Author Archives: Dr. Brian Lawenda

Cannabis and Cancer: Prescribe 5 different drugs or simply one botanical…your choice



 

This is a completely non-political blog entry on the science of the medical efficacy of

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Cannabis (marijuana) in oncology.  Cannabis is plant that is classified in the U.S. as a controlled substance with an “increased potential for abuse and no known medical use” (Schedule 1). By federal law, possessing Cannabis, is illegal in the U.S.  Although U.S. federal law prohibits the use of Cannabis, 16 states and the District of Columbia permit its use for certain medical conditions with a physicians’ prescription. That said, doctors in these states may not legally do so without violating federal law and can lose their federal license to prescribe drugs and be prosecuted.  Presently, 3 states (Colorado, Maine, and New Mexico) license producers and distributors of medical cannabis. Now that I have established that, let’s learn more.

WHAT ARE THE ACTIVE COMPOUNDS IN CANNABIS?

There are over 400 chemical compounds that have been discovered within the Cannabis plant. The phytocannabinoids (or simply,” cannabinoids”) are the main chemical components that exert most of the pharmacological activity of the plant. There are more than 60 identified cannabinoids, but the 4 most well-studied and characterized cannabinoids are delta-9-tetrahydrocannabinol (d-9-THC), cannabidiol (CBD), cannabinol (CBN), and tetrahydrocannabivarin (THCV).cannabinoid molecules

Cannabinoid compounds are currently available as either synthesized chemicals or whole plant extracts, including:

Interesting references:
  • Here’s a great article on the development of Sativex. (Mother Jones)
  • Review articleon the differences between Marinol and Cannabis (NORML.ORG):
    • Summary of key points: 1) Marinol lacks several of the therapeutic compounds available in Cannabis, 2) Marinol is more psychoactive than Cannabis, 3) Cannabis vaporization offers advantages over orally administered THC, 4) Marinol is more expensive than Cannabis, 5) Patients prefer Cannabis to Marinol

WHAT IS THE ENDOCANNABINOID SYSTEM?

Perhaps the most exciting area of cannaboid research involves the discovery of the body’s endocannabinoid system. Incredibly, our bodies make their own cannabinoid chemicals which interact and stimulate cannibinoid receptors on our cells. Studies continue to uncover the numerous functions of our endocannabinoid system, including:

  • anti-inflammatory activity: anticancer
  • antioxidant activity: anticancer
  • inhibiting tumor cell growth (apoptosis): anticancer
  • inhibiting blood vessel growth to tumors (anti-angiogenesis): anticancer
  • antiviral activity
  • involved in learning and nervous system plasticity
  • pain processing
  • neuroprotective effects
  • visual perception
  • immune system modulation: anticancer
Learn more about the endocannabinoid system (Nature Reviews)

ROUTES OF USE OF CANNABIS:

pax vaporizerCannabis may be taken by mouth (i.e. baked products, butters, teas, liquid sprays and tinctures, gum, beer, etc.) or may be inhaled, through smoking or vaporizing (read my blog entry on vaporization). One of the most safe and consistent methods of obtaining a controllable dose of active drug when using Cannabis is through vaporization.

It takes over one hour for Dronabinol (Marinol) to reach full systemic effect, compared to minutes for smoked or vaporized cannabis.

Is Smoking Marijuana Safe? A new research study has found that habitual use of marijuana DOES NOT appear to lead to  abnormalities in lung function, nor does it increase the risks of COPD (chronic obstructive lung disease) or either lung or upper airway cancer. It is associated with an increase in symptoms of chronic bronchitis; however the symptoms go away upon discontinuation of use.

That said, I still would prefer that my patients vaporize versus inhale smoke.

USES OF CANNABIS IN ONCOLOGY:

As an integrative oncologist, I recommend the use of various methods for helping patients manage commonly encountered side effects and symptoms of cancer treatment and the cancer itself. Whenever possible, I start by suggesting non-pharmacologic therapies that have been shown to be effective, safe and are inexpensive. If the symptoms are moderate-to-severe or unlikely to be able to be controlled with non-pharmacologic approaches, this is when I will recommend using natural botanical products and/or pharmaceutical drugs.

