Parkinson's Disease

#012: Role of Cannabinoids in Management of Parkinson’s Disease

One day you look over at grandpa and you see that he shakes just a little even as he’s sitting still. You might wonder, “What could be the matter with him?”. In this episode I talk about Parkinson’s disease, including its symptoms, the current drug regimens recommended by doctors, and how cannabis could help patients control some of their symptoms.

Parkinson’s disease is a progressive degenerative disorder of the central nervous system, and while we don’t know exactly what causes it, we have some good ideas.

One of the most noticeable symptoms of Parkinson’s disease is tremors in the hand, but these could progress onto other parts of the body. Other symptoms of the disease include:

  • Swallowing problems
  • Incontinence
  • Constipation
  • Sleep disorder
  • Hypertension
  • And Sexual dysfunction

Diet and exercise are just a few of the non-pharmacological ways we can start the treatment of this disease. Like many diseases, it’s important to start slow and go slow when treating a disease. If we want to support patients, we also need to educate caregivers and family members to help them as they care for patients with Parkinson’s.

The main drugs used to treat Parkinson’s disease are Levodopa and Carbidopa, but there are some drawbacks to these two drugs. I explain how other drugs are often paired together with these drugs to enhance their benefits and limit their side effects.

After non-pharmacological and pharmacological means have been used to treat Parkinson’s disease, how can cannabis help? For years, patients with Parkinson’s have told doctors how they use cannabis to help reduce their tremors. There is some hopeful evidence from new studies in the annals of Neurology about the positive effects of cannabis for this condition. I share the best routes of administration specific to this condition and some cautions about the special circumstances that people with Parkinson’s are in.

What’s Inside:​

  • Some of the risk factors for Parkinson’s disease include gender, age, and genetics.
  • The side effects of anticholinergic drugs exacerbate underlying conditions in the elderly population.
  • Low dopamine in a patient with Parkinson’s is a more complicated problem to solve than just giving the patient more dopamine.
  • I discuss the side effects of dopamine agonists.
  • How doctors used cannabis before it was prohibited by the government.

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Parkinson’s study in Neurology

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Transcription:

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TRANSCRIPT

This show is for educational purposes and should not be taken for a doctor’s advice. Welcome to Let’s Talk About Medical Cannabis with Doctor O. A clinical pharmacist certified in medical cannabis. Every week, you’ll learn about alternative ways to improve your health and well-being, using the powers of healing botanicals.

Hi, everybody. Welcome to episode 12 of let’s talk about medical cannabis with Doctor. O. Thank you for joining me again today. I’m glad you are here. For those of you that don’t know me. Hi, I’m Lola Ohonba Everybody calls me Doctor O. I’m a clinical pharmacist certified in medical cannabis. Today we’ll be looking into the role of cannabinoid in the management of Parkinson’s disease. Thank you for joining me. Before I go on, this show, this episode is sponsored by WCI Health. WCI Health we sell high quality hemp derived CBD. We have the topical, the oral. Whatever you need concerning your CBD products, you can check us out. We are on WCI-health.com. For those people that do not want to use oral or any edibles cannabinoid product. You could try the cream or the balm. That could help with localized pain or muscle contraction. So do check this out. Thank you so much for joining me. Also, before I go on, let me say thank you to all our listeners. All our subscribers, I would like to say thank you for your support. For those of our sponsors, patreon sponsors. I am very appreciative of your financial support. If you would like to support the show, you can access all the information on our Web site, WCI-health.com, you can access the subscription information.

So on today’s show we’ll be looking into Parkinson’s disease. We will look at what might be the cause of it. The medication, traditional pharmaceutics days that is used in the management of the disease. And we will also look at the role of cannabis cannabinoids in what might would be of help to people going through this disease. So what is Parkinson’s disease? Parkinson’s disease is a progressive degenerative disorder of the central nervous system. So it’s a nervous system condition. It’s a faulty system that controls movement. So when you talk of Parkinson’s disease, the first thing that comes to your mind is movement. Generally it normally starts slowly. And these the tremors, the movement is barely noticeable in in some in some patients. The tremor starts from around your hands area. That’s where it normally starts from. So apart from its tremors, the patient also experienced stiffness. There is slow movement. It could be soft or slurred speech. There could be lack of facial expression. Sometimes patients are unable to move or swing their hands around.

