Neuropathy

Genes in the Endocannabinoid and Opioid Systems may Provide Biomarkers of Obesity

Title: Preclinical and Clinical Evidence for a Distinct Regulation of Mu Opioid and Type 1 Cannabinoid Receptor Genes Expression in Obesity

Researchers have recently found that alterations of the type 1 cannabinoid receptor gene (CNR1) and mu opioid receptor gene (OPRM1)  contribute to the development of obesity. This phenomenon was shown in rat models who were given a high-fat diet and humans currently dealing with obesity. Due to the possibility of the up-regulation of CNR1 and OPRM1 providing a mechanism for developing the obesity phenotype, those two genes could serve as biomarkers for obesity. Fortunately, the up-regulation of CNR1 and OPRM1 is reversible and may also provide a target for combatting obesity and encouraging weight loss in obese individuals. 

Highlighted here are the interactions of the endocannabinoid and opioid systems. Contradictory evidence concerning the interaction of the two systems has come out in recent years making it difficult to come to any conclusions. The endocannabinoid system has been thought to provide a safe and effective method for combatting the opioid crisis. Opioids are highly addictive and dangerous, but they are an efficient way to minimize pain which has kept them in mainstream medicine. Opioids have led to countless overdoses in recent decades causing researchers to search for a more ethical option for pain relief. Cannabis has a much better safety profile, poses no risk of overdose, and offers a welcome change of pace to traditional choices. Conclusive research is still needed to confirm, and reconfirm the details.

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Benjamin Caplan, MDGenes in the Endocannabinoid and Opioid Systems may Provide Biomarkers of Obesity
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Cannabinoids Treat Chronic Gastrointestinal Disorders

Title: Nabilone administration in refractory chronic diarrhea- a case series

A new study reveals the efficacy of treating chronic gastrointestinal disorders with cannabinoids, such as Nabilone. Researchers followed case studies in which patients were given nabilone which greatly reduced symptoms of chronic diarrhea and weight gain, over a period of three months.

The cannabinoid treatment also reduced the abdominal pain felt by patients and improved their overall quality of life. Considering the favorable safety profile of cannabinoids and the effectiveness demonstrated in the patients, cannabinoids were deemed an appropriate and clinically beneficial method for the treatment of chronic gastrointestinal disorders, such as chronic diarrhea. 

Highlighted by this article are the many symptoms cannabis used to treat before the prohibition of cannabis and the scheduling of the medication under the Controlled Substances Act. Cannabis has been used in eastern medicine, for thousands of years, and used to be a prevalent medication in the late 19th and early 20th centuries, and has just recently been re-recognized as an option to treat anorexia associated with human immunodeficiency virus (HIV), nausea and vomiting due to chemotherapy, and various sleep disorders. Cannabis was once a well-recognized medication, but it has been mercilessly slandered by politicians. The rise and fall of cannabis have largely been politically driven pushes, and the plant and its effects deserve further study to examine the scope and efficacy of its therapeutic benefits. 

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Benjamin Caplan, MDCannabinoids Treat Chronic Gastrointestinal Disorders
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Medicinal Value of Citrus Peels

Citrus peels waste as a source of value-added compounds: extraction and quantification of bioactive polyphenols

Previous analysis of citrus peels has demonstrated high content of biologically active polyphenols, with significant quantities of flavonoids and phenolic acids present. Both these compounds have been associated with antioxidant, anti-inflammatory, antiproliferative, anti-allergic, antiviral, anticarcinogenic, neuroprotective, and antimicrobial properties.

A recent paper points out that citrus peel waste alone makes up nearly 50% of wet fruit mass discarded as waste and proposes extraction of polyphenols to minimize waste. The bioactive substances in peels can be used in dietary supplements, cosmetics, food products, and pharmaceutical products.

Citrus peels contain significant polyphenols, compounds which have health benefits ranging from antioxidant to anticancer. Polyphenols are also found in large quantities in cannabis, undoubtedly contributing to it many of its well-known health benefits. 

Image result for citrus peel eating

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Benjamin Caplan, MDMedicinal Value of Citrus Peels
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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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A Report on the Psychiatric Effects of Cannabis Demonstrates the Progress and the Gaps in Cannabis Knowledge

Psychiatric effects of cannabis 

A report published by the British Journal of Psychiatry in 2001 demonstrates the progress the medical community has made but also what gaps still need to be filled in when utilizing cannabis. This report found that excess consumption of cannabis leads to feelings of panic and anxiety and that 15% of those willing to respond to a survey experienced acute psychotic symptoms. It was also found that cannabis dependence can occur, as well as withdrawal, which can last for close to a week.  This article was a review that synthesized relevant studies but also claimed that the casual conclusions of these papers were difficult to find or replicate. 

This paper is interesting given its age considering it put out what was current data but then ended by stating the casual conclusions of each paper may not stand. 18 years later, some of the data has stood, and some have not. Users can gain a tolerance to cannabis but many are looking to mitigate it. The author uses the word dependence when discussing cannabis which is a word that holds weight and is up for debate. Intoxicating cannabinoids, like THC, affect the reward center, but non-altering cannabinoids, such as CBD, tend to work more noticeably outside of the brain, although all have mixed effects in both regions. Cannabinoids are not all the same, apply quite differently to various ailments, and have divergent effects. Blanketing an entire crop with a misinformed warning label seems irresponsible and unduly harsh. Users or those looking into cannabis-based medicine are encouraged to do their research. 

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Benjamin Caplan, MDA Report on the Psychiatric Effects of Cannabis Demonstrates the Progress and the Gaps in Cannabis Knowledge
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Video: Cannabinoid Delivery Systems for Pain and Inflammation Treatment

A 2018 literature review summarizes the various ways patients can consume cannabis (orally, topically, etc.) and the pain reductions associated with each method. The review focuses on the treatment of multiple sclerosis, cancer, anorexia, arthritis, and other painful disorders.

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Benjamin Caplan, MDVideo: Cannabinoid Delivery Systems for Pain and Inflammation Treatment
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80%: Cannabis extremely helpful for pain; 82%: helped reduce or stop over-the-counter medications; 88% able to stop taking opioid painkillers

“The study, published in the Journal of Psychoactive Drugs, which looked at 1,000 people taking legalized marijuana in an American state found that among the 65% of people taking cannabis for pain, 80% found it was very or extremely helpful.”

“82% of these people being able to reduce, or stop taking over the counter pain medications, and 88% being able to stop taking opioid painkillers.”

“74% of the 1,000 interviewees bought it to help them sleep – 84% of whom said the marijuana had helped them, and over 83% said that they had since reduced or stopped taking over-the-counter or prescription sleep aids.”

“The study adds weight to the theory that widening access to medical cannabis could lower the use of prescription painkillers, allowing more people to manage and treat their pain without relying on opioid prescription drugs that have dangerous side effects.”

“This is backed up with other research that shows that states with medical cannabis laws have a 6.38% lower rate of opioid prescribing and that Colorado’s adult-use cannabis law is associated with a relative reduction in opioid overdose death rate from 1999 to 2010.”

“”Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen cause GI bleeding or kidney damage with chronic use. Paracetemol (Acetaminophen) toxicity is the second most common cause of liver transplantation worldwide, and is responsible for 56,000 ER visits, 2600 hospitalizations, and 500 deaths per year in the U.S.”

Link to news brief: https://eurekalert.org/pub_releases/2019-07/tfg-cmb062819.php

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Benjamin Caplan, MD80%: Cannabis extremely helpful for pain; 82%: helped reduce or stop over-the-counter medications; 88% able to stop taking opioid painkillers
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Non-Psychoactive Cannabis Treatments for Chronic Muscle Pain

Cannabidiol, cannabinol and their combinations act as peripheral analgesics in a rat model of myofascial pain

Some of the non-psychoactive cannabinoids in cannabis, cannabidiol (CBD) and cannabinol (CBN), have recently been found to produce analgesic effects (pain relief) in mouse models. A combination of CBD and CBN causes a decrease in sensitization of muscles, leading researchers to believe the combination could provide relief for those suffering from chronic muscle pain disorders. Cannabis products are already being prescribed for chronic pain disorders and this new study provides evidence that cannabis-based medicine can also be applicable when treating chronic pain associated with disorders such as fibromyalgia and temporomandibular disorders.

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Benjamin Caplan, MDNon-Psychoactive Cannabis Treatments for Chronic Muscle Pain
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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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Benjamin Caplan, MDCannabidiol Treatment for Parkinson’s Disease
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Development of Cannabis-Based Treatment for Bipolar Disorder

Bipolar disorder and the endocannabinoid system

A recently published article serves as a call for research to be conducted to discover how cannabis could impact the management of bipolar disorder (BD). Presented in the article is a full review of the advantages and disadvantages of cannabis-based medicine in the treatment of BD and provides insight into possible mechanisms might affect the pathophysiology of the disorder. The insights listed within the article provide the rationale for examining the endocannabinoid system, specifically the cannabinoid receptor 2, with the hopes of finding therapeutic targets for mood control associated with BD.  

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Benjamin Caplan, MDDevelopment of Cannabis-Based Treatment for Bipolar Disorder
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