Rick: Welcome to the Tuesday webinar series, “Chiropractic Economics Webinars for Doctors of Chiropractic.” I’m Rick Buck, editor in chief, “Chiropractic Economics.” Today’s webinar, “Improve Compliance and Treatment Outcomes with CBD and Menthol Topicals” is sponsored by The CBD Clinic. And as always, our program is being recorded and will be archived at Chiropractic Economics’ website, chirooeco.com/webinar, for one year. Our experts are on board here today to speak with you and when their presentation is complete, we’ll follow with a Q&A. You can submit questions throughout the presentation by clicking on the appropriate icon on the right side of your screen.
Our presenters today are Jen Palmer, M.D., director of education for Charlotte’s Web. She’s a naturopathic doctor with 20 years experience in the dietary supplement industry and integrative medicine profession. As a graduate of Mystere University, she is passionate about sharing her knowledge about natural medicine through writing and speaking to consumers, retailers, and physicians. She recently created a one-year herbal certification CME program for physicians and authored “Berberine: Everything You Didn’t Know” by Woodland Publishing, among other writings. Her dedication to educating on the health benefits of CBD started when she used hemp extract to successfully support her dog’s health.
Carly Hudson, D.C., Healing Ground Movement in Denver, has a combined 15 years of experience in chiropractic and massage. She graduated with her doctorate in chiropractic from the University of Western States in 2015. Her extensive training and hands-on work helps patients release long-held patterns of body movements that are no longer useful. She has experience in providing gentle manipulations to support the body’s need to change and heal quickly. Driven by a love of learning, she continues to explore the latest research and training in her field to optimize patient outcomes. Ladies, thank you for taking the time to participate in our webinar and for sharing your experience regarding CBD and menthol topicals. Before we get started, can you ladies please each give us a brief background of your work with CBD CLINIC?
Dr. Palmer: Sure. This is Jen Palmer. I’m the education director for Charlotte’s Web and for CBD CLINIC. And in case you’re weren’t familiar with the company, recently, eight months ago, Charlotte’s Web acquired CBD CLINIC and some other advocate brands. And so we’ve been diving into the medical channel and reaching out to provide education to all of our health care practitioners. So it’s been a really fun time that we’ve been having. And hopefully our practitioners are enjoying these education series that we’ve been doing with your magazine and directly through our own webinars on our website. So I encourage people to join in and listen to more as we go along over 2021.
Dr. Hudson: And this is Dr. Carly Hudson. I have been working with CBD CLINIC in my office and private practice for about four years now. When CBD topicals became widely available, I started looking deeply into the quality and efficacy of all the different brands that are popping up and really found that Charlotte’s Web and CBD CLINIC have the best product with the best efficacy and the safest delivery system. So been working with them and teaching with CBD CLINIC and Charlotte’s Web for most of 2020 now.
Rick: Thank you, ladies, for that background. And now we’re gonna hand it over to you to start the presentation.
Dr. Palmer: All right, well, thank you, everybody, for being here. You go to the next slide there. Actually two more slides, please, to the welcome page. Sorry, everybody, I’m on the phone and they’re directing the slides, but I just wanna welcome everyone and thank you for being here. Like I said, I’m the director of education for Charlotte’s Web and CBD CLINIC. And we are providing a lot of different educational topics. And today, we’re gonna be talking about the endocannabinoid system. And I’m just gonna give an overview of that so you understand the big picture. In case you’re not familiar with that, it kind of sets a good foundation. And then we’re gonna talk about how the ECS restores a balance in our mind, and body, and in our skin. And then we’re gonna talk a little bit about endocannabinoid deficiency, how that’s related to health conditions. And then the really exciting part is when Dr. Carly jumps in and she’s gonna be sharing some of her experiences of using CBD topicals in her chiropractic treatments and she’s gonna provide some really interesting case studies. And I think you’ll be surprised at how different uses that she’s been finding are effective for the CBD topicals. It’s not just you know, the basic pain relief, although it does do a great job of that too.
And so to just jump right in, we’re gonna be talking…you can go to the next slide. We’re gonna be talking about the endocannabinoid system. But first, just thinking back a little bit. It’s kind of interesting how modern medicine, we’re still learning about how this human body works. And I find it really fascinating that the endocannabinoid system wasn’t really fully discovered until the late 1990s. So for me, I was in naturopathic medical school at that time. And we really didn’t talk about the endocannabinoid system at all. And so it’s pretty fascinating that during that time where I was in school, we still didn’t know everything about how the human body works. And I didn’t realize I was going to learn something major later. The endocannabinoid system is really considered the master switchboard for the human body. So it’s pretty important.
Today, in 2020, what, 30 years later after this discovery, we’re still finding that the majority of medical schools in the U.S. are not educating their student-physicians about this really important system. In fact, there was a study done, a survey in 2017, and they found that only 17% of medical schools were even mentioning the endocannabinoid system. And that’s true even including the naturopathic schools, I found that some of them are still not really teaching or talking about the endocannabinoid system and cannabis medicine. Next slide.