That will be at the early stage of the disease. So what is the cause of Parkinson’s disease? What causes this disease? The actual costs of the disease is unknown, but it could be due to breakdown of some nerve cells. Some nerve cells in the brain is said to be responsible for the disease. It can be diagnosed by at least two of the following symptoms. When a patient is going through these listed symptoms. If you have two of them, that’s one of the way it’s diagnosed. So these symptoms that is using the diagnosis, a resting trauma. That means when you’re sitting down, you’re not moving, but your body is kind of moving. That’s called resting tremor. Also, if you also have rigidity, just stiffness, that is another symptom that we look out for. And also bradykinesia. I know you be like, oh Doctor O, always back with all this stuff. Don’t worry. I will break it down to the best of my ability. For you guys. So bradykinesia is a kind of characteristic slow movement seen in Parkinson’s Disease. Brady just means slow and kinesia is kinetics, which means movement. So bradykinesia is a slow movement. You know, when you see a patient going through Parkinson’s disease, that slow movement does what is called Brady kinesia. So I end up also the other way people diagnose the diseases.

If a patient responds positively to anti Parkinson’s disease drugs. So any of those listed characteristics will tell us that a patient is probably going through Parkinson’s disease. Also apart from the listed symptoms, it’s also said Parkinson’s disease is also said to be due to a chemical in the brain called dopamine. These chemicals are found in the brain is called dopamine. So the reduction of dopamine level in our brain is what leads to Parkinson’s disease. So what are the factors that can contribute to this Parkinson’s disease? Some of the factors that contribute to Parkinson’s disease are genetics in nature. Studies have shown the genetic mutation or variation in the gene can lead to Parkinson’s disease and other factors that can play a role is environmental pollution is said to be contributing factor to this. And that will make sense. All these chemical toxins, it goes into the human body and it can cause the mutation of our gene, which can lead to all forms of other diseases, including Parkinson’s. One of the main factors that we’ve also found is what we’ve called Lewy bodies. Lewy body. This is a soft cell found in the brain cells of people with Parkinson’s disease. A lot of patients with Parkinson’s disease, when they look into the brain cell, they notice that there’s this kind of chemicals, kind of a compound is proteinous in nature called Lewy body. The Lewy body serves as a marker to know who might have Parkinson’s because it’s seen in all the patients suffering from Parkinson’s. So it’s used as a way of knowing that, ok. I mean if you know a what is common to all the patient, then we start looking for what we can do to remove whatever the issue is. This Lewy body is said to affect the memory. It’s affects the mood. It also affect the behavior of patients suffering from Parkinson’s disease.

Scientists have also found a chemical called alphnucein within the Lewy bodies. So for all the patients going through Parkinson’s disease, they find a lewey body. And when they find a lewey body, inside the Lewy body they find this chemical is a protein. It’s chemical called alphanoclein. So for patient when the doctor comes in or a caregiver comes in and they do the tests to look in the brain when they see the lewey body and they see the alphanoclein. They can say, oh, it looks like we might have Parkinson’s on our hand. The body’s unable to break down the alphanuclein. So only a way for people to know the people have the disease. So this is a chemical in the brain. Our bodies are not able to break down. So what are the risk factors for Parkinson’s disease? What causes it? What are the risks? We know we don’t know what causes it but, what are the things that can lead people to have it? Mostly there is genetics, like I said earlier. Also age, plays a factor as we grow older, there is a tendency for Parkinson on or other form of disease to manifest themselves. Apart from genetics, we also have sex. So Parkinson’s disease is common in male compared to the female, so it’s more prevalent in the male population. Like I said earlier, exposure to environmental toxin is one of the risks factor. As a result of the Parkinson’s disease, patient can also experience memory issues as a form of dementia and difficulty remembering. And so for patients that are going through Parkinson’s disease tends to have dementia and other memory related issues. They also go through depression, anxiety and fear. There is swallowing problems.

