Change Your Brain Every Day - CBD Use: What Does the Research Say? with Dr. Rebecca Siegel

Episode Date: April 30, 2019

The debate rages on over whether doctors should be allowed to prescribe medical marijuana to their patients. But what does the science say on the matter? In this episode of The Brain Warrior’s Way Podcast, Dr. Daniel Amen and Tana Amen are again joined by Dr. Rebecca Siegel, this time to discuss what scientific studies have shown us about using CBD for certain treatments.

Welcome to the Brain Warriors Way podcast. I'm Dr. Daniel Amen. And I'm Tana Amen. In our podcast, we provide you with the tools you need to become a warrior for the health of your brain and body. The Brain Warriors Way podcast is brought to you by Amen Clinics, where we have been transforming lives for 30 years using tools like brain spec imaging to personalize treatment to your brain. For more information, visit amenclinics.com. The Brain Warriors Way podcast is also brought to you by BrainMD, where we produce the highest quality nutraceuticals to support the health of your brain and body. To learn more, go to brainmd.com. Welcome back to CBD Week. We're here with Dr. Rebecca Siegel, child, adolescent, and adult psychiatrist in our Manhattan, New York clinic. We are having a very interesting time talking about the difference between marijuana and hemp and THC and CBD.

And most of the country now thinks it's innocuous and should be legal. It's legal in 26 states, 10 states for dementia. The problem I have with it all, and I always say I have no dog in this fight, is that for the last 30 years, we've been looking at people's brains, and brains of marijuana smokers are not healthy. It's just been a pattern I have seen for decades and we published two large studies one on a thousand people showing virtually every area of their brain is lower in activity that's a bad thing and in a study of sixty two thousand4 scans, we showed that marijuana was one of those things that prematurely aged the brain. Now, is it worse than alcohol? Is it worse than Xanax? Is it worse than sleeping pills?

It's an interesting question. But as far as we know, so there have been a couple of studies now, I think out of Norway, showing that marijuana in young people actually increases the risk of psychosis 450%. Brand new study, the teenagers who smoke or ingest marijuana have a higher incidence of depression in their 20s

and a higher incidence of suicide. And those things are not correlated with early drinking, although it sort of probably wouldn't surprise Rebecca or I that early drinking is associated to brain damage and more psychiatric problems. The Daily Mail did a big article on my marijuana piece, and there were over 500 comments. Probably not all positive. Oh, no. The haters totally come out. People who want to smoke pot. The pot smokers totally come out. People who want to smoke pot. The pot smokers totally come out. But one of the comments

was my dad always regrets that he was smoking pot because he never felt as sharp. And even though he stopped in his 40s, he still had cognitive problems in his 50s, why compare it to alcohol? They're both bad for you. And from sort of a neuroscience perspective, that's clearly what we've seen on scans. Yet, when our father-in-law was dying of cancer- He was terminal, so no one cares. He... You know, I'd go pick it up for him right that because the only thing that killed his pain it would help stimulate his appetite and um so it's

not like i'm saying all opiates are bad but please don't start them too soon because they can ruin your life and now the question is which i hope you're going to talk about, Dr. Siegel, is you just talked about marijuana. The question is, what about CBD? So we talked about that in the last episode, but I want to hear more. Like, what do you know about the studies on CBD? Is it as bad? What do we know?

Well, that's the issue. And the studies that have been done mostly have been done in mice or rats, or in individuals in very small numbers. That's the problem. Much larger scale trials need to be done. And that is how the medical community can feel better that, you know, I see that CBD and medical marijuana are options. I see them, like you said, for end stage cancer, pain relief, chemo related nausea, things like that. I see it as an option, but what, where they're finding. So now that there's,'s a fda approved medication at the dialects they're finding um what cbd side effects can be things like sleepiness

decreased appetite potentially um increases in the liver enzymes you know that's that's very concerning that's concerning that's very concerning so there's a 2012 study looking a brain imaging study looking at blood flow and cbd and thc and i think it was not done in the united states it was done in the uk and they did a randomized placebo crossover trial in 16 healthy male subjects and they gave them 10 milligrams of THC or 600 milligrams of CBD and that's very important because a lot of the CBD you'll find I guess CVS is now going to carry it or online. It's 10 milligrams, 20 milligrams. And the Epidiolex, the anti-seizure dose, I believe is 600 milligrams.

