Updated: Jul 10, 2022
This week, readers learn about how cannabis and its constituent molecules may be of therapeutic value to humans—particularly in the treatment of conditions based in inflammation—from Sunil Pai, MD, a veteran clinical practitioner.
Pai is an internationally recognized expert in integrative medicine based in Albuquerque, New Mexico and author of the critically acclaimed 2016 book An Inflammation Nation. He is a lecturer and a contributing author to a number of medical textbooks and scientific journals.
He is a practicing doctor who combines an evidence-based approach with 20 years of clinical experience. Each year, Pai educates thousands of physicians and medical professionals about the nuanced biochemistry involved in the administration of hemp-derived cannabinoids and terpenes for the treatment of a variety of disease states and conditions.
In August 2021, Higher Learning LV conducted the following exclusive interview with Pai.
Higher Learning LV: "As a medical expert on the management of inflammation and author of the 2016 book An Inflammation Nation, how can the cannabis/hemp plant species help humans in terms of managing their inflammation and achieving improved health?"
Sunil Pai, MD: "The use of cannabinoids from cannabis and hemp can help with the self-regulatory process of lowering inflammation through a variety of biological mechanisms. These include stimulation of certain endocannabinoid system receptors, such as CB1 and CB2, in many organs. These include the brain, all bones and muscles, the GI tract, and many other areas. Cannabinoids provide immunomodulation by repairing and protecting the tissues in these organs. This, in turn and over time, can balance inflammatory conditions and achieve homeostasis, which is critical for overall health improvement."
Sunil Pai, MD
HLLV: "CBD is being touted for treatment of a range of disease states and ailments. Is limiting one's therapeutic viewpoint to a single phytomolecule wise?"
SP: "Limiting one's consumption to one phytochemical has both benefits and disadvantages. The benefit is that, sometimes, using a single molecule can provide a stronger clinical response due to the ability to achieve a more potent and focused dose. "However, the disadvantage is a lack of biochemical balance. Like a pharmaceutical, CBD can feature side effects and a relatively small therapeutic window before side effects begin to occur. The pharmaceutical industry likes single phytomolecules due to the ability to patent them and own the extraction process or resulting compound. It also allows them to make a medical claim because drug studies employ only single molecules. Like pharmaceuticals, the cannabis and hemp industries also like single molecules such as CBD. They allow them to advertise a new product and increase SKUs with new indirect claims to the general public."
HLLV: "What other cannabinoids, beyond CBD, should wellness professionals and patients be paying attention to, Dr. Pai?"
SP: "That's a great question. Here's a few phytocannabinoids that have my attention currently and that I'm integrating into my clinical practice:
CBC (cannabichromene): Possibly helpful for brain health via support of the process of neurogenesis. Reduces inflammation and may target more CB2 receptors in gastrointestinal conditions (such as Crohns or IBS) and neuropathy.
CBG (cannabigerol): Interacts with both CB1 and CB2 receptors in the brain and indirectly elsewhere. May reduce inflammation and tumor growth.
CBN (cannabinol): Possible sedative and anti-inflammatory effects."
HLLV: "There's been plenty of talk recently about the THC isomer delta-8. What are your thoughts on the medicinal efficacy and utility of this molecule that is being adopted by many patients and lifestyle consumers, especially in states where delta-9 THC remains prohibited?"
SP: "Many companies are providing delta-8 products for two primary reasons. First, the public wants something close to THC, with aspects that deliver euphoria and pain control, with less feeling of being 'high.' This is particularly true in states where delta-9 remains illegal.
"Delta-8 THC is commonly called 'weed lite' or 'diet weed' because, for most consumers, it features lower potency and fewer side effects than delta-9 THC. Just as important, the industry is now oversaturated with CBD products, which is causing prices to drop really low. To remain competitive, cannabis and hemp companies need new product segments featuring new items.
"Unfortunately, to obtain adequate amounts of delta-8 from hemp, a process of synthesis must take place. This puts delta-8 in a grey zone in terms of regulation.
"Many delta-8 products on the market have been found to contain either delta-9 THC or other adulterants and chemicals. Until better regulations ensure safety and quality and its legal status is clarified, I prefer not to recommend delta-8 to my patients or colleagues. As you are aware, when it comes to hemp, I prefer to use the plant holistically, taking advantage of as many of the entourage mechanisms of these efficacious compounds as possible."
HLLV: "Terpenes are often hailed for their medicinal properties, including their anti-inflammatory prowess. What are your thoughts about the usefulness of terpenes, particularly in the realm of their effectiveness for treating inflammation?"
SP: "I like the use of terpenes—either that occur naturally in the product or that are added. However, our knowledge of terpenes is still in its infancy. We understand the range of different types of terpenes and, to a certain degree, the effects derived from them. Some are anti-inflammatory, which I naturally appreciate. I believe we should strive to preserve the natural terpenes that occur in loose-leaf cannabis and hemp flower samples and other products. We also have the opportunity to enhance CBD with terpenes, especially those that possess anti-inflammatory effects.
"That said, I must stress that controlling terpene dosage remains a major challenge. Terpenes are sold to manufacturers and processors for addition to their CBD products. However, this must be performed with expertise and caution.
"Terpenes can be dangerous; some consumers are allergic to certain terpenes! When companies in the industry use them, many lack formulation and manufacturing expertise and treat terpenes as merely another casual ingredient. With the growth of the use of terpenes in CBD and other cannabis and hemp products, there is increased danger of adverse responses from some patient and consumer populations to these compounds.
"Unfortunately, many manufacturers and distributors are focused on selling products in bulk and are not seeking safety and true medicinal efficacy. As an integrative medicine physician, I always consider how we can best use natural products like CBD safely and with maximum efficacy. If used properly, terpenes enhance the overall benefits of the other compounds, both directly and indirectly."
HLLV: "Thanks for your time and sharing your deep clinical experience with our readers, Dr. Pai."
SP: "Certainly. Thank you for the opportunity to help clarify the real science of how the phytocannabinoids and terpenes from cannabis may aid some patients and lifestyle consumers."
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