So for patients, when they starting having problems with swallowing where the care giver who will have to be on the lookout and watch them. Because when the patient is unable to swallow, this results in drooling. So when they are not able to swallow their spit, this could lead to choking. They could choke on their spit. So a caregiver has to be on the lookout for that. Other symptoms that is seen in Parkinson’s patients are incontinence. That is in our ability to control their urine, so they can urinate on themselves. There is constipation, sleep disorder, pain, sexual dysfunction, hypertension. Hypertension is a sudden drop in your blood pressure, and also fatigue. They can also experience fatigue. It’s a lot going on in the brain, you know. So when somebody is going through all these scenarios in the brain and we are talking about a lot of the time these Parkinson’s disease happens in the elderly population. I mean, younger people do have each it too, but it tends to be seen more in the elderly population. So when we look at that situation, people can get tired going through all that.

So how can we prevent it? What are the terms we can do to prevent or reduce the manifestation of this disease? Research and scientist they’ve shown, that people that drinks coffee or tea frequently have reduced chance of getting this disease. But more studies needs to be done along that line. So apart from trying to drink coffee or tea, what else can we do that could help in the slowing down of this disease? Other non-pharmacological ways we can manage is to try to educate not just the patient or the person going through this disease. We need to educate the support system, because if you don’t know what is going to happen, or what’s going on. There can’t be that panic, there can be that fear. Fear that comes with the unknown. So we need to not just educate the patient, the family members, the caregiver is going to be taking care of. This patient will also need to walk on diet and exercise. This disease it affects movement. It affects speech. So if one can prolong the manifestation of the disease, that will be a great thing. So we need to look at the diet and the exercise to help in the management of this disease. So other than diet and exercise and education and support, the pharmacological therapy, these are the drugs, the medication, the traditional medicine that we use in the management of this disease. The first medication that we look at is called anticholinergic drugs. These drugs, they help with the tremors and did dystonia feature when I said dystonia. What I’m simply mean is, is the involuntary and the repetition of muscle contraction or twisting that is seen in Parkinson’s patients. So the drug does not help with the bradykinesia, you know, like I said earlier. Bradykinesia is just the slow movement. It helps with the repetitive muscle contraction. But that slowness that is characteristic of Parkinson’s disease. Anticholinergic drugs does not help.

What are the side effects. For mild side effects, we have the dry mouth, the blurred vision, constipation, urinary retention. It can worsen BPH in patients. So I mean we already said the male population are more affected so when we are using drugs that is also going to affect their BPH. When I say BPH that is benign prostatic hyperplasia. Just Prostrate concentration, that’s what that really means. So serious side effects of the anticholinergic drugs are memory loss. It could lead to sedation. It could also lead to depression or anxiety. So when you look at the totality of the side effects of this class of drug, what comes to mind is the elderly population. These are some of the issues elderly populations are already going through. So these are the kind of drug we don’t necessarily want to use in the elderly population. Examples of anticholinergic is what we call Bense, dropping or congentin. Congentin is one of the example of the drug that anticholinergic. We tried to stay away from those kinds of drug when it comes to our elderly population because of this side effect that is associated with those drugs.

Another type of drug that is used is called amantadine. This drug Amantadine is effective for minor symptom, especially for the tremor. When the patient, towards the beginning of the disease, that’s when this drug will be effective. For and it helps with the control of the tremor. It may also decrease the dyskinesia at relatively high dose. So amantadine when it’s on a high dose, say like around 400 milligrams per day that would…. It tends to help with the slow movement as well. But the side effects that comes with Amantadine are sedation, vivid dream, dry, mild depression, hallucination, patients could experience psychosis or confusion. So when this occurs, one needs to probably reduce the dose or look for an alternative. Also, those should also be reduced in patient going through renal function or any patient that have kidney problem. They might want to reduce the dose or even try some other medication.