That's a big difference. So what they found was relative to both placebo and CBD, that the administration of THC was associated with anxiety, dysphoria, sadness, positive psychotic symptoms, mental and physical difference between CBD and placebo on any of the symptomatic physiological variables. So I think that's really important. It's one of the only imaging studies comparing CBD and THC. There's a new study that just came out this year in the Brazilian Journal of Psychiatry on CBD. It was 300 milligrams, significantly reduced anxiety during public speaking, but 150 milligrams didn't do any, which is a more common dose for people to take.

Actually, they take much less. And 600 milligrams didn't do anything. So there was like this inverted U-shaped dose response curve, which means it didn't work at small doses. There was sort of a sweet spot, and it didn't work at small doses. There was sort of a sweet spot and it didn't work at larger doses. So what other studies do you know about, Rebecca, on the benefits of CBD? There may be a very small therapeutic window of dosing that we need to figure out.

And that is going to take time. But you said with Epidiolex, we need to figure out and that is going to take time you know but you said with epidiolex you need to use tremendous amounts of cbd um most people will not be using tremendous amounts you know they say twice a day daily dosing you know every day to do something but this may do nothing i'm not really it may it may not be harmful, but might it be, will it actually be helpful? So my question before about, we have so many patients who like, you know, they don't want to, they don't, they've stopped drinking or they don't want to smoke pot. Is CBD better for their anxiety, for sleep, for pain? And your response in the last episode was, I'm not sure. We're not sure yet. We don't have enough information. Do we have any information? Is it dose dependent? Are there

any studies showing that it's better than alcohol or marijuana? Well, you just saw the study that I talked about. But that was high doses. No, with marijuana, it was, well, it was still high dose, but marijuana caused anxiety and psychotic symptoms, depression, where CBD did not. But getting ready for this, I went to PubMed. And when you actually go to clinical trials on humans with CBD, there is only a total of 84 studies in history for something that everybody and their mother and their dog is using literally that's ridiculous and you know and part of it is because of it's just not been legal for a very long time correct and it's still there are places where it's still not legal and especially if you're going to use marijuana you know cbd from marijuana that is federally not legal.

That's actually a whole nother, uh, you know, topic that is incredibly interesting. So Dr. Siegel, would you prefer that CBD and marijuana are both, um, for medical use only prescribed by a practicing physician? I think that is a much safer and much better way to go because if it's going to be sold over the counter at CVS or Walgreens, you know, people don't necessarily know what they're getting. They don't know how to dose it. You know, they don't know that the other thing is they don don't necessarily know what how much CBD is actually in the product. They may say it is a certain amount, but that's not necessarily so.

There's been research to show that I think 70 percent of, you know, there's inaccuracy in the dosage claims. You know, what CBD, how much CBD, the percent of CBD could be more, could be less. Well, and they also don't have anyone to follow up with if they have, if they have side effects. Which, absolutely, which is why I would only feel comfortable, you know, prescribing medical CBD, medical marijuana. I'm, I am very, I'm very cautious and very concerned about over-the-counter CBD.

Well, and all you have to do is look at the states where they've legalized marijuana and see the problems that we're having associated to legalized marijuana and the increased use in teenagers because it's now accessible. And it's not that hard to figure out. So there's a brand new study in translational psychiatry, which when we come back, we're going to talk more about marijuana, CBD. Is this something you should give to your mother-in-law if you like her or if you don't like her? Stay with us. If you're enjoying the Brain Warriors Way podcast, please don't forget to subscribe so you'll always know when there's a new episode.

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