The endocannabinoid system is made up of an extensive web receptors that are found almost everywhere in the body. Hence, it plays an important role in regulating and influencing every system in the body, from the digestive and nervous system to he hypothalamus-pituitary-adrenal axis. Yet the importance of this system isn’t taught to most practitioners in training —and confusion (and some times alarm) swirl around exogenous ways to strengthen and tone the endocannabinoid system since many of the healing compounds are derived from the same plant as marijuana. In this episode of New Frontiers, Dr. Fitzgerald talks to the senior vice president of portfolio development at Thorne Research, Dr. Jacqueline Jacque, about the endocannabinoid system and ways to support with food, spices, and targeted supplements.
In this podcast you will hear:
- How the endocannabinoid system (ECS) works
- About the top line function of the ECS as a homeostatic agent in the body
- About the health-improving role that a robust ECS plays in supporting the body’s other systems, including the nervous system, reproductive system, digestive system, and emotional wellbeing
- How to support the ECS with specific foods, spices, and supplements
- About the importance of starting with low doses when introducing ECS-supporting supplements to a patient’s protocol
- What differentiates hemp from marijuana and the legal issues around ECS-supporting supplements
- About the benefits of whole plant extracts and the limitations of reducing supplements down to one isolated strain, e.g. only CBD
Dr. Jacqueline Jacques is the Senior Vice President of Portfolio Development for Thorne. Dr Jacques is a Naturopathic Doctor with almost 20 years expertise in medical nutrition. She has spent much of her career in the dietary supplement industry as a formulator, speaker, writer and educator. Her most recent passion is the endocannabinoid system and tapping into its potential through nutrition.
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Dr. Kara Fitzgerald: Hi everybody, welcome to New Frontiers in Functional Medicine. I’m your host Dr. Kara Fitzgerald and I’m really, really, really excited to be talking with Jacqueline, Dr. Jacqueline Jacques today, of Thorne. She’s actually the senior vice president of portfolio development for Thorne Nutraceuticals and she’s going to be talking about the endocannabinoid system, which I have been wanting to dive into desperately on this podcast. Let me tell you a little bit about Dr. Jacque, in addition to her role at Thorne, she’s a naturopathic physician graduating from my alma mater with 20 years experience in medical nutrition.
Dr. Kara Fitzgerald: She actually has a great career, a really interesting history, we’ve been chewing the fat for a while here. She spent much of her career in the dietary supplement industry as a formulator, a speaker, a worldwide speaker, published author, peer reviewed published author and educator. And her most recent passion is all things endocannabinoid and tapping into its potential through nutrition. Dr. Jacques, welcome to New Frontiers.
Dr. Jacqueline Jacques: Thank you so much, and for the lovely introduction. Very happy to be here.
Dr. Kara Fitzgerald: Yay. All right, so let’s just dive right in. Talk to me about the endocannabinoid system, what is it? Why the heck do we care about it?
Dr. Jacqueline Jacques: Yeah. I keep becoming fond of telling people that the endocannabinoid system is the most exciting thing that you didn’t learn about in school. Or at least-
Dr. Kara Fitzgerald: I think that’s true.
Dr. Jacqueline Jacques: For me, the most exciting thing I didn’t learn about in school at least.
Dr. Kara Fitzgerald: Yeah.
Dr. Jacqueline Jacques: I graduated in 1997 and science really wasn’t uncovering that we even had this system in our bodies, really until the 1980s, 1990s. So it is common when I start talking about the endocannabinoid system, or ECS as we shorten it, for people is, they say, “How come I didn’t learn about that?” And I say, “Well, it wasn’t in the books.” No one was teaching it, no one was doing it. The focus had been on marijuana and marijuana as a drug of use or abuse and for a long time no one looked any further. So we really just didn’t know that this was there. When we looked, and as we’re continuing to look, because much of the science is still new, we’ve discovered that it’s a really, pretty well distributed vast system in the human body, not a structural system.
So this isn’t something like your skeletal system, or your muscular system, or your vascular system where you can dissect it out and see it. But it’s a broadly distributed set of receptors that are found really almost everywhere in the body. And the two primary ones are the CV1 and the CV2 receptor, but there are some others that are emerging. There’s at least one PPAR receptor, we’re looking at interactions between endocannabinoids now and vanilloid receptors. So probably some other things that will continue to emerge as the science evolves. So we have these receptors, we find them in the nervous system, the digestive system, in the skin, in the reproductive system, as I said, they’re very well distributed.
And humans make two of our own endogenous cannabinoids, or endocannabinoids, and those are anandamide, which also gets called the bliss molecule. That’s when it was first discovered and it was discovered because a lot of it’s endogenous actions, most similar to what THC does so it was probably the easiest one to isolate and find. And then 2-arachidonoylglycerol, which gets abbreviated to AG, is our other endogenous cannabinoid. It sounded like you were going to say something, so I’m going to stop talking.
Dr. Kara Fitzgerald: Well, I’m just thinking about anonda… and the anandidoid, anandeoid receptor. Say it again? I may have mispronounced it.
Dr. Jacqueline Jacques: Anandamide is the cannabinoid.
Dr. Kara Fitzgerald: Anandamide, excuse me.
Dr. Jacqueline Jacques: And the receptors are cb1 and cb2.
Dr. Kara Fitzgerald: Yeah, okay. So the anandamide, so Ananda, I think isn’t that one of the gods of bliss, and Hinduism?
Dr. Jacqueline Jacques: Yes.
Dr. Kara Fitzgerald: Okay. So it’s like a-
Dr. Jacqueline Jacques: I do not know my Hindu mythology very well, so someone listening probably does, but I know that they frequently call this the bliss molecule.