One of the main drug, in fact the main drug. When you think of Parkinson’s disease, you gotta think of levodopa, carbidopa. Those are the main drugs that are used in the management of this disease. Ultimately all the Parkinson’s patients are going to be on some types of levodopa based medication at one time of their life. This is the most effective drug. Deliver. Dorper drugs are the most effective drugs for Parkinson’s patients. The drug is a precursor of dopamine. So would like we said earlier, the body does not have, there is a decrease in dopamine level that’s part of what causes, in fact, that is one of the main causes of Parkinson’s. So levodopa is a precursor of dopamine. It crosses the blood brain barrier. Because people will say, look, if we have low dopamine, we might as well just give patient dopamine straight up. But the problem is that the Parkinson’s disease all the nerves we are trying to target is in the brain. And the brain is lipid bilayer a lipid level in the brain, the Parkinson drug like dopamine, they are not able to cross the blood brain barrier. When you say the blood brain barrier that is the part of the brain that covers the brain protect the brain from our regular environment. And brain is of course we all know how important and very delicate the brain is. So we cannot just allow anything. Just run in and run out, lie down. So the blood brain barrier is what prevents any Tom, Dick and Holly just jumping in a brain coming out.

So the dopamine is not able to move straight into the brain. But the liver the parts of the dopamine, that helps. It has a more lipifiley. We call it lipifiley What that means is that a small of a lipid is like oil and water. If you are trying to move something into an oily environment, you’ll use something that has oil in it. If you try to get water into where you want oil to be, it’s going to be difficult For what a soluble compound to move into oil. So what you’re gonna do is you’re gonna need to package your water in an oily environment for you to be able to this successfully. It’s just like a capsule. You can put your water in a capsule. I use the outside layer of the capsule, wrap it up in the oil so that is able to transport your water in to where water is not allow.

That’s the same sense that is used here. The levodopa is a precursor of dopamine because levodopa can cross the blood brain barrier while dopamine is unable to. So for drugs that just dopamine based, they are not going to be as effective as in a drug like Levodopa that can cross in that blood brain barrier. So by crossing into the brain, levodopa is able to get more medication into the brain. So that’s why the drug is very, very effective. The carbidopa part of it is for people would have maybe a family member that is going through Parkinson’s disease. You see they will have a levodopa. The carbidopa part of the drug, it always helps in the movement. Not just movement of the levodopa, but also reduce the side effect. So because dopamine is unable to move into the brain when it stays outside the brain, it causes a lot of side effects. So when we add carbidopa to levodopa, it not just assists in the movement for levodopa into the brain by preventing chemicals from destroying the drug. It also helps to reduce side effect.

So what are the side effects that is seen with levodopa, carbidopa based medication? One of the side effects that is seen is what we call end of those wearing off. Or big dose dyskinesia. The end of this is due to short half-life of the drug. The levodopa drug. The longer it stays, how long it stays in your body is about one hour. So when it wears out in the body, it gives the end of dose wearing or so. What happens is that you start seeing the symptoms more in the patient. Just like when you use your medication and you feel fine as soon as the medication. Say like a pain medication and as soon as it wears off you start experiencing pain again. So in the case of this levodopa, it doesn’t take long in the body for it to start walking. And you add by the pig dose dyskinesia. That involuntary movement, that part is where when you initially take your dose, is concentrated in the body because it’s so much medication at that particular time. You have a lot of movement. It’s like your drink, a very strong coffee as soon as you drink your coffee. You have this rush of energy. That is your big dose. That’s what the best way to explain that.

So how can we prevent this from happening? One of the ways we could reduce the dyskinesia, part of it, is to use the standard release form. When we use the extended release form of the drug, it doesn’t just push to whole drug in the body at one time. It slowly releases to the body thedrug. So you don’t have that peak dose, those involuntary movement. And also for the end of dose where in for the drug wearing off. Other ways that we could do that is to use the sustained release for muscle contraction and we also use the sustained release formulation to control the muscle contraction or we can use our backlowfeen or botox. So those are the ways we could control desired effect that we see in the Levodopa Carbidopa type of medication. Also, we can also use the patches that in that situation the patches will release slowly. So you don’t have that wearing off effects of the drug. So apart from levedopa and carbidopa, what are the medication under we use in the management of Parkinson? The other medication that we use, these are added to levedopa like I said earlier. Levodopa Carbidopa, those are the big guns, those are the main drugs. But when patients start having maybe end of dose wearing off or the diskenesia , we start adding some other stuff. So either medication that we can have is Compton. We call and tackipon. These bind using combination with the levedopa and what that does to reduce is the requirement of levedopa. Instead of using say like three pills, it helps to reduce the number of doses that you use so you can use maybe two pills. And it also helps with the off time, the off time like wearing off, it helps with that. It helps the drug to stay longer in the body. It increases the half life of the drug and it’s also help avoiding the wearing off of the drug.

