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Endometriosis and Cannabis by Jodie

So, this week’s fact Friday is something that I’ve wanted to research for a while and is coming up in the group a lot, so I thought I’d kill two birds with one stone and get it out for you lovely lot to read!

I am not going to be advocating either way on whether cannabis is a good idea or not, I just want to provide you with the facts.

Hemp and CBD oil has an optimum omega3 to omega-6 ratio, making hemp oil a great supplement if you didn’t want to go for CBD

So first, what is Cannabis (Marijuana, weed, pot, dope or grass)?

Cannabis is a psychoactive drug from the cannabis plant used primarily for medical, spiritual or recreational purposes (1).

The effects of cannabis vary from person to person (2):

  • you may feel chilled out, relaxed and happy

  • some people get the giggles or become more talkative

  • hunger pangs ("the munchies") are common

  • colours may look more intense and music may sound better

  • time may feel like it's slowing down

Cannabis can have other effects too:

  • if you're not used to it, you may feel faint or sick

  • it can make you sleepy and lethargic

  • it can affect your memory

  • it makes some people feel confused, anxious or paranoid, and some experience panic attacks and hallucinations – this is more common with stronger forms of cannabis like skunk or sinsemilla

  • it interferes with your ability to drive safely

If you use cannabis regularly, it can make you demotivated and uninterested in other things going on in your life, such as education or work.

Long-term use can affect your ability to learn and concentrate.

Can you get addicted to cannabis?

Research shows that 10% of regular cannabis users become dependent on it. Your risk of getting addicted is higher if you start using it in your teens or use it every day.

As with other addictive drugs, such as cocaine and heroin, you can develop a tolerance to cannabis. This means you need more to get the same effect.

If you stop using it, you may get withdrawal symptoms, such as cravings, difficulty sleeping, mood swings, irritability and restlessness.

If you smoke cannabis with tobacco, you're likely to get addicted to nicotine and risk getting tobacco-related diseases such as cancer and coronary heart disease.

If you cut down or give up, you will experience withdrawal from nicotine as well as cannabis.

Cannabis and mental health

Regular cannabis use increases your risk of developing a psychotic illness, such as schizophrenia. A psychotic illness is one where you have hallucinations (seeing things that are not really there) and delusions (believing things that are not really true).

Your risk of developing a psychotic illness is higher if:

  • you start using cannabis at a young age

  • you smoke stronger types, such as skunk

  • you smoke it regularly

  • you use it for a long time

  • you smoke cannabis and also have other risk factors for schizophrenia, such as a family history of the illness

Cannabis also increases the risk of a relapse in people who already have schizophrenia, and it can make psychotic symptoms worse.

Other risks of cannabis

· Cannabis can be harmful to your lungs

· Cannabis may affect your fertility

Research in animals suggests that cannabis can interfere with sperm production in males and ovulation in females.

· If you're pregnant, cannabis may harm your unborn baby

· Cannabis increases your risk of cardiovascular disease and stroke

What is CBD (Cannabidiol)

CBD is safe and legal in the UK. Not only has the World Health Organization classified CBD as a safe substance to use, they have further stated that “the evidence from well-controlled human experimental research indicates that CBD is not associated with abuse potential.”

CBD is a Phyto cannabinoid and accounts to 40% of the plants extract (3).

CBD is not psychoactive, so you won’t feel any euphoria affects, but about 5% of people react differently to CBD, these are normally the same people that get an affect from taking paracetamol or ibuprofen. So be aware of this if you try CBD for the first time.

You can buy CBD in a lot of different ways

· Oils - To have the maximum effect, CBD taken sublingually must be allowed the time to absorb into the bloodstream from under the tongue. This means it should be held there for up to 10 minutes before being swallowed. Absorption of CBD occurs much quicker and more effectively if taken after you have just eaten and swishing around under the tongue and the back of the bottom teeth will increase bioavailability.

· Edibles - CBD that is ingested enters the digestive tract. Here it will be absorbed into the bloodstream. Most of the CBD that enters the body this way will reach the stomach and the liver and be destroyed before it has a chance to be absorbed into the bloodstream.

· Balms - Skin cells have cannabinoid receptors which can be directly stimulated. Topicals are used for localised treatments such as muscle aches, sites of inflammation, pain receptors or for skin conditions.

· Bath Salts

· Bath Bombs

· Vapes - When vaping CBD, after inhalation it immediately enters the bloodstream where it takes immediate effect. It is by far the quickest way to consume CBD and the peak bloodstream levels are in 5 minutes after inhalation.

Now to the meaty bit!

The Endocannabinoid system has been identified as important in Endometriosis development, maintenance, and pain mechanisms (4). This means that the endocannabinoid system is a potential target for treating the pain and inflammation associated with Endo (5).

Both the EC system and the opioid system are very much intertwined and are found in the same regions of the brain. Cannabinoids can boost the rewarding properties of opioids and vice versa (6).

Endo associated pain can be split into 3 main categories

· Nociceptive pain

This pain comes from sensory receptors of the peripheral nervous system that turn stimuli from mechanical, thermal or thermal sources into energy. Endometriotic lesions can cause infiltration into and compression of nerves and activate the receptors (7).

The fluid in the peritoneum also has chemical changes in Endo patients and sensitise the peripheral nerves. When either of these happens then an inflammatory response occurs and pain is generated (8)!

· Inflammatory Pain

Endo can be considered an inflammatory disease. Peritoneal fluid changes and hormone status with Endo create hypersensitivity to stimulus that may cause inflammation, as well as a high level of oxidative stress (9).

· Neuropathic pain

Is associated with damage to the neurons themselves. This normally follows infection or injury and causes pain signals to be sent to the central nervous system. It is normally described as a shooting pain.

Endocannabinoid system (ECS) and Endo pain

The ECS interacts with all of the pain pathways that have been mentioned above.

Now is where it gets interesting Endocannabinoids bind to receptors CB1 and CB2 that are usually found on neurons of the peripheral nervous system (sorry about the science). CB1 receptors are highly expressed in the …………………. UTERUS!

CB2 receptors are in the immune system and intestines as well as the lungs, uterus, pancreas, and skin (4). Even Oocytes (egg) express CB1 and CB2 receptors (5).


The levels of CB1 and CB2 expression change at different points of the menstrual cycle. And it has been found in studies that people with endometriosis lower levels of CB1 receptors in endometrial tissue when compared to controls, this has been suggested that this leads to growth of endometrial tissue and more severe pain (10).

Unfortunately, most studies that have taken place show that though CBD oil can improve endo patients’ pain, it is most effective when taken with a small amount of the psychoactive THC.

Where to buy?

Deciding which UK wholesale CBD oil to purchase can be a daunting experience.

However, you just need to know what to look for, such as:

· CO2 Extraction – Why it’s the best

The most preferred quality method of extraction for CBD oil is CO2 extraction – and the product information should clearly state this. It is the cleanest way the CBD can be taken from the cannabis buds that doesn’t involve using heat or using solvents (such as butane or alcohol) to extract the CBD.

· Check third-party lab test results – COA's

Any credible company selling CBD will have their products tested by a third-party and will make the results easily accessible to potential buyers.

These lab tests will give information on any contaminants such as pesticides, heavy metals and solvents as well as giving the cannabinoid concentrations (11).

Dosing

Chronic Pain

The current advice is to consume regular doses of the same amount of CBD oil three times per day (i.e. 3 x 30mg), to apply topicals to the area of pain for localised relief and to top off with a vape if the pain levels are too high.

However, it should be noted that there is no current recommended dosage on using CBD for pain, mainly because defining the pain scale on a quantifiable level is difficult because we all perceive pain differently.

Start by taking 70mg a day for one week. If you’re satisfied with the results then decrease your dosage by 20mg a day. If you’re dissatisfied with the effects of the CBD then increase your daily dosage by 20mg. Getting to know your body and what works for you will help you enjoy your CBD journey even more. In fact, you’re 76% more likely to be satisfied with CBD if you take your CBD consistently and adjust your dosage to suit you. Strength and dosing usually vary across manufacturers so always check what they recommend. A good manufacturer will talk through options and dosing with you! (12)


So all in all CBD is good for your body and certainly won't do you any harm. However, most scientific trials that have taken place have shown that CBD has more of an effect when it contains the psychoactive THC.


I hope it has shed a little bit of light on the whole subject




References

1. Vij K. Textbook Of Forensic Medicine And Toxicology: Principles And Practice. 4th ed. India: Elsevier India; 2012.

2. NHS. Cannabis: the facts [Internet]. 2017. Available from: https://www.nhs.uk/live-well/healthy-body/cannabis-the-facts/

3. Campos AC, Moreira FA, Gomes FV, Del Bel EA, Guimarães FS. Multiple mechanisms involved in the large-spectrum therapeutic potential of cannabidiol in psychiatric disorders. Philos Trans R Soc B Biol Sci [Internet]. 2012 Dec 5;367(1607):3364–78. Available from: https://royalsocietypublishing.org/doi/10.1098/rstb.2011.0389

4. Sanchez AM, Cioffi R, Viganò P, Candiani M, Verde R, Piscitelli F, et al. Elevated Systemic Levels of Endocannabinoids and Related Mediators Across the Menstrual Cycle in Women With Endometriosis. Reprod Sci [Internet]. 2016 Aug 17;23(8):1071–9. Available from: http://journals.sagepub.com/doi/10.1177/1933719116630414

5. Bouaziz J, Bar On A, Seidman DS, Soriano D. The Clinical Significance of Endocannabinoids in Endometriosis Pain Management. Cannabis Cannabinoid Res. 2017;2(1):72–80.

6. Wiese B, Wilson-Poe AR. Emerging Evidence for Cannabis’ Role in Opioid Use Disorder. Cannabis Cannabinoid Res [Internet]. 2018 Sep;3(1):179–89. Available from: https://www.liebertpub.com/doi/10.1089/can.2018.0022

7. Howard FM. Endometriosis and Mechanisms of Pelvic Pain. J Minim Invasive Gynecol [Internet]. 2009 Sep;16(5):540–50. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1553465009003409

8. Kyama CM. Role of cytokines in the endometrial-peritoneal cross-talk and development of endometriosis. Front Biosci [Internet]. 2009;E1(2):E40. Available from: https://www.bioscience.org/2009/v1e/af/40/list.htm

9. Santulli P, Chouzenoux S, Fiorese M, Marcellin L, Lemarechal H, Millischer A-E, et al. Protein oxidative stress markers in peritoneal fluids of women with deep infiltrating endometriosis are increased. Hum Reprod [Internet]. 2015 Jan;30(1):49–60. Available from: https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/deu290

10. Smith SC, Wagner MS. Clinical endocannabinoid deficiency (CECD) revisited: can this concept explain the therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuro Endocrinol Lett [Internet]. 2014;35(3):198–201. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24977967

11. The complete guide to CBD oil dosage and it’s benefits [Internet]. The Extract. Available from: https://www.theextract.co.uk/cbd-oil-dosage-guide/

12. Simms J. New to CBD? Everything you need to know in 10 minutes! [Internet]. BEYOU. Available from: https://beyouonline.co.uk/blogs/news/new-to-cbd-everything-you-need-to-know-in-10-minutes


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