1. Holistic Cannabis Academy
RDNs: Get Up to Speed about Cannabis!
Denver Dietetic Association
November 9, 2017

2. Donna Shields, MS, RDN Co-Founder, Holistic Cannabis Academy

3. Integrating Cannabis Holistically
FIX SLIDE PLEASE + PUT LEAF ON SOMEWHERE

4. Today’s Objectives Review the history of cannabis as medicine
Discuss the endocannabinoid system + cannabinoids
Classify cannabis formats + delivery systems
Examine nutrition-related health conditions for integrating cannabis as a remedy + for wellness

5. Cannabis as Medicine History
Cannabis as medicine for thousands of years, only illegal in US for about 80 years
US Pharmacopeia listing
Ancestors used mother nature’s medicines – plants – to heal

6. Legislative Landscape

7. Why Should Dietitians Care?
Healthcare paradigm shift driven by consumer demand gaining national momentum
Cannabis has synergy with nutrition-related health conditions + general wellness
Other healthcare practitioners becoming competent
Remain competitive, expanding scope of knowledge

8. Cannabis Is a Plant!

9. RDNs versus Store Staff
importance
importance
“…some are recommending cannabis that has either not been shown effective for, or could exacerbate, a patient’s condition. Findings underscore the importance of consistent, evidence-based, training of dispensary staff who provide specific recommendations for patient medical conditions.

10. Challenges for Cannabis
Not covered by insurance in the medical model
Access to medical cannabis products in various formats – flower, oil, topical – varies among states
Not approved in all states
Not always approved for all health conditions
Cannaphobia is real

11. DEA Schedule 1 Listing Controlled Substances Act
Listed as a schedule 1 drug with
heroin, cocaine, MDMA, LSD
Contradiction between states and
federal regulations

12. Endocannabinoid System (ECS)
All living things with a spine produce endocannabinoids
Collection of binding molecules
Ligands
Enzymes
Receptors
Endocannabinoids – keys that open receptors
Anandamide + 2-AG, or 2-arachidonoylglycerol

13. Endocannabinoid System
Key component of physiology of healing
System of communication between cells
Balance + homeostasis
Basic components are receptors
System similar to other receptor systems with lock + key mechanism
Key = chemical compound

14. Endocannabinoid System
Two key receptors discovered to date
CB1 - CNS, adipose, heart, lung, GI, muscle, joints, skin
CB2 - immune, bone, spleen
Regulates physiological processes
Appetite
Memory
Pain
Sleep
Mood
Immune Function

15. Why Modulate the ECS?
‘modulating ECS activity may have therapeutic potential in almost all diseases affecting humans, including obesity/metabolic syndrome, diabetes and diabetic complications, neurodegenerative, inflammatory, cardiovascular, liver, gastrointestinal, skin diseases, pain, psychiatric disorders, cachexia, cancer, chemotherapy-induced nausea and vomiting, among many others’.

16. Cannabis Dosage Impact on ECS
Chronically high doses can desensitize or down-regulate endocannabinoid receptors
Fewer receptors means maximal effect of cannabis diminishes
Reduce the dose to allow cells to build new receptors
Micro-dose to restore sensitivity

17. Endocannabinoid: Anandamide
Derived from ananda = Sanskrit for bliss
Chronic anti-depressant/anti-psychotic meds elevate anandamide production
Receptors eventually get desensitized

18. Sativa versus Indica
Dr. Russo: Since the taxonomists cannot agree, I would strongly encourage the scientific community, the press, and the public to abandon the sativa/indica nomenclature and rather insist that accurate biochemical assays on cannabinoid and terpenoid profiles be available for Cannabis in both the medical and recreational markets. Scientific accuracy and the public health demand no less than this.