So apart from Compton, other drugs that we use are called dopamine agonists. When you say agonists, it’s just like a form of dopamine. But like I said earlier, dopamine when we give dopamine based drug because they have limited transition into the brain is not really as effective. But we still use it as an add on. Examples of the dopamine agonist are the mirror pass and that is promeprazil. Derekqip or duripril. These are dopamine agonists. These drugs are used in patients that are having a worsening conditioning. Either they are having a worsening situation or their condition is flotrating or they are  not responding to the levedopa medication. So when a patient is not responding to treatment, we begin to add the dopamine agonsts like the mirapriz, the requip, the nupril to help to have a kind of addition to the drug.

So what are the side effects of the dopamine agonist? It can have nausea and vomiting. We can have what we call postural hypertension. Postural hypertension is when you are sitting down and you try to stand up, basically your blood pressure suddenly drop. When blood pressure suddenly drop like that, the patient can have what we call a syncope, which means they can faint and fall. And we are talking about most high elderly population. And so what we do is we have to reevaluate to make sure the drug is ideal to be added to levodopa for that particular patient. Apart from the postural hypertension, you can also see confusion, sedation, lower extremities, edema. Which basically what that means is that water is gathering on the lower part of the body like the feet, on your feet.

So this one when we start seeing edema water in the feet. Gathering in the feet. We have to be careful, especially for patient with heart failure patient because they have the tendency to have edema too. So we have to be careful about that. We can also see the issue of psychosis and sleep, it can worse the dyskinesia with levodopa. So for the pharmaceutical management of the disease, after giving the patient the drug, how do we know if it’s working, if it’s not working. How do we evaluate the outcome of the medication? What we really have to do is involve the patient and the caregiver to participate in the treatment. We need to encourage the family members and patients to record time and duration of the on and the off period, because, like I said, the drug wears out. So when they know this is where my drug wears out, then you can add another medication to help or if this is the time they have the peak where they are experiencing shaking. We can probably reduce the medication. So we have to, it has to be all hands on deck when we are dealing with this drug and managing the disease. Some of the symptoms are individualized, they are what one percent is experiencing, another patient might not experience. So, treatment for each patient is different. So the other way we evaluate this situation is make sure we look into all the medication that the patient might be taking. When we look at the other medication the patient is taking, we try to stop any medecine that is maybe non necessary for the patient. But it’s worsening the side effect of the Parkinson disease drug. So we might have to stop or reduce some order medication the patient might be taking.

So after we have tried exercise, we have tried our traditional pharmaceutics and our patient is still having a problem. In what way can cannabis be of help? How can cannabis help Parkinson’s patients? For many years people with Parkinson’s disease have been praising cannabis for its ability to reduce tremor, which is one of the major symptoms of the disease. So many patients that have tried cannabis cannabinoid based product. They have testified to the fact that the drug, the pants cannabis cannabinoid botanicals have helped with the movement is shaking the tremor that comes with this disease. Also before the prohibition back in there in the 19th century, health care provider doctors, they used to make the cannabis tincture and sell it to the patient for to help manage and control trembling saw back in the days before cannabis was prohibited, doctors offices, they put together a compound is a cannabis based tinctures and oil and sell it to patients who used to help in the control of all trembling. Studies also showed the cannabinoids can improve movement and coordination in patients with Parkinson’s disease. The way it does is it bind to the CB one receptor in the brain.