Hints about the presence of this endocannabinoid system actually date way back to the 1960s. And the National Institute of Drug Abuse was doing some research to find out how THC works in the brain. And so they stumbled on to the hint of this endocannabinoid system. So then we’re trying to better understand how THC worked on the brains of animals. They discovered that the brain worked in different ways that they were previously unaware of. And so then in the 1980s, a university researcher discovered the presence of these endocannabinoid receptors in the brains of mice. And then by the ’90s, scientists realized that this was also present in humans, and practiced in all living beings, except perhaps insects. And I think we just still don’t know enough about that yet. Next slide.
So Raphael [inaudible 00:07:49.061], you may have heard of him. He is the premier Israeli scientist who pioneered cannabis research. And he says that there is barely a biological, physiological system in our bodies in which these endocannabinoids do not participate. So what did we learn about the ECS? We found out that it’s the master switchboard to help create balance or homeostasis throughout the entire body. And we discovered that it intersects with all systems of the body so these receptors as part of the endocannabinoid system can be found in every other system of the body. So the immune system, the cardiovascular system, the endocrine system, the nervous system, and it helps create balance or homeostasis throughout every single system. In fact, researchers surmise it as being cast with these very basic functions of the human body, relax, eat, sleep, forget, and by forget, I mean forgetting negative memories, and protection. Next slide.
So our body makes endocannabinoids and these are chemical compounds that resemble the plant source cannabinoids that cannabis and hemp makes. So endocannabinoids are produced from fatty acids. And so there’s another reason if you’re doing nutritional counseling for your patients, you want to encourage them to get enough of those good fats like the omega-3 fatty acids from fishbecause the endocannabinoids are made from these fats. Now, the endocannabinoids are rapidly produced in response to external factors. So when the body is experiencing stress or pain, it helps bring about balance to reduce those negative feelings.
Now, these endocannabinoids that our body makes, they don’t last very long in the body. They are just around long enough to redirect a system. And then enzymes, such as FAAH, these degrade the endocannabinoids very quickly and so we’re only getting short spurts of endocannabinoid. And later we’ll talk about ways that we can support the production of endocannabinoids. But when it comes to phytocannabinoids from plants, they have a much longer half-life in the body and they’re not broken down quickly, so they circulate much longer and have a longer-acting effect.
Now, because these ECS receptors interact with so many other systems in our body, cannabinoids can play a really significant role in our health. For example, the ECS can moderate inflammation, and neurotransmitter production, they can be neuroprotective, and the ECS is also involved with gastrointestinal support and the immune system. So in my opinion, the presence of these endo cannabinoid receptors throughout our body really shows us that our bodies, as humans and animals, we were designed to utilize plant-based cannabinoids from cannabis. And also, we make our own cannabinoids which are similar and that these things are required for our optimal health.
So let’s talk a little bit about the two endocannabinoids that we know the most about. It’s been theorized that there’s more than two, but these are the ones that are well researched. So, anandamide, you probably have heard of that. It’s also called the bliss molecule, and that’s because it has a positive effect on our mood and it gives us that sensation of happiness or feeling content. It also has been shown to support brain development and cognition. And it helps in the formation of memories. But as part of its role to bring about balance, it also helps the brain avoid excessive memories of traumatic events. And so that’s where I was saying earlier about forgetting because that helps us prevent us from being paralyzed by a flood of negative memories that would actually put our body in protection mode all the time. So we really…it’s important to forget those negative things so that we can function normally.
Now, there’s some research that shows that anandamide has a beneficial anti-inflammatory response. It’s very supportive for heart in the cardiovascular system. Anandamide can help us balance metabolism, and also reduces that perception of pain. And again, it provides a positive mood and reward sensation. Now, there’s some interesting research on animals. And they did a study where they actually suppressed anandamide production in mice, and then they put them under a stressful environment. And what they found is that they experienced much higher levels and symptoms of anxiety. And when they let them make anandamide at the second stage, they really could control the anxiety better. So this is just more proof that if we don’t make enough anandamide, we’re low in endocannabinoid production, then that can really influence our well being and our mental health state.
Now, this other endocannabinoid, 2-AG, it has some very similar actions. It helps to regulate energy metabolism, it may be linked to weight balance, it’s good for preventing inflammation, also anxiety and depression, it has been shown to support the immune system. And interestingly, it seems to help repair the brain after trauma. There was a study done where they found that people who experienced TBI, or traumatic brain injury, they had an increase in their 2-AG levels and it seems to be the body’s natural response in order to help protect the brain when it’s been injured. Next slide.
So how does this endocannabinoid system work? Well, there’s these receptors and they are found throughout the body. And then we have…it’s like a lock and key situation. So the key being, you know, the cannabinoids or the endocannabinoids, and the receptors being these CB1 and CB2 receptors. And so when these keys and locks attach either directly, or more often it’s an indirect action, it triggers a specific action which is going to lead to better balance throughout all those systems that I mentioned before.
