Many people assume CBD oil its "safe" simply because it's a natural substance. Research suggests that CBD can cause liver damage similar to conventional… Dysautonomia includes POTS, neurocardiogenic syncope, and other disorders affecting the autonomic nervous system. Symptoms can be completely debilitating restricting patients from many day to day activities. Cannabis can be a helpful tool for managing symptoms of dysautonomia and POTS, but there are some things to be aware of. Cannabidiol (CBD) can exert neuroprotective effects without being intoxicating, and in combination with Δ<sup>9</sup>-tetrahydrocannabinol (THC) CBD has shown to protect against THC psychosis. Acute concussion and post-concussion syndrome (PCS) can result in autonomic dysfunction in heart rate varia …
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Many people assume CBD oil its “safe” simply because it’s a natural substance. Research suggests that CBD can cause liver damage similar to conventional medications. We encourage you to talk to your doctors about all treatments you are using. Please don’t assume things are safer simply because they are natural.
Marijuana Study Finds CBD Can Cause Liver Damage
Although CBD is often revered as a miracle drug, a new study finds that it could be causing liver damage.
For the folks complaining that we shouldn’t post this, here are a few things we’d like you to know. It’s a bit of a long read, so find a comfy seat and kick up your feet.
If CBD has helped you, that’s great! We’re not opposed to the use of CBD or medical marijuana. We’ve asked the notable autonomic researchers to study the use of medical marijuana and CBD in people with autonomic disorders, and have encouraged them to submit grant applications on this topic. No takers yet.
We think it’s important for patients to work with their providers to come up with a treatment plan that is based on the current state of science. That includes understanding identified risks of any treatment, as well as the benefits.
There is a naive assumption by some people that “natural” always means “safe.” That is simply not true. We think it’s important for everyone to understand this. Any biologically active substance can have benefits and risks, and an informed patient would want to know about both.
Research has shown CBD can cause liver damage similar to conventional medications. That doesn’t mean “OMG, don’t take CBD!” We just want you to be aware of potential risks, and to talk to your doctors about all of the treatments you are using, because quite a few common drugs that rely on certain liver enzymes to metabolize may increase the risk of liver damage from CBD use.
Here are some resources for those who would like to read more on liver enzyme/CBD interactions:
1. Hepatotoxicity of a Cannabidiol-Ric h Cannabis Extract in the Mouse Model
https:// www.mdpi.com/ 1420-3049/24/9/ 1694/htm
This was one of the studies discussed in the Forbes article that seemed to irk a lot of people.
Some people noted the higher dose that the mouse received, suggesting this made it irrelevant to humans, who take a smaller dose. However, the journal article notes that the dose was based on allometric scaled mouse equivalent doses. Allometric dosing takes into account that the metabolic rate of an animal is based in large part on its body size. In other words, smaller animals=faster metabolic rate. Allometric dosing is often used in medical research involving animals. The researchers used mouse dosing allometrically equivalent to 5mg/kg human dosing, in their lowest dosing group (on the lower end of CBD dosing used in humans), up to 200mg/kg in their highest dosing group (on the higher end of what humans might take), and several dosing groups between 5-200mg/kg. There were different scientific reasons for each of these doses, which you can read about in the full journal article.
Other people complained that the study is irrelevant because it was using the FDA approved form of CBD, Epidiolex. Nope, this study was not using Epidiolex. You can read about the process the researchers used to make their own CBD oil directly from cannabis plants in the journal article.
Other people complained that the study was funded by big pharma. You can read the funding sources for almost any research study at the bottom of the article. This article notes federal government funding from the NIH, funding from the American Association for the Study of Liver Diseases Foundation (which appears to be a legit charity for liver diseases), and the Arkansas Biosciences Institute (which appears to be funded by Arkansas tobacco settlement money, and led by university researchers from around the state).
2. Read Section 5.1, Hepatocellular Injury, from the package inset for the first FDA approved CBD product. https:// www.accessdata.f da.gov/ drugsatfda_docs/ label/2018/ 210365lbl.pdf
3. Effect of Cannabidiol on Drop Seizures in the Lennox–Gastaut Syndrome
https:// www.nejm.org/ doi/10.1056/ NEJMoa1714631?ur l_ver=Z39.88-20 03&rfr_id=ori%3 Arid%3Acrossref .org&rfr_dat=cr _pub%3Dwww.ncbi .nlm.nih.gov
Some of the data that lead to the first FDA approval of a CBD product comes from this study. “Elevations in liver aminotransferas e concentrations occurred in 9% of the patients who received cannabidiol.” The study used 10mg and 20mg per day dosing, and some of the patients in each dose level developed elevated liver enzymes. People in the control group did not. Some of the people who had elevated liver enzymes were on other medications, but importantly, some were not. Read the full article for details.
4. A Review of Human Studies Assessing Cannabidiol’s (CBD) Therapeutic Actions and Potential.
https:// www.ncbi.nlm.nih .gov/pubmed/ 30730563
After a detailed discussion of liver enzymes impacted by CBD and known drug interactions with CBD, the pharmacologist author of this July 2019 CBD review article notes, “The potential for so many drug interactions makes patient use of CBD without input from a health care professional risky.”