I mean, from the previous episode that we talked about how THC binds to say CB one and CBD bind to CBD two to this receptor in our brains that the cannabinoids bind to. And we already have our own body that produces anadima which is equivalent to THC and 2AG, which is an equivalent to CBD. So studies show that cannabinoid can improvement or coordination in patients with Parkinson’s disease by binding into the CB one receptor. So we know THC bind to CB One receptor. And we also know that CBD binds to the CB2 2d receptor. But it selectively bind to CB1 receptor. So you come by CBT combined to CB1. It can also bind to CB2. So these cannabinoids have been shown to help with movement associated with Parkinson’s disease. Studies have also shown the neuroprotective properties of cannabis may help brain cell death and prevent buildup of neurotoxin. Yes. Evidence has shown Cannabis have properties to protect the brain. Called neuroprotective properties and with cannabis is being able to protect the brain, this helps to prevent accumulation of neurotoxins like the lewey bodies and the alphaneuclein.

Studies also shows that some ratio of CBD to THC can help with its muscle spasm, with nausea and other side effect pain, fatigue. These are all the symptoms that Parkinson patient is going through. If you remember in our previous episode, we talked about depression, we talked about anxiety, we talked about pain. So we already know that cannabis and cannabinoids are able to help with muscle spasms. They are able to help with sexual dysfunction. They are able to help with depression. All these symptoms are what we are seeing in patient going through Parkinson’s disease. So this shows that if we get a ratio of CBD to THC, maybe a low THC, a high CBD product, this might be, not just help, even if it’s not gonna cure the patient, at least it can help with the side effect that again from the traditional pharmaceutics that the patient is using.

So for those of you that have not listened to our previous episode, so you might want to check it out, we’ve really touch on a lot of things in the past. So how is a patient going to take cannabinoids? In what form? Maybe I’m here to somebody say, oh, what if I don’t feel like I don’t want to smoke or I don’t want I don’t want to eat this stuff? How do I take it? Earlier we mentioned part of the challenges for Parkinson’s patients is inability to swallow. So because they have the issue of swallowing, products such as oil, cannabinoids oil, cannabinoid tinctures or patches. Or they can even use the suppository that goes into another part of the body. This will be an effective means for Parkinson’s patients.

So you do not have to smoke. You do not have to vape. You do not even have to use like cookies or brownies. Don’t want to do it like that. The tincture goes in your under your tongue and the patch goes on any part of the body. And what it does is that it goes straight into the bloodstream. It does not pass through the liver. It doesn’t, for people to have kidney problem, it does not pass through your kidney. It just goes straight into the bloodstream. And it also works faster, too. So the effect is felt. I mean, for people that have, that needs CBD products, you might want to check out our line of high-quality hemp derived CBD on our Web site. We have the oil, we have the tincture, we have the balm. So you want to check it out it will be nice.

Finally, according to the article published in the annal of Neurology, this is one of the publications where the clinical trials have been done. There is probability of being able to reduce the risk of  having Parkinson’s disease for people that drinks coffee, tea and for people, some people that have smoke in the past, they say this reduces the risk of developing the disease, basically to increase our risk of not having the disease. I guess a lot of us, there is hope for us cause I’m sure at least all of us have at least tried coffee or tea even if we don’t smoke.

So that will be, that will be hope there’s a hope for us. So that’s our show for today. Thank you guys for hanging out with me again today. Please live or review. I am begging. I’m asking you guys to live a review on your listening platforms. By this review, we are able to see how we are doing. If we are doing anything right or if we need to improve on any. And he also gave me motivation to know that I have people that are important. And you want me to continue the show. One of those review that we got from one of our listeners, Nikki. Nikki left this review for us to say. First of all, I’ve always loved listening to your podcast because you know just the right thing to say. You make podcasting seem so effortless. Thank you so much, Nikki, for that review. Appreciate that. Podcasting is not easy, but it gives me joy to know I am making a positive impact on the life of people out there. That is the one of the main reasons why I started the show. The aim is to be a blessing and to use what I know to be able to impart life. So I will appreciate if you guys leave me a review on Apple podcast or whatever platform you use for your listening. For listening.

Also, you can also follow me on Twitter at WCIHealth. I’m on Twitter at WCI. And on Instagram, WCIHealth19. And until next time, please be safe out there. Follow the scientist. Wash your hands. Covid is still out there. Stay safe out there. Be safe. Social distancing does not mean emotional separation. Let us check on one another. And until next time. Always remember health equals wealth.

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