Now, there’s a variety of different cannabinoid receptors throughout the body, but these CB1 and CB2 are the most clear and well researched, and these are the ones that we really understand the best. Now when we are deficient in cannabinoids, this means that the system can break down and a cannabinoid deficiency or endocannabinoid deficiency can lead to health problems. And it’s just like when we don’t have enough vitamin D, it can present clinically in many different ways. Because like vitamin D, we have receptors in all these different systems so a deficiency can show up in a lot of different ways.
Now, back to the CB receptors. The CB1, now these are found…thank you for turning that slide. These are found all throughout the body, but we’re going to see them primarily concentrated in the central nervous system. So they’re in the brain, the spinal cord, and in the cerebellum, in particular. And then the C2 receptors are also found all over but you’re going to see higher concentrations peripherally. So they’re gonna be in the peripheral nervous system, the immune system, digestion, and then organs like the heart, and the eyes, and the kidneys, and the lungs have all been shown to have these CB2 receptors. Next slide.
So in addition to the CB1 and CB2 receptors, we have other interactions with the endocannabinoids or phytocannabinoids on a lot of different receptors. And so these are technically not part of the ECS. But there are things like serotonin receptors like 5-HT, and GABA receptors, which we know will give us a calming effect, and pain receptors such as the TRP. And so other neurotransmitters are going to interact with these receptors. And so this just shows us how much the endocannabinoid system intertwines with all these other different body systems.
And then just kind of as a side note, these TRP receptors that I mentioned before, we also have found that the terpenes menthol and camphor can act on these TRP receptors and these help mediate sensations of pain, and temperature, and taste, and even pressure. And so that’s why these OTC menthol and camphor ingredients are in the topical lotions and ointments that we’re talking about.
The menthol is a natural analgesic, and it’s also an anesthetic. And so it’s going to be very soothing for aches and pain and it’s also known as a counter-irritant. So menthol interacts with specific receptor sites in our nervous system. These are the TRPM8 channels, or transient receptor potential melastatin, in case you wanna get into the nitty-gritty there. And these nerve receptors, these are involved with our perception of temperature, and because of their famous association with menthol, they even go by the name of cold and menthol receptors. So when you have menthol in a topical cream, it produces a very, very cooling sensation on the skin at the source of the pain. Now, it’s not actually reducing the temperature of your skin, but it creates the sensation of cooling by interacting with those TRPM8 nerve receptors. And so this means that the cooling sensation of menthol will compete with and counteract sensations of pain. And so the messages of pain going through your brain are interrupted.
Now, there’s a study and menthol, there’s actually a lot of studies, but one in particular from 2014 found that topical menthol applications significantly reduced pain intensity among people with symptoms of carpal tunnel syndrome, which you know can be very hard to treat. So the menthol will penetrate the stratum corneum. And it interacts with a dense network of nerves that are in the skin’s dermal-epidermal junction, and those get close to the skin surface so the mental doesn’t have to absorb very deeply in order to interact with those receptors. So these nerves send pain signals and activate inflammatory processes and the menthol can actually interrupt those responses.
Now, camphor has very similar anti-inflammatory properties. And both of these ingredients are approved by the FDA as OTC ingredients, and they’re approved as topical analgesics and anesthetics. So there’s a study about camphor and menthol used in combination along with some other natural oils, and it found that they were effective at relieving mild to moderate pain and inflammation when applied to the skin several times a day for 14 days. Now, I find that people really get a pretty instant relief on the very first use. But it shows you that, you know, using it for two weeks, it continues to be successful.
There’s another research study that showed that camphor by itself was effective at relieving back pain. And it’s also been shown to have an anti-inflammatory effect in the animal study which was studying arthritis. And it’s soothing to rub into your muscles and it can also help relax muscle cramps and spasms. So in a similar way to menthol, camphor acts as a counter-irritant and it produces…they say it produces like a cold and warm sensation, it’s kind of an unusual feeling. And that’s when it’s applied as a topical cream and it can also help with the penetration of other terpenes and compounds. Next slide.
So just to dig into the physiology of the endocannabinoid system for those who are interested, these receptors, they’re located in the cell membranes, in that phospholipid, bilipid membrane. And so the CB1 and CB2, what they do is they receive messages or signals from outside the cell and then they take that information inside the cell to trigger the cell to create an appropriate response. And this is technically called a G protein-coupled receptor, which basically means that it’s receiving messages from outside the cell. Next slide.
So how does the endocannabinoid system bring balance? So the way that we create homeostasis with these is interesting because it actually works backwards as compared to what we’re used to with the normal neurotransmitter pathway. So as you know, the neurotransmitters, these are chemicals that the brain uses to communicate with the rest of the body via the nervous system. And so these messages will help us coordinate everything that we are feeling, and thinking, and doing. The pathway, as you know, for a neurotransmitter starts at that presynaptic nerve, it jumps the synapse, and then it triggers the postsynaptic nerve to take action, and that’s to create balance. So it’s a very logical sequence going from…starting at the beginning to the end. Next slide.