5. Paradoxical Patterns of Sinusoidal Obstruction Syndrome-Like Liver Injury in Aged Female CD-1 Mice Triggered by Cannabidiol-Ric h Cannabis Extract and Acetaminophen Co-Administrati on
https:// www.mdpi.com/ 1420-3049/24/12/ 2256/htm
6. Pharmacokinetic s, Safety, and Clinical Efficacy of Cannabidiol Treatment in Osteoarthritic Dogs https:// www.frontiersin. org/articles/ 10.3389/ fvets.2018.00165 /full
Discussing an increase in alkaline phosphatase in dogs after four weeks of 2mg/kg dosing of CBO oil.
7. Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome
https:// www.nejm.org/ doi/full/ 10.1056/ nejmoa1611618
8. Long‐term cannabidiol treatment in patients with Dravet syndrome: An open‐label extension trial
https:// onlinelibrary.wi ley.com/doi/ full/10.1111/ epi.14628
9. MedlinePlus is a resource from the US National Library of Medicine: “Signs of liver injury have also been reported in some patients, but this is less common [than other side effects].” https:// medlineplus.gov/ druginfo/ natural/ 1439.html
There are numerous other peer-reviewed journal articles discussing potential risks and benefits of CBD. PubMed.gov is a good place to find free journal abstracts, and sometimes full journal articles.
Bottom line. if you’re taking CBD or thinking about taking it, you should know about this potential risk, and you should talk to your doctor about all of the treatments you are using.
POTS, Dysautonomia, and Medical Cannabis
When I tell people that I have a condition called POTS they often laugh and crack a joke about how it’s the perfectly named condition for me given my line of work and passion. I can’t help but chuckle and agree, but the reality of living with a condition like POTS is far from a laughing matter.
Before I was dealing with the symptoms myself I had no understanding of or awareness of the disorder or it’s umbrella category – dysautonomia. This was a bit of surprise to me considering I’d devoted my entire career to helping people with chronic illness. So how did I learn about it? By passing out cold in the bathroom and slicing my head open on a cabinet and toilet roll holder – more than once. What can I say, I like to learn things the hard way.
POTS stands for Postural Orthostatic Tachycardia Syndrome, a form of dysautonomia.
Let’s break those two down.
Dysautonomia refers to any disorder of the autonomic nervous system (ANS). The ANS controls important parts of our body that we don’t have to think about like blood vessels, stomach, intestines, liver, kidneys, heart, etc. Common forms of dysautonomia include POTS, neurocardiogenic syncope, multiple system atrophy, and diabetic autonomic neuropathy. While dysautonomia can develop for a range of reasons, conditions such as diabetes, MS, rheumatoid arthritis, Parkinson’s disease, and celiac disease can contribute to its onset.
Postural Orthostatic Tachycardia Syndrome is a form of orthostatic intolerance, meaning symptoms surface when standing from a reclining position and may be relieved upon lying back down. By definition POTS is a rapid increase in heart beat when standing (over 30bpm), but other symptoms can include dizziness, light headiness, fatigue/exhaustion, chest pain, brain fog, temperature deregulation, nausea, and other similar symptoms.
People with POTS have difficulty regulating blood flow and volume, meaning blood pressure and heart rate become unstable. For me this leads to episodes of Neurocardiogenic Syncope (NCS) in which I faint and loose consciousness. When I come to I experience extreme nausea, vomiting, exhaustion, and a general feeling of unwellness. Many individuals with dysautonomia have other related conditions like Ehlers-Danlos syndrome, gastroparesis, and Mast Cell Activation Syndrome (MCAS) that include symptoms of severe pain, stomach discomfort, difficulty with appetite, and allergic reactions. Many of these symptoms can be managed with cannabis, but there are also some things to be aware of.
Using Medical Cannabis for Dysautonomia – Things to Know
Every single person will respond to cannabis differently. Patients with dysautonomia find that cannabis helps them immensely for some symptoms, but can exacerbate others. Being aware of these potential side effects is important to getting the most out of your cannabis routine.
THC can raise heart rate.
Individuals with POTS by definition have difficulty with tachycardia, or an elevated heart rate. THC can raise heart rate for the short-term, while lowering it over the long term. Some patients with POTS have difficulty bringing their heart rate back into a normal range – even requiring IV fluids and medications to do so. Some cannabis users are particularly sensitive to this increase in heart rate and finds it worsens these POTS symptoms. Other dysautonomia patients, like myself, actually benefit from this action – I medicate with THC prior to showering as my heart rate and BP tends to bottom out during and after showers. I can use it mindfully to help regulate my heart rate and BP when needed.
Cannabis can trigger orthostatic hypotension.
Cannabis contributes to vasodilation, which for many people with chronic illness is an added benefit (reduces blood pressure). Patients already prone to orthostatic hypotension (a severe drop in blood pressure when changing from sitting/laying to standing) may find these symptoms exacerbated with cannabis, especially with high doses. As orthostatic dysfunction is a hallmark feature of dysautonomia, patients should be mindful of this potential exacerbation when using cannabis and take necessary precautions.