5 commonly experienced symptoms in cancer patients are:

  • nausea
  • diminished appetite (and associated weight loss)
  • pain
  • sleeping difficulties
  • psychoemotional distress (i.e. anxiety, stress and depression).

Cannabis (as the whole plant compound) and the synthetic and extracted delta-9-tetrahydrocannabinol (d-9-THC) and cannabidiol (CBD) have all been shown to have significant efficacy in improving these 5 common symptoms in clinical trials.

Your physician would need to prescribe 5 different drugs to (with the associated side effects and costs) to manage these symptoms…or you they can prescribe one drug which improves all 5 symptoms.

If only one or two of these symptoms are causing significant problems, I typically don’t recommend using a cannabinoid since other pharmacologic options may be more effective in treating those individual symptoms. Unfortunately, it is quite common to see patients with the majority of these symptoms manifesting at once (particularly in advanced stages of disease and treatment). For these patients, I think it is very appropriate to recommend a cannabinoid or Cannabis by itself or in combination with other pharmacologic (i.e. Megace for poor appetite, Zofran for nausea, etc.) and non-pharmacologic therapies (i.e. mind-body therapies, etc.)

Recently reported data indicate that the combination of inhaled Cannabis (via vaporization) with opioid pain medications leads to a synergistic affect, which decreases the amount of opioids needed for pain control. This synergistic action helps patients by reducing the side effects of higher dose requirements of opioids (i.e. sedation and nausea).

IS THERE ANY VALIDITY IN THE USE OF CANNABIS AS AN ANTICANCER AGENT?

marijuana scienceThere are no quality clinical studies in humans that have been done for us to know if Cannabis or any of the cannabinoids are able to improve cancer-specific outcomes (i.e. survival, recurrence, progression).

There are interesting and promising preclinical studies (using cancer cells or animal studies) that demonstrate the anticancer activity of cannabinoids:

(from the U.S. NCI PDQ: Cannabis and Cannabinoids):

  • “Studies in mice and rats have shown that cannabinoids may inhibit tumor growth by causing cell death, blocking cell growth, and blocking the development of blood vessels needed by tumors to grow.”
  • “Laboratory and animal studies have shown that cannabinoids may be able to kill cancer cells while protecting normal cells.”
  • “A study in mice showed that cannabinoids may protect against inflammation of the colon and may have potential in reducing the risk of colon cancer, and possibly in its treatment.”
  • “A laboratory study of delta-9-THC in hepatocellular carcinoma (liver cancer) cells showed that it damaged or killed the cancer cells. The same study of delta-9-THC in mouse models of liver cancer showed that it had antitumor effects. Delta-9-THC has been shown to cause these effects by acting on molecules that may also be found in non-small cell lung cancer cells and breast cancer cells.”
(from NORML.ORG)
  • Glioma and other cancer cell types: 
    • “In addition to cannabinoids’ ability to moderate glioma cells, separate studies demonstrate that cannabinoids and endocannabinoids can also inhibit the proliferation of other various cancer cell lines, including breast carcinoma,[11-15] prostate carcinoma,[16-18] colorectal carcinoma,[19] gastric adenocarcinoma,[20] skin carcinoma,[21] leukemia cells,[22-23]neuroblastoma,[24] lung carcinoma,[25-26]uterus carcinoma,[27] thyroid epithelioma,[28] pancreatic adenocarcinoma,[29-30], cervical carcinoma,[31]oral cancer,[32] biliary tract cancer (cholangiocarcinoma)[33] and lymphoma.[34-35]
  • Colon cancer:
    • “Although cannabidiol has been shown to kill glioma cells, to inhibit cancer cell invasion and to reduce the growth of breast carcinoma and lung metastases in rodents, its effect on colon carcinogenesis has not been evaluated to date. This is an important omission, since colon cancer affects millions of individuals in Western countries. In the present study, we have shown that cannabidiol exerts (1) protective effects in an experimental model of colon cancer and (2) antiproliferative actions in colorectal carcinoma cells.”
  • Breast cancer:
    • “The administration of THC reduces the tumor growth of metastatic breast cancer and “might constitute a new therapeutic tool for the treatment” of cancerous tumors, according to preclinical data published online in the journal Molecular Cancer.”