So endocannabinoid signaling actually works backwards, and we call that retrograde signaling. So it works as an inhibitory feedback response. So that means these endocannabinoids, they’re produced in response to something that’s excessive like neurotransmitters, and they’re giving the signal to slow down. So those are produced in that receiving neuron at the bottom by lipid precursors. I said before fatty acids help make endocannabinoids and they are released and they go back up to the presynaptic nerve or the originating neuron, and then they will give the message to create balance.
So if you think about the case of anxiety, there may be too many excitatory neurotransmitters being produced, and those will overstimulate the nervous system and that can increase blood pressure and heart rate. So the endocannabinoid system recognizes that imbalance and responds by moderating those excitatory neurotransmitters, and it’s signaling that presynaptic neuron to slow down and create less of those excitatory neurotransmitters and that, in turn, will help regulate, like, heart rate and blood pressure. And so the endocannabinoid system, as you can see, works backwards from the neurotransmitters. Next slide.
So that’s how it works more systemically in the body, but what about when we use it topically and apply it to the skin? So it’s interesting because the skin seems to have, kind of, its own little microcosm of an endocannabinoid system. And so whatever you’re applying on the skin, it only works in that one local area and doesn’t get absorbed systemically in the blood. So our skin is really cool though because in these dermal layers, we have CB1 and CB2 receptors, and all these different types of skin cells like the keratinocytes, and sebaceous glands, and hair follicles, and sweat glands. And also even the immune cells that exist in the skin, in the dermal layers including, like, macrophages and B cells and T cells. And so the research shows that we have receptors in all these different facets of the skin. And then next slide. Interestingly, we also make endocannabinoids in the skin. So 2-AG and anandamide are both created in the skin. And we’ll see that in the epidermis, in the sebaceous glands and the hair follicles. Next slide.
So the endocannabinoid system is involved in all these cutaneous functions by a lot of different ways like regulating keratin cell growth and differentiation and regulating the immune and inflammatory responses in the cutaneous layers. And therefore, if you think about it, if the endocannabinoid system in the skin area is not functioning properly or is dysregulated, it can be linked to a lot of different skin diseases. It’s also been shown to be altered in conditions such as fibrosis or allergic contact dermatitis. And in addition to the CB1 and CB2 receptors in these layers, there’s TRP receptors in those nerve endings, and so the endocannabinoid system also interacts with them and it helps modulate pain and itching.
So if you think about it, the endocannabinoid system helps regulate hair growth. Therefore, if it’s not working, you might have a patient with alopecia or hirsutism. If it helps regulate sebaceous secretions on cutaneous inflammation, then when it’s not working, you might end up with acne or dry skin. It also helps regulate keratinocytes and skin cell proliferation. And so when that’s not functioning properly, you might have a patient with psoriasis or atopic dermatitis. And Dr. Carly will talk about this one, it also helps support wound healing, possibly via these keratinocyte differentiations and fibroblasts functions. And so the endocannabinoid system dysregulation may also apply to chronic pain sensations, including things where you’re not really sure why there’s pain there, what it’s coming from, it could simply be an imbalance of this endocannabinoid system or its inability to regulate those pain receptors. Next slide.
So we know that the ECS supports balance. What is going to cause the endocannabinoid system to be out of balance? Well, unfortunately, some very common factors that we are all dealing with, such as chronic stress, and also drinking too much chronically, and environmental toxins such as pesticides and plasticizers or phthalates. All of these factors can actually interrupt the CB receptors or limit the endocannabinoid production. And these are all just normal lifestyle things that can cause endocannabinoid dysregulation. And so when that happens, you know, a person could really benefit from taking phytocannabinoids from plant sources in order to get that ECS back into balance.
So some of the things that we do to help increase endocannabinoid production, next slide, is things like reducing stress because we know that that’s really gonna dampen those endocannabinoids signals. And things that can do that are things like exercise, moderate exercise, not overdoing it. Meditation is a great example of increasing endocannabinoid production, as well as yoga and deep breathing. And massage and acupuncture have actually been shown in research to boost endocannabinoid production. I haven’t seen chiropractic be researched on that, but I imagine that would also fall under those categories. And there’s also a cool study that shows that singing and dancing can really boost endocannabinoid production by 40%.
And I’m sure you’ve all heard of runner’s high. So we’ve always talked about that as being an increase in endorphin production, which is a neurotransmitter, but as it turns out, anandamide production is also boosted from exercise and all these other factors to give us that euphoric sensation. So these basic, simple lifestyle recommendations that we all make to our patients actually are very supportive of also increasing and boosting and balancing our endocannabinoid system. Next slide, please.
So now Dr. Carly is going to jump in and share a few cool case studies. One is about scar tissue. One is about helping a patient with her opioid discontinuation. And another one about bursa inflammation. Thank you, Dr. Carly, for being here. You go ahead and jump right in.
Dr. Hudson: Thanks, Jen. Thanks for having me. And Hello, everyone. So in my office, I am primarily an extremity specialist. So all of these case studies are going to have to do with extremity conditions that present quite regularly. We’ll start with the bursa and inflammation, Baker’s cyst behind the knee being something I see quite often, the change of using topicals for pain support versus prescribed medication, and then finally, the scar tissue that Jen alluded to earlier e came upon a little bit quite by accident and it’s, kind of, turned into the coolest application of CBD that we’ve been using. So next slide.
And we will start with the Baker’s cyst. So I tend to see a Baker’s cyst a month in my office, just pain behind the knee and that bulging and tightness from irritation from the hamstring attachments most typically, and the patients exhibit trouble flexing, bending the knee, complain of a fullness behind the knee. Now, my typical treatment in-office involves manual therapy, adjusting the knee and helping to move some of that inflammation out and in and around the Baker’s cyst itself, soft tissue to the tight muscles like the hamstrings, and sometimes recommending an anti-inflammatory diet, or at least removing some key inflammatory lifestyle choices like excess sugar and alcohol and things of that nature.
I tend to see improvements with all of those things in about six to eight weeks with my patients depending upon how well they do their at home exercises and make dietary changes. Now, I’ve started adding in topical CBD and menthol cream typically in that level three category and having them apply it directly to the back of their knee. And that will actually reduce their recovery time by about two to four weeks, again, depending on the patients and their compliance. So that just helps speed up their improvements. And as well as that menthol and camphor in the topical, as well as the CBD, are going to help with some of that pain and irritation from the fullness of the Baker’s cyst itself causing problems as that space-occupying object in their knee. And then, of course, those CBD systems work with the inflammatory processes happening behind the knee helping reduce that swelling. Next slide, please.
So this one is a particular patient who presented in my office, she was having shoulder pain on and off again for about 10 years of duration. She had stiffness, limited range of motion and shoulder impingement. She was previously diagnosed with bursitis of her shoulder. The recent incident that she presented to my office for had lasted for a year with on and off complaints. She most consistently reported about a 6 out of 10 on the oral pain scale, with occasional spikes that require the use of Tramadol, muscle relaxer, and Vicodin for pain management, she would often find herself in urgent care for these issues, you know, this would typically be that reaching behind to put on a sweater or jacket, undoing a bra, and those kinds of activities of daily living.
She’s tried other topicals, which I think just kind of bears mentioning for the quality of the product that CBD CLINIC is, and they hadn’t done well for her. So initially, the treatment in-office we started with, just manual therapy, didn’t really dive into CBD right away because she had previously tried it. She had relief in-office but because she had so much swelling and tightness in the muscles and in that joint, the movement created irritation inflammation and it actually triggered an episode at home. And the in-office involved gentle joint manipulation in some of the lower force techniques that we can do, as well as soft tissue to the surrounding muscles of the rotator cuff, as well as stretching. She did end up taking an opiate and muscle relaxer that night to get through the night. Next slide, please.
So then we started using…you know, I have a different CBD here and we went with a level five, and we started using that to help with the adjustments. Because of the camphor and menthol as well as the CBD’s ability to regulate that inflammation, we put a little bit on in-office and applied the same therapies and then sent her home with some to use at home as needed. Initially, this ointment allowed for the treatment in-office to not have a rebound effect of pain. And it also opened up the opportunity for her to do at-home exercises, which included shoulder mobilization, working on that scapulohumeral rhythm, and finding a better glide within that joint.
It resulted in her ending up being pain-free for several nights in a row after using the sample, and that was the longest period in 10 years. She stuck with the treatment and even ended up having a little bit better compliance with returning to the office where, you know, she was one of those patients that, kind of, wanted to move her appointment around a bit. She used her CBD topical as needed. As the mobility increased, the pain decreased…sorry, the mobility increased, the pain decreased. She was able to return to many of her activities of daily living, and she does have a farm with goats, and so a very active lifestyle. She reduced her dependence on the oral medication. She was even able to stop using it entirely and use the CBD topical as her only as-needed pain treatment, which moved to once a week. And then over the course of six weeks, she became symptom-free. Next slide, please.
All right, so this is the scar tissue. So this particular patient I’ve been seeing for a while, and she presented into my office back in August of 2017 having fallen on a motorcycle, and such that the hottest element of the motorcycle, and I know there’s many of you who could tell me what that is, but I’m just gonna roll here, came in contact with her calves creating deep third-degree burns. It had deep burns and muscle bruising. So she immediately came into the office and we adjusted her knees, her ankles, her hips, assessed the burns and allowed them to heal. She had deep muscle pain in the gastroc as well as tibialis anterior muscles, that’s where the main burns occurred. Once the burns themselves had healed over, we did tape for lymph drainage, and I did manual lymph drainage therapy with massage to address the bruises. We massage the surrounding tissues, did manual scar tissue release, both with hands and with instrument-assisted stretching, and adjustments to the knees, ankles, hips, and whole body. Our goal here was to return her whole body to regular function but reduce that scar tissue as much as we could. Next slide.
Now, the scar tissue really didn’t go anywhere and she ended up having some rather deep…I don’t have ultrasound in my office or diagnostic ultrasound, and it would have been an interesting pause to see how deep it went. Palpably, it felt like it went quite deep into the muscles. And they were about two inches in diameter. And the scar tissue did not relieve itself very much even with all of those manual treatments. Well, she went through the winter and it was all fine until she started running again. So once she started running, she was having pain in these muscles in her calves because they were so restricted from the presence of the scar tissue. So of course, we went back to trying to reduce the scar tissue some more and I gave her the CBD level three cream to put on topically to help with that localized inflammation and pain that she could put on before and after running so she could keep with an activity she enjoyed.
Well, lo and behold, it helped reorganize the keratinocytes within those scar tissues, it would reduce the size of the scar tissue, it would increase the malleability of the tissue. We used the same techniques I had been using previously and suddenly that tissue was starting to shift and change in a functional direction. She had no pain with running by September. And I’ve seen her in my office since then and there is minimal palpable scar tissue. Which also, for the sake of mentioning, visibly, she doesn’t have any visual scar tissue either. She would have to point out to me where the scar tissue was located in order for me to find it. Next slide, please. So that is all I’ve got for the case studies. And so three particularly interesting ones that go beyond just the direct pain management.
Rick: Thank you, ladies. It’s been extremely informative. Are you ready for questions?
Dr. Palmer: Yeah.
Rick: Great. We’ve got a few that have come in. And let’s start with one that asks, “How are endocannabinoids different from phytocannabinoids?”
Dr. Hudson: So that would be a question I think Jen would be able to answer, but I’m hearing the silence on her part. I’m wondering if her phone is…
Dr. Palmer: Oh, sorry. I was on mute.
Dr. Hudson: Okay, there you are.
Dr. Palmer: Technical problem.
Dr. Hudson: All right.
Dr. Palmer: Thank you, Carly. Yeah, so the endocannabinoids are the cannabinoids that our body produces endogenously from those fatty acids, and then the ohytocannabinoids are very similar chemical compounds which are created in the cannabis plant. And for those who are still a little bit confused about the hemp versus marijuana situation, I should probably throw that in right here. Hemp is actually the same plant as marijuana. They’re both cannabis sativa. However, hemp has to have less than point 0.3% THC. And any plant that ends up measuring over point 0.3% THC gets thrown into the category of marijuana. But typically, you’ll see marijuana with 20% or even 30% THC and, as you know, that’s the compound that produces that euphoric effect.
So in the case of hemp, it doesn’t really have much THC and you don’t get that euphoric effect. But at any rate, the compounds made by this cannabis or hemp plant are very similar if you look at the chemical structure as the ones that our body makes. But like I said before, they hang out in the body a lot longer, and they don’t get broken down by those enzymes. In fact, those enzymes, FAAH, which breaks down our endocannabinoids, the CBD actually
inhibits the enzymes. And so they actually can’t break down the endocannabinoids very fast in that case, and that’s another way that CBD works in the body.
Rick: Thank you. We’ve got not a question but a statement from Kathy. She says, “I’m a very strong testimonial, had a total knee replacement nearly two years ago, and CBD with menthol work just as quickly as I applied it.” And question from Brenda, “Is CBD effective in helping stretch marks?”
Dr. Palmer: That’s a very interesting question that I’ve never been asked. And I can’t say that I’ve ever seen any research on it. It does help with the remodeling of the skin. And so there’s potential that it could help that. And as Dr. Kelly mentioned, it does help with scarring. So it’s something I would try for sure. And you can use products like the CBD CLINIC products, which have CBD and menthol and camphor in them. But if you’re just going to go for that more cosmetic purpose, you might wanna use one of the Charlotte’s Web topicals that has just really high levels of CBD in it to just get that benefit from it. But I think it’d be a worthwhile experiment since we don’t really have a lot of good solutions for stretch marks.
Rick: Great, thank you.
Dr. Hudson: I was gonna just add in that the scar tissue that we’ve seen it change in my office, while yes, it doesn’t include the stretch marks on that list and I’m really intrigued to try it now that you mentioned it, it has run the gamut of burns, scrapes, and surgical. Because now that we’ve seen that that works, it’s become part of my protocol, and it has worked equally well across all categories. So I think it would be definitely worth trying.
Dr. Palmer: Oh, that’s good to know, Dr. Carly.
Rick: And Kathy asked if we could email the presentation because she had to leave early. And yes, we’ll be sending that once…Once it’s been processed, we’ll send the link to everyone via email. And a question…
Dr. Palmer: Yeah, and if I could just throw out my email is on this last slide, jen.palmer@ charlottesweb.com. And so please feel free to email me any technical questions that you may get afterwards if you’re not thinking of them right now. I’m always available to answer your questions or have a phone consult. And also, there’s that promotion there for 10% off your order. So you can buy the CBD topical products, and also the Charlotte’s Web tinctures through our website as well.
Rick: Great, thank you. And another question from Soon [SP], “How much CBD is included in level three and level five cream?”
Dr. Palmer: Oh, it’s like a pop quiz. I think in the, like, entire bottle, it’s somewhere around 200, 250 milligrams of CBD. And that’s a 1.55-ounce container, I believe. And so it’s a pretty decent amount. And then there’s, you know, the levels of menthol and camphor increase as you go up the ladder to the, you know, level four and five are the highest amounts of the menthol and camphor so they get really strong and really potent. The level five is our top selling one. It’s extremely strong. There aren’t very many other products out there that have…I think it’s about 15% or 16% menthol in those and also high levels of camphor. And so people tend to use those primarily, but you also might wanna have a lower level on hand for people who don’t want something as strong and potent because you get that very strong odor and also the cooling sensation’s really potent too. And so some people might prefer a little bit toned-down version of that.
Rick: Great, thank you. And a two-parter from Nicole. “Where in the body are endocannabinoids made, and what’s the depth of penetration of topical CBD products?”
Dr. Palmer: So the endocannabinoids are made, you know, all throughout the body. And as you saw, they’re made right and those dermal layers of the skin are made in the nervous system and all throughout the other systems. And so they are active everywhere as well. But when we are thinking about the phytocannabinoid part of that, of supplementing it, when you apply that topically, it only goes in superficially, so just those top layers of the dermis, and it’s not reaching the blood vessels, it’s not getting absorbed into the blood vessels. So whenever you apply CBD topically, it’s only working on that one particular area and those cutaneous CB1 and CB2 receptor sites. So that’s why it’s really a great idea to use it both topically for that particular pain source, and then use it also orally so that you get all those other benefits from the endocannabinoid system throughout the body, which we know one of those is helping balance inflammation. And we know that pain is usually associated with inflammation. So that’s a really good two-pronged approach to help people get the symptom relief, but also getting at the root cause of the inflammation as well.
And you can buy both of these through CBD CLINIC’s website, or Charlotte’s Web. And also, you can buy products wholesale to sell to your patients as well. And that’s something that Dr. Carly does as well. She sends people home with these products and they use them in between treatments. And she finds that people, they’re feeling better faster, so they’re more willing to continue on with their whole treatment plan and they keep coming back more regularly. So giving people that stuff to bring home and feel the relief is really beneficial for the whole treatment plan.
Rick: That’s wonderful. Thank you. And a question from Jean. “I am an LMT and use both CBD CLINIC and Charlotte’s Web in my practice. My clients have been have had great results as well. These products are by far the best out there. Is this safe to use for police/and others who get drug tested? I’ve been asked this and do have the brochures saying they’re aren’t any traces in the body, but I just wanted to confirm.”
Dr. Palmer: And we did not pay her for that plug. Thank you very much. So yes, the CBD CLINIC topicals are completely THC-free. So you would not have to worry about any kind of drug testing, And like I said, the THC and CBD don’t get absorbed systemically anyway, so you would never test positive from that. If you’re using the Charlotte’s Web full-hpectrum Hemp extract, that does have that little bit of THC, the less than point 0.3%. So, in general, that’s fine. But it is possible to test positive on a THC patch based on how much is the person taking? How regularly are they taking it? What’s their metabolism? What’s their genetics? So we never would say that’s impossible to get a positive drug test. So if you are somebody who’s working in one of those very strict professions where you’re getting tested regularly, it might be better for the oral consumption part of it to take the CBD isolate, or broad-spectrum without THC, or just take real small amounts of the full-spectrum hemp extract.
And I noticed there’s…I saw this question right here and I’ll just go ahead and answer it about the FDA prohibiting claims. And so that’s how the dietary supplement industry works. We’re not allowed to make any kind of disease claims for any kind of nutrients or herbs, we can’t say it cures or mitigates any conditions, including things like pain and inflammation. And so CBD is following dietary supplement regulations and that’s why we’re not allowed to make any specific claims about that. But if you understand the endocannabinoid system and how it works and how endocannabinoids function, then you also understand how CBD functions. And therefore, we can, sort of, indirectly talk about the conditions that CBD works on.
Rick: Thank you for that. And I believe you addressed this a little bit earlier. But Lior [SP] asked, “Is this available for sale in my office?”
Dr. Palmer: Yes, you can buy wholesale from us and resell them in your office. And I don’t know if Carly wants to add anything to that, but I know that she’s been doing that successfully. And also, did you use a virtual dispensary, Carly?
Dr. Hudson: We did. So particularly during the months of lockdown here in the United States, here in Colorado, we did, excuse me, the virtual dispensary, which was really nice, particularly because when patients were unable to get care here, the CBD helped them manage their pain symptoms while we waited to resume office care as normal. In my office, I tend to carry level three and level five. I also make sure I always have a lot of samples on hand. Sometimes, you know, patients…it’s much less now as CBD becomes more ubiquitous, but there’s a little bit of concern about using it and how much and how expensive. And so sending a patient home with a sample for them to use is frequently the best-selling approach that I have. I use a little in-office and it helps with the treatment, they feel relief pretty much immediately with these products, and then send them home with a sample. And usually, by the next visit, they’re coming in ready to get one for themselves and one for their neighbor and cousin and on and on from that. So selling it in-office is pretty quick and easy, and then does help people when they’re unable to continue with care due to illness or global pandemics.
Rick: Thank you. And we’re getting some great questions here. Felicia asked, “How can I use CBD topical or oral products for people with type 2 diabetes?”
Dr. Palmer: I don’t think the topicals would be beneficial in that case. However, there are some indications that it might help with blood sugar regulation if you use it orally. So I would go over to the Charlotte’s Web tinctures, and there are two kinds. One is an alcohol extract, and that’s the original formula. And the other one is a carbon dioxide extract, or CO2 extract, and that one’s called the 60 milligrams. I would probably use that one, it’s 60 milligrams-per-milliliter. And what I would do probably is start with a low amount, maybe like 10 to 15 milligrams a day, and increase it very slowly. Especially if the person’s using insulin, you don’t wanna create a huge change really fast because then their blood sugar can drop too much. So have them work up and increase considerably to maybe 60 milligrams per day. And just have them monitor their blood sugar levels and see if they’re seeing an adjustment there. And so maybe that would allow them to…as the CBD stabilizes the blood sugar, they may be able to lower down their amount of insulin that they’re taking regularly. But I would do it really progressively and just kind of track it.
Dr. Hudson: And I would add for the topical if there’s any skin irritation from any ongoing effects of maybe the diabetes hasn’t been treated as effectively as you might like, using a topical and perhaps using the Charlotte’s Web balm, we’ve had some success treating skin irritation by just putting that topical balm on top. And again, the balm itself doesn’t have the camphor and menthol in it so it wouldn’t create that irritation. If there are any sores that still remain, of course, don’t apply to any open wounds and it’s not really going to help with any neuropathy because that’s due to vitamin deficiency.
Rick: Thank you. We’ve got a few minutes left here for questions. Soon asked, “What is common concentration in our body, UM or NM level?”
Dr. Palmer: For the endocannabinoids, is that what she meant?
Rick: I believe so. That’s the entirety of the question.
Dr. Palmer: That, you know, I don’t think we know that. And it’s hard to measure the endocannabinoids in our body that our body’s making, partly because of that enzyme, FAAH, and there’s another one, MAGL, they break down the endocannabinoids so quickly that it’s hard to measure them because they’re just in the body for a short period of time, and then they disappear. So, because they’re just so responsive to whatever’s going on, we don’t have this continuous flow of endocannabinoids in our body to measure it.
And so that’s a question I get a lot, you know, “Can I get a test to see if I’m deficient in endocannabinoids?” And in a lab research study they have in a really controlled setting, they have a way that they could actually measure endocannabinoids at precise moments, but there is no general lab test to measure endocannabinoids as a general human test, unfortunately, because that would be very interesting. So anyone who ever developed something like that, that would be great. So right now if you’re considering like maybe my patient has an endocannabinoid deficiency, you’re really gonna have to do it just based on the clinical presentation and then just testing how CBD orally works for them and see if that resolves the situation.
Rick: Thank you. And Jean asked, “Is there a CBD tincture that is water-based for clients who have had their gallbladders removed?”
Dr. Palmer: No, all of ours are lipid-based. So you would probably do well to take it with, like, a lipase or bile acids to help the absorption of the CBD because it is lipophilic and it does do best when delivered in a fat, like with fatty foods. And also in the oils, there’s a fat carrier so we use olive oil or coconut oil. And so I think that they would probably benefit from using some sort of enzymes to help improve the digestion of the CBD in the fat.
Rick: Thank you. We’ve got a few other questions, but unfortunately, we’re out of time. We’re gonna try to have our panelists answer the additional questions when we follow up with our participants on email. At this time, we’d like to thank our sponsor, CBD CLINIC, and Doctors Hudson and Palmer for today’s webinar. And thank you all for attending. Remember, this webinar, including our speakers’ PowerPoint presentation, has been recorded. We’ll alert you via email when the webinar’s available online. Thank you for attending, and we look forward to seeing you next time. Have a great day, everybody.
Dr. Palmer: Thank you so much for hosting us. Appreciate it. And thank you, everybody. Have a great day for taking time with us.
Dr. Hudson: Thank you. Be well, everyone.