Everyone responds differently.
I do well with THC – I can use it mindfully to raise my heart rate in situations where my dysautonomia causes it to drop, but products and strains dominant in CBD seem to exacerbate my symptoms and propensity towards syncope (more on this below). It’s important that dysautonomia patients are aware of both the positive and potential negative effects of cannabis so they can effectively monitor their symptoms and results.
Benefits are varied and affect multiple systems.
Cannabis has neuroprotective and anti-oxidant properties. There is some suggestion that cannabis may be healing for dysautonomia patients by addressing the underlying nerve damage. However, this is a theoretical assumption and beyond our current understanding of the plant. Most dysautonomia cannabis patients use it to manage day to day symptoms including nausea, fatigue, and pain. Cannabis may also be effective in managing inflammation and other symptoms associated with commonly co-morbid conditions. For example, patients with related MCAS my find cannabis topicals helpful for localized reactions and those with gastroparesis may find it helpful for appetite.
My Personal Experience
Cannabis has been life changing for me in so many ways, but when I started experiencing symptoms of dysautonomia, primarily fainting episodes, my world was thrown upside down. My cannabis physician and friend Dr. Scott Gebhardt suggested to me that my CBD intake could be contributing to my episodes and recommended I take it out of my routine to test if it could be contributing. I was less than willing to take on this experiment, so I initially stopped my oral doses for only a week. My dysautonomia symptoms weren’t improving and my pain was increasing so I called the ‘experiment’ a loss and started taking my oral CBD again.
Months went by and my dysautonomia symptoms were continuing to worsen. I had continued to up my CBD intake over this time – both orally and via inhalation. Dr. Gebhardt was still in my ear about my CBD use dropping my blood pressure and contributing to my orthostatic episodes. I really really didn’t want to hear him.
Every time I faint or have a near fainting episode I feel a little piece of my independence slip away. Not wanting this anymore, I finally gave in and stopped my CBD intake all together – no oral and no CBD dominant strains or 1:1 via inhalation. I had to make adjustments to my overall routine to better manage my pain without the CBD, but to my surprise I went THREE MONTHS without having a fainting episode, something that was happening far more regularly prior to stopping. The first syncope episode I had after cutting out my CBD was when my air conditioner broke (heat is a major trigger). I’ve experienced a drastic reduction in orthostatic intolerance with almost no pre-syncopal episodes.
While I can’t deny that CBD was contributing to my dysautonomia symptoms, my endometriosis symptoms have really ramped up without it. I recently tried to add inhaled CBD dominant products back into my routine to work on this pain. Unfortunately, I was met with the full array of my dysautonomia symptoms – including fainting. Now that I have a better understanding of how cannabis affects my blood pressure and symptoms, I’m better able to manage both my dysautonomia and medical cannabis use.
I Have Dysautonomia and Want to Try Medical Cannabis – What Does This Mean for Me?
Choose a quality cannabis physician (who knows a thing or two about dysautonomia).
Despite all of my knowledge and experience with cannabis, I would have NEVER stopped taking my CBD and identified it as a trigger if it wasn’t for the outside perspective and guidance from my cannabis physician, Dr. Scott Gebhardt. Choose a physician who understands the plant and body, looks at the bigger picture, and is not just there to issue a certification. This will pay you back in ways you never imagined.
EVERY single patient is different. Journal your cannabis use and symptoms to figure out your personal patterns, reactions, and best products.
Take your BP and HR.
As patients with dysautonomia can have difficulty regulating blood pressure and heart rate, be mindful to take regular readings when starting a new cannabis routine.
Keep a positive mindset.
Cannabis is psychoactive and sensitive to set and setting. If you go into a situation expecting a negative reaction, you are more prone to have one. Try to be calm and collected before medicating.
Effects of phytocannabinoids on heart rate variability and blood pressure variability in female post-concussion syndrome patients: case series
Cannabidiol (CBD) can exert neuroprotective effects without being intoxicating, and in combination with Δ 9 -tetrahydrocannabinol (THC) CBD has shown to protect against THC psychosis. Acute concussion and post-concussion syndrome (PCS) can result in autonomic dysfunction in heart rate variability (HRV), but less information is available on blood pressure variability (BPV). Furthermore, the effects of phytocannabinoids on HRV and BPV in PCS are unknown. The purpose of this study was to observe the influence of daily administration of CBD or a combination of CBD and THC on HRV and BPV parameters in four female PCS participants. Participants completed a seated 5-min rest followed by six breaths-per-minute paced breathing protocol. Data was collected prior to phytocannabinoid intake and continued over 54 to 70 days. High frequency systolic BPV parameter increased every assessment period, unless altered due to external circumstances and symptoms. HRV parameters showed less consistent and varying responses. These results suggest that CBD can help to improve the altered autonomic dysfunction in those with PCS, and that responses to the drug administration was individualized. Double blinded, randomized controlled trials with greater sample sizes are required to better understand the influences of the varying dosages on human physiology and in PCS.
Keywords: blood pressure variability; cannabidiol; commotion cérébrale; concussion; post-concussion syndrome; syndrome post-commotion cérébrale; variabilité de la tension artérielle.
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