Dr. Kara Fitzgerald: Yeah, that’s through … okay. So at some point we need to circle back and talk a little bit more about how we, beyond using cannabinoids, how we might boost that maybe. So I’ll take a note and we’ll circle back to it. It’s widespread, these receptors are found everywhere, we’re just starting to uncover their functions. And that… I know their functions are incredibly varied, but talk about some of the top ones that you’re thinking about and that we’re concerned with.
Dr. Jacqueline Jacques: Absolutely. So, I think, just to give people an overview. The top line function of endocannabinoid system is that it’s a homeostatic regulatory system for the body. So it’s almost like the body’s natural adaptogenic system.
Dr. Kara Fitzgerald: Interesting.
Dr. Jacqueline Jacques: It’s a system that is very concerned with keeping homeostasis and keeping balance. So if you always keep that in mind, in the back of your head as you’re learning about functions of the endocannabinoid systems, certain things start to make more sense. So people can look … I’ve had people ask me … so, in the nervous system, the endocannabinoid system will down regulate both glutamine and GABA. And they’re like, “Well, how does that make any sense?” I’m like, “Well, it keeps everything from getting too extreme.” So, it keeps our tone in our nervous system because it down regulates both glutamine and GABA, right?
Dr. Kara Fitzgerald: Mm-hmm (affirmative).
Dr. Jacqueline Jacques: So you don’t want things to be too relaxed, you don’t want them to be overstimulated, you want good tone, and that is what ECS is concerned with. So, in terms of other functions, a lot of function in nervous system, the nervous system is very rich with endocannabinoid receptors, plays a big role in learning and memory, in pain signaling, we have a big role in how the brain responds to and stores memories related to trauma in particular. It’s very important in what the ECS does, it acts a lot … there’s a lot of cb2 receptors, the other receptors are found a lot in the sympathetic nervous system, and help to maintain the tone of the sympathetic nervous system.
Dr. Jacqueline Jacques: And then, we also see within the nervous system, if we want to count the functions related to stress and mood, are very much under control how we respond to those things or are activated by the endocannabinoid system. So, it modulates the release of things like dopamine, norepinephrine, serotonin, initiates our first response to something stressful. The ECS reacts very quickly to things like acute fear or acute anxiety and helps us to modulate, when it’s got a healthy tone to it, it really helps us to modulate our level of arousal to particularly unpleasant stimuli. So I hope ECS can be the difference between something small causing type of very traumatic experience, or to your ability to brush things off more healthily.
Dr. Kara Fitzgerald: So I mean, would you say that this is almost like an HPA adaptogen? Or an HPA-
Dr. Jacqueline Jacques: Well, it’s its own system, so it does interact with our whole cortisol regulatory system and our fight-or-flight system. So it’s interacting with those systems, but more to keep them in check than to directly be part of those systems itself.
Dr. Kara Fitzgerald: Okay.
Dr. Jacqueline Jacques: Did that make sense?
Dr. Kara Fitzgerald: Yeah. No, it absolutely makes sense if it attenuates a fear response or a hyper-arousal response, it does make sense that it would have a balancing impact on that system as well.
Dr. Jacqueline Jacques: And we see it everywhere. I mean, I could go on, but we’ve got a lot of ECS functions in the digestive system and it’s got a role within metabolic function, immune inflammatory responses-
Dr. Kara Fitzgerald: Yeah, exactly. I was reading about NMDA regulation being influenced by the endocannabinoid system.
Dr. Jacqueline Jacques: Yep.
Dr. Kara Fitzgerald: And NERF2, which regulates NF-kappa-B, so potent regulatory player in inflammation, is that correct?
Dr. Jacqueline Jacques: Yeah. In inflammation and also the immune system. So we see, there are endocannabinoid receptors in virtually every important organ and cell of the immune system. And when we get to … hopefully we’ll have a point here where we get to talk about phytocannabinoids in a way that some of the things we find in plants or in nature can interact with the system, but I think that’s going to become a fairly important area of research in the future.
Dr. Kara Fitzgerald: I’m really excited about that. Yeah, we’re going to dive into phytocannabinoids here in a minute. Let me just pick your brain on some more of the basics though.
Dr. Jacqueline Jacques: Sure.
Dr. Kara Fitzgerald: All right. So clearly, we’re sourcing some of … so, phytocannabinoids as I understand it, there are a lot of sources. And we can, as you said, we can generate endogenous cannabinoids, but hemp and marijuana are the ones that we think about as being the big provider of the cannabinoids. So what’s the difference between hemp and marijuana, from a broad perspective?
Dr. Jacqueline Jacques: Yeah, it’s a really important question for people to ask. So I mean, they are cultivars of the same plant, so they are both cannabis sativa. So it’s not really surprising that people get a little bit confused when they’re thinking, “Okay well, how do I know? What is hemp? What is hemp? Which one is which? How do I know the difference between them?” They look different, so if you see them growing, if you get familiar with how they’re cultivated and what they look like, they appear as different plants. Some hemp plants are taller and stalkier, and I mean, they have longer stalks and they have less of the developed tops, or the flowers that people who are growing for marijuana purposes, are looking to cultivate.
So hemp, primarily … it’s starting to be cultivated again in the United States, but it’s primarily cultivated outside the US for industrial purposes. So hemp is used all over the world for things like clothing, and paper, and bio fuels, and plastics. And you see hemp in cosmetics, you also see it in supplements. Typically, it’s cultivated outdoors, it’s a large scale crop. And a big part of the definition of what makes something hemp is the concentration of the psychoactive compound THC. In most of the world to be classified as hemp versus marijuana, you have to have less than, or equal to 0.3% THC in the aerial parts of the plant.