19. Cannabis Constituents + Terms
Cannabinoids – compounds in cannabis
THC, tetrahydrocannabinol: psychoactive, analgesic
CBD, cannabidiol: anti-inflammatory
THCA + CBDA – acids, prior to heating
Decarboxylation
Ratio – CBD:THC
Terpenes – volatile molecules present in plants

20. Cannabis Characteristics
Lipophilic = binds to fat
Hydrophobic = repels waters
Body fat impacts absorption
Start low, go slow
Cannabinoid release from adipose
Vigorous exercise

21. Cannabis Delivery Systems
Smoking – raw plant flower, immediate effect
Vaporizing – raw plant flower or extracts (more controlled dosage) immediate effect
Edibles – extracts in foods, slow absorption
Tinctures – oil bases, highly concentrated, sublingual, mid-range absorption
Topicals – extracts in oils, non-psychoactive

22. Format Follows Function
Format depends on individual patient
90/90 rule for inhaled meds: 90% peak plasma drops in 90 minutes
Tinctures: minute onset lasting 2-4 hours
CBD patch: up to 8 hours of relief

23. Raw Cannabis Juicing Raw, unheated leaves means no psychoactivity
Ingredients, such as kale & Echinacea, influence cannabinoid receptors
Raw cannabis leaf juice
Chlorophyll is a super anti-oxidant
Wheat grass “on steroids” with cannabinoids
For autoimmune + blood disorders

24. Integrating into Nutrition Care
Gastrointestinal Disorders
Inflammation
Insomnia
Multiple Sclerosis
Pain
Stress
Tourette’s Syndrome
Women’s Health
ADHD
Alzheimer’s Disease
Anxiety
Autism
Cancer
Crohn’s Disease
Epilepsy
Fibromyalgia
PLEASE MAKE INTO TWO COLUMNS AND 36 POINT.

25. Intersection with Nutrition
Anxiety
Insomnia
Pain
Food + nutrition can optimize cannabis effects

26. Intersection with Nutrition
Reduce Chronic Pain
Anti-inflammatory foods + cannabis = symptom relief for joint pain, fibromyalgia
Essential oils, chiropractic, energy medicine, acupuncture

27. Intersection with Nutrition
Mitigate Insomnia
Caffeine elimination, protein + fat at all meals + herbals teas + cannabis = improved sleep

28. Mood Disorders + Nutrition
Reduce Anxiety
Adaptogenic herbs + morning protein + hydration + cannabis = improved anxiety management

29. What Are Terpenes?
Unsaturated hydrocarbons found in plant essential oils
Monoterpenes are most abundant
Beta-caryophyllene is major terpene found in hemp seed oil

30. Aromatherapy as Intro to Cannabis
Phytocannabinoids + terpenes are synergistic
Herbal steams of hemp oil with other essential oils are non-threatening + non-psychoactive
Inhalation influences limbic system for healing benefits

31. Functions of Terpenes Beta-caryophyllene In carrot seed Anti-fungal
Anti-malarial
Protects gastric cells
Skin protection

32. Functions of Terpenes Limonene In citrus Immune stimulant
Reduces anxiety
Treats acne
Fights breast cancer cells
Potent detoxifier. Recommend ajuice of a whole, organic lemon in water every morning.

33. Functions of Terpenes Linalool In lavender Local anesthetic
Reduces spasms
Anticonvulsant
May counteract psychoactivity
Like pinene – from the same family – very relaxing.

34. Functions of Terpenes Myrcene In mango + thyme Analgesic
Muscle relaxant
Promotes digestive mobility
Couch lock. Cultivars high is myrcene can promote sleep – accompanied by appropriate nutrition & lifestyle recommendations. No stashing your cell phone under you pillow and checking FB in the middle of the night. Or even the time, blue light.

35. Functions of Terpenes Pinene In pine Anti-inflammatory
Helps arthritic pain
Acetylcholinesterase inhibitor to aid memory

36. Cannabis + Meditation + Yoga
Cannabis facilitates
Mindfulness
Slowing down
Decision making
Empowerment
Self-determination

37. Cannabis + Stress Can reduces stress PTSD + anxiety + mood disorders
Lower stress = healthier adrenals = healthier thyroid

38. Colorado MJ Resources Colorado.gov/cdphe MMJ Registry Research Grants
Testing & Safety

39. Holistic Cannabis Academy
Expands your scope of practice plus client base
Positions you as a progressive practitioner
Provides a unique point-of-difference for clients

40. Free Resources & Discounts
CELEBRATE 10%