So, when asked by my patients if using Cannabis or cannabinoids can help improve their cancer-specific outcomes I can only point to preclinical data on that question. We know that many seemingly amazing outcomes have been reported in preclinical studies, only to later have no effect in human studies. Therefore, it is important to recognize the limitations of projecting preclinical outcomes to human study outcomes.

WhatIfCannabisCuredCancer-posterHere’s a fantastic 50-minute documentary (What if Cannabis Cured Cancer). Dr. Andrew Weilwrites “What If Cannabis Cured Cancer summarizes the remarkable research findings of recent years about the cancer-protective effects of novel compounds in marijuana. Most medical doctors are not aware of this information and its implications for prevention and treatment. This documentary presents compelling evidence that our current policy on cannabis is counterproductive and foolish. An excellent film.”

SAFETY OF CANNABINOIDS:

According to a 1995 review prepared for the World Health Organization, “There are no recorded cases of overdose fatalities attributed to cannabis, and the estimated lethal dose for humans extrapolated from animal studies is so high that it cannot be achieved by … users.”

In 2008, investigators at McGill University and the University of British Columbia reviewed 23 clinical investigations of medical cannabinoid drugs (typically oral THC or liquid cannabis extracts) and eight observational studies conducted between 1966 and 2007. Investigators “did not find a higher incidence rate of serious adverse events associated with medical cannabinoid use” compared to non-using controls over these four decades.

Pharmacologic studies indicate that a human would need to eat 1,500 pounds of Cannabis within 15 minutes to achieve lethal levels of cannabinoids.

That said, cannabinoids are active drugs with potential side effects and risks.

Potential side effects of cannabinoids may include (from the NCI PDQ):

  • Rapid beating of the heart.
  • Low blood pressure.
  • Muscle relaxation.
  • Bloodshot eyes.
  • Slowed digestion and movement of food by the stomach and intestines.
  • Dizziness.
  • Depression.
  • Hallucinations.
  • Paranoia.

Both Cannabis and cannabinoids may be addictive. Symptoms of withdrawal from cannabinoids may include (from the NCI PDQ):

  • Restlessness.
  • Hot flashes.
  • Nausea and cramping (rarely occur).

References on safety and risks:

Clinical Trials of Cannabis or Cannabinoids in Cancer

In preparing this blog entry, a search of the U.S. NCI Clinical Trials website (with search keywords: cannabis, cannabinoid, THC) identified 5 registered phase 2 and phase 3 clinical trials that are currently active or approved for studying the effects of these agents in patients with cancer. Unfortunately, none of these studies involves the use of the whole plant (Cannabis).

CLEARING THE SMOKE: THE SCIENCE OF CANNABIS

MontanaPBS’s new documentary, Clearing the Smoke, reveals how cannabis acts on the brain and in the body to treat nausea, pain, epilepsy and potentially even cancer. Extensive interviews with patients, doctors, researchers and skeptics detail the promises and the limitations of medicinal cannabis. (57 minutes. February 2011)

 

The Science of Medical Cannabis: A Conversation with Donald Abrams, M.D.

Donald Abrams, M.D. is chief of Hematology and Oncology at San Francisco General Hospital and the co-author with Andrew Weil of Integrative Oncology (Oxford University Press). Abrams has extensive experience working with cancer and HIV/AIDS patients and is a pioneer in the field of medical cannabis research.

Dr Sanjay Gupta: Why I Changed My Mind On Weed (CNN)

Dr. Sanjay Gupta says we have been “systematically misled” on marijuana. Watch the video.

 

MARIJUANA GATEWAY TO HEALTH: HOW CANNABIS PROTECTS US FROM CANCER AND ALZHEIMER’S DISEASE

marijuana gateway to healthClint Werner is a recognized expert in the science, history and politics of Cannabis. This excellent book is a review on everything you ever wanted to know on this subject. It is up to date, scientific and factual, which appealed to me over a biased rant. (published: September 2011).

 

 

 

 

 

 

 

I recently found this well-written article reviewing the commonly asked questions about whether cannabis has anti-cancer efficacy, safety issues, conspiracy theories and legalization. 

By Dr. Brian Lawenda

Using Complementary Therapies to Reduce Side Effects of Radiation

I love integrative oncology because it allows me to interact with my patients in a holistic manner.  And holistic is a word that means taking care of the whole patient.

I use complimentary alternative medicine therapies with radiation for a variety of reasons.  I’ve found that they may be helpful to reduce the side effects of radiation treatment.  For example I might use a botanical based cream to apply to the skin that we’re radiating.  Calendula is the name of the cream that I like to use.  Aloe vera is another one.  Both of these have been shown to reduce the radiation skin reaction that is fairly common during radiation treatment to the skin.


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Juicing and Blending: AntiCancer Turbocharging

 

Juice-and-Blend1-300x215
Unless you have the time and ability to prepare and eat large quantities of fresh produce every day I highly recommend you consider juicing or blending.

 

TERMINOLOGY:

 

Juicing involves grinding, pulverizing and squeezing the juices out of the produce while discarding most of the fiber. Juicing makes “juice.”

 

Blending finely chops up all the plant material in the container without extracting any of the fiber or cell walls that are typically discarded during juicing. Blending makes “smoothies.”

 

WHY AM I A FAN OF JUICING AND BLENDING?

 

Most of us simply do not consume the recommended amount of fruits and vegetables per day (2-3 cups of fruit, 3+ cups of vegetables) that are required to reduce our risk of cancer and other chronic diseases. Drinking juice or smoothies can help you reach this goal. In a single 12-ounce glass of juice you are getting on average 2-3 pounds worth of plant nutrients.

 

Another important point to make is that even if you consume the recommended amount of produce each day, that produce is not nearly as nutrient-rich as the same produce grown 50 years ago. This is mainly due to: 1) soil nutrient depletion from over-farming, 2) nutrient degradation begins immediately after the produce is harvested; it takes most produce a few weeks to make their way to your grocery store. Juicing (more so than blending) can help you make up for this nutrient depletion simply by the fact you are consuming a larger quantity of nutrients in your juice than most people can consume in a day through eating or blending the same produce.

 

  • Many of these nutrients (also known as phytonutrients) have powerful anticancer activity! You want your body to be full of these compounds so you are literally making your tissues more hostile to any hiding cancer cells that may try to grow there.

 

Here’s a list of the main compounds you get when juicing or blending produce:

 

  • Water
  • Vitamins
  • Minerals
  • Enzymes
  • Phytochemicals (such as antioxidants, anti-inflammatory compounds and many other anticancer compounds)
  • Proteins
  • Carbohydrates
  • Fats
  • Fiber
  • Other Unknown Nutrients

 

Although this may look like all the nutrients your body needs, I do not recommend that you use juice or smoothies in place of your meals unless you are on a ‘physician/nutritionist/dietician-approved’ dietary plan or you are not able to get adequate nutrition consuming whole food (i.e. you have pain or other difficulty swallowing foods, gastrointestinal distress, poor appetite, etc.) I want to emphasize this because whole foods contain quantities of protein, fat, carbohydrates and fiber that are not always easily obtainable through juice or smoothies (unless you add additional nutrient supplement powders). Think of juices and smoothies as simply the ultimate anticancer supplement.

THE PROS AND CONS OF JUICING AND BLENDING:

Let’s go through some of them here:

Juicing Pros:

juicing-300x199

 

  • Without the fiber, your intestines don’t have to work as hard digesting and absorbing the nutrients in the plant material as they would if you ate the produce or blended it. If your intestines are sensitive or are irritated or inflamed from an illness or cancer treatment (i.e. chemotherapy or radiation therapy), I’d recommend juicing over blending.
  • You can pack many more servings of produce into your juice than you can a blended drink and you will absorb far more nutrients from each serving of juice than from a serving of a blended drink.

Juicing Cons:

  • Fiber is important in slowing down the absorption of the sugars from the produce. Without this fiber, the sugars are quickly absorbed into your bloodstream causing a sharp rise in your blood sugar. Not only can this lead to mood swings and energy loss (as your blood sugar levels eventually drop below their baseline levels), but spikes in blood sugar also cause the pancreas to secrete insulin and the the liver to produce IGF-1. We don’t like this since cancer’s #1 fuel is sugar and insulin and IGF-1 are cancer growth factors!
  • Another con is that fibers in the juice help keep you feeling full longer, so juices are not as filling as blended drinks.
  • Juicing is more expensive than blending. Juicers are more expensive than blenders (typical range: $60 to $600). You will use more produce for each serving of juice than a serving of a blended drink.
  • Juicing takes more time. You will spend more time making the juice and cleaning your juicer than you will with a blender.

Blending Pros:

  • Because the blended drink (“smoothie”) contains all of the plant fiber, the nutrients are more slowly absorbed than with juices, thereby avoiding blood sugar spikes.
  • The fiber in smoothies also helps you feel full longer.
  • Plant fiber is the main source of prebiotic material which is required for maintaining a healthy flora.
  • Faster preparation and clean up time.
  • Uses less produce in each drink than with juices.
  • Lower cost: Blenders tend to be less expensive than juicers and you use less produce in each drink.

Blending Cons:

  • Since the fibrous material takes up more volume, you will not consume as many cups of produce in a blended drink as you will in a similar serving size of juice. Therefore you will not absorb as many nutrients per serving in blended drinks.
  • Smoothies require your intestines to work harder than juices to digest and absorb. If your intestines are upset, irritated and inflamed juicing will be easier for you to consume.
  • Smoothies are more pungent in flavor and thicker in consistency than juices made from the same produce. This can be a ‘con’ for those who prefer the flavor profile and thinner consistency of juices.

DOC, WHAT DO YOU PREFER?

When my patients ask me what I prefer to do, I tell them that it depends on what ingredients I would like to consume (i.e. vegetables or fruits or both) and what my palate desires (i.e. am I very hungry, do I want thin or thicker consistency, etc.) In general, I prefer to juice vegetables and blend fruit. If I’m really hungry I’ll favor a thicker and more filling smoothie over a juice. If I’m planning to also eat a more filling meal shortly after drinking my juice or smoothie I will probably opt to have a juice.

WHICH JUICERS AND BLENDERS DO I RECOMMEND?

New units are coming out all the time, so it is important to do your research. You have to figure out what you can afford to spend as there is a wide range of prices and quality from which to pick. My suggestion is that if you intend to use your juicer or blender more than a couple of times per week invest in a higher quality unit. You’ll actually spend less money in the long run since you won’t have to replace or repair a cheap unit that breaks down too quickly. Additionally, higher quality units are much more efficient so you will get a larger yield of juice or smoothie from your produce. If you buy a good product expect it to last you for years.

Juicers:

There are many different types of juicers on the market (i.e. centrifugal, centrifugal ejection, masticating, manual press, single auger, dual stage single auger and twin gear press juicers.) As of 2014 the two types of juicing units I recommend are the following:

  • If you are looking for a juicer that can juice both vegetables and fruit equally well, make juice quickly and are the easiest juicers to clean get a vertical single auger juicer (such as the Omega VRT400HD, Tribest Slowstar SW-2000). Important caveat: these don’t juice leafy greens (i.e. wheatgrass) very efficiently.
  • If you want to mainly juice vegetables and leafy greens (i.e. wheatgrass) get a horizontal single auger juicer (such as the Omega NC900) or double auger juicer (such as the Green Star GSE-5000) as they are more efficient in juicing these harder to juice produce than the vertical single auger types.
  • Find Juicers Here: Amazon

Blenders: If you plan to use your blender more than a couple times per week I’d recommend you get a blender that is durable, easy to clean, BPA-free and has more power than most home blenders (which are rated about 350 watts).  The model most raw food experts recommend is the Vitamix 1732 Turboblend VS (1380 watts).

DR. LAWENDA’S JUICING TIPS:

Drink juices and smoothies on an empty stomach:

  • Drinking juice or smoothies on an empty stomach allows the vitamins and minerals in the drink to go straight to your bloodstream. Having fiber or a meal already in your stomach prevents your body from quickly absorbing the nutrients from the juice. A good general rule of thumb to follow is to wait at least 2 hours after a meal to drink your juice and wait 20 mins after drinking a juice or smoothie to consume a meal.

Don’t wait too long before you drink your juice or smoothie:

  • When your juice or smoothie is exposed to air its enzymes and nutrients oxidize and they begin to degrade, therefore decreasing the nutritional content. To make sure you are consuming the highest levels of nutrients and live enzymes I recommend always consuming your drink within 15 mins of making it.
  • If you want to drink your juice or smoothie later, make sure to store it in an airtight container (filled to the top with no air gap) and in a refrigerator for a maximum of 24 hours.

Do not use too many sweet fruits and vegetables in your juice:

  • Juicing produce with a high sugar content will cause a rapid rise in your blood sugar and an insulin spike since the fiber is removed in juicing (less of a problem with smoothies since the fiber is not removed and slows the absorption of sugar). As mentioned above, this is not a good combination.
  • I recommend keeping the sugary fruits and vegetables in your juice to a maximum of 1 per serving. Examples of sweet fruits and vegetables: like watermelon, apples, pears, carrots and beets.

Don’t always juice or blend the same produce:

  • Variety is important when juicing and blending so you get different nutrients while also reducing your risk of over-consuming some that can cause problems. For example, if you do not rotate the greens (kale, chard, spinach, mustard greens, collards, dandelion, arugula, etc.) in your juice or smoothies each week you run the risk of consuming to much oxalic acid (which can affect the thyroid gland).

Keep your drinks cold during juicing or blending:

Heat is generated when making juice or smoothies and this heat may decrease the nutritional value of the drink as heat breaks down many of the healthful compounds (primarily the natural enzymes). Most of the enzymes will not start to degrade until about 118 degrees Fahrenheit (this is much higher than your juice or smoothie will likely get to in usual circumstances.) Nevertheless I still recommend you take the following precautions to reduce the amount of heat generated during juicing or blending:

  • Use cold produce. Leave the produce in the fridge before juicing or blending.
  • Do not overload your juicer.  Feed in only a little produce at a time. Overloading causes the juicer to work harder which produces more heat.
  • Chop up your produce into smaller pieces so the juicer doesn’t have to work as hard.
  • While juicing, occasionally juice an ice cube, which will help to reduce the temperature of the blade/auger and the juice. It will also dilute the juice.
  • Replace dull blades or cutters since they generate excess heat due to friction.
  • Juice in small batches, rather than “juice marathons”.   The longer the juicer runs, the warmer things get.

Buy organic whenever possible:

  • Studies show that organic produce contains more nutrients than conventionally grown produce and has far fewer toxins.
  • If money is an issue, make sure to buy produce on the EWG’s “Dirty Dozen” list as organic. You can save your money and buy produce on the EWG’s “Clean 15” list as conventionally grown.
  • Local Harvest.org can help you find local organic farms, farmers markets and other organic retailers in your area.

Supplementing Beyond Just The Produce:

If you don’t have time to juice every single day but you still want to massively increase your intake of cancer-fighting phytonutrients, I recommend you consume one “green drink” per day. These are highly concentrated green extract powders that contain tons of natural whole plant food ingredients, enzymes and pre- and pro-biotics.

You simply take a scoop of the green powder and mix it in a single 8 oz cup of water, stir and drink.

I wish I had time to juice or blend everyday but I don’t, so I drink one green drink every morning to boost my intake of these powerful anticancer compounds.

Here are the ones I recommend:

Additionally, if you are looking for some high quality complete protein powder supplements to add to your smoothies here are the ones I recommend:

 

By:  Brian D. Lawenda, M.D.