Marijuana on the other hand, the other major cultivar of cannabis, was initially primarily grown for recreational purposes. Humans have done that with many plants in our history, and so those plants have primarily been cultivated over time to enhance the content of THC, rather than to enhance the other properties. Though technically, if it’s got higher than the allowable 0.3% of THC, most of the world, that would then be considered to be marijuana and not hemp, but there are other differences in the way that the plants appear and the way that they’re cultivated. So they’re usually pretty distinct looking from each other.
Dr. Kara Fitzgerald: Got it. So, same plant but different cultivars.
Dr. Jacqueline Jacques: Yep.
Dr. Kara Fitzgerald: And they’re just … okay. And then you’re just emphasizing different aspects within hemp.
Dr. Jacqueline Jacques: So it’s kind of like if you grew roses and you grew one to be red and one to be white.
Dr. Kara Fitzgerald: Got it.
Dr. Jacqueline Jacques: Different properties.
Dr. Kara Fitzgerald: Got it, okay. Well, so then the next question, I wanted to ask you about the legality of hemp and that’s probably a little bit, since it’s the same plant, the legality must be a little more muddy than I thought. Which was, yeah hemp is legal, although we can’t grow it. So actually, just as I’m talking to you about it out loud, there’s some … or we can’t grow it everywhere. But anyways, so is hemp legal? Kind of just talk to me about some of that.
Dr. Jacqueline Jacques: Yeah, it’s a really tricky place right now in the United States. We are in this big place of flux in terms of legality of all these things right now. And it’s going to look different depending on where in the United States you live in particular. So on the federal level, the top level, all cannabis was made illegal in the United States in 1970. So when the controlled substances act was passed, it made all of cannabis, hemp and marijuana, illegal. And almost since that time, people making efforts to bring back use of one or others of the cultivars. So where we stand right now, we’ve got I don’t know how many right now, 28, 29, maybe 30 states that have passed their own state level laws for medical marijuana.
Some states like mine here in California, have now enacted personal use allowances for marijuana as well. And separately from marijuana, so completely separately, in 2014 there was an amendment to the agricultural act, which allowed for the limited production of hemp under state licenses as part of the farm bill. So we now have some states that under these experimental licenses, are also able to grow hemp. And some of those are the same states that have legalized marijuana and some of them aren’t the same states that have legalized marijuana. So the top line is that on the federal level, anything that’s grown here domestically, while some of it may be legal at the level of your individual state, is not legal federally. And that includes both marijuana and hemp.
So when we’re looking for … or what I do, being in the dieatary supplement industry, when we started looking at these things and saying, “How can we bring some of these health benefits to our doctors and to our customers?” The only thing that is currently allowable for our purposes, is to actually import hemp stalk extract from Europe, and probably from other places, but we’re importing from Europe. That was something that was never made illegal under the controlled substances act. So as long as you’re using correct parts of the plant, like the stalk or the seed, and as long as you’re able to demonstrate that you meet the criteria for having the very low levels of THC in the plant, you’ve got correct documentation, you can bring, for Commerce, you can bring in things like hemp stalk extract from places like Europe.
We will see greater legality for hemp and for marijuana. In what time frame, it’s hard to tell. It’s a very hot topic right now and it’s a very rapidly moving target. We just saw, I think it was the state of Kentucky just introduced a proposal for making hemp growth federally legal. And you’ve had some increased push, also in the federal government for rescheduling marijuana. So I don’t know what we’re going to see in the coming years, but I suspect it will keep changing.
Dr. Kara Fitzgerald: Yeah. Right. It sounds like it’s a totally big moving target. Although, you know interestingly, just as a historical sidebar, we used to grow hemp everywhere. I mean, it was a massive crop a hundred years or so ago, when we used it in industry quite a bit. It’s…
Dr. Jacqueline Jacques: We used the medicine, so doctors, some of the greatest people who opposed the laws against marijuana in this country were physicians who were very upset by the loss of some of these things as medicine. So if you look back at the history, doctors were some of the loudest voices in protesting things like the marijuana tax act and things like that, that eventually led to these substances becoming illegal.
Dr. Kara Fitzgerald: Well, all right. So let me ask you a question. In my clinical practice, and we’ve got a clinical development program where physicians transitioning, and other clinicians transitioning in functional medicine, are working with us and we have grand rounds and all sorts of discussions. And this is, CBD is a massive topic. Medical marijuana, less so, hemp, less so, but specifically cannabidiol, cannabinoidiol, if I’m saying it right, sorry.
Dr. Jacqueline Jacques: Cannabidiol, you’ve got it.
Dr. Kara Fitzgerald: It’s something that everybody’s using and experimenting with and thinking about. And we’re all attempting to dive into the endocannabinoid system and think about how we might influence patient outcome with this. And you know, cannabidiol, CBD concentrate, or CBD from hemp source is available all over the place now, but if I’m hearing you correctly, it’s such a moving target as far as regulation. And if we’re only allowed to use the stem and the seeds, we actually want to … just to kind of CYA, to make sure we’re practicing correctly in the state of current regulation, we probably want to be mindful around our source material. And if we’re looking at concentrated for CBD, we might actually need to be a little bit mindful around that, is that true?
Dr. Jacqueline Jacques: Or even honestly frankly, even labeled as CBD. To be a dietary supplement you have to follow certain rules, and if you don’t follow certain other rules, you’re a drug. So right now the FDA has made it very clear through warning letters and other things that they’ve sent to existing commercial companies, that they consider cannabidiol to be a drug. Primarily based on the fact that GW pharmaceuticals was publishing investigational trials going back as far as 2007, and they are a plant derived CBD. So they basically claimed ownership over that well before anybody was demonstrating doing that in Commerce in the food or supplement space.
Could that change in the future? Yes. Could somebody find a way to demonstrate that maybe these things were used in commerce prior to 2007, or even before that ideally, so they were compliant with the DSHEA law. It’s possible, but it hasn’t been done yet to the best of my knowledge. So it’s a sticky place, you know. And separate from that, there are states that on a state level, similar to passing medical marijuana laws, there are states that have passed local laws making CBD legal within their state. So I think for practitioners, probably the most important thing for them to do is just be familiar with what the regulations are that govern them where they are because it’s a mis-mash right now of what is and isn’t allowed depending on where you live.
So for us, just to speak on behalf of what I do and what Thorne has done, the position that we took on this is that we wanted to be able to provide something that was going to be appropriate for our customers wherever they were.
Dr. Kara Fitzgerald: Right.
Dr. Jacqueline Jacques: The only way that we currently understand that that can be done is by using an extract that’s made from the, again, the legally allowable parts of the plant, which would be things like hemp stalk. And that the extract be unmanipulated, meaning it’s not enriched with CBD for example, it’s not standardized for anything but it is reflective of a natural blend of the compounds that are in the plant.
Dr. Kara Fitzgerald: Okay.
Dr. Jacqueline Jacques: And again, I can’t play lawyer for all of your listeners out there. I think it’s an area that is complex enough that people should try to probably understand what impacts them most where they are.
Dr. Kara Fitzgerald: Got it, right. And many of us, our clinic included, well we’re a multi state clinic, and we work with people from all over the country. And I’m in a very conservative state, Connecticut, even though we’ve got medical marijuana, it’s so, so tightly regulated, it’s actually minimally used in our state, unfortunately. So we would need to be just mindful on what we’re purchasing, especially as we also practice across different states. But you and I were talking about your source material being from Europe, and Europe has this incredibly rich history in developing and growing really quality hemp with adequate concentration of the important constituents, is that true?
Dr. Jacqueline Jacques: Yeah. So I mean, again, where we cut off the ability for our agricultural industry here in the United States to be able to grow and develop cannabis, many other parts of the world never did. And Europe has had a continual business in heading the hemp cultivation for many, many decades. And again, I don’t want to slight the work that’s going on here in the US, I mean, states like Kentucky and other places have really led the way in starting the process of building an industrial hemp growing trade here in our state. It’s just in it’s infancy, it’s very young and so many things haven’t been worked out.
So, in Europe there’s actually approved strains of hemp that are very well understood in terms of the growing conditions and things required to make them be very consistent. And there’s hundreds and thousands of hectares of land that are dedicated to growing some of these things and people who have been doing this for decades. Again, when we’re looking at wanting to do something that’s very consistent, every time we make a batch of product, it’s very comforting to be able to know that we’re buying the same thing, every single time.
Dr. Kara Fitzgerald: Right.
Dr. Jacqueline Jacques: It’s grown under the conditions that foster it to have the chemical properties that it does. Do I think that we’ll get here in the US to be able to do that at some point? I hope so, but I think Europe is decades ahead of us right now. They really are.
Dr. Kara Fitzgerald: Good. Okay. Well we’ll definitely pay attention to how we evolve in the US. And I’m glad we’re starting to launch the industry again and that research is emerging in this field, it’s extremely important and very interesting. And obviously important to us as practitioners because the system is clearly one that we can impact and have a benefit in our patients. So let’s go back to the cannabinoids, specifically phytocannabinoids and what … they’re present in hemp, they’re present in the stem, they’re present in the seeds, what do they do?
Dr. Jacqueline Jacques: Yeah, what do they do? So we can have these compounds in nature that interact with the system in several different ways. One of the things I didn’t mention when we talked about the endocannabinoid system, so I said we’ve got a couple of our own cannabinoids that we make, we have a couple of well known receptors, which are cb1 and cb2, and probably some others that are still being sorted out. And then we also have enzymes actually that make the cannabinoids, but more importantly we have degrading enzymes that break them down. So when we look at how substances from plants, which we call phytocannabinoids, because phyto, plant, cannabinoids, interact with the system.
Dr. Jacqueline Jacques: They’re primarily interacting in a couple of different ways, at least from the ones that we’ve identified so far. So they can act at one of the receptors as an agonist, or partial agonist. They can act at one of the receptors as an antagonist, we know of a few of those that are found actually in some very common plants. Or, they can act sort of as reuptake inhibitors, and most commonly by acting on a degrading enzyme called fatty acid amide hydrolase, or FAAH. Those are the ones that are showing up most commonly with natural substances.
Dr. Kara Fitzgerald: Okay. And so what are we seeing in hemp? And why-
Dr. Jacqueline Jacques: A little bit of all of the above actually. So when we look at the collective compounds that are found in hemp, probably the major thing … some of the compounds in hemp act on the cb2 receptor but more weakly. So the strongest acting substance on the cb2 receptor in the hemp plant is actually found in the flowering tops, which again we can’t use legally in a dietary supplement, but it’s something called beta-caryophyllene, is a selective cb2 receptor agonist. But the good news is, we can get beta-caryophyllene from things that you just find in your spice cabinet. So it’s in clove, it’s in black pepper, it’s in several other places, so we can get that from places other than the flowering tops of the plants and add it back in.
Dr. Kara Fitzgerald: Oh interesting. Okay. So the really new, the brand spankingly new launched hemp plus product has some of these other phytocannabinoid sources in them?
Dr. Jacqueline Jacques: Yeah. And that’s the major other one, is adding back in that constituent of the beta-caryophyllene, that again, because we can’t extract from the flowering tops of the plants. But we can get that from, as I said, very common things. It’s pretty easy to get out of other sources.
Dr. Kara Fitzgerald: That’s great. All right. So you said pepper, you said rosemary, what are some other sources?
Dr. Jacqueline Jacques: There’s some cool sources of phytocannabinoids, it’s sort of like once people discover the system, they really started going and looking for some of the things that might be out there and could we explain that activity as being part of the system, or acting on the system. So even within hemp, they’ve already identified, depending on who’s paper you read, somewhere between 80 and 100 cannabinoids that just come from cannabis. And so, whereas THC and CBD are the ones that get talked about a lot, there’s CBC, and CBN, and CBG, and there’s a whole range of these things that I strongly believe we’re going to see more information coming out about them over time.
They’re already starting to see particularly cannabichromene, which is CBC, is having a lot more research done on that compound especially its role in inflammation. And it has some fairly significant activity in the skin and the digestive system, so we may see some topical applications with CBC, other things like that. CBG as well, also very active in skin and in the immune system. But then outside of cannabis, I mentioned beta-caryophyllene because that’s one that’s found in a lot of places in nature. One that I think your listeners might appreciate, is diindolylmethane, DIM. It turns out to be a phytocannabinoid, so even though you don’t … you have to sort of make DIM in your body from other compounds in cruciferous vegetables, it actually is a selective cb2 receptor agonist, which probably helps to explain some of the things that we know about the benefits of DIM, right?
Also, echinacea, so echinacea has a group of compounds in it called … I always butcher this, but I think it’s alkylamides, which are starting to draw a lot of attention in research, again because of their action on the cb2 receptor. And I think I mentioned this earlier, but our immune system is very rich with cb2 receptors, so we find them in the bone marrow, in the spleen, and a whole range of cells in the immune system. So that probably helps to explain some of the benefits that people attribute to echinacea, you’ve got these compounds in there that we now know are interacting with that part of the endocannabinoid system.
Dr. Kara Fitzgerald: God, that’s so fascinating.
Dr. Jacqueline Jacques: Right, isn’t it?
Dr. Kara Fitzgerald: Yeah, I mean I prescribe DIM-
Dr. Jacqueline Jacques: Right?
Dr. Kara Fitzgerald: I prescribe DIM all the time if I want to modulate estrogen metabolism, I use it all the time, and here there’s a whole, I don’t know, other world of interventions and it’s ability to bind cb2. That’s very interesting to me. All right, thanks. And clove is particularly rich?
Dr. Jacqueline Jacques: Well, clove and pepper. So beta-caryophyllene is part of a set of aromatic compounds, it’s actually a sesquiterpenoid, for your people who like chemistry, but its’ a sesquiterpenoid phytocannabinoid, and a lot of our aromatic plants are actually good sources of beta-caryophyllene. In our case for the hemp oil cluster, Thorne, we are using a combined extract of clove and unripe black pepper to provide that compound.
Dr. Kara Fitzgerald: Geez, that’s so interesting. Might you just, out of curiosity, might you find it concentrated in essential oils?
Dr. Jacqueline Jacques: Yeah, absolutely.
Dr. Kara Fitzgerald: Since it’s a turbine?
Dr. Jacqueline Jacques: Yeah, you would. We are particularly using oil extracts in our product.
Dr. Kara Fitzgerald: Are you?
Dr. Jacqueline Jacques: Yeah, because you get different, depending on how you extract, you’re going to get different components of a plant.
Dr. Kara Fitzgerald: I love it.
Dr. Jacqueline Jacques: I’m not a big expert in the setting of whole essential oil space, but it has these aromatic compounds and they are in that oil fatty part of the plant. I would assume that some of those essential oils might be exceptionally rich in some of these compounds.
Dr. Kara Fitzgerald: That’s just great, that’s extremely interesting to me. Okay, so you know, what about … a lot of people want to use THC. I mean, I think in our world we’re leaning more on CBD these days, but does THC need to be a part of the whole cannabinoid product you’re using to get any benefit?
Dr. Jacqueline Jacques: It’s going to depend with anything, the benefit people are looking for. I think that THC has demonstrated medical benefit and it has a different action from many of the other phytocannabinoids, it acts very strongly on the cb1 receptor and some of those actions have real medical benefit. And I think in certain conditions, particularly certain kinds of pain, probably certain things that we see within oncology, or with other chronic diseases, maybe like HIV, there’s really good valid medical uses for THC containing extracts from marijuana. I don’t want to set that apart as having medical value, I think that we’ve seen enough data on it that it’s hard to deny that there are medical benefits that are associated with THC.
Dr. Kara Fitzgerald: Right. Well, and it’s-
Dr. Jacqueline Jacques: A lot of people … go ahead, I’m sorry.
Dr. Kara Fitzgerald: Well, I just wanted to throw in the obvious, it’s potently psychoactive and it, in fact, binds the anandamide receptor, right? And that’s what induces that?
Dr. Jacqueline Jacques: Yes.
Dr. Kara Fitzgerald: Okay.
Dr. Jacqueline Jacques: So that’s the other part of it, is that for some people who maybe … especially people who want the benefit of these compounds but either they don’t need that component of THC because of what they’re health concern is, or they don’t want to have that psychoactive effect. There’s people who just don’t want that and it’s not a small group of people. They can tap into getting some of these benefits from natural compounds without having to have the effects of THC. So I think the question of whether it’s necessary, really depends on the individual and what they’re trying to address rather than it being a good or bad thing. Does that make sense?
Dr. Kara Fitzgerald: Well, not only does it make sense but we just got off the topic of regulation and clearly, in many states, even in conservative Connecticut, I’m not going to be prescribing the psychoactive THC anytime soon as a naturopath here, even a lot … as I said, even though we’re legal, it’s just so, so tightly regulated that it ends up sort of squashing our ability to access medical marijuana here.
Dr. Jacqueline Jacques: Yeah. And I think, you know, there’s other people who have other concerns. Like they’re being drug tested at work, or if they’re in the military, there’s quite a number of people who have valid reasons to be concerned about not wanting THC.
Dr. Kara Fitzgerald: Yep.
Dr. Jacqueline Jacques: Again, I don’t want to diminish that there is … I personally believe there’s medical benefits for people who need it.
Dr. Kara Fitzgerald: Got it. All right. So let’s go back to the phytocannabinoids available in hemp and some of the other aromatics that you’ve talked about, why are we prescribing it?
Dr. Jacqueline Jacques: So I’ve probably gone overboard in getting excited about the endocannabinoid system, I’m just going to admit that right off the bat. I really feel like my personal feeling now about looking at phytocannabinoids and their functions within human health is at a level where we’re looking at being able to nourish the endocannabinoid system. I see phytocannabinoids being to the endocannabinoid system, almost like fish oil is to our eicosanoids. I feel very much like there’s a lot of people probably who, based on our lifestyles, and sort of generally poor diets for a lot of people, not consistent physical fitness, exposure to a great deal of stress, people walking around with pretty damaged endocannabinoid systems who would probably just benefit from using some of these things at a low level to boost their endocannabinoid health and tone.
But beyond that, I think that some of the best applications are within mental and emotional health, we see a lot of interest there. A lot of the calls I’ve been getting actually, in the last couple of weeks are from psychiatrists, which probably is the first time in my career I’m probably getting more calls from people practicing psychiatric medicine with interest in how can they support the endocannabinoid system in their patient population. Immune health is something you and I have discussed today, digestive health, so the endocannabinoid system plays a big role in gut motility, but also in gut immunity. So I think we’re going to see a lot of future interest in using things to manipulate or feed the endocannabinoid system that are related to digestive health, maybe with irritable bowel, inflammatory bowel conditions, things of that nature.
Dr. Kara Fitzgerald: Isn’t that interesting? Any particular cannabinoid we’d be looking at that might be a little more gut centric?
Dr. Jacqueline Jacques: Yeah. Well, I mean I think that some … the gut is interesting, we talk a lot about gut immunity, but the gut is also very … it’s almost like an extension of the nervous system as well, right? So it’s rich in both cb1 and cb2 receptors, so you’re going to see some pretty broad applications from a lot of the different phytocannabinoids in the system. So I think I mentioned CBG as one, where there’s some emerging research in GI health, but also beta-caryophyllene and some of the others. Looking at things like gut motility, but also gut immunity, they’re looking at the ECS as being the system that regulates the cross talk between the microbiome and the immune system.
So I’ve seen it raised in a couple of more very preliminary studies, the question of ECS maybe being the system that keeps the body from killing off the healthy parts of our microbiome. So keeping the immune system from maybe attacking that when it’s strong and healthy, but may not regulate that as well if it’s stressed by things like inflammation. So I think you’re going to see a lot more emerging on the role of the ECS there. There’s some early data looking at things like bone health and reproductive health, and so the endocannabinoid system seems to play a real role, particularly in implantation, also infertility, and in regulation of bone metabolism.
Dr. Kara Fitzgerald: Isn’t that fascinating?
Dr. Jacqueline Jacques: As I said, there is so much research coming out every day. I could make this probably 100% of my job and not learn enough.
Dr. Kara Fitzgerald: Right. Cognition, memory, again pain, I know we’ve already talked on it, and gut immune system. God, it’s just really far reaching, so I see why you would put it into the fish oil camp in supporting anti-inflammatory, eicosanoids, and resolvents. It seems like it could be a real workhorse intervention for us, one of the foundational things we go to rather than specific application in certain conditions, which I think a lot of us are thinking of or are using it now. I tend to think about CBD with pain, and my MS patients. But really, it might be something we use, as you say, a motility agent and I guess because you’re talking about the cb2s being prevalent in the gut along with cb1, the product you designed with these varied sources of phytocannabinoids might actually be more effective than leaning on just hemp oil.
Dr. Kara Fitzgerald: And I guess, before you jump in on that, the other thought that I’m having is this opens up a whole new vista as to all of the nutrients that we employ in our … either as food that we’re taking in and spices we might recommend, or as actual supplements. It occurs to me that our curcumin, one of the wonder spices of the world, turmeric, it must have some phytocannabinoids in it. Do you happen to know whether it does or not?
Dr. Jacqueline Jacques: I have seen one paper that suggested that there may be some phytocannabinoid activity in curcumin, and then I’ve seen some other data that refutes that.
Dr. Kara Fitzgerald: Oh is that right?
Dr. Jacqueline Jacques: It’s still one of the ones that’s sort of a question mark, you know is it or isn’t it? But ginseng is on there on the list with established phytocannabinoids, kava is on the list with plants with established phytocannabinoids in it. You’re seeing as people start to look, again, we’re finding more and more of these things. And the other place other people are studying, peripherals, so for your listeners who’ve maybe gotten into reading some of this literature already. There’s a whole emerging body of science around what’s called the entourage effect, which is looking at the interaction of the actual known phytocannabinoids. So the ones that either touch the receptors directly and interact with the receptors, or maybe act on the degrading enzymes, so we’re going to call those the actual phytocannabinoids. But then, they’re looking at many of the things like terpenes, or terpenoids, or flavonoids as having complimentary effects to the phytocannabinoids.
Dr. Kara Fitzgerald: Right.
Dr. Jacqueline Jacques: So hopefully we really start to see the sort of entourage benefits of using a more whole plant extract, is you have more of those constituents that are still present rather than isolating down for a single molecule, like isolating down just for CBD. You get a more broad benefit for nourishing the entire endocannabinoid system at providing substances that interact. So for example, we’ve added in, we have a hops extract and a rosemary product as well, and so hops can be a very close cousin of cannabis, they’re very closely related plants, has some of those other terpenoids that seem to be beneficial, like humulin, and lupulin, and things that may not be direct phytocannabinoids, but may support the benefits of the phytocannabinoids.
Dr. Kara Fitzgerald: Right.
Dr. Jacqueline Jacques: So we’re bringing those benefits together for a richer effect.
Dr. Kara Fitzgerald: Geez, that’s fascinating, right? There’s a molecule that we’re kind of excited about over here called palmitoyl-phosphatidyl-ethanolamide, or PEA. It’s often been used in pain management and it seems to be able to stabilize mast cells and I do a lot of allergic disease in practice, so I’ve been interested in it for that reason. Yeah, it’s just kind of a cool underused molecule, but it too has been considered to be part of the entourage.
Dr. Jacqueline Jacques: Yeah. No, it’s actually a selected cb2 agonist, so PEA has a really rich body of research behind it.
Dr. Kara Fitzgerald: Yes, I know. It’s rather extraordinary, it’s like the little molecule that could that nobody really knows about. Well geez, I love this. So you can go into your cabinet and pull out a whole lot of foods and you’re enriching your endocannabinoid system without even knowing it. And I just … you know, and it makes me appreciate the design of your product, you know, you guys are smart. You’re smart over there, and I like … so you’ve just got a compliment of these varied compounds that extend beyond myopic hemp and marijuana land that just nourish in far reaching affects, so I appreciate that.
Dr. Kara Fitzgerald: So we’ve talked about diet, unless you have more to add, but just diet and lifestyle to support the endocannabinoid system. But-
Dr. Jacqueline Jacques: Yeah so…
Dr. Kara Fitzgerald: Yeah, Go ahead.
Dr. Jacqueline Jacques: So we’ve already mentioned some of the important places you can find phytocannabinoids in diet, but I would say that probably a lot of the things that you are already recommending or your listeners already recommend in diet, would further support this system. So diets that help to eliminate the inflammatory effects in the body are all going to help people have a healthier endocannabinoid system. One of the other things that’s also important that I would doubt anyone in the functional medicine world isn’t already doing this all the time, but is making sure that people have really adequate levels of essential fatty acids on board because our own endogenous cannabinoids are made in the cell membrane from EFAs. So if you’re EFA deficient, or even borderline on that level, your own endocannabinoid system can’t be healthy. You’re never going to be able to do a good enough job, since these cannabinoids in your body are made on demand, say, on demand when you experience an acute stress or an acute injury, something like that, right?
Dr. Kara Fitzgerald: Yes.
Dr. Jacqueline Jacques: If you don’t have adequate levels already on board of your essential fatty acids, you’re not going to respond appropriately in terms of the response of your endocannabinoid system. So there’s a lot that we can do through diet and lifestyle, exercise of course good for everything, right? Maybe, might cause you some injuries but also very good for helping to maintain an endocannabinoid tone, so when we talked about anandamide when we first started speaking, one of the reasons anandamide has become so well known as a bliss molecule is, we now understand it to be the thing that’s responsible for the experience of things like runners high, right? So as people engage in more regular exercise, they actually do a better job of upping their own endocannabinoid tone. So people are looking to enhance that experience of say feeling even better when they exercise, then they want a healthier endocannabinoid system. So it plays very closely together.
Dr. Kara Fitzgerald: Yeah. I love it. Okay, so we talk about the resolvents, the second group of eicosanoid-like compounds from fatty acids and there’s tons of eicosanoids and there’s tons of these resolvents, and they all have these important network of really supportive effects. And clearly, they must think they’re touching on the endocannabinoid system and it’s like the symphony of all of these things together, I just really appreciate you opening up and coloring in this world for me. I also want to mention, at the very beginning of our conversation, you talked about the 2-AG receptor, the arachidonoylglycerol receptor, arachidon, you know so that’s actually coming from arachidonic acid. So we need a smidge of that around to support this, would you say that’s correct?
Dr. Jacqueline Jacques: Yes. Yeah, you do. That’s a reality is that arachidonic acid, I think we tend to bucket things as humans as good and bad, right?
Dr. Kara Fitzgerald: Right.
Dr. Jacqueline Jacques: So we tend to say, “All things in this category.” But arachidonic acid is important for generation of 2-AG.
Dr. Kara Fitzgerald: Yeah.
Dr. Jacqueline Jacques: And other things in the body, so you certainly need a certain amount of it around to have a healthy endocannabinoid system.
Dr. Kara Fitzgerald: And we know when you look at the eicosanoids derived from arachidonic acid, some of those are attenuating to the pro inflammatory ones and really necessary.
Dr. Jacqueline Jacques: Yeah.
Dr. Kara Fitzgerald: And arachidonic acid, while generally speaking, I would say I’m trying to lower it because the standard American diet and lifestyle tends to promote excess quantities of it, background arachidonic, or some arachidonic acid is important. And this 2-AG receptor, or compound that you mentioned is certainly one of them. That’s just a really nice balancing edition. So we’re probably, if we’re eating a healthy diet, if we’re engaging in a healthy lifestyle, we’re supporting our endocannabinoid system, but we can also use some of these really neat products extending far beyond hemp and marijuana, but including them to just optimize the system and beyond. How do you actually prescribe the Hemp Oil Plus from Thorne? I mean, I see on the label it says one capsule. I mean, is that just maintenance? Is that realistic? I mean, what if you’re actually trying to use it for pain? Or use it for gut motility? I mean, how might we think about it beyond just, “Here take one of these?” How do you dose it?
Dr. Jacqueline Jacques: One thing we don’t have at this time is we don’t have a good test that we can run and see how healthy people’s endocannabinoid system is, right? It’s not like vitamin D where I can draw your blood and run a lab and go, “Oh, you are low in vitamin D and therefore we need to give you this much vitamin D to get you up to normal.” Right? We don’t know that. We do know that these things are very biologically active at very small levels. So my general rule for people is start low and go up if you need to, rather than … I’ve had a lot of people say, “Well should I start with just a really high loading dose for people?” And I haven’t seen anything that would support doing that for anyone. In fact, a lot of people who even have what I might say the least healthy endocannabinoid systems, actually experience the most immediate benefit from starting to do something to increase the health of their endocannabinoid systems.
Dr. Kara Fitzgerald: And what would that be?
Dr. Jacqueline Jacques: But a general dose range with our product would probably be in the range of one to four a day.
Dr. Kara Fitzgerald: One to four a day.
Dr. Jacqueline Jacques: That’s maybe generalized, but I tell you a lot of people … I mean one is a fairly healthy dose of phytocannabinoids, you’re getting 15 milligrams total of phytocannabinoids in one capsule, which is a fairly healthy amount for people just looking to have some of the more broad benefits for the system.
Dr. Kara Fitzgerald: Did you say 50, or 15?
Dr. Jacqueline Jacques: 15 total.
Dr. Kara Fitzgerald: 15, okay, of phytocannabinoids. That’s really good to know. And do you … if you’re going higher than one cap, do you space it out, or can you take it at once?
Dr. Jacqueline Jacques: Yeah, I would probably … I mean, you certainly could take it all at once, but again, because the action of these compounds is pretty fleeting, it’s probably better for most people if they’re going to have a need for more than one, just space them out a little bit throughout the day.
Dr. Kara Fitzgerald: Okay.
Dr. Jacqueline Jacques: I would really tell people to start with one, it’s better to start lower and go higher.
Dr. Kara Fitzgerald: Okay. And what might you notice?
Dr. Jacqueline Jacques: They might not need it, they just might not need it.
Dr. Kara Fitzgerald: Got it.
Dr. Jacqueline Jacques: Especially if they’re doing any of the other things, if they’re working with a practitioner, they’re doing the other things to improve the health of their body and of their whole endocannabinoid system. So they’re bringing in, say, some supplemental fish oil and they’re cleaning up their diet, they’re increasing their own production of endocannabinoids at the same time by doing those things. So, where there are probably some specific cases where people might need much more substantial … although at some point, honestly they’re moving into the level of needing a cannabinoid-based drug, right? Which is another level we’re doing with the dietary supplement, but in fairly short order here. For example, people probably have access to epidiolex, which is the GW pharma CBD drug. So people will probably have access to many other ways to be getting higher levels of cannabinoids if they really need them for certain purposes.
Dr. Kara Fitzgerald: What’s GW marketing their CBD product for?
Dr. Jacqueline Jacques: For resistance seizure diseases in children, children and young adults, I guess there’s study data that goes up to about age 30, for really severe seizure disorders. And I know they’ve got some other research going on in other areas, but I think that, that will be the first approved indication that they have.
Dr. Kara Fitzgerald: Geez, resistance seizure disorder, interesting. Okay. Can I just ask, I want to ask you two more questions and I know we’re still emerging on this area big time and the research is kind of brand spanking new. So how would we know if somebody is dialed in and when we need to increase? I mean, are there signs of endocannabinoid toxicity that we might look for? I mean, might somebody get lose bowel movements, stomach ache, headache? Would any of those things occur if it was dosed too high? Like, why are you cautioning us to start … well, other than what you’ve explained as nourishing the whole system and doing a full functional approach, but would we be concerned about toxicity or intolerance?
Dr. Jacqueline Jacques: At very high levels, but not … it would be very hard for people to get … I think, from taking a product that has the level of phytocannabinoids that ours has in it from getting any … like, with CBD directly, for example, at very high doses, if you look at the study data, you’re really talking about doses of hundreds of milligrams. There are some documented side effects and some documented drug interactions, but it would be very hard to achieve those levels with our product, it would be really hard. More than anything, I think, I look at what people need versus what they take, so I think of it more maybe in a different perspective is that people don’t probably need more than maybe one or two a day for most things.
If they have, as I said, something that’s a more serious indication, or a much less healthy endocannabinoid system, then they may benefit from a larger amount. Irritable bowel is one I’ve been asked about a lot, so just since you mentioned motility. That’s probably the one where, particularly if you had someone who had … sorry my brain’s going blank, but if they had IBSD, where they had more diarrhea, I would just as a general, I think, be more cautious with those people rather than less cautious, is always a good idea. But the substance is in an … it is an oil, which just in general, somebody already has a very irritated bowel and they’re tending towards much more frequency of bowel movements, that’s probably one place where I would err on the side of caution and just start people slow.
Dr. Kara Fitzgerald: Okay, I got it.
Dr. Jacqueline Jacques: I would probably do that with anything I was giving to someone who needed a probiotic or anything else because it just … you know, possibly-
Dr. Kara Fitzgerald: Well, let me just tell you, Dr. Jacque, it was really nice to meet you. I realize we both graduated from the same alma mater and we’ve been in the same space for a long time, but I don’t think our paths have crossed. And I just appreciate your time on this and your knowledge, it’s been inspiring. I love the fact that you just expanded the endocannabinoid and the phytocannabinoid story for me, actually, pretty exponentially. And you know, I’m excited. I’m just excited to use it, I see the logic and the design of your product and I can see how we can enrich this system, either directly or indirectly by what we’re doing in functional medicine. I look forward to more research. And as you guys move forward on this path, we’ll have to circle back and see what else you’re thinking about, but I’m excited for this new product. And just again, thank you so much for joining me today on New Frontiers.
Dr. Jacqueline Jacques: Well, thank you for letting me be here. And hopefully if you ever let me come back and talk about this again, hopefully I’ll be a little bit more of an expert.
Dr. Kara Fitzgerald: Hey, no need to be modest. You did a g-
Dr. Jacqueline Jacques: I am normally on the ground with everybody else so I’m like an excited newbie myself in this space a little bit too. So I love talking about it but I also love learning about it, so thank you for the opportunity to share with everyone, really appreciate it.
Dr. Kara Fitzgerald: Absolutely, my pleasure.