical cannabis show that while many are still skeptical and do not think it is completely safe, younger doctors and those on the East coast are more supportive. This clash could be good for solving some common concerns with cannabis. http://bit.ly/2XQVxWz

Benjamin Caplan, MDSurveys show medical professionals’ opinions clashing around Cannabis
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Topical Cannabis to help heal chronic wounds

Another thoughtful piece by Abbie Rosner at Forbes, reviewing the healing of chronic wounds with topical cannabis treatments.

https://www.forbes.com/sites/abbierosner/2019/07/09/cannabis-based-medicine-a-breakthrough-for-healing-intractable-chronic-wounds/#7b1362bf9387

Benjamin Caplan, MDTopical Cannabis to help heal chronic wounds
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Herbal Treatments may prove valuable to treat Alzheimer’s Disease

Promising Therapeutics with Natural Bioactive Compounds for Improving Learning and Memory — A Review of Randomized Trials  

A recent review has determined that herbal treatments, such as those including flavonoids, are beneficial when attempting to prevent neurocognitive decline, commonly seen in Alzheimer’s Disease. Galantamine, quercetin, examples of two flavonoids, as well as huperzine A, bacoside A, and ginkolide B, three flavonoid-like compounds, all proved to be effective when used as a treatment for poor memory function. The authors mention the need for similar results in clinical trials but find the current data compelling evidence for future drug development. 

Highlighted in this paper is the current perception of herbal products as natural, gentle, and safe in comparison to current synthetic drugs. While herbal products are generally safer and considered to be more gentle, it is important to note that for these herbal compounds to truly be effective when treating patients they likely need modification in order to optimize their benefits. The modification would increase potency, selectivity, and pharmacokinetic abilities, as well as lessen any possible side effects. Synthetic drugs may seem frightening, particularly in light of recent illnesses and mortality associated with their abuse, but technology can also be used to optimize novel drugs and it can be efficient to do so. 



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Benjamin Caplan, MDHerbal Treatments may prove valuable to treat Alzheimer’s Disease
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Cannabidiol Treatment for Parkinson’s Disease

Cannabidiol: a hope to treat non‑motor symptoms of Parkinson’s Disease Patients

Cannabidiol (CBD) has recently been postulated as an ideal drug to address the treatment of non-motor symptoms of Parkinson’s Disease (PD) due to its multifaceted mechanism of action. The plethora of effects of CBD includes anti-inflammatory, neuroprotective, anxiolytic, and antipsychotic actions, which improve non-motor symptoms of PD and lift the quality of life for patients coping with the illness. Further research is recommended to garner support for FDA approval.

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This paper is also stored here:    http://bit.ly/2KXTb0Y     inside the CED Foundation Archive

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Benjamin Caplan, MDCannabidiol Treatment for Parkinson’s Disease
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Study Reveals that Flavanoids can act as Allergy Medications

Anti-histaminic Effects of Resveratrol and Silymarin on Human Gingival Fibroblasts

It has recently been revealed that the flavonoids resveratrol and silymarin have an anti-histaminic effect on human gingival fibroblasts (HGF). HGF are cells that compose part of the gum tissue in the oral cavity. Silymarin and resveratrol were already known to have anti-bacterial and anti-inflammatory properties, but a recently published study has now revealed that silymarin alone and a combination of the two flavonoids both provide novel therapeutic approaches for inflammation due to allergies.

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Benjamin Caplan, MDStudy Reveals that Flavanoids can act as Allergy Medications
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A systematic review of Safety and effectiveness of cannabinoids for the treatment of neuropsychiatric symptoms in dementia

A 2019 literature review summarizes the finding on using THC and CBD on patients with dementia. Researchers found that Dronabinol and THC were associated with significant improvements in a range of psychiatric scores. Interestingly, cannabis products showed the most promising results in patients whose symptoms were previously unmanageable or resistant to other treatments.

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This paper is also stored here:    http://bit.ly/2IWFA8R     inside the CED Foundation Archive

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Benjamin Caplan, MDA systematic review of Safety and effectiveness of cannabinoids for the treatment of neuropsychiatric symptoms in dementia
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Cannabidiol May Provide Novel Treatment for Rare Ovarian Cancer

Dramatic response to Laetrile and cannabidiol (CBD) oil in a patient with metastatic low grade serous ovarian carcinoma

A recent case study has examined a patient’s response to the consumption of cannabidiol (CBD) as a treatment for a rare type of ovarian cancer. Rather than participate in chemotherapy, which has been shown to only be effective in 5% of patients with low grade serous ovarian carcinoma, an 81-year-old decided to take a combination of amygdalin and CBD. Although CBD has only been shown to have effective anti-cancer properties in murine models the featured patient reported a significant decrease in tumor size, revealing that CBD may, in fact, be an effective treatment for patients looking into alternative care methods.

Although proven ineffective, the use of amygdalin highlights alternative therapies derived from naturally occurring chemicals found in common plants. Flavonoids and terpenes are chemical components of cannabis plants, also found in a variety of fruits and vegetables, that are just now being investigated for their therapeutic benefits. The results of those inquiries may prove useful for similar patients suffering from illnesses that are resistant to the usual treatments.

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This paper is also stored here:   http://bit.ly/2L9pCJZ      inside the CED Foundation Archive

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Benjamin Caplan, MDCannabidiol May Provide Novel Treatment for Rare Ovarian